All Australians should have access to vaccines before we reopen. That includes children
Australia’s national reopening plan is set to move between various phases of opening, predicated on the proportion of the population who are vaccinated. What is often omitted from the conversation is that these percentages account only for people aged 16 years and older.
Children younger than 16 make up 20% of the Australian population but they are not included in the proportions being discussed in the national reopening plan. It discusses a “70% of the eligible population” vaccination phase (which is really 56% of the total population) and an “80% of the eligible population” vaccination phase (64% of the total population).
While Australia looks forward to the easing of some restrictions as a 70% vaccination target is reached, and holiday plans dance in the heads of Australian families when they hear that a further easing of restrictions might occur in December, at 80% vaccination coverage – what will families with young children do? March 2022 has been discussed as a date when all Australian children aged 12 to 16 may be invited for vaccination. That leaves out children under 12, for whom Covid vaccine trials have not yet been completed.
Under current plans, Australia may begin to reopen around November or December, given good adult Covid vaccine coverage. Unless we have managed to reduce community transmission of Covid back down to zero, households with children under 16 who have not had the opportunity to receive a vaccine but who want to stay safe, are likely to need to retreat into a harder, lonelier, self-imposed lockdown, as the world picks up around them and the Delta variant infects the unvaccinated.
At some point we will loosen public health restrictions and are likely to move forward with Covid as an endemic disease. Doing this before children have the same access to vaccination is unjust. In countries with good rates of vaccination, including Canada, the UK and the US, Covid is becoming a disease of the unvaccinated. As Australia urgently aims for reopening, it will become a disease of the unvaccinated here as well. Children do not have a say in this – they will be the unvaccinated, and they will get Covid.
And some children get very sick. Studies suggest that long Covid does occur in children, including in those with initial mild symptoms or no symptoms at all. The majority of data we have about the disease in children is based on previous variants of the virus.
Delta has changed the scene. It has higher transmissibility, leads to more hospital admissions, appears to affect younger age groups, and the existing vaccines are slightly less effective against it.
We need our national reopening to take into account Covid vaccinations in children as well as adults. A reopening that expands freedoms (but also Covid risk) based on 70% to 80% of adults being vaccinated but none of the children feels morally wrong. Due to vaccine supply, current policies regarding who is eligible and the fact that research trials are still ongoing for Covid vaccines in children, most children will be unprotected in 2021 and younger children are likely to remain so through much of 2022.
Vaccines for children 12 years and older
A welcome announcement has been that children 12 years and older who have specific medical conditions, as well as Aboriginal or Torres Strait Islander children over 12, are now eligible for priority vaccine access in Australia. How easily this priority group will be able to access vaccines, given the long waiting lists and lack of Pfizer in the country, is unclear.
Australia will ideally open this access to all children 12 years and older as soon as vaccine supply allows. All children of this age are being vaccinated against Covid in Canada and the US. In Canada, 40% of those 12 to 17 are fully vaccinated and 71% have received their first dose.
What about vaccines for our youngest?
In March Pfizer started trials of its vaccine in children aged five to 11, two to five, and six months to two years. Moderna also started trials in March for children aged six months to 11 years old. AstraZeneca was initially testing its vaccine in children aged six to 17 but it has halted recruitment. The US Food and Drug Administration has asked Pfizer and Moderna to recruit more children into their trials to ensure no safety signals are missed. FDA approvals of vaccines for younger children are now anticipated in late 2021; this is likely to be for the five to 11 age group only. The youngest children, from six months to five years, will need to wait until 2022 for approvals and after that one must account for vaccine procurement and the logistics of vaccine delivery.
Why is this important?
While the Doherty Institute modelling for the national cabinet discusses the importance of vaccinating younger people who tend to transmit the virus more, there remains a lack of discussion about daycare centres and schools as being important future sites of transmission. Data from Canada demonstrate that large outbreaks of Covid do occur in these settings.
Schools are important for children’s education, social and emotional wellbeing, as well as for their parents’ ability to work. But if we open schools under a scenario of continued community transmission of Delta and zero Covid vaccination in children, we can expect outbreaks in schools and daycare centres, and that some families will keep their children home to protect them. One study, using UK data, found that just that had taken place. Though schools reopened and all students were expected to attend, low rates of attendance were observed.
Pathologists have said they do not want SARS-COV-2, especially the Delta strain, in children’s blood, brain and other organs. The national reopening plan needs to be based on vaccination proportions of the entire population.