THE GOVERNMENT IS this week due to receive advice on vaccinating children against Covid-19 from the National Immunisation Advisory Committee (Niac).

The HSE is likely to expand the Covid-19 vaccination rollout to include children aged 12 to 15 in the coming weeks if Niac gives the green light.

Registration for vaccines is due to open to teenagers aged 16 and 17 in the coming days.

Children over 12 in the UK are set to be offered a Covid vaccine only if they have underlying conditions and are vulnerable, or live with someone at high risk from the virus.

Niac may recommend that a similar approach is taken in Ireland, or may advise that all children over the age of 12 be offered vaccines.

Some ministers are understood to want children with underlying conditions to be prioritised.

On Thursday, the HSE confirmed that about one-third of recent Covid-19 cases have been in those aged under 13.

HSE CEO Paul Reid said 75% of cases in the previous 14 days were among people aged under 34 and 32% of people who tested positive were children under 13.

Also speaking last week, HSE Chief Clinical Officer Dr Colm Henry said in order to reach herd immunity in Ireland, vaccination would have to be expanded to younger age groups.

He said Niac has to consider the relative risks and benefits for children as Covid-19 presents a very low risk for children in terms of serious illness and hospitalisation.

Dr Henry said there is “disagreement internationally” on the issue and he does not expect Niac to “emphatically recommend” vaccinating children at this stage.

“Certainly they’re looking at teenagers, aged 12-16, but with younger age groups I expect it’s going to be more complicated,” he said.

Reopening schools

Vaccinating younger teenagers will come into more focus as schools prepare to reopen late next month.

Speaking on Today with Claire Byrne this morning, Education Minister Norma Foley said she has “every confidence” her department “has the capacity for the full reopening of schools in late August, early September”, regardless of whether or not the vaccine is extended to younger age groups.

Foley said there is “ongoing engagement” with public health officials on the matter, and that “strong mitigation measures” such as C02 monitors will be in place in schools to ensure that they continue to be “controlled environments”.

The minister said the decision with regard to vaccine advice “rests with Niac”.

“Niac are currently still considering that and the HSE awaits their guidance,” she said, adding that the Government has based its approach on “guidance from experts every step of the way”.

Foley could not give a timeline of when the advice was expected but said it must be “a measured decision”.

“I have received confirmation that the 16 to 18-year-old cohort should be in a position for online registration in the coming days, and I have been advised that the 15-year-olds cohort are still being considered by NIAC and there has been no definitive timeline given,” she said.

Niac is understood to be examining the approaches taken by other countries.

A spokesperson for Niac told The Journal the body is currently considering advice for Chief Medical Officer Dr Tony Holohan who will in turn consider it and “may amend or adopt as policy”.

A spokesperson for the HSE told us: “We expect to be in a position to open online registration for those aged 16 to 18 this week, following NIAC approval for vaccination of this age group.”

Neither spokesperson would elaborate on vaccination among younger age groups.

What’s happening in other countries?

Children in the UK who are at increased risk of Covid-19 are to be offered the Pfizer/BioNTech vaccine on the NHS “as soon as possible”, as are those living with people with weakened immune systems, the British Health Secretary announced last week.

Sajid Javid said he had accepted the advice of the independent Joint Committee on Vaccination and Immunisation (JCVI), which has ruled out mass vaccination of healthy children for now.

The move means thousands of children in the UK aged 12 to 15 with the following conditions can access the vaccine: severe neuro-disabilities, Down’s syndrome, immunosuppression, multiple or severe learning disabilities.

The European Medicines Agency (EMA) last Friday recommended authorising Moderna’s Covid-19 vaccine for children ages 12 to 17, the first time the shot has been authorised for people under 18.

The EU drug regulator said research in more than 3,700 children aged 12 to 17 showed that the Moderna vaccine — already given the green light for adults across Europe — produced a comparable antibody response.

Until then, the vaccine made by Pfizer and German partner BioNTech had been the only option for children as young as 12 in North America and Europe.

