Johannesburg - While there are no immediate plans to vaccinate children between the ages of five and 11 in SA, health experts say the age group should be vaccinated before the expected fifth wave this winter.
The World Health Organization (WHO) said the greatest burden of disease in terms of severe disease and deaths, remained among older persons and those with comorbidities.
Overall, there were proportionally fewer symptomatic infections, and cases with severe disease and deaths from Covid-19 in children and adolescents, compared with older age groups.
Age-disaggregated cases reported to WHO show that children under five represented 2% of reported global cases and 0.1% of reported global deaths. Older children and younger adolescents (five to 14 years) accounted for 7% of reported global cases and 0.1% of reported global deaths. Older adolescents and young adults (15 to 24 years) represented 15% of reported global cases and 0.4% of reported global deaths. Deaths for the under 25s represented less than 0.5% of reported global deaths.
In November last year, one stringent regulatory authority approved the mRNA vaccine, BNT162b2, for the use in children aged five to 11. Trials in children as young as three were completed for two inactivated vaccines. Countries like the UK, Italy, Germany, Ireland, Poland, France, Spain, Switzerland and Sweden have vaccinated children between the ages of five and 11.
The head of the South African Vaccination and Immunisation Centre at Sefako Makgatho Health Sciences University and chair of the National Immunisation Safety Expert Committee, professor Hannelie Meyer, said that in SA, the Pfizer vaccine was registered for use from 12 years only.
The National Health Department confirmed that there were no plans to start vaccinating children younger than 12 years.
Wits professor of vaccinology Shabir Madhi said that as far as he was aware, there were no plans to vaccinate those aged five to 11.
“With more than 70% of this age group having already been infected, coupled with the low risk for severe illness (unless they have underlying medical conditions), and that vaccines are tenuous in how well they protect against mild Covid, it’s not deemed essential for this age group to be vaccinated.”
Madhi expected the fifth wave to be far less severe than the Omicron wave.
“We are likely nearing the start of a fifth wave, however, expect it to be of smaller, if not lesser, magnitude compared with the Omicron wave which, although causing many infections, resulted in modest severe disease and death.”
“I expect the next wave to be even less severe than Omicron, now that more than 85% of SA have developed immunity from infection, as well as with ongoing roll-out of Covid vaccines.”
Professor Benjamin Smart, of the University of Johannesburg (UJ), who is an expert in public health and medical philosophy, said that while he supported vaccinations for children, he was unsure whether the country would be progressing with vaccinations for those aged five to 11.
“Children continue to be the lowest risk group for Covid-19, and much like adults, the Omicron variant has been less dangerous than previous variants,” said Smart.
“There has been a rise in hospital admissions for young children who test positive for Covid-19, but 30 to 40% of these positive tests have been incidental – the children were admitted for surgery or unrelated medical conditions.
“The increase in cases is, in part, due to a general increase in unrelated hospital admissions.
“Whilst I support vaccinating 5- to 11-year-olds, since the vaccination may protect children against more dangerous variants moving forward, vaccinating more vulnerable citizens should remain the priority.”
Smart believed the fifth wave would probably be sparked by a new emerging variant.
“It is difficult to make definitive predictions about future waves since viruses evolve in unpredictable ways.
“It is likely, however, that the fifth wave will be sparked by a new variant. So far, new waves have been characterised by an increase in transmissibility, and a decrease in the severity of illness, in part because of the protection provided by vaccination and immunity from prior infection and, in part, because of the nature of the virus.
“If this trend continues, we should expect the fifth wave to infect many people (a large proportion of whom will never know they were infected), but should not overwhelm our health-care services.
“That being said, a more dangerous variant could well emerge, so people should remain vigilant, and keep up-to-date with their vaccines and boosters.”
Professor Refilwe Phaswana-Mafuya, the director at the SAMRC/UJ Pan African Centre for Epidemics Research Extramural Unit, and a professor of epidemiology and public health, at the Faculty of Health Sciences at UJ expected children aged five to 11 years to be vaccinated in the future.
“There are speculations that this may happen by mid-year. The electronic Vaccination Data System still shows vaccinations for children aged 12 to 17 years (from 20 October 2021).”
She said that vaccinating young children was important.
“Paediatric data from various reliable sources including the Centres for Disease Control and Prevention recommends that children aged 5 to 11 years be vaccinated with Pfizer-BioNTech Covid-19 vaccine as Covid-19 can cause severe illness in children too.
“Children with underlying medical conditions such as metabolic diseases, congenital heart disease or immunosuppressed children are at increased risk of disease as it is the case with adults.”