After the United States, Israel and, more recently, Austria, should France extend its vaccination campaign against Covid-19 to children aged 5 to 11 years? At a time when increased pollution is worryingly resuming and we are diving into a fifth wave as Christmas approaches, the question comes back in an annoying way. Because although the vaccination coverage rate is 75% in France, one of the highest rates in the world, there are still almost 7 million people over the age of 12 who are not vaccinated. This leaves Sars-Cov-2 the possibility of spreading throughout the territory and generating thousands of contaminations.
So, to limit the circulation of the virus, should vaccination be extended to 5-11 years? Today, only children with very serious pathology can receive an injection. For the rest, we will have to wait for the opinion of the European Health Agency, scheduled for December, and then that of the French health authorities. This should postpone authorization until January 2022. Unless France decides, like Austria, to override the European opinion. Unlikely. Or that the health situation is not degenerating frankly? Less unlikely.
Few benefits, “extremely rare negative effects” not yet ruled out
But what do we really know about the action of vaccines in the very young? Preliminary results from a clinical trial conducted by Pfizer in 4,500 children show the absence of serious side effects and reveal only minor effects, such as injection site pain, some redness, even fatigue or tiredness. They confirm that this vaccine protects them by 90.7% against symptomatic forms of Covid-19. Moderna’s clinical trial, which involved 4,753 children, shows comparable results, close to those obtained in adults. In addition to protection against Sars-Cov-2, vaccinating the very young could help keep schools open, or even reduce the transmission of the epidemic in the general population. But many experts believe that the risk-benefit ratio is not so obvious.
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“Currently we are struggling, not with one, but with several epidemics (bronchiolitis, measles, chickenpox, etc.) that send dozens of children to intensive care, so much so that some pediatric wards are already saturated, but not everyone does it matter, like every year … And they tell us that we must urgently vaccinate children between 5 and 11 years old against Covid-19, a disease that most of the time is benign for them? ”, annoys Christèle Gras-Le Guen, head of pediatric emergencies, Department of the University Hospital of Nantes On November 15, the French Society of Pediatrics, of which she is president, signed a forum with three other scientific societies of Pediatrics, as well as the Society of Infectious Pathology of the French Language, stating that “there is no emergency.” vaccinated 5-11 years.
“In the vast majority of cases, the Covid-19 of the youngest takes an asymptomatic or very little symptomatic form, such as a cold. Since the beginning of the epidemic, we have only detected around 600 cases of multisystem inflammatory syndrome (PIMS) and all have evolved favorably. In adults, we are in more than 100,000 dead! ”, In front of the three of the children, insists Professor Gras-Le Guen. Secondary benefits, nothing obvious, therefore. And in such a case, the imposition of vaccination on children can only be justified if the risks, even extremely rare, are completely ruled out, the forum authors argue. “We are vaccine professionals and we are not very concerned about possible serious side effects, the first data on a few thousand children seems to confirm this. But if we want to be absolutely sure of detecting the risks, we have to wait for millions of injections,” explains Professor Gras-Le Guen. In adolescents, the excess risk of myocarditis or pericarditis has been calculated, for example, in real life between 5 and 21 cases per million injected doses.
So why did the US authorities, in particular, still choose to vaccinate the very young? “The American health situation certainly justifies this lower risk, but not here”, slices Professor Gras-Le Guen. On the other side of the Atlantic, where the population is five times that of France in the same age group, the estimated number of deaths was 94. For a situation of equality with France, they should deplore only 15. This difference can be explained by a greater marked obesity in the youngest, as well as the strong inequalities of their health system. In Austria, this decision can be explained by the strong epidemic wave.
Focus on a third dose for adults
The Academy of Medicine also published, on November 15, an opinion tending to confirm the recommendations of pediatric learned societies. Academics continue to oppose the obligation to mass vaccinate the little ones. “It would not be ethical to launch such a campaign, when the benefit is minimal, because there are still many unvaccinated adults who keep the virus circulating. This will inevitably provoke strong reluctance on the part of parents and could even discredit the current vaccination campaign,” warns. Pierre Bégué, member of the Academy of Medicine.
However, academics are in favor of extending vaccination to children who are “at risk of suffering from serious forms of comorbidities, whatever their age, as well as to other children who live in their family and school environment”, but also those who live in the environment of vulnerable adults, in particular the immunosuppressed and people with chronic diseases. They are also concerned about possible future mutations of the virus. “Severe forms in the very young are very rare, but there are reasons to be cautious, adds Pierre Bégué. The Delta variant, which is already more contagious and causes more severe forms, has recently mutated with an” AY4.2 “subvariant. it will have to be monitored, and we are seeing an increase in severe cases in children, especially in Eastern European countries, without really understanding why. ” Another variant, B.1.640, known as “Congolese”, is also of interest to specialists.
In both press releases, the researchers add that since the disease is mostly benign in children, “the benefits of natural immunity” can be considered. Clearly, the strategy of letting the virus circulate in the offspring to develop natural immunity in the population could represent an option. Observations that inevitably surprise, since even if the vaccine can cause serious side effects, these will logically always be more rare and less serious than those of the disease. “We hesitate to write this sentence, acknowledges Pierre Bégué. It is justified by the fact that we know that the disease is largely benign for children.” Christèle Gras-Le Guen believes for her part that even if the risks of side effects from vaccines are minimal, you should be sure before recommending an injection.
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Still, vaccinating the very young would likely reduce the circulation of the virus in the general population. “It is true, but the protection of vaccines decreases over time, so that herd immunity increasingly looks like an unattainable Grail”, responds Christèle Gras-Le Guen. Also, children are already low pollutants compared to teens and adults. Asking babies to be vaccinated to allow adults who do not want to be vaccinated can walk without a mask, that bothers me, instead we must focus on them. “Other priorities seem more urgent according to pediatricians, such as the administration of a third doses to frail people or people over 65, then, undoubtedly, to the entire population It remains to be seen whether this position will continue to be sustainable in a few weeks, while the number of new daily cases of Covid-19 already exceeds 20,000.
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