Op-ed: Vax the youngsters
Why all children older than 12 need to get the Covid-19 jab
Children constitute a third of the population and must be included in plans to curb Covid-19 infections, while at the same time ensuring they can take part in activities crucial to normal development and health.
On 10 September 2021, the South African Health Products Regulatory Authority approved the use of the Pfizer vaccine for children 12 years and older. This approval was followed by Minister of Health Joe Phaahla announcing that the government had opened Covid-19 vaccinations to children in this age group.
However, uptake among these children has been quite low. There seems to be resistance from some quarters, including parents and healthcare workers. More recently, the African Christian Democratic Party, supported by some organisations, asked the courts to issue an interdict to stop the roll-out of Covid-19 vaccinations to children. The Pretoria High Court ruled that the application was not urgent and could be heard at a later stage.
Children under 18 comprise 34.5% of the population, with about 16% being between the ages of 12 and 18. During the Covid-19 third wave in South Africa, the weekly incidence of admissions associated with Covid-19 in children increased in all age groups, with 565 in-hospital Covid deaths — an in-hospital case fatality risk of 3.6%. Among all deaths in children, 201 (35.6%) were among adolescents aged 15 to 19. Children with underlying conditions comprised 56% of those who died. Poorer outcomes are recorded in children with comorbidities.
Shift in infection ages
Commonly reported underlying conditions in South African children include HIV, TB, chronic respiratory diseases and diabetes. Older teens and adolescents are acquiring Covid-19 at rates similar to adults. It is noted that in the Netherlands, unlike the previous waves where mainly older age groups have been infected, the current fourth wave is especially affecting children under 15 years of age.
It seems like a similar scenario could be emerging in South Africa, especially in light of what is being observed with the emergence of the new variant, Omicron.
Schools have seen a surge of absenteeism and learning losses because of pandemic-related school closures. Learning losses are not uniform, and are higher in disadvantaged pupil groups, resulting in a widening of inequalities. For many pupils, school is a source of education as well as safety, food (for those dependent on feeding schemes) and support.
Can a case be made for the expedited vaccination of children with underlying conditions and older adolescents based on the burden of cases, hospitalisations and learning loss? Will vaccinating all children result in a decrease in community spread? Is the wellbeing of children in South Africa vital for a brighter future for the country?
Covid-19 has introduced significant additional challenges to child health in South Africa. The lockdowns disrupted several essential services to children such as basic education, school feeding systems, healthcare access, mental health support and food security. The closure of schools has increased food insecurity, as close to nine million South African children are dependent on their daily meals provided through these school feeding schemes, with subsequent worsening in malnutrition.
Furthermore, children from disadvantaged communities with limited access to digital resources have probably lost more than a school year, which is devastating with regard to the worsening inequity in education between affluent and disadvantaged communities in South Africa.
Most primary clinics have not functioned normally during the lockdowns, leading to disruption in immunisation administration, basic primary healthcare and delays in rendering treatment to children with chronic illness.
Children from socioeconomically disadvantaged communities have had far less access to mental support. Their parents often have not been able to work, with resultant increased family tension and violence.
Many parents are forced to leave children on their own at home as child-minding services are not affordable. Children have also suffered the loss of parents and grandparents, and there are many child-headed households with limited support systems. This has tremendously increased the number of children suffering from severe anxiety. Childline has recorded an increase in anxiety-related phone calls of 67% in 2020 compared to 2019.
Infected children pose a risk of transmission to more vulnerable household members with an increased risk of serious morbidity and mortality, especially in the context of extended family households common in South Africa. The latter is particularly relevant where grandparents are raising their grandchildren. As SARS-COV-2 is more contagious than the influenza virus, containment is crucial in the control of Covid-19 infections.
As children constitute a third of the population, it is important to include them in plans to curb Covid-19 infections while simultaneously ensuring that they can continue with the regular activities that are necessary for normal child development and child health. These activities include access to basic health services, education, sport and normal play activities.
Count the kids in
As affirmed in the Constitution, children’s constitutional rights should be upheld. Inherent in this is that all forms of neglect are prevented and children’s best interests are of paramount importance. Children should therefore benefit from any new medical interventions that are developed under scientifically robust methodologies to address their health needs, including vaccines for prevention of diseases.
Bearing in mind South Africa’s high burden of infectious diseases, the realities of overcrowding and the impossibility of maintaining safe distances in most South African schools, it is critical that children take up or are assisted in taking up the Covid-19 vaccine provided for them in the national roll-out programme.
The restrictions of physical movement during the lockdowns may have prevented the spread of Covid-19, but have negatively affected the essential activities of children, such as education, sport and cultural events. Unfortunately, thus far, physical protection has taken precedence at the expense of the mental health and intellectual development of children.
For this, and all the reasons above, a case is made for the vaccination of children against Covid-19, and parents, guardians and communities are urged to facilitate children’s access to the vaccination programmes. DM/MC
Mariana Kruger, Ames Dhai, Jerome Singh, Mantoa Mokhachane, Glenda Gray and Mongezi Mdhluli are members of the South African Medical Research Council Bioethics Advisory Panel.
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