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 Table of Contents  
Year : 2021  |  Volume : 23  |  Issue : 2  |  Page : 228-230

COVID-19 vaccine in Indian children: A debatable issue!!

1 Department of Internal Medicine, Armed Forces Medical College, Pune, Maharashtra, India
2 Department of Anesthesiology and Critical Care, Military Hospital, Ambala Cantt, Haryana, India

Date of Submission02-Aug-2021
Date of Decision13-Aug-2021
Date of Acceptance22-Aug-2021
Date of Web Publication25-Sep-2021

Correspondence Address:
Dr. Vishal Mangal
Department of Internal Medicine, Armed Forces Medical College, Pune - 411 040, Maharashtra
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jmms.jmms_104_21

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How to cite this article:
Mangal V, Kaur KB. COVID-19 vaccine in Indian children: A debatable issue!!. J Mar Med Soc 2021;23:228-30

How to cite this URL:
Mangal V, Kaur KB. COVID-19 vaccine in Indian children: A debatable issue!!. J Mar Med Soc [serial online] 2021 [cited 2021 Dec 3];23:228-30. Available from: https://www.marinemedicalsociety.in/text.asp?2021/23/2/228/326738

  Coronavirus Disease-19 and Children Top

The World Health Organization (WHO) declared COVID-19 a pandemic on 11 March 2020.[1] Since the onset of this pandemic in December 2019, there has been 194.56 million cases and 4.1 million deaths globally as of July 27, 2021.[2] The children and the adolescents (0–20 years) constitute <12% of the total number of confirmed COVID-19 cases and <2% of the total COVID-19-related deaths in India.[3] However, the data from the WHO suggest that globally children and adolescents constitute 0.3% of the total COVID-19-related deaths. Out of these confirmed cases, only 1%–3% develop severe or critical illness requiring hospitalization. Recently, a systematic review and meta-analyses highlighted that mortality is 0.1% in children and adolescents with COVID-19.[4]

The largest study from India showed that 35.8% of the pediatric COVID-19 patients were asymptomatic, and 54.5% had mild disease. The mortality was 3.2% among the hospitalized patients; however, all the children who succumbed to the illness had underlying comorbidities such as, cyanotic congenital heart disease, rheumatic heart disease, nephrotic syndrome, Wilson's disease, seizure disorder, and other genetic syndromes.[5] This translates to the fact that the mortality in healthy children is almost negligible.

  Coronavirus Disease-19 and Vaccination Top

COVID-19 pandemic has devastated the best of the economies with no cure at hand. At present, there are 292 candidate vaccines under development, out of them 108 are in various clinical phases and 184 are in preclinical studies.[6] The WHO has given emergency use approval to nine vaccine candidates which are being used globally. India has approved five vaccines named Covaxin, Covishield, Pfizer-BioNTech, mRNA-1273 vaccine (Moderna) JnJ-78436735 (Johnson and Johnson/Janssen Pharmaceuticals), and Sputnik V.

The efficacies of different vaccines vary widely. The estimated effectiveness in preventing COVID-19 in increasing order is CoronaVac (Sinovac) 50%, JnJ-78436735 (Johnson and Johnson/Janssen Pharmaceuticals) 66%, ChAdOx1 (University of Oxford/Astra Zeneca) 70%, NVX-CoV2373 (Novavax) 89%, Sputnik V (Gamaleya Scientific research Institute) 92%, mRNA-1273 (Moderna) 94%, and BNT162b2(Pfizer/BioNTech) 95%.[7]

However, with the emergence of new variants, skepticism has increased among the general public and researchers regarding the effectiveness of existing vaccines against these new variants. The effectiveness of two doses of BNT162b2 (Pfizer/BioNTech) vaccine was 93.7% among persons with the alpha variant and 88.0% among those with the delta variant. The effectiveness of two doses of ChAdOx1 (University of Oxford/Astra Zeneca) vaccine was 74.5% among persons with the alpha variant and 67.0% among those with the delta variant.[8] This demonstrates that the existing vaccines have reduced effectiveness against the new variants even in adults.

