KIndians are much less likely to contract Covid-19 than adults, on average one in a thousand. Older infected people are hundreds of times more likely to be affected. Many experts therefore refer to the vaccination of children against the Sars-CoV-2 pathogen as “non-profit”. There is no child vaccine yet, mind you, but the ethical debate around it is already mapped out.
Editor in the features section, responsible for the “Nature and Science” section.
For the benefit of others, namely those at risk, children should be vaccinated – to eliminate them as carriers of the virus. But is that really all? The repeated lockdown discussions about the closing and opening of schools and daycare centers already show that child welfare is a political issue, for many in the middle generations it is even the most important thing.
An ethical question
The pragmatic-epidemiological question of the role of children as virus carriers is always coming to the fore, and there was a lot of argument about it again in the third wave. But at its core, the conflict over the children in the pandemic touches many levels, including in terms of health. The psychological consequences of the epidemic, for example, are playing an increasingly important role. And here, too, the following applies: Children are not little adults.
So should the children be left out of the vaccination strategy? Is it perhaps particularly harmful for them and their parents when they are assigned so much responsibility in coping with the pandemic? One thing is clear: with each progress in vaccination, the question arises more urgently.
In the meantime, the number of citizens with a greatly increased risk of severe Covid 19 disease is still large – and the progress made in vaccination is small. The Robert Koch Institute quantified the risk group after evaluating the German Geda study at the beginning of March: 30.6 percent of the population over the age of 15 or 21.6 million people have a greatly increased risk if you add those with a moderate risk there are 36.5 million citizens.
So far only Biontech / Pfizer approved for young people
And most of them will remain unvaccinated for the next several weeks and months. Unlike in her case, however, vaccination is practically out of the question for the children.
To date, none of the globally approved vaccines have been given to children, at least not to young children. Only the mRNA vaccine from Pfizer-Biontech is approved for adolescents from the age of 16 years. Children as well as pregnant women or the immunologically ill – those with autoimmune diseases, for example – are almost never included in the large clinical approval studies.
Their particular physiology makes it necessary to test special dosage regimens. It’s time-consuming. As a result, after the vaccine studies were completed and evaluated, there was hardly any data that would justify approval for children and adolescents right from the start. In the meantime, however, a lot has happened in this regard.
Moderna, the second mRNA vaccine supplier, announced the start of the “KidCove” study earlier this week: 6750 children in the United States and Canada will be vaccinated at different doses over the next few weeks. Six-month-old infants and children up to twelve years of age will receive different vaccine doses for the effectiveness tests, with the lowest vaccine amount being a quarter of that for adults.
High hurdles before approval
The effectiveness of the active ingredient should then be determined for twelve months and in two phases after administration of the second dose. Biontech / Pfizer is already in the middle of children’s studies with 12- to 15-year-olds, and Johnson & Johnson is already planning studies. For all of them, however, the following applies: Because children so rarely get sick or show symptoms at all, the statistical hurdles for the approval of a children’s vaccine are high.
So far, the vaccines on adults have been rated according to how well and safely they are protected against Covid 19 disease. In children, the main aim is to determine the amount of neutralizing antibodies in the blood as an indicator of protection against virus replication in the body.
Is it still worth it?
According to the estimates of those involved and independent experts, it will probably be the end of the year, maybe even next year, before the vaccination offer also applies to children. Only with the data then available can conclusions be drawn with regard to the contagion potential of vaccinated children.
By then, however, if no further vaccination stops and incalculable immune escape mutations on the part of the pathogen, most people at risk should have been vaccinated long ago – and thus be protected from serious illnesses. So is child vaccination still worthwhile at all?
The pediatricians in the country have already positioned themselves with their professional association in this regard: They are urging the vaccination of minors to be accelerated – not least in order to end their discrimination with a view to school and daycare closings. From a medical point of view, however, that is by no means the only reason why the call for equal protection for children is likely to grow louder.
In recent weeks, numerous clinical studies have shown that millions of children could also be handicapped in the future as a result of consequential damage from an infection. In addition to the new, acute clinical picture “multisystemic inflammatory syndrome”, an overreaction of the immune system, long-term damage – “long covid” – comes to the fore after infections. Italian doctors, for example, are currently reporting on 129 underage Covid-19 victims of the first and second waves, more than half of whom still suffered from symptoms four months after the illness and almost a third who were therefore also restricted in everyday life.
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