Let’s hold off vaccinating children and teens against COVID-19. Prioritising adults is our best shot for now


Shutterstock

Fiona Russell, The University of Melbourne; Peter McIntyre, and Shidan Tosif, Murdoch Children’s Research InstituteEighteen months into the COVID-19 pandemic, some countries that have achieved high vaccination coverage in adults have started vaccinating adolescents aged 12-15.

Drivers to vaccinate children and adolescents include building confidence to open schools, preventing severe disease, and reducing transmission in all ages to achieve “herd immunity”.

But in most countries, including Australia, vaccination of the highest-risk groups is not nearly complete. So does it make sense to vaccinate children and adolescents at this stage?




Read more:
What’s the Delta COVID variant found in Melbourne? Is it more infectious and does it spread more in kids? A virologist explains


COVID-19 in children

COVID-19 is less severe in children and adolescents; most have mild infections or are asymptomatic.

Studies have found multisystem inflammatory syndrome and long COVID to be uncommon after COVID-19 infection, especially in young children.

Newborns and children with other medical conditions are at higher risk of severe disease. But with the level of medical care in Australia, even the more vulnerable children have a very low risk of dying.

Given the increased risk in children with underlying health issues, there may be benefit to vaccinating these children over 12, and a strong case for 16- to 18-year-olds.

But as increasing age is the biggest risk factor for severe disease, vaccinating older people should remain the priority.




Read more:
Children, teens and COVID vaccines: where is the evidence at, and when will kids in Australia be eligible?


Are COVID vaccines safe for kids?

Common side-effects seen in a clinical trial of the Pfizer vaccine in 12- to 15-year-olds included injection site pain (up to 86% of participants), fatigue (up to 66%) and headache (up to 65%). These were mild to moderate in severity and short-lived.

However, two more serious, related conditions — myocarditis (inflammation of the heart muscle) and pericarditis (inflammation of the heart lining) — have been identified in safety surveillance in the United States, Canada and Israel following mRNA vaccines (Pfizer and Moderna).

The highest rates are in men under 25 after the second dose. Based on US data up to June 11, for boys aged 12-17, the rate was 66.7 cases per million second doses.

This is more than double the estimated risk of thrombosis with thrombocytopenia syndrome (TTS) following the AstraZeneca vaccine, although myocarditis and pericarditis are less severe.

Most of the 323 cases recorded in the US data went to hospital; some needed intensive care, but the vast majority fully recovered.

A young man receives a vaccine.
A heart condition has been seen in some people, particularly young men, following vaccination with mRNA vaccines.
ADC/Unsplash

What are other countries doing?

These heart conditions may be triggered by autoimmune responses following mRNA vaccines in susceptible young people. Given immune responses are higher in adolescents than adults after vaccination, experts are considering altering the vaccine dosage or schedule in this age group.

Israel is now weighing up a single dose for adolescents, as one dose produces a good immune response, and almost all cases of myocarditis or pericarditis believed to be associated with the vaccine occurred after the second dose.

In the US, the risk of COVID-19 was judged to render the benefits of the existing adolescent vaccination program substantially greater than the risks from vaccination.

In the United Kingdom, infections with the Delta variant have increased, particularly in older adolescents in hotspots. However, the UK has decided not to vaccinate children under 18 just yet, as there would be little direct benefit in this age group.

Vaccine safety must be paramount, especially where the risk of COVID-19 is low, such as in Australia. Although Australia hasn’t yet approved a COVID-19 vaccine for this younger age group, any risk/benefit calculation would be based on our local context, as we’ve seen with the AstraZeneca vaccine.




Read more:
Yes, we’ve seen schools close. But the evidence still shows kids are unlikely to catch or spread coronavirus


What about outbreaks in schools?

The most profound effect on children and adolescents during the pandemic has been the impact of school closures on learning, socialisation and emotional development, especially in children with special needs or mental health issues.

The US and Canada are vaccinating adolescents partly to build confidence for returning to school.

School outbreaks do occur and are proportionate to the degree of community transmission. In Australia’s current Delta outbreak, we’ve seen very few school-related infections.

But it’s important to understand adult staff are responsible for most transmission in schools. And most transmission — linked to schools or generally — occurs in households. We’ve seen this even in the UK with the Delta variant.