The US Food and Drug Administration is currently considering whether to extend the use of the Moderna vaccine to the same age group.

Hundreds of millions of Moderna doses already have been administered to adults, and the company says the two-dose vaccine is just as protective for adolescents.

In a study of more than 3,700 12 to 17-year-olds, the Moderna vaccine triggered the same signs of immune protection, and no Covid-19 diagnoses arose in the vaccinated group compared with four cases among those given dummy shots.

Sore arms, headache and fatigue were the most common side effects in the young vaccine recipients, the same ones as for adults.

US and European regulators caution, however, that both the Moderna and Pfizer vaccines appear linked to an extremely rare reaction in teens and young adults — chest pain and heart inflammation.

EMA has just approved the #COVID19vaccine Spikevax, previously known as COVID-19 Vaccine Moderna, for children aged 12 to 17 in the 🇪🇺.
👉https://t.co/pnxvNYXDBH pic.twitter.com/WZgUz7G19K

— EU Medicines Agency (@EMA_News) July 23, 2021

Both Pfizer and Moderna have begun testing in even younger children, from age 11 down to six months old. These studies are more complex: teens receive the same dose as adults, but researchers are testing smaller doses in younger children.

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The EU drug regulator said it would continue to monitor the safety and efficacy of the Moderna vaccine in children as it is used in European member countries.

‘More evidence needed’

The World Health Organization’s current guidance states that “more evidence is needed on the use of the different Covid-19 vaccines in children to be able to make general recommendations on vaccinating children” against the virus.

A WHO statement notes: “Children and adolescents tend to have milder disease compared to adults, so unless they are part of a group at higher risk of severe Covid-19, it is less urgent to vaccinate them than older people, those with chronic health conditions and health workers.”  

WHO’s Strategic Advisory Group of Experts (Sage) has concluded that the Pfizer/BionTech vaccine is suitable for use by people aged 12 years and above.

“Children aged between 12 and 15 who are at high risk may be offered this vaccine alongside other priority groups for vaccination. Vaccine trials for children are ongoing and WHO will update its recommendations when the evidence or epidemiological situation warrants a change in policy,” the statement adds.

A recent analysis of hospital admissions and reported deaths across England suggests that Covid-19 carries a lower risk of dying or requiring intensive care among children and young people than was previously thought.

As reported by Nature, a team of researchers examined all hospital admissions and deaths reported for people younger than 18 in England. The studies found that Covid-19 caused 25 deaths in that age group between March 2020 and February 2021.

About half of those deaths were in individuals with an underlying complex disability with high health-care needs, such as tube feeding or assistance with breathing, according to preliminary findings that have not yet been peer reviewed.

Nature notes that the studies did not evaluate rates of less-severe illness or debilitating so-called ‘long Covid’ symptoms that can linger months after the acute phase of the virus infection has passed.

“The low rate of severe acute disease is important news, but this does not have to mean that Covid does not matter to children,” said Danilo Buonsenso, a paediatrician at the Gemelli University Hospital in Rome who is leading separate research to quantify ‘long Covid’ in children.

“Please, let’s keep attention — as much as is feasible — on immunisation,” he said.

Vaccine shortages 

It’s also worth noting that, with global vaccine supplies still tight, much of the world is struggling to immunise adults.

The WHO and other agencies have urged rich countries to donate their doses to the Global South — where fewer than 2% of people have been vaccinated — rather than moving on to inoculate their less vulnerable populations.

Earlier this year, WHO’s executive director of emergencies Dr Mike Ryan said wealthy nations such as Ireland should share their vaccine supplies with countries in need prior to vaccinating healthy young people.

“If we stand by and allow frontline health workers and vulnerable people in developing countries to not be vaccinated while the rich north gets on with vaccinating perfectly healthy young people, then I hope then history books write that down,” Dr Ryan said at a Trócaire event in February.

Contains reporting from PA