Vaccination hesitation: A bigger evil than the virus

Rajesh Khanna, Deputy Director, Health and Nutrition, Save the Children dives into the vaccination debate and impact on children

Take the example of Telangana, where health authorities recently stated that 37,332 children were infected with the virus between March and May 2021. This coupled with the fact that 19,824 children got infected from August-November 2020 tells us how we grossly underestimated the impact of Covid-19 on children.

Compared to the first wave, the number of positive cases and their severity has increased among children this time. Why is this concerning?

This is in contrast to what was earlier perceived globally that children will not suffer from the severe direct symptoms of the virus, the indirect fallout on their lives and rights is a topic for another discussion.

Direct Impact on Children

Arrival of the mutant strain, delayed diagnosis and treatment, challenge of access to healthcare services, lack of space for social distancing are making children vulnerable. Children are showing symptoms of high grade fever, severe body aches, diarrhoea, coughing and abdominal pain requiring hospitalisation. In some cases, children are also showing symptoms of multi-system inflammatory syndrome.

The fear of a third wave affecting children more than the adults has set alarm bells ringing. To safeguard children, the Union Health Ministry has listed guidelines for Covid-19 treatment for those below 18 years of age. According to government data, around 26 per cent of people infected with Covid-19 in India since May 1 are in the 18-30 age group.

Debate -- Is Vaccination safe for Children

Vaccination for people above 18 in India has been anything but smooth with reports of acute vaccine shortage and difficulty in registering for vaccination online. Globally, a conversation around vaccination for children has started with countries like the US taking the lead. According to the Centers for Disease Control and Prevention, 6,00,000 children in the US between age 12 and 15 have received the Pfizer shot. Studies showed that the vaccine is 100 per cent effective in kids in the same age group.

Canada, Singapore and the UAE, too, approved the Pfizer vaccine for emergency use in the 12-15 age group. Moderna is currently conducting age de-escalation studies. Johnson & Johnson also plans to do the same.

Meanwhile, in India the Phase 2 and 3 clinical trials of Bharat Biotech's Covaxin for 2-18 age group will begin in June, which will include 525 subjects across canters in AIIMS (Delhi and Patna) and Meditrina Institute of Medical Sciences, Nagpur. India is also developing nasal vaccines which could prove to be a game changer. But these won't be ready until next year.

Vaccination and Covid Protocols For Children

Before vaccination for children is rolled out, it is imperative that trials are conducted following compliances and guidelines to prove the effectiveness of the vaccine and how safe it is. Instead of hastening the process, protocols and standard norms need to be maintained.

At this point, equitable access to a suitable and effective vaccine is critical and it is upto the global leaders to continue dialogue on this. Meanwhile, stringent public health measures like social distancing, wearing masks, sanitising hands and avoiding gathering of crowds need to be maintained.

Vaccination alone cannot help in ending the pandemic.

While it may take some time for vaccines to be available for children, early testing and detection are key to treating children with Covid and preventing hospitalisation. Simultaneously efforts have to be made to strengthen hospitals and other health facilities for providing quality care to those children who might require hospitalization. Management of the infection will depend on the severity of the case.

Vaccine Hesitancy

Another issue to address is vaccine hesitancy as a large sample of the population are hesitant about receiving the vaccine owing to concerns about side effects or potential adverse outcomes and misinformation; especially when it concerns children. History shows that vaccine hesitancy has always existed; the experience of polio eradication in India has shown how it adversely impact the health of other children. An interesting fact: In the 19th Century, Charles Dickens had published several essays advocating the small pox vaccine and other public health initiatives in his weekly journal Household Words.

India is not alone, many Americans are hesitant to get the Covid-19 vaccine and to convince them the US government, the states and the local businesses are offering all kinds of incentives. Free doughnuts, lottery tickets, cash prizes, free to tickets to events and parks, even beer are being offered. With the looming fear of a third wave in India, vaccinating parents is important to ensure we protect our children.

Though rapidly changing, perceptions are that children have lower risk of severe outcomes from Covid-19, however, the infection can still impact children and be passed on from infected family members. While India has recently initiated vaccination trials for under 18, it is imperative that our central and state government agencies conduct mass awareness campaigns in rural and semi-rural areas to tackle vaccine hesitancy; to ensure the caregivers of children are protected.

Moreover, to bust the myths and rumours around vaccinations and the ongoing trials, the government needs to create and disseminated data on public forums for scientists, medical experts and parents to study.

Data Collection

In 2020, Tedros Adhanom Ghebreyesus, the World Health Organisation (WHO)'s director-general, had said, "We're not just fighting a pandemic; we're fighting an infodemic." Countries, healthcare workers and scientists need accurate data to design an effective response to control the pandemic.

"The first thing you could do is collect data on transmission and its severity among youth and children in your district, and analyse them on a regular basis. I urge all officers to make an assessment yourself; this will help you in preparing for the future," Prime Minister Narendra Modi recently told district collectors and field officials of 10 states.

The government should ensure the data collection is disaggregated by sex, age and disability, prioritising the most vulnerable and marginalised children, including those who are orphaned, living in street situations, those in child care institutions, belonging to migrant families, refugees and those internally displaced.

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