  COVID-19 Vaccination in Children Top

As of July 27, 2021, COVID-19 vaccines are not approved for children and adolescents below 18 years of age in India. Some countries have approved the Pfizer-BioNTech vaccine for children more than 12 years of age based on the initial results of a randomized placebo-controlled trial on 2260 children between the ages of 12–15 years. The study showed that the vaccine had 100% efficacy in preventing COVID-19.[9] However, we think that for low and middle-income countries like India, vaccinating all the children should not be the priority at present due to the following concerns:

  Natural Immunity Top

The fourth round of serological surveys in India was conducted in the months of June and July 2021. This serological survey included 28,975 individuals (adults and children aged 6–17 years), apart from 7,252 health-care workers. The seropositivity rate among the children aged 6–9 years was 57.2%, and among the adolescents aged 10–17 years was 61.6%.[10] This clearly shows that more than half of the population aged <18 years already had COVID-19 infection.

  Probable Long-lasting Immunity after Natural Infection Top

The duration of immunity after natural COVID-19 infection is still under research. A recent study had shown that the titer of antispike antibodies declines between 1 month and 4 months; however, the rate of decline slowed between 4 months and 11 months. SARS-CoV-2 infection elicits a T-cell-dependent B-cell response, in which an early antibody production is due to the extrafollicular plasmablasts which decline relatively quickly. This is followed by more sustained antibody production by long-lived bone marrow plasma cells.[11] Similar results were shown by Valeria De Giorgi et al. in their study on antibody titers in convalescent plasma donors. They showed that 91.4% of donors had detectable immunoglobulin G levels up to 11 months postsymptom recovery, while 63% had detectable neutralizing titers.[12]

  Lack of Trust in the Government and Already Overwhelmed Health Infrastructure Top

As of 27 July 2021, after more than 6 months of mass vaccination drive in India, 441.9 million doses of COVID-19 vaccines have been administered, with only 7.2% of the population fully vaccinated and around 26% of the population has received at least a single dose.[13] In more than 6 months, we could vaccinate only 7.2% of our population. People of India already feel betrayed due to the incidences such as hoarding and black marketing of oxygen, and drugs, and nonavailability of beds during the second wave of COVID-19. Similarly few reports of fake vaccines containing only saline being administered to people have surfaced recently which have completely broken the trust of population in the government.[14]

  Vaccine Hesitancy Top

Vaccine hesitancy is a complex phenomenon with various factors influencing the individuals, which force them to decide to either delay or not accept the vaccine at all. Recent data have revealed that more than 50% of the most vulnerable group (age >60 years) in India has not even received even a single shot of vaccine till the month of July 2021. This is mainly because of the rising prevalence of vaccine hesitancy, which is a major threat to pandemic mitigation.[15] If the parents and grandparents are not willing to take the vaccine, then they will not bring their children for vaccination.

  Vaccine Safety Issues Top

The two most commonly used COVID-19 vaccines worldwide are Pfizer-BioNTech and the University of Oxford-AstraZeneca. The postmarketing data from the Pharmacovigilance Risk Assessment Committee (PRAC) of Europe have shown that increasing number of cases of myocarditis and pericarditis have been reported after the Pfizer-BioNTech vaccine.[16] Similarly, hundreds of cases of Guillain-Barré syndrome and vaccine-induced immune thrombotic thrombocytopenia with almost 100 deaths have been reported from the European Union out of the 51.4 million doses of University of Oxford-Astra Zeneca vaccine administered till June 27, 2021. Furthermore, PRAC has concluded that capillary leak syndrome is a rare life-threatening adverse effect of University of Oxford-Astra Zeneca vaccine, and people with a history of capillary leak syndrome should not get vaccinated with this vaccine.[17]

To conclude, we recommend that only the children with comorbidities should be vaccinated against COVID-19, in whom the risk of severe COVID-19 illness is very high. Till the time, we overcome the above-enumerated issues, rolling out the vaccination program for all children would be just an eyewash, it would not achieve any benefit.

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Conflicts of interest

There are no conflicts of interest.