A Scottish study with data up to February found the highest risk factor of infection in people at risk of severe COVID-19 was the number of adults in their household. Living with children was not a risk factor.

Vaccinating adults, parents and school staff will be key to preventing infections in children and schools.




Read more:
We need to prioritise teachers and staff for COVID vaccination — and stop closing schools with every lockdown


Do we need to vaccinate children and teens to control COVID-19?

Vaccinating large numbers of adults will allow us to prevent deaths and serious illness, and therefore reduce the burden on health systems. That’s the primary goal.

But many countries are also aiming to achieve “herd immunity” through vaccination. High coverage in adults will go a long way to achieving this, but the incremental benefit from vaccinating children 15 and under is still unclear.

In Serrana, a small town in Brazil, where 95% of the adult population (about 75% of the total population) were given two doses of Sinovac vaccine, deaths were reduced by 95%, hospitalisations by 86% and symptomatic infections by 80%. Infections in unvaccinated children and adolescents also went down.

In some countries with adult vaccination rates above 50%, such as Israel, infections have declined overall, suggesting adults play a key role in transmission and preventing infections in children.

In fact, one study in Israel found vaccinating adults did prevent infections in unvaccinated children.

A young girl gets a vaccine.
Vaccinating adults can indirectly protect children.
Shutterstock

Let’s keep the focus on adults for now

At this stage, the focus of a vaccination program should remain on attaining high coverage in adults, especially the elderly and those with other medical conditions. We should aim for above 90% coverage in these groups to maximise individual protection and prevent transmission to younger age groups.

Another reason to hold off with adolescents is the fact the global COVID-19 vaccine rollout has been slow and highly inequitable.

The World Health Organization has expressed major concern over higher-income countries beginning to vaccinate children while many lower- and middle-income countries have insufficient supply to vaccinate high-priority groups.

Recommendations for vaccination will evolve. But the top priority right now must be maximising vaccination in adults — both in countries that may have the capacity to vaccinate children, and around the world.The Conversation

Fiona Russell, Senior Principal Research Fellow; paediatrician; infectious diseases epidemiologist; vaccinologist, The University of Melbourne; Peter McIntyre, Professor, Department of Women’s and Children’s Health (Dunedin), and Shidan Tosif, Paediatrician/Clinician Scientist, Murdoch Children’s Research Institute

This article is republished from The Conversation under a Creative Commons license. Read the original article.

We need to prioritise teachers and staff for COVID vaccination — and stop closing schools with every lockdown


Shutterstock

Asha Bowen, Telethon Kids Institute; Archana Koirala, University of Sydney, and Margie Danchin, Murdoch Children’s Research InstituteYesterday Victoria announced a snap lockdown to last at least seven days starting from 11:59pm last night.

As part of the lockdown, schools will close and move to remote learning, and today is a pupil-free day while schools prepare to teach online. Only the children of authorised workers and vulnerable kids will continue to be able to learn in person.

It’s another episode of schools being closed seemingly as par for the course in any COVID-19 outbreak. While communities are concerned about the outbreak, the inclusion of schools in the lockdown should be as an extension of controls if transmission is more widespread, rather than the immediate response.

Despite good evidence, the previously developed traffic light system isn’t being used for schools during outbreaks in Australia. There’s currently no national plan to guide states and territories on how to manage schools during COVID outbreaks, and to advise them on the evidence and best-practice. This needs to change.

We argue schools should be prioritised to remain open, with transmission mitigation strategies in place, during low levels of community transmission.

What’s more, if schools are a priority, then vaccinating all school staff is something we should be urgently doing as part of these strategies.

Schools should be a priority

As paediatricians and vaccine experts, we believe kids’ well-being and learning should be among the top priorities in any outbreak.

We advocate for strategies to reduce the risk of COVID transmission in schools during outbreaks, including measures like:

  • minimising parents and other adults on the school grounds, including dropping kids off at the school gate rather than entering the school
  • parents, teachers, other school staff, and high-school students wearing masks
  • focusing on hand hygiene
  • enhanced physical distancing
  • good ventilation in classrooms and school buildings.

On top of this, we believe if schools, teachers and kids are viewed as a priority by decision makers, then vaccinating all school staff should urgently be considered.

Vaccinating all school staff would reassure those who have concerns about being at work in a school environment during a lockdown, and potentially lower the risk of spread in schools even further. This would increase the confidence in schools remaining open.

