This Melbourne paediatrician addresses Pfizer vaccine concerns

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Dr Raj Khillan

Last month, Australia’s Therapeutic Goods Administration (TGA) approved the use of the Pfizer vaccine in children aged 12 to 15 years. As the Delta variant of COVID-19 rages on, this comes as good news.

As with all of vaccination decisions associated with the COVID-19 pandemic, the Australian Technical Advisory Group on Immunisation (ATAGI) will now consider this approval and provide expert advice on which groups of adolescents should be prioritised for the roll out of the vaccine and how and when it should be administered.

The Indian Sun speaks with Dr Raj Khillan, Director and Paediatrician at Western Specialist Centre, and a leader for healthcare in the Victorian multicultural community on how safe the vaccine is for children as also other concerns. Read on.

How safe is the Pfizer vaccine safe for children?

Let’s look at it this way. Any vaccine that comes goes through a phased trial—from the lab to animals to human beings. It always starts with adults and once the safety is confirmed in adults, it is slowly rolled out to children. So, when it comes to the safety profile, if we are confident to use in adults then children as young adults can access the vaccine.

When we look at the safety profile of COVID-19 vaccinations particularly when we talk about the Pfizer, it has been a very safe vaccine for adults all over the world from whatever data we have so far. Similarly, it is safe in children as shown by the biggest trial in the US where 226,000 children were enrolled and it was found to be a very safe vaccination.

The human body is the same but there may be some differences in immune response. Generally it is the same side effects for both adults and children where one experiences mild temperature, headache, body ache, muscle pain—which is more of a mild systemic reactions similar to a mild virus infection.

But when it comes to the local reactions, there is a slightly high response among children because their immune response is much stronger and that’s why some studies have shown little bit of a bigger edema or swelling around the site of injection. But again, it’s just a matter of a day or two before one gets back to normal. It does not leave any permanent damage.

However, a couple of very rare serious complications have been seen. One is the inflammation of the heart or the mild colitis, inflammation of the heart muscles and inflammation of the pericardium which is the outer covering of the heart. Again, it’s very rare. With the first dose we’ve seen around 4.4 cases per one million doses, and with the second dose it is 12.4 cases per one million doses. So it’s more common with the second dose but majority of the time they are mild and haven’t led to any mortality or death and with hospitalisation it can be managed safely. Overall, we can say if a systemic reaction happens because of the strong immune response in children, it is not life threatening, it is safe and it can be managed.

Because this vaccine has been proclaimed safe, we can use them in children less than 12 years of age. In Israel they have started using it in children between 6-12 six months old.

The immune response in children is generally very intense and relatively strong particularly in the adolescent age group and that’s why the local area swelling may be more than adults. That’s why we now have a trial going on whether giving only one dose as opposed to two doses may be enough in children. That could also reduce the chances of second dose induced heart complications. But, yes, as data indicates it is at the research stage now.

How long will the immunity last?

It is difficult to say how long the immunity will last because we don’t have the longevity data at this stage. Vaccination for children started around six months ago in the US. So far, we believe children up to six months old would be OK, but definitely we have to wait for more data. If you recall the news from few days ago, the Australian government has ordered for more booster shots, so the concept of booster has come because we know that the immunity keeps fading off with time particularly with these types of viruses. As per our experience with the flu vaccinations, initially we give two vaccinations of two doses one month apart and every year we give a booster dose. That’s the concept because the immunity wanes with time somewhere between 6 -12 months and then it goes to the stage where you are no more immune.

How does Covid and the Delta variant affect children? What are the viral load differences between adult and children?

The virus does not discriminate the age group. It affects everyone equally. So far what we have seen is infection in children is less common and the reason, which we are not 100 per cent sure, is perhaps because they have less exposure children to the outside world as opposed to adults who get into public transport, are in work areas and so on. While that could be the reason, we also know that the Delta variant has been changing the whole picture as more children are getting affected. We have been seeing the experience back in India where the Delta virus has affected many young children and seriously. Because the Delta virus is more infectious, more transmissible and more contagious it is likely to infect the younger age group, hence the medical need now for us to think about vaccinating children.

There are apprehensions expressed by children that it will change their DNA in a few years’ time. How do you quell such apprehensions in children?

It’s a very interesting question. Not only children, but adults are also apprehensive. I believe it is created by people who do not believe in vaccinations. There is no rationale behind it, it is not going to change your genetic make-up. Pfizer is a Messenger RNA (mRNA) vaccine, which means the vaccine controls the protein production of the virus, so it is not going to be linked to your DNA and change your DNA structure, or make you from a simple person to a horrible person. It doesn’t happen that way as in the movies and there is no scientific explanation for that.

There is also a myth that taking the mRNA vaccine will lead to infertility in women, which is another biggest myth created by a certain group of people those who oppose vaccinations.

Infectious diseases specialists have warned against using children as tools to achieve herd immunity. Conflicting message, how should one filter those messages?

There is always ethical issues when it comes to vaccinating children. First thing is, yes it is a valid question when we know that the infection rate is relatively less among children and we have more high risk group in a community such as front line workers, health care professionals, aged care workers, elderly people people with disability, those with congenital heart issues, lung issues, diabetes, etc.. So the ethical question is, why do we need to vaccinate children when we don’t have enough to vaccinate the most needy ones. And I agree to that in that way.

The vaccines have been approved for use in children but it does not mean they are going to get it right away. Firstly, we don’t have enough vaccines at this stage so I don’t see children getting vaccination before the end of the year or by early next year. We have more people in the priority list.

In cases of children, I would advocate for vaccination of high-risk children—those who are autistic, diabetic, with congenital heart issues, down syndrome, cerebral palsy or others with severe mental health issues as they cannot understand what is isolation or social distancing or cannot put mask because of sensory issues.

With Delta because it is affecting children, we have the ethical responsibility to vaccinate children but then we have the high-risk children and adults who are priority.

Also when it comes to her immunity, in general we say that we cannot prevent this pandemic until we achieve the vaccination rate of minimum 80 per cent. How can we achieve the 80 per cent rate in our community when the population of children less than 18 years of age is 29 per cent. So, if we have 20 per cent children less than 18 years, how can we achieve 80 per cent without vaccinating children? And vaccine uptake rate in any community is never 100 per cent, it is generally between 85 to 90 per cent if we are a very committed community. So that means we would be hanging around somewhere between 50-60 per cent rate in the community. This is what we are seeing in the US where the vaccination rate initially went very well and now it has plateaued and slowed down. To increase the vaccination rate, to reach to the stage of herd immunity we need to vaccinate children too. Otherwise they would be harbouring this virus and keep transmitting the infection to the community. We have protected a certain adult group but now we will see more serious illness and death in children. And for these multiple reasons, we are pushing for children to be vaccinated.


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