Covid-19 Vaccines Are Safe And Work For Children — Dr Musa Mohd Nordin, Dr Zulkifli Ismail & Prof Mohd Farhan Rusli

What is the prevalence of Covid-19 among children, and what kind of complications are we seeing as a result of infections?

What is the prevalence of Covid-19 among children, and what kind of complications are we seeing as a result of infections?

In 2020, there were 7,730 cases among children less than 11 years old. In 2021, there were about 379,245, and for the first three months of 2022 alone, there have been 119,719 cases.

These are probably below real estimates, because children are often asymptomatic, less tested, less detected, and therefore least reported.

The United States’ Centers for Disease Control and Prevention seroprevalence studies have shown that 38 per cent of children were infected with Covid-19.

The increased burden of the infectious Omicron variant has led to several serious complications in unvaccinated children:

  • The increased numbers of children infected has led to outbreaks in households, daycare centres, kindergartens, and schools. There were about 367 educational clusters prior to the school holidays. One can expect increasing reports of such clusters with the reopening of schools on March 21, 2022.
  • There has been a 2.5 fold increase in children being hospitalised.
  • There is a twofold increase in children admitted to intensive care units for serious Covid infections, mainly due to MIS-C (Multisystem Inflammatory Syndrome in Children).
  • An increasing number of deaths has also been reported in children below 18 years old. In 2020, there were six deaths, which increased to about 110 deaths in 2021. There were 22 deaths in children aged under 12 from January 1 to March 11, 2022, and eight deaths were recorded during the second week of March alone, which is the highest in almost six months.

Health Minister Khairy Jamaludin earlier set a target of 50 per cent vaccination for children under 11 by the start of the school year. We have clearly fallen short of this, as at the moment, only 34 per cent of children have received their first jabs.

What is the reason for the slow take-up rate, and what needs to be done to address this?

Two major factors have contributed to this low uptake:

Parents are freaked out by the safety of the mRNA vaccines. Misinformation is rife on social media about the dangers of the mRNA vaccines.

The anti-vaxxers have been fear-mongering about Adverse Effects Following Immunisation (AEFI) as a result of vaccination from mRNA vaccines.

Not surprisingly, most of them who are inflating the dangers of mRNA vaccines are also the same ones who are promoting Ivermectin, chloroquine, mega-doses of vitamins, herbs, naturopathy, and homeopathy 

Parents are in a ‘wait and see’ mode, which is very dangerous because the Omicron variant will not wait. The BA2 Omicron sub-variant, which now makes up 27 per cent of the circulating strains, is even more transmissible and is creating havoc in Hong Kong, China, the US, and Europe.

Its reproduction number (Ro) is 12, which is very close to measles. This simply means that in a playroom of 10 children, one Covid-19 positive child can potentially infect seven or eight other children.

There are a few actions that can be undertaken to improve the uptake of the Covid-19 vaccines. 

  • Better, smarter, and more creative awareness programmes should be crafted and disseminated widely to all parents and guardians of children. There needs to be a more concerted effort to go to the ground and educate, even if it means doing it door to door. The government machinery that was effective in garnering votes in the recent by-elections should be used to convince vaccine-hesitant parents in Kelantan, Terengganu, Kedah, and Pahang, whose vaccine uptake are 9.5 per cent, 11.6 per cent, 22.1 per cent, and 26.3 per cent respectively, as compared to the national average of 35.6 per cent as of March 21, 2022.
  • If teachers who refused vaccination are transferred to different posts, surely there must be similar actions for children whose parents have refused to allow them to be vaccinated. We are however of the opinion that the so-called solution for teachers was not really a solution, as it was the easiest thing to do for bureaucrats and politicians who refuse to think out of the box. The evidence thus far has shown that vaccines are effective and safe for school children, and thus, it should be mandated that all children must have completed their vaccinations, prior to registering for Standard One. 
  • There should be more involvement of parent support groups to reassure other parents of the safety and effectiveness of the vaccines.
  • There is an urgent need for better collaboration with family general practitioners and paediatricians in the PICKids programme. Doctors in the private health care sector who have been vaccinating children, adolescents, and adults since the 1950s have so far been marginalised in the campaigns.
  • The government must be very serious, firm, and consistent in handling anti-vaxxers who continually spread misinformation on the pandemic and the vaccines.

