India needs a plan for inoculating its below-18 population

The US could begin vaccinating children over the age of 12 with the Pfizer-BioNTech Covid-19 vaccine (Phase 3 trials showed 100% efficacy) soon. An authorisation from the US Food and Drug Administration is expected as early as next week.

The EU drug regulator, European Medicines, on Monday announced that it too is evaluating data submitted by Pfizer-BioNTech on the vaccine’s efficacy and safety for children between the ages of 12 and 15.

In both the US and the EU, the Pfizer-BioNTech vaccine has already been approved for use on anyone over the age of 16.

Even as India works on getting its vaccine strategy for the 18-plus segment right — the drive has been plagued by shortages and vaccine hesitancy is still high in many parts of the country — it needs a plan for those below the age of 18, a staggering 450 million people.

Till Sunday night, India had administered 158 million doses of vaccines to around 129 million people (100 million have received one shot of the vaccine and 29 million, both).

India should definitely start thinking in terms of vaccinating those under the age of 18 -- if they are not protected, neither will the country be safe, nor will it be able to open up to any sort of new normal -- and there are two key factors that need to be considered, say experts.

The first is the country’s slow progress in vaccinating those over the age of 18, with just around 14% of the eligible segment (those over the age of 18) getting at least one shot of the vaccine.

“At the moment the urgency is to cover the older age groups and comorbidties so that people do not die. Ultimately we need to vaccinate children and vaccines are being tested in children,” said Dr Gagandeep Kang, one of country’s top vaccinologists, from the Christian Medical College, Vellore.

As Dr Anurag Agarwal, director, CSIR-IGIB, put it, “Universal immunisation is desirable as a future but impractical at the moment.”

And the second is safety and efficacy data.

“There aren’t enough published results to establish safety and efficacy among children which is important to include in the vaccination drive. Pfizer is testing till 12 years. We should do children as well; that day may come but it will depend on vaccine supply chain,” said Dr K Srinath Reddy, founder, Public Health Foundation of India.

Last month, the University of Oxford said it paused administering doses of the Covid-19 vaccine it developed with AstraZeneca in a UK study to test the shot in children after reports of blood-clotting events in adults.

Both SII and Bharat Biotech did not comment on the matter.

But given that young people are mobile, that many of them live in multi-generational households in India, and that India has

‘Examine Mumbai model’

The court also asked the officials of the Centre and Delhi government to have a meeting on Wednesday evening for a deliberation on supply and distribution of oxygen, besides also examining the “Mumbai model” of optimal utilisation of oxygen.

The S-G had cited the “Mumbai model”, pointing out that despite having a case load of

more people under the age of 18 than the entire population of the US, UK and France, the country has to work with vaccine developers to come up with a plan for young people soon.

Some countries have realized this. Israel has crushed the pandemic with vaccination — the positivity rate of infections dropped to 0.1% earlier this week (there were no deaths) — but is yet to open up fully because it realizes that it is yet to vaccinate people under the age of 16.

Right now, the country has extended its Covid-19 passport system to children, allowing them to visit malls, cinemas, restaurants and other public spaces based on a negative reverse transcription polymerase chain reaction (RT-PCR) Covid-19 report.

Experts say that there is a need for data on how the vaccine works in children, even as India’s hospital data from national Covid registry shows higher number of children are affected in the second wave as compared to the first.

“We need quick data and some analysis of risk-benefit for both children and pregnant women,” said Dr Randeep Guleria, director, All India Institute of Medical Sciences, Delhi.

“When you start your trial, you want to keep it clean, and gradually add on more categories,” added Dr Reddy.