Why Israel will ‘bet’ on COVID vaccines for children ages 5-11
About a third of Israel’s population is under the age of 17, meaning that despite its previous vaccination and booster programs, the country lags many others in terms of the percentage of the total affected population.
But the situation is likely to change soon.
FDA scientists are expected to vote on giving children a modified dose of the Pfizer vaccine on Tuesday. Briefing papers released over the weekend ahead of their meeting said scientists believed the likely benefits of giving Pfizer vaccine to young children outweighed the risks.
If the FDA votes in favor, the Centers for Disease Control will meet on November 2-3 to make their recommendations on how the injections should be administered. Israel is expected to follow up and approve the shooting a few weeks later.
Health officials believe there are many reasons to immunize children. The number one motive is to protect them.
Some 65% of all positive cases in the past few months were under 19. The Delta variant has infected more children than previous ones – in Israel and around the world – causing the number of children in hospitals to skyrocket.
“In some places, all the beds in the pediatric intensive care units have been occupied by patients with COVID-19,” said the president of the Israel Medical Association, Dr. Zeev Feldman.
While children in general tend not to develop severe cases of COVID-19, the past few months have shown that they can. Images of children on fans or even hooked up to ECMO machines plagued the evening news. In Israel, around ten children have died from the virus, although the majority of them suffered from underlying health problems.
In addition, there have been growing reports of young people developing long-COVID and life-threatening pediatric multisystem inflammatory syndrome (PIMS), which has characteristics similar to Kawasaki disease and toxic shock syndrome.
Less than 100 Israeli children are known to have been diagnosed with PIMS, but about half of those cases were during the Delta Wave.
Moreover, even with the green classroom plan, thousands of Israeli children are isolated at home, having missed nearly a full year of their education at Zoom School in 2020.
“We should consider the effect of vaccination on the education system,” said Professor Zachi Grossman, director of the Israel Pediatric Society. “An open school year where children are not quarantined every day or two is also the target of vaccination – to enable them to have healthy lifestyles.”
IMMUNIZING CHILDREN could also help Israel better control the level of disease in the country as a whole.
“I see anti-vaccines saying that there is no excuse to immunize children to protect society, but I disagree. There is certainly a reason to vaccinate children or any population in order to protect society, ”said Professor Hagai Levine, epidemiologist and public health physician at the Hebrew University of Jerusalem.
Boys and girls, for example, receive the papilloma vaccine, although it largely protects women against cervical cancer and other cancers of the vulva and vagina.
However, health officials have said that one needs to be careful when talking about “herd immunity” following childhood immunizations.
While at the start of the pandemic it appeared that having less than 75% of the population immunized against the virus led the country to herd immunity, this percentage has risen to around 90% with the Delta variant and is steadily steadily increasing. evolution.
“I think we should stop looking for the holy grail of collective immunity,” Levine said. “Herd immunity depends on specific attributes of the population, environment and pathogen – targets that change over time. So, will we get collective immunity if we vaccinate children? We do not know.
There is also no guarantee that vaccinating children will mean that another variant will not be able to enter the country and partially cancel their protection, as we have seen with previous waves.
“We can talk about vaccination of children and then see a real decrease in the number of cases, and then in two months the ‘Omega’ variant – a variant that does not yet exist – will make its way in Israel and things will get tough in Israel. new. », Explains Professor Cyrille Cohen, head of the immunology laboratory at Bar-Ilan University.
Although he noted that what doctors have seen so far is that although some vaccinated people will still contract the virus, they are much less likely to develop serious illness. As such, one of the strategies to prevent a severe fifth wave would be to vaccinate as many as possible in the population, Feldman said.
Data released by Pfizer last week showed 90.7% efficacy against the coronavirus in a clinical trial in children aged five to 11. While only several thousand children participated in the study, compared to about 40,000 adults who were enrolled in Pfizer’s initial Phase III study that led to its FDA approval, Grossman explained that this was expected and acceptable.
He said the aim of the study was not on the effectiveness of the vaccine but on ensuring that a sufficient number of neutralizing antibodies were induced by the vaccine in children, which was the case.
“These are immune bypass studies,” Grossman explained of the Pfizer trials for children 5 to 11 years old and the previous one for adolescents 12 to 15 years old, for whom the vaccine has already been approved for. emergency use of the FDA. “If the vaccine is successful in showing a fairly good level of antibodies, we can assume that the efficacy will be similar to what has been observed in previous studies involving 40,000 adults.”
He said the study also widely demonstrated the safety of the vaccines.
FDA scientists said it could be assumed that the number of cases of heart inflammation – the most serious potential side effect of the vaccine – seen in the younger age group would be similar to that seen in the 12 -15 years old. Pfizer scientists suggested it would be even less, given that young children are given a dose that is only a third of the amount given to older children.
A study released by Israel Health Services Clalit and Harvard University in August found that unvaccinated people who contracted COVID-19 were four times more likely to develop myocarditis than those who were vaccinated.
BUT QUESTIONS REMAIN, Levine said.
For example, there is still a lot of uncertainty about the long-term effects – both beneficial and negative.
Scientists also do not fully understand what contribution the vaccine will make to preventing transmission in the community or society. It’s also not clear whether the vaccine prevents the long COVID, something children often develop after experiencing asymptomatic cases of the virus, and one of the reasons doctors are eager to strike at young people.
“One problem for those who pro-vaccinate children are the potential complications of COVID, such as long COVID and PIMS. But does the vaccine prevent this? We would like to see evidence for that, ”Levine said.
And what about the dosage of the almost 12-year-olds, for example? Levine said her daughter will be 12 in two months. Should he wait to vaccinate her with a higher dose after her birthday or give her the lower dose a few months before?
And finally, the question arises as to where children should be immunized – in schools, clinics or community centers?
A recent survey by Bar-Ilan University found that despite all of these questions, the majority (57%) of Israeli Jewish parents of children aged five to 11 will have their children vaccinated if the FDA approves the vaccine.
The survey was conducted between September 23 and October 3 by Dr Liora Shmueli of the school’s program for public health and health systems management and included a representative sample of 894 Jewish parents nationwide.
Some 27% of parents said they would vaccinate their children within a month of vaccine availability, and 27% said they would vaccinate within one to three months. The rest said they would wait four months to over a year, or not vaccinate their children at all.
However, some 60% of parents said including children in a Green Pass that would make it easier to get around would speed up their decision to vaccinate. Another 50% said administering vaccines in the education system would encourage them to vaccinate their children faster.
Levine suggested that instead of rolling out the campaign to all children at the same time, the country could consider vaccinating the highest-risk child population first, then the rest.
“Right now, the data for what we’re hearing looks good,” Cohen said. “But these are children and we want to be extremely sure that we do no harm.”
Feldman and Grossman, however, said Israel should advance youth immunization as soon as possible.
When the FDA approved vaccination for children aged 12 to 15, the third wave was in decline in Israel and health officials questioned the need to rush a mass vaccination campaign for this cohort of ‘age. As such, the Department of Health initially approved the vaccine but did not “recommend” it – leaving it to parents to vaccinate their children if they thought they were at high risk of developing a disease. serious illness, lived with someone at high risk, or their children were planning to travel abroad.
A month later, after massive outbreaks in schools triggered the Delta Wave, the health ministry recommended vaccination and launched a campaign dedicated to adolescents.
“We know that new variants exist and are already entering Israel,” Grossman said. “This time, we must not play.