Did state err in not immediately inoculating teens?
Israel is currently grappling with a new surge in COVID cases following outbreaks in schools, with a third of the 1,200 active cases being among children aged 12-15.
The high number of infected youth makes one wonder: What would have happened if the country had started vaccinating children as soon as it could have instead of delaying its decision and then avoiding a clear recommendation on the matter?
When the US Food and Drug Administration granted emergency authorization to administer the Pfizer-BioNTech vaccine to children of that cohort on May 11, Israel had just launched a massive operation against Hamas in the Gaza Strip. Barrages of rockets were pounding the country and ethnic riots had broken out across mixed Arab-Jewish cities. With COVID cases – including serious patients and deaths – dramatically dropping for months, the authorities did not feel a need to prioritize an inoculation campaign among these youth.
Instead, the Health Ministry announced at the time that it would hold consultations with relevant experts to formulate a policy. As the war went on, meetings were postponed and a decision was slow in coming.
In spite of the fact that the vast majority of experts – including the Israeli Pediatric Society – had come out strongly in favor of vaccinating children, another problem loomed.
In April, a preliminary report by the Health Ministry, and leaked to the media, suggested a possible link between the vaccine and myocarditis – inflammation of the heart muscle. The condition was reported to be especially frequent among young men ages 16-19.
At the time, the ministry confirmed that such a report existed and that it wanted to have a more complete picture before making the information available to the public. It did so on June 1, releasing a short statement saying that indeed, some myocarditis cases were likely connected to the vaccine – even though in over 95% of the cases, they were mild and without long-lasting side effects.
The following day, the ministry announced that children ages 12-15 could be vaccinated starting from the following week (June 6) but if they did not present a specific risk factor or were planning on traveling abroad, the recommendation was not to rush to vaccinate.
This meant that no SMS or phone call was made to parents, no post were published on Facebook
and no public address was made to get parents to go and get their children vaccinated.
IN THE FIRST days after the move, some 2,000-2,500 shots were administered per day, but the number soon dropped to below 2,000 and even below 1,500, out of a total population of about 550,000 children in that age range.
Then, at the end of last week, news began to emerge about some outbreaks in three Israeli schools: one in Modi’in and two in Binyamina. Daily cases identified in the country rapidly climbed from less than 20 to over 30, 40 and then 100.
Among these new cases, the 12-15 cohort is much more prevalent than any other age group.
Of the current 1,200 new cases, over a third – more than 400 – are 12-to-15 year olds.
At the beginning of the outbreak, the rate was even higher. On June 19, some 68% of the 47 new identified cases belonged to that age group; on the following two days they constituted 47% of the 48 and 124 new cases. In the following days, they would remain between 30% and 40%.
What would have happened if the government had lobbied parents to have their children vaccinated? Would they have avoided contracting the virus themselves, and spare the contagion from others? Most likely the answer to this question is yes.
Meanwhile, the government has changed. One of the first measures to counter the rise in cases promoted by the new Israeli leadership was an active campaign to get children vaccinated. Since then, the number of daily shots has quadrupled, with some 8,000 children jabbed on Thursday.
On Sunday, Clalit – Israel’s biggest health fund, which provides healthcare services to about half of the population – announced that some 25,000 children had been vaccinated and another 30,000 had booked an appointment to do so in the coming days.
While the numbers have been increasing, they are still much lower than the goal set by Prime Minister Naftali Bennett last week of 30,000 teens jabbed every day.
Bennett also warned that while Israel has enough doses to cover all eligible people, its vaccines will expire on July 31, so all those who wish to be certain to get fully immunized according to the normal schedule – three weeks between the first and second shot – should make sure to get their first appointment before July 9.
Also on Sunday, the Israeli Pediatric Society published a new position paper reiterating its support for the vaccine, and addressing the issue of possible side effects.
IPS HEAD Prof. Tzachi Grossman, along with the organization’s colleagues, wrote that the risk for a child to develop a severe form of COVID if infected – which stands at 1:3,000 – outweighs that of developing a myocarditis – which according to US data for ages 12-17 is more than five times less likely at 1:16,000 (according to Israeli data for the age group 16-19, the occurrence was half as likely at 1:6,000).
Their recommendation was therefore to continue promoting vaccinating children, with the exception of those who have suffered from myocarditis in the past.
However, both Grossman and Dr. Galia Barkai, director of the Pediatric Infectious Diseases Unit at Sheba Medical Center, said that the decision of the ministry to take a conservative approach was the correct one, just as now it is right to encourage children to get vaccinated.
“We made the decision together, in consultation,” said Grossman.
“We were gathering information regarding myocarditis, we were waiting for more children to get vaccinated in other countries such as in the United States,” Barkai added. “There were days with no COVID-19 cases in Israel. I tend to think that being more conservative was the right decision, and now things have changed.”
By now, millions of children have been vaccinated around the world.
“With more than 50% of the population vaccinated, we had the privilege to be able to wait and see what was happening,” Barkai said.
The caution was a way to show the public that the authorities were not rushing but were taking into consideration all factors, she said.
Asked if Israel will be able to reach 30,000 shots a day, Barkai said it is going to be difficult.
But at the same time, she is not excessively worried about the current outbreak.
“I do not see that we are going to witness a catastrophe here,” she concluded. “The vaccine is effective against the Delta variant and I do not believe the outbreak is going to be uncontrollable.”