COVID-19

Vaccination should be open to all children, not just the most vulnerable.

Following the authorization, on November 25, of the use of Pfizer’s Comirnaty vaccine in children aged 5 to 11 years by the European Medicines Agency (EMA), the High Health Authority (HAS) announced, on November 30, that recommended vaccination against Covid for the most fragile children.

During his speech on December 6, Prime Minister Jean Castex announced that vaccination would be open, from December 15, to children aged 5 to 11 years at risk of serious illness. Vaccination of all children remains suspended in the opinion of the HAS, but should probably go mainstream “before the end of the year.”

Here we would like to detail the reasons why we believe it is appropriate to promptly recommend vaccination for all children. We will refer in particular to a recent report by European experts, published by the ECDC on December 1, 2021.

Let’s talk about the vaccine itself first:

  • Remember that it is a vaccine designed specifically for children and that it has been approved by the European Medicines Agency. Its dosage is different from that of adults to ensure a more favorable benefit / risk ratio.
  • The vaccine appears to be a safe and effective vaccine, both in view of the studies that led to its approval and the experience gained with its massive use in the United States, where pharmacovigilance, which scrutinizes the least adverse effect, has no news. reported major event suggesting significant iatrogenicity.
  • The vaccine also appears particularly effective in this age group, not only in preventing severe cases, but also in limiting the transmission and spread of the virus and, hopefully, in limiting the risk of Covid in the long term.

A partial view of the situation.

That said, we must understand the importance of vaccinating all children, and not just those with comorbidities. Since the beginning of the pandemic, the impact of Covid infection on the pediatric population has been greatly minimized. In the spring of 2020, the reason was simple: We were running out of tests and only people in serious condition and hospitalized were being tested. Early reports from China also showed very low circulation of the virus among children, but the picture was heavily skewed as they were not tested.

Hence the idea that the children were not very contaminated and with few vectors … which in fact is a lens problem that gives only a partial view of the situation. Subsequently, both the pediatrician associations and the Ministry of National Education have generally underestimated contaminations in children and by children, even seeking to throw dust under the rug, with the commendable desire to keep schools open. Commendable certainly, but in the short term, because the dust has quickly overflowed and the schooling of children has not stopped being affected, interrupted in many classes during these last months.

Denying the evidence has only had the effect of delaying decision-making to ensure lasting safety for schools against the risk of transmission of the virus. Pediatricians certainly wanted not to stigmatize children, already very indirectly affected by Covid and sanitary restrictions (closure of classes, as well as educational, sports and cultural establishments). Still, the objectivity was painfully lacking and led to the belief that the children were not infected at all, that if they did it was just a simple cold, that they did not need to be tested, and that they were not transmitting the virus to adults anyway .

russian roulette

Today we have more perspective and, in addition, we are faced with the Delta variant more contagious than its predecessors, pending the eventual Omicron, to which we will return when we get to know it a little better.

We now know that children contract Covid and that, although it is true that on rare occasions, they can report serious forms, in particular myocarditis and pediatric multi-system inflammatory syndrome (PIMS), even when they do not suffer from comorbidities. –In Europe, 78% of hospitalized children did not have a risk factor in recent series. In addition, like adults, they can also suffer a prolonged Covid with a considerable impact on their quality of life for long months. And, like adults, it’s a real lottery … In other words, trying to get pediatric immunity naturally is like playing Russian roulette.

Preventing community transmission also means avoiding school closings.

Not to mention, we also know that children transmit the virus, perhaps for a shorter period of time than adults, especially in schools where most of the contamination is found. Even asymptomatic, they could, upon returning home, infect their parents and especially their grandparents, who are more fragile because they are often affected by immunosenescence.

Here we look at the direct individual benefits and the family benefits of vaccination. Remember that many children have lost their loved ones since the beginning of the pandemic with a dramatic psychological, but also educational and social impact.

Limit the saturation of pediatric services

Then we slide into collective benefits. In fact, avoiding community transmission also means avoiding the closure of classes and schools. We know the weight of these closures in the educational and social life and in the moral of the children. We also know what this means for parents. Of course, we must remember how much these closures tend to increase social inequalities, not to mention the economic consequences.

But the benefits are not limited to children and their loved ones. In fact, vaccination of children has a collective effect on the rate of reproduction of the virus. In a country with a high vaccination rate like France, it is estimated that you can reduce R0 by 15%. It is far from insignificant. Another collective benefit, in addition to the health of the children themselves: avoiding severe cases means limiting the saturation of pediatric services, which we know are already overwhelmed by epidemics of bronchiolitis, especially this year.

So why recommend vaccination only to the most fragile children? On this point, we can only speculate. First, we can think that prioritizing children is about preventing dose shortages and / or logistical difficulties.

But other hypotheses come to us. That of a consistent policy, as in early 2021, in not rushing the French seen as reluctant to vaccination. The figures have shown us that public authorities tend to overestimate this reluctance. We are talking about opening immunization to all children, not forcing them, which is another matter, of course. Why not suggest to all parents that they want to vaccinate their children?

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Because we do not understand why children today would be deprived of a safe and effective vaccine, which has already been administered to millions of children around the world, in the spotlight. This vaccine did not show undesirable reactions that we were not aware of and shows excellent efficacy. Let us protect our children, their health, their education, their morals against this coronavirus whose circulation is dragging the planet. And if, as a bonus, we also protect their families, loved ones and the entire community, then tomorrow we will be happy that we were able to make these decisions.

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