  References Top

A Timeline of COVID-19 Developments in 2020; January 2021. Available from:https://www.ajmc.com/view/review-baseline-gut-microbiota-may-predict-immunotherapy-responses. [Last accessed on 2021 Jul 25].  Back to cited text no. 1
COVID Live Update: 194,567,226 Cases and 4,171,596 Deaths from the Coronavirus. Available from: https://www.worldometers.info/coronavirus/?fbclid=IwAR35ZFiRZJ8tyBCwazX2N-k7yJjZOLDQiZSA_MsJAfdK74s8f2a_Dgx4iVk. [Last accessed on 2021 Jul 25].  Back to cited text no. 2
Guidelines on Operationalization of COVID Care Services for Children and Adolescents; June 2021. Available from: https://www.mohfw.gov.in/pdf/GuidelinesonOperationalizationofCoVIDCareServicesforChildrenandAdolescents14062021.pdf. [Last accessed on 2021 Jul 25].  Back to cited text no. 3
Meena J, Yadav J, Saini L, Yadav A, Kumar J. Clinical features and outcome of SARS-CoV-2 infection in children: A systematic review and meta-analysis. Indian Pediatr 2020;57:820-6.  Back to cited text no. 4
Jat KR, Sankar J, Das RR, Ratageri VH, Choudhary B, Bhat JI. Clinical profile and risk factors for severe disease in 402 children hospitalized with SARS-CoV-2 from India: Collaborative Indian Pediatric COVID study group. J Trop Pediatr 2021;67:fmab048.  Back to cited text no. 5
COVID-19 Vaccine Tracker and Landscape; July 27, 2021. Available from: https://www.who.int/publications/m/item/draft-landscape-of-covid-19-candidate-vaccines. [Last accessed on 2021 Jul 27].  Back to cited text no. 6
McCarthy N. Infographic: How Effective Are the COVID-19 Vaccines? Statista Infographics; February 2, 2021. Available from: https://www.statista.com/chart/23510/estimated-effectiveness-of-covid-19-vaccine-candidates/. [Last accessed on 2021 Jul 27].  Back to cited text no. 7
Bernal JL, Andrews N, Gower C, Gallagher E, Simmons R, Thelwall S, et al. Effectiveness of COVID-19 vaccines against the B.1.617.2 (delta) variant. N Engl J Med 2021;385:585-94.  Back to cited text no. 8
Frenck RW Jr., Klein NP, Kitchin N, Gurtman A, Absalon J, Lockhart S, et al. Safety, immunogenicity, and efficacy of the BNT162b2 COVID-19 vaccine in adolescents. N Engl J Med 2021;385:239-50.  Back to cited text no. 9
COVID 19 India: '40 Crore Indians Still Vulnerable to COVID': Details of ICMR's 4th Sero Survey. India News – Times of India; July 20, 2021. Available from: https://timesofindia.indiatimes.com/india/40-crore-indians-still-vulnerable-to-covid-details-of-icmrs-4th-sero-survey/articleshow/84583067.cms. [Last accessed on 2021 Jul 27].  Back to cited text no. 10
Turner JS, Kim W, Kalaidina E, Goss CW, Rauseo AM, Schmitz AJ, et al. SARS-CoV-2 infection induces long-lived bone marrow plasma cells in humans. Nature 2021;595:421-5.  Back to cited text no. 11
De Giorgi V, West KA, Henning AN, Chen LN, Holbrook MR, Gross R, et al. Naturally acquired SARS-CoV-2 immunity persists for up to 11 months following infection. J Infect Dis. 2021 Jun 5:jiab295. doi: 10.1093/infdis/jiab295. Epub ahead of print. Available from: https://academic.oup.com/jid/advance-article/doi/10.1093/infdis/ jiab295/6293992.  Back to cited text no. 12
Coronavirus in India: Latest Map and Case Count. Available from: https://www.covid19india.org/. [Last accessed on 2021 Jul 27].  Back to cited text no. 13
Agarwal V. COVID-19 Vaccine Scams Hit India as Country Struggles with Immunizations; July 24, 2021. Available from: https://www.wsj.com/articles/covid-19-vaccine-scams-hit-india-as-country-struggles-with-immunizations-11627126201. [Last accessed on 2021 Jul 29].  Back to cited text no. 14
COVID-19 Vaccine Hesitancy: Trends across States, Over Time. Ideas for India; April 14, 2021. Available from: https://www.ideasforindia.in/topics/governance/covid-19-vaccine-hesitancy-trends-across-states-over-time.html. [Last accessed on 2021 Jul 27].  Back to cited text no. 15
COVID-19 Vaccine Safety Update; July 14, 2021. Available from: https://www.ema.europa.eu/en/documents/covid-19-vaccine-safety-update/covid-19-vaccine-safety-update-comirnaty-14-july-2021_en.pdf. [Last accessed on 2021 Jul 27].  Back to cited text no. 16


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Coronavirus Dise...
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Natural Immunity
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