The government has approved Sinovac as one of the vaccines under the PICKids programme. What does one make of this decision, especially in light of research from Chile that showed Sinovac is only 38 per cent effective in preventing infections in children?

The Real-World Evaluation of Covid-19 Vaccines Under the Malaysian National Covid-19 Immunisation Programme (RECoVaM) and the National Medical Research Register (NMRR) have proven that the vaccine effectiveness (VE) of Sinovac drops from 76 per cent following immunisation to 28 per cent within three to five months.

The mRNA (Pfizer) vaccine is more effective, dropping from 89 per cent to 68 per cent. The Ministry of Health (MOH) has recommended mRNA (Pfizer) vaccines as the vaccine of choice for children between 5 and 11.

Only if the child develops a severe reaction to mRNA (Pfizer) vaccines should they switch to the Sinovac vaccine. We are sure that as parents and guardians, you would not want to give your children a second-best vaccine.

Are paediatricians in the private sector participating in the programme? Has the process been easy, and is that improving the take-up rate? 

The Malaysian Paediatric Association (MPA) has done a survey, and found that 97.8 per cent of paediatricians strongly support vaccination of children between 5 and 11.

The executive committee of the MPA recently met with the team from ProtectHealth which operates the PICKids programme. Apparently, only 20,000 doses are being utilised daily, which is very disappointing. Up until March 21, 2022, only 35.6 per cent of children aged between 5 and 11 have been vaccinated.

We are exploring new strategies to increase the uptake, because we know the 3Cs of any successful vaccination programme are Coverage, Coverage, and Coverage.

We are hopeful that children would soon be able to get their shots from their family GPs and pediatricians, whom parents and guardians have been trusting to care for their children’s health, and who have given them their routine shots since birth.

What about the government’s handling of the tragic death of Revnesh Kumar? Does this have an impact on perceptions of vaccine safety for children and teenagers?

It is most unfortunate that the government’s handling of the case has impacted adversely on the level of vaccine confidence among parents and guardians of children.

The drama was further worsened by the irresponsible nuances of the vaccine-hesitant lobby. We had to undertake a lot of damage control, and intensify our awareness programmes to counter the misinformation.

It has to be clearly and unequivocally stated that the Covid-19 vaccines are not in any way causally linked to any deaths in children.

The US has the largest experience with mRNA vaccines for children aged between 5 and 11. They have prescribed about 8.7 million doses.

AEFIs were mostly mild and brief. and consisted mainly of pain at the injection site, fatigue, and headaches. There were 11 reported cases of myocarditis, and all of the affected children recovered fully after two to seven days. There were no causal links to any deaths.

The National Pharmaceutical Regulatory Agency (NPRA) has reported that 1.1 million doses of mRNA vaccines have been used up until March 11, 2022.

There were 182 reports of AEFIs, a rate of 0.17 per 1,000 children, which is very similar to reports from Canada and Australia. 97 per cent of AEFIs were non-serious, and did not affect the child’s daily activities.

These were mainly fever, pain at the injection site, headaches, and body aches, which often disappeared after one or two days. There were five children with serious AEFIs who were admitted and were later discharged.

A 7-year old girl with an underlying health condition was classified as brought-in-dead (BID). and the case is still under investigation.

We hope all parents and guardians will be reassured by these facts and figures, and do not become victims of the misinformation disseminated by the fear-mongering anti-vaccine groups.

Please consult your family GP or pediatrician if you have any further concerns about the vaccines.

  • This is the personal opinion of the writer or publication and does not necessarily represent the views of CodeBlue.

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