Kids are not major drivers of transmission

Kids can and do get sick with the SARS-CoV-2 coronavirus, though they tend to get less severe disease.

The best available evidence suggests kids and schools are not major drivers of transmission, even though children can transmit the virus.




Read more:
Why do kids tend to have milder COVID? This new study gives us a clue


Snap lockdowns have become the new norm in Australia for managing COVID transmission emerging from hotel quarantine. We strongly argue snap lockdowns shouldn’t automatically include schools. Data from overseas, where widespread community transmission is occurring, suggests schools remaining open with public health measures in place hasn’t changed transmission rates very much.

We advocate for schools to remain open, and if a student or teacher attends a school while infectious, the measures in place to test, trace, and isolate the primary and secondary contacts are activated. We have done it before. NSW was able to continue with face-to-face learning and had 88% attendance in term three 2020 even with low levels of community transmission.

When there’s rampant community spread like some countries overseas, this changes the risk-benefit equation and school closures may be needed. The traffic light system has been developed for exactly this scenario.




Read more:
We can’t close schools every time there’s a COVID outbreak. Our traffic light system shows what to do instead


But with an outbreak of 30 cases so far, we don’t think Victoria is near the flexion point where school closures are necessary. If there were many more, the risk equation would change, and the traffic light system could be applied.

Also, there’s a different risk equation for primary and secondary school students. Primary school kids are much less likely to transmit the virus than secondary school students. Daycare and early childhood centres remain open in Victoria. The evidence supports at least primary schools remaining open too.

We need a national plan on schools

Our concern is that jurisdictions are reaching for school closures as an almost predictable part of lockdown, without relying on a national plan to guide these decisions. The only current guidelines are the Australian Health Protection Principal Committee’s (AHPPC) statement from February on reducing the risk of COVID spread in schools.

Only about 13% of Australians have received at least one COVID vaccine dose, and ongoing community COVID outbreaks are expected for at least the next year or more. So, we need a proper national plan on COVID and schools. States and territories would benefit from a national plan, as they could lean on it to make informed decisions on schools during outbreaks.

School closures cause enormous strain

Whenever school closures are announced, we hear many parents sigh and say things like “I won’t be able to get any work done!”. Indeed, school closures put enormous strain on families, especially working parents with pre-school or primary school aged children. Younger children require some supervision and are less likely to have the skills necessary to get value out of online learning, compared to older kids in the latter stages of high school who may be more independent.

Challenges might also include poor or no internet, not being able to have relevant supervision, or not having the right devices.

Home learning has a substantial impact on children’s well-being and mental health. Over 50% of Victorian parents who participated in a Royal Children’s Hospital poll in August 2020 reported homeschooling had a negative impact on their kids’ emotional well-being during the second wave in 2020. This was compared to 26.7% in other states. Jurisdictions keep playing into this risk if they keep closing schools.

It’s an absolute priority we find and use ways to support kids to continue face-to-face learning in times of low community transmission, especially primary schools. One important way to do this is to prioritise teachers and other school staff for COVID vaccines.




Read more:
Children, teens and COVID vaccines: where is the evidence at, and when will kids in Australia be eligible?


The Conversation


Asha Bowen, Program Head of Vaccines and Infectious Diseases, and Head of Skin Health, Telethon Kids Institute; Archana Koirala, Paediatrician and Infectious Diseases Specialist, University of Sydney, and Margie Danchin, Paediatrician at the Royal Childrens Hospital and Associate Professor and Clinician Scientist, University of Melbourne and MCRI, Murdoch Children’s Research Institute

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Australia and other countries must prioritise humanity in dealing with displaced people and migration



File 20180801 136661 kxqnsm.jpg?ixlib=rb 1.1
The United Nations says the number of forcibly displaced persons around the world has risen to 68.5 million.
Shutterstock

Samuel Berhanu Woldemariam, University of Newcastle; Amy Maguire, University of Newcastle, and Jason von Meding, University of Newcastle

After six rounds of consultations, United Nations member states have produced the final draft of the Global Compact for Safe, Orderly and Regular Migration (GCM).

It is preceded by the New York Declaration for Refugees and Migrants, which the UN General Assembly adopted in 2016. This was an intergovernmental declaration to initiate development of two separate global compacts: one on refugees and another on migrants.

