APPG on Coronavirus: vaccinating children, booster jabs and global access

The session on 10 August, began with questions to the All Party Parliamentary Group (APPG) about the much discussed issue of vaccinating children. On the surface it seems obvious; vaccinate children so they don’t get sick with Covid-19 and vaccinate children so we get closer to the frequently discussed notion of herd immunity.

The APPG session heard evidence for considering that there are very good reasons why vaccinating all will not necessarily result in all these advantages. The session can be watched here.

No increase so far in children admissions

Paediatric critical care consultant, Dr Ruchi Sinha, Imperial NHS Health care trust and member of the Royal College of Physicians and Public Health expert Covid group said that the Delta wave had not so far resulted in a higher proportion of children being admitted to hospital in the UK.

She said:

“I think it is right to vaccinate 16- to 18-year-olds. But I think the blanket roll out for 12 to 16 depends on whether we are seeing an increase in the hospitalisation rates and critical care rates.”

“In the last four weeks looking at the paediatric critical care database there have only been about 30 critical care admissions… from my own experience and anecdotally from my colleagues who look after these children in the intensive care across the country. They tend to be the children who have got those comorbidities, neurological problems, and obesity. And, actually, that is the current recommendation that those children should be considered for vaccination.”

Vaccines for children?

Professor Devi Sridhar: Professor at the University of Edinburgh where she holds a Personal Chair in Global Public Health. She described the conundrum about what to do about children 12 to 15. This is a controversial issue with expertise across the world coming to very different conclusions on that age group. In The United States the American Academy of Paediatrics, has written to the FDA to expedite a vaccine for five- to 11-year-olds ahead of return to school.

Dr Sinha said:

“I do think we should be offering the vaccine to children who are vulnerable and more likely to suffer…. With about 300 paediatric critical care beds that we’ve got in this country, it’s all about capacity, and what we’re finding is that that’s been tested in the last month because the District General Hospitals are full of children with Respiratory syncytial virus, (RSV). [a common respiratory virus that can be serious, especially for infants]. Also there’s quite a disproportionate number of children with significant mental health needs that are in acute inpatient beds awaiting specialist input. …. But at the moment, Covid in itself is not the problem.”

Herd immunity

On answering a question from Layla Moran (Chair of APPG Coronavirus) of how far away was herd immunity, Professor Sridhar talked about the NMR programme for measles. If enough children are vaccinated the virus will no longer circulate as it can no longer find hosts that it can jump between. This will not be the same for Covid-19.

With the delta variant people can still transmit when fully vaccinated and can still get Covid. The threshold for herd immunity is therefore less likely to be reached. Dr Sridhar suggested that vaccinating children is less the question of vaccinating them for herd immunity. It’s more about vaccinating them because we prefer them to be vaccinated and protected from Covid and future variants.

Professor Andrew Pollard, Professor of Paediatric Infection and Immunity at the University of Oxford, Honorary Consultant Paediatrician at Oxford Children’s Hospital who chairs the Joint Committee on Vaccination and Immunisation (JCVI) and Professor Paul Hunter, Professor in Medicine at the University of East Anglia, expert in infectious diseases, and member of the World Health Organisation (WHO) committees advised on the global response to the pandemic. They agreed that with the current variant, herd immunity is not a possibility because it still infects vaccinated individuals.

Children, long Covid, school and vaccines

The question of do we vaccine children remains. There is the issue of long Covid in children and of the importance if children are staying in school. Professor Sridhar commented on the US experience where in some states there have been increased paediatric admissions to intensive care. Dr Sridhar, from Florida, said admissions were increasing in Florida and Texas.

This issue is different in that their adults are not being vaccinated as in the UK; there is high vaccine hesitancy in these States. Professor Sridhar said:

“I don’t understand why we’re seeing such a different picture across the pond with the similar variants in a similar virus.”

Professor Pollard referred to the important point about the uncertainty with Covid relating to long Covid and also the situation US.  JCI provides a scientific opinion based on today’s evidence which will change if new evidence emerges.

“I think that’s a critical point, that it is not a not a political debate about whether children should be vaccinated or not. It’s about trying to weigh up risks and benefits to make the best possible decisions for the benefit. …. There might or different views when we have more evidence, or they might not, but I think it’s important to support that.”

Global access to vaccines

The discussions about children led into the discussion of global access to vaccines. It was chilling to hear that this week there will be around 65,000 deaths worldwide. We have now over 4 billion doses; enough doses to have prevented almost all those deaths.

However, the question of whether we should vaccine the world rather than children was considered a false debate. The main vaccine supply to the UK is AstraZeneca. Dr Sridhar said:

“The only two vaccines that are approved in the younger age group are Moderna and Pfizer. However, if we have ample supply of Astra Zeneca for over 40s then we should be giving those abroad if we don’t need them here. It’s not about vaccinating kids versus the world.”

The question about boosters in the UK is another matter. Dr Gregg Gonsalves, Associate Professor of epidemiology at Yale University and expert in policy modelling on infectious disease said:

“The point is, is that if we’re going to boost people in the UK or United States before the rest of the world has had even a single dose and we have to ask really what we’re doing and whom we’re doing it for. I have had two doses of the vaccine right now. I feel like I’ll be protected against serious disease and death. I don’t need another booster. The data shows that I’m adequately protected against serious diseases and hospitalization. So let’s get the doses on the plane. Let’s move them quickly.“

Dr Ayoade Alakija, Co-chair of the Africa Union Africa Vaccine Delivery Alliance for Covid-19 and Nigeria’s former Chief Humanitarian Coordinator added:

“…Prioritizing booster vaccines at this point of this pandemic I don’t think is what the world should be thinking about.  We need to save lives first before we think about improving levels of immunity.”

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