COVID vaccination in Indian children: Current status and considerations

Maya Sharma a, *

a Global Medical Director - Win Medicare, Modi Mundipharma, Signutra, Modi Tower, Nehru Place, New Delhi 110019, India


COVID vaccines have been available for almost a year now, but their geographical distribution and vaccination programs in different countries have been far from equal. There have been multiple waves of COVID-19 in different parts of the world, so countries are in different stages of a pandemic, as the coronavirus continues to mutate and new strains emerge (WHO, 2021).

With 1.3 Billion population, every day 67,385 babies are born in India (UNICEFa, 2021).   Still, vaccination/immunization in children is a well-established and well-executed concept. Its Universal Immunization Program (UIP) is one of the largest public health programs in the world. Ministry of Health and Family Welfare, Govt. of India provides access to vaccines to infants, children, and pregnant women for  Diphtheria, Pertussis, Tetanus, Polio, Measles, Rubella, severe form of Childhood Tuberculosis, Hepatitis B and Meningitis & Pneumonia caused by Hemophilus Influenza type B, Rotavirus diarrhea, Pneumococcal Pneumonia and Japanese Encephalitis (Rashtogi et al., 2021; NHM, 2021).

In 2020, when the trials to find COVID vaccines were still on, 23 million children missed out on basic vaccines through routine immunization services, with conspicuous disruptions in Southeast Asian and Eastern Mediterranean Regions, leading WHO Director-General Dr. Tedros Adhanom Ghebreyesus raising an alarm - “Even as countries clamor to get their hands on COVID-19 vaccines, we have gone backward on other vaccinations, leaving children at risk from devastating but preventable diseases like measles, polio or meningitis. Multiple disease outbreaks would be catastrophic for communities and health systems already battling COVID-19, making it more urgent than ever to invest in childhood vaccination and ensure every child is reached” (UNICEFb, 2021). As we aim to vaccinate children against COVID-19, let us not forget to keep the awareness and enthusiasm high for other infectious diseases as well.

Children, compared to adults, are less affected by COVID-19 in terms of incidence, as well as the severity of infection. Various hypotheses were proposed to substantiate the difference but the only validated reasons were age-related changes in immune and endothelial/clotting function (Zimmermann et al., 2021). For COVID vaccination, children are the lowest category in risk stratification, hence the least priority to vaccinate them. Now with a good % of elderly, patients with comorbid conditions, and the adult population being vaccinated, the path has opened up for trials and approvals of COVID vaccines in children.

Bharat Biotech’s Covaxin (inactivated SARS-CoV-2 Virus) and Zydus’s ZycovD  (novel DNA vaccine) has been approved in India for use in the age group of 12-17 years, though none of these vaccine candidates have received WHO EUL for the same age groups. Published Phase 3 Trial data is still awaited before these can be accepted for younger age groups

A couple of considerations: In India, during pandemics and lockdowns, online school education was considered a savior by urban and/or affluent parents. But poor and/or rural children had no access to the laptop, PC, Tab, mobile, and internet for online education. The closure of 1.5 million schools impacted 247 million children enrolled in elementary and secondary schools (UNICEFc, 2021). Schools had to be opened up in rural towns after the 1st wave and 2nd wave subsided, as besides education, physical fitness, mental well-being, socializing, nutrition are other important pillars of overall well-being, to which schools contribute a lot (UNICEFc, 2021). Unfortunately, there were reports of COVID outbreaks in some schools (Nath et al., 2021; Jaiswal et al., 2021; TOIa, 2021). Many parents in India feel that not only teachers and non-teaching staff, but even their children should also be vaccinated before schools are opened, which appears unlikely (TOIb, 2021). Governments and Health authorities have to consider all nuances before taking the tough call.

Secondly, till the time WHO approves Covaxin and ZycovD, the currently available options for children, parents who have received WHO-approved vaccine  - Covishield by AstraZeneca/Serum Institute of India, will not be able to take children along for International travel. But obviously, safety from COVID is a priority over international travel for fraction of Indians.

Polio Vaccination drive has been one of the most successful Indian govt. funded and executed programs, which led to the eradication of Polio. Its print/TV campaign had a famous slogan 'Ek Bhi bhachha choot gaya, to suraksha chakra toot gaya'. The same applies to COVID vaccination in India and around the world. We are not safe, till all are safe. Current data on available vaccine options for adults in India is encouraging, and though we are waiting for more data on different subsets in children to be published, there is no reason why it should not be safe and protect our children.

References

Jaiswal, P., B. (2021). COVID-19: Is reopening of schools a cause of worry? The Week. 24 September 2021. Retrieved from https://www.theweek.in/news/india/2021/09/24/covid-19-is-reopening-of-schools-a-cause-of-worry.html

Nath, A. (2021). Over 30 test Covid positive after schools reopen in Tamil Nadu. India Today. 07 September 2021. Retrieved from https://www.indiatoday.in/coronavirus-outbreak/story/teachers-students-covid-positive-tamil-nadu-school-reopen-1850114-2021-09-07

NHM. (2021) Immunization. Assessed on 22 November 2021. Retrieved from https://nhm.gov.in/index1.php?lang=1&level=2&sublinkid=824&lid=220

Rastogi, A. (2020) Universal Immunisation Programme NHP Admin. Assessed on 22 November 2021. Retrieved from https://www.nhp.gov.in/universal-immunisation-programme_pg 

TOIa. 2021. Bengaluru: 33 kids, one staffer test Covid-19 positive in Whitefield school. The times of India Bangalore, 22 November 2021. Retrieved from https://timesofindia.indiatimes.com/city/bengaluru/bengaluru-33-kids-one-staffer-test-covid-19-positive-in-whitefield-school/articleshow/87920850.cms

TOIb. (2021). School reopening: No vaccine shot for kids makes parents jittery. Nagpur News, 03 October 2021. Retrieved from https://timesofindia.indiatimes.com/city/nagpur/school-reopening-no-vax-shot-for-kids-makes-parents-jittery/articleshow/86715104.cms

UNICEFa. (2021). Collection and analysis of disaggregated data for evaluating evolving risks and opportunities for children is key to all UNICEF programming. Key Data. UN0200159. Assessed on 22 November 2021 Retrieved from https://www.unicef.org/india/key-data.

UNICEFb. (2021). COVID-19 pandemic leads to major backsliding on childhood vaccinations, new WHO, UNICEF data shows. Press release. UNI325806. Assessed on 22 November 2021. Retrieved from https://www.unicef.org/press-releases/covid-19-pandemic-leads-major-backsliding-childhood-vaccinations-new-who-unicef-data

Unicefc. (2021). COVID-19: Schools for more than 168 million children globally have been completely closed for almost a full year, says UNICEF. Press release, 10 March 2021. UN0423792. Retrieved from https://www.unicef.org/india/press-releases/covid-19-schools-more-168-million-children-globally-have-been-completely-closed

WHO. (2021). Interim statement on COVID-19 vaccination for children and adolescents. WHO News, 24 November 2021. Retrieved from https://www.who.int/news/item/24-11-2021-interim-statement-on-covid-19-vaccination-for-children-and-adolescents

Zimmermann, P., Curtis, N. (2021). Why is COVID-19 less severe in children? A review of the proposed mechanisms underlying the age-related difference in severity of SARS-CoV-2 infections. Archives of Disease in Childhood, 106, 429-439.