In several European countries, children between the ages of five and eleven can soon be vaccinated. In the Netherlands, doctors do discuss vaccinating young children, but the debate does not get started in political The Hague. Seven questions about vaccinating children.
1 Which countries are already vaccinating young children?
There are currently none within the EU, but it is expected that several countries will do so soon. Unlike in the Netherlands, the decision has already been made in those countries. Tipping point was the green light that the European Medicines Agency gave EMA at the end of last month for the use of the Pfizer/BioNTech vaccine in younger children. Italy, France, Germany, Denmark, Spain and Poland, among others, have indicated that they want to start later this month or early next year, on a voluntary basis (in France only vulnerable children). Since the beginning of November, a “pilot” has been running in the Austrian capital Vienna, whereby 200 children between the ages of five and 11 can also be vaccinated daily, but that is not a national policy. In the rest of the world, national campaigns are already underway, which sometimes started much earlier. China started vaccinating children from the age of three in October. Last month, the US gave the green light to vaccinate children from the age of five.
2 How is the vaccination campaign going in those countries?
Vaccinating young children sometimes leads to heated debate. In Brazil, all five directors of the drug agency that advises on vaccinating children have received death threats. Sometimes authorities go under extreme pressure to get children vaccinated. In the American city of New York, the mayor this week ordered that children between the ages of five and eleven must have had a first injection before December 14, on pain of exclusion from, among other things, extracurricular activities. China, meanwhile, is overcoming resistance from rebellious parents through a vigorous campaign of seduction. Children who join the ‘army’ of the ‘little vaccinated warriors’ are rewarded with balloons, toys and stickers. Since the campaign began in mid-October, half of all eligible children between the ages of three and 11 have had their first shot.
3 How dangerous is the coronavirus for children?
Children currently account for the majority of corona infections. The vast majority of children hardly experience any complaints. So far, about three hundred children under the age of twelve have been hospitalized with corona, according to figures from the national study COPP. Of these, about half had no underlying conditions. The vast majority of these children are younger than two years old – so not the target group for the childhood vaccinations. One in three had to go to the ICU. In the Netherlands, no child has yet died of Covid-19. By way of comparison: every year about 250 children end up in hospital because of chickenpox, and 1,500 because of the flu.
Four in ten children who end up in hospital because of corona have serious breathing problems; three in ten have no specific disease, and three in ten have MISC: multisystem inflammatory syndrome in children. The immune system goes haywire after a corona infection, which can damage all kinds of organs. Recovery can take months.
It is not yet known whether children can also contract lung Covid, the long-term variant of the disease. It is also still unknown whether vaccination can help prevent MISC and lung Covid.
4 What are the risks of vaccination for young children?
These risks have only been examined in one clinical study so far, with some 1,500 children receiving the vaccine. No serious side effects emerged from that study. But such a study is too small to rule out very rare side effects. Now that several countries have started to vaccinate teenagers on a large scale, including the US and Canada, side effects have emerged: myocarditis and pericarditis, an inflammation of the heart muscle and the pericardium, respectively. It occurs in approximately seven out of every hundred thousand vaccinated boys aged twelve to seventeen. In 80 percent of those cases, the condition is mild. Whether this is also the case in young children is not yet known.
Also read this opinion article: Vaccinating children: don’t wait any longer
5 What do pediatricians think about vaccinating children against Covid-19?
Very different. In the past two weeks it became clear that there are two different ‘camps’. The Association of Youth Doctors (AJN) advocates that vaccines be made available for all children between the ages of five and eleven. Not only would society as a whole benefit from this, but also for individual children the benefits outweigh the risks. The AJN thus follows the position of the European Medicines Agency EMA, which approved the Pfizer/BioNTech vaccine for this age group at the end of November.
Other doctors, including those united in the Dutch Association for Pediatrics (NVK), think it is still too early to make a good assessment of this cost-benefit. Too little research has been done into this age group for that, said pediatrician Patricia Bruijning of UMC Utrecht earlier in NRC.
Disagreements have now arisen within the NVK about this. The NVK’s Ethics & Law expertise group believes that the interests of the individual child are closely intertwined with those of society. “Small children may not often become seriously ill, but they can infect others,” said professor-pediatrician Martine de Vries of the LUMC, a member of this NVK expert group, on Sunday. news hour. “That way they can partly maintain the epidemic. This could lead to a lockdown and also to the closing of schools. That ultimately affects the children themselves, but also society as a whole.”
The NVK is now developing a position. In the meantime, De Vries does not want to comment further.
6 Is there already a political discussion in the Netherlands about vaccinating children?
There is not yet a heated debate in The Hague about the need to test healthy young children. As for all issues related to vaccination, the outgoing cabinet has asked the Health Council for advice. The council needs even more time for this, but last week recommended that children between the ages of five and eleven with underlying conditions be vaccinated. The Health Council believes that for them ‘the benefits outweigh the potential side effects’.
The advice about the healthy children will follow “soon”. Chairman Bart-Jan Kullberg called the decision “complex”, because the medical necessity of vaccination for children is in any case smaller than for adults. However, it could be epidemiologically beneficial because vaccination could reduce the spread of the virus in primary schools. There may also be indirect health benefits for children themselves. The Health Council previously wrote that corona measures such as not being allowed to go to school, not being able to exercise and limited social contact with peers “have disrupted the lives of millions of children”.
Also read this article: What’s it like to be a teenager during the coronavirus crisis?
In the House of Representatives, some parties, such as D66, have been arguing for some time that children and their parents should be given the opportunity to opt for the vaccine as soon as possible. Other parties, especially those in the right-hand corner, again believe that vaccinating children should not be used as an epidemiological tool because too few adults have been vaccinated.
7 Is the Netherlands well prepared to vaccinate children?
RIVM is currently preparing scenarios for vaccinating children, pending the advice of the Health Council, Minister Hugo de Jonge (Public Health, CDA) recently wrote to the House of Representatives. The cabinet has bought special vaccines with adjusted child dosages. A pediatric dose is one third of an adult dose. The first delivery of Pfizer (42,000 doses) is expected at the end of December. There are approximately 1.3 million children between the ages of five and eleven living in the Netherlands.
A version of this article also appeared in NRC on the morning of December 8, 2021
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