This latest global compact document focuses on the latter issue. It lays down 23 objectives in order to establish “a cooperative framework to address migration in all its dimensions”.

Key points include securing the human rights of migrants, reducing vulnerabilities in migration, and the use of migration detention only as a last resort. The global compact also promotes “integrated, secure and coordinated” border management. Its aim is for states to cooperate rather than focus strictly on their domestic priorities.

National responses to the draft global compact

Over the last month or so, states have started to declare their positions on the draft text. Notably, these positions do not always align with how those states have conducted themselves in intergovernmental negotiations. As is often the case, tensions can arise between domestic political priorities and intergovernmental relations.

Home Affairs Minister Peter Dutton said Australia would not sign the global compact in its current form. Australia is “happy to negotiate in good faith”, according to Dutton, but it will not “sign its border protection policy over to the UN”.




Read more:
Why does international condemnation on human rights mean so little to Australia?


The Hungarian government also declared its opposition and officially announced its exit from the adoption process.

These developments follow the high-profile US withdrawal from the drafting process in December 2017. At the time, the Trump administration argued that numerous provisions of the New York Declaration were “inconsistent with US immigration policy”.

As the Global Compact on Migration moves towards finalisation in December 2018, there is a chance these early challenges may snowball.

The key to Australia’s resistance

The grounds for Australia’s particular resistance to the global compact are the provisions relating to migration detention. The compact insists detention should only be used as a “last resort”. Signatories would commit to:

review and revise relevant legislation, policies and practices related to immigration detention to ensure that migrants are not detained arbitrarily, that decisions to detain are based on law, are proportionate, have a legitimate purpose, and are taken on an individual basis, in full compliance with due process and procedural safeguards, and that immigration detention is not promoted as a deterrent or used as a form of cruel, inhumane or degrading treatment to migrants, in accordance with international human rights law.

Critical readings of domestic policy and practice find Australia’s behaviour in violation of some or all of the compact’s checks on migration detention.




Read more:
Offshore detention: Australians have a right to know what is done in their name


Indeed, Dutton effectively acknowledges that Australia’s practice is out of alignment with international legal standards. He notes that “we’ve fought hard for [our policies]” and “we’re not going to sign a deal that sacrifices anything in terms of our border protection”.

Multiple actors have sought to bring Australia’s treatment of asylum seekers before the prosecutor of the International Criminal Court. The Australian government faces allegations including crimes against humanity and torture, arising from the system of mandatory offshore immigration detention it continues to enforce.

Global forced displacement and migration challenges are unprecedented

It is clear that states typically prioritise their national interests in international relations. Arguments are often framed in such a way as to absolve states of responsibility and position vulnerable refugees and migrants as a “problem”. It is past time for this mentality to change.

The UN High Commissioner for Refugees (UNHCR) recently released the 2017 Global Trends Report. It confirms that the number of forcibly displaced persons around the world has risen to 68.5 million. This is 2.9 million more than reported at the end of 2016.

The estimated global migrant population is 244 million.

States’ approaches to challenges of forced displacement and migration often fail to acknowledge a sometimes competing, but always essential, consideration – the basic dignity of the human person.

The agenda of the global compact is to encourage states to prioritise human dignity. This consideration does not have to contravene sovereignty. It does not dictate that a country abolish its borders. Nor is it against measures to protect its security.

To construct a justification for state cruelty based on sovereignty is an affront to the shared objectives of member states of the UN.

The case for greater cooperation

The current scope of forced displacement and migration necessitates more rather than less cooperation. Pakistan’s ambassador to the UN, Maleeha Lodhi, stated that the “success rests on mutual trust, determination and solidarity to fulfil the 23 objectives and commitments contained in the GCM”.

Bonds of solidarity at the international level are heavily strained by the disproportionate burdens borne by a small number of receiving states. Developing countries now host 84% of the world’s refugees.

In this context, the last thing national governments should do is abandon cooperative efforts to build stronger global responses to migration and refugee protection.

The ConversationThe lives and wellbeing of millions of people depend on countries working together and prioritising humanity in their domestic policies.

Samuel Berhanu Woldemariam, PhD Candidate (Law), University of Newcastle; Amy Maguire, Senior Lecturer in International Law and Human Rights, University of Newcastle, and Jason von Meding, Senior Lecturer in Disaster Risk Reduction, University of Newcastle

This article was originally published on The Conversation. Read the original article.