Lots of parents have questions about Covid vaccination in children here in Australia and I have fielded many questions over the past few months about this.  I cannot pretend to have all the answers, but I can try my best to give you what I think is the best advice based on the evidence-based information that is available at present.  I am not meaning to engage anti-Covid vaxxers in argument, I have been in this game long enough to know there is no point in that. The purpose of writing this blog is to help those parents who are legitimately anxious about the vaccine and its side effects (and are hence vaccine-hesitant) and to also provide more evidence-based information to those parents out there who have already decided to vaccinate their children such that you can all make an informed decision.

The Therapeutic Goods Administration (TGA) has granted provisional approval to Pfizer for the use of their Covid-19 vaccine “Comirnaty” in children aged 5 years and older and the Federal Minister for Health and Aged Care, Greg Hunt has announced in the last couple of days that (subject to final considerations and recommendations from the vaccination experts on the Australian Technical Advisory Group on Immunisation (ATAGI) and other related approvals), the Australian Government is aiming to start rolling out the Pfizer vaccine to 5-11 year-olds from 10 January 2022.  In the context of this, and given that I recorded a audio podcast a couple of weeks ago on this very topic (that we are still awaiting editing and release of), I thought I’d publish a written blog for those of you who have a pressing need to have your questions answered now.

So today I want to cover the most common questions I seem to be getting in clinic from parents.  To save a 20 page article (and time), I am publishing my notes from the podcast in dot-point below so please forgive the informal format of this post.  These answers I prepared a couple of weeks ago – so note the updated planned roll-out dates as noted above.

Covid-19 vaccination in 5-11 year-olds – Q&A with Dr Megs

“I have heard that vaccination could be soon expanded to include 5-11 year-olds before Christmas 2021. Is this true and should I get my child vaccinated?”

Yes, my professional opinion is that children all children should be Covid-19 vaccinated. Regarding the vaccine expansion: release before Christmas WAS previously anticipated BUT Federal Health Minister Greg Hunt indicated (in the 1^st week of November) that this is unlikely given that Pfizer had only submitted the first part of its data for the younger cohort to the TGA with more expected to follow (in the next few weeks).  In late October the US Centre for Disease Control and Prevention (CDC) became the first health regulator to recommend emergency use of Pfizer among 5-11 year-olds after being advised by their FDA.  Despite this, Associate Professor Margie Danchin of the Murdoch Children’s Research Institute (MCRI) has been quoted as saying that regulatory approval in Australia for the Pfizer vaccination in 5-11 year-olds is unlikely to be given until at least early 2022.

Which vaccination should I get for my child?

It is unlikely that the 5-11 year-old cohort will have a choice.  From what I have read, if/when approved, 5–11-year-olds will be administered two 10 microgram doses 8 weeks apart (ATAGI recommendations) but this can be shortened to three weeks if there is a major outbreak. Each dose a third of what is currently being given to those aged 12 and over.  It appears to be the same vaccine as used in the 12 years-and-over cohort, but diluted to a third the concentration. As a result of the lower dosing schedule, Pfizer says it anticipates the rare risk of developing myocarditis may be reduced.

The Moderna vaccine is reportedly also being assessed for the 6-11 years age group and advice on this is likely to be released in coming weeks.

Is the lower dose vaccination less effective than the shot given to those over 12 years of age?

For primary school-aged kids, Pfizer tested a much lower dose (10 micrograms) and after their second dose, children aged five to 11 developed coronavirus-fighting antibody levels just as strong as teenagers and young adults getting the regular-strength shots, according to a Pfizer press release in late September.  The process following this was that Pfizer was to turn over its study results for the FDA to evaluate, which it has now done and decided that the shots were both safe and effective for younger children.

The lower dosage also proved safe, with similar or fewer temporary side effects — such as sore arms, fever or achiness.

What is an mRNA vaccine and how does it work?

Molecular biology is a complex science (as anyone who studied it in university will attest), so trying to explain it simply is actually really difficult… I’m going to give it a good crack though.  Here goes…

Coronavirus (like many other viruses) uses a protein on its surface to attach to and enter human cells.

Antibodies (produced by our bodies’ immune system) that fit onto this protein can stop the virus from attaching and make virus particles easier to recognise and destroy by our immune system cells.

mRNA vaccines trick our bodies into MAKING the viral surface protein and this in turn causes an immune response. In other words, the mRNA vaccine teaches our bodies’ immune system to MAKE antibodies against Covid-19. This kind of vaccine technology is NOT new. Human trials of mRNA vaccines have been going on since 2011.

• mRNA stands for “messenger RNA” or “messenger ribonucleic acid”
  • it is genetic material that instructs our cells to produce proteins
• The mRNA that is in the vaccine is wrapped in a layer of fat particles that not only protect it, but helps it to be taken up into specialised immune system cells called dendritic cells
• Once the mRNA is inside the cell, it does NOT enter the cell’s nucleus OR interact with the person’s DNA, but remains in the cytoplasm (the jelly-like substance that fills a cell) with other mRNA molecules waiting to create to the enzymes/proteins our body needs.
• When a ribosome reads the mRNA particle, pieces of the virus surface protein are produced and displayed (like Christmas ornaments on a tree) on the surface of the dendritic cell
• The dendritic cell travels to a lymph node, where it presents the viral protein to other cells of the immune system (like helper T lymphocytes and B lymphocytes). 
• The helper T lymphocytes train the B cells to make antibodies that will fit perfectly into the surface protein of the coronavirus (blocking it from binding to the surface of the cell to enter)
• Other T cells called cytotoxic T cells are stimulated by the viral surface protein learn how to recognise and kill cells that are infected with the coronavirus.

So now, when we are exposed to coronavirus our body is READY and able to quickly recognise, block, neutralise and destroy the virus, sometimes even before we know that we are sick or develop symptoms!

I have heard that children are at lower risk of severe illness or death than older people – so on the basis of this, is it safer to NOT have my children vaccinated?

• While kids are at lower risk of severe illness or death than older people, the Delta variant is proving more infectious in the younger population than previous iterations of coronavirus
• According to the American Academy of Pediatrics (AAP) website:  as at 9/11/21 6.3 million children have been infected with Covid-19 since the pandemic started
• 70,000 children had been hospitalised in the US (as at 4/11/21).
• 897 children under 18 had died from Covid-19 (and it is the 9^th leading cause of death amongst children aged 5-11)
• When you compare Covid-19 to other diseases we routinely protect children against ( for example, hepatitis A, meningococcus, rubella, chickenpox) – many if not MOST of these diseases killed fewer children per year prior to the vaccines becoming available than Covid-19 has.
• The longer we wait,
  • The longer children will be walking around unprotected
  • The more likely that infections will be spread to younger children who are not yet eligible for vaccination and the more likely they will spread the virus to other vulnerable people
  • The more likely that more virulent Covid-19 virus variants will emerge (as evidenced by Omicron and its ensuing variants); we already know that the Delta variant is more infectious in younger populations – and this is only a sign of what will evolve in subsequent mutations of the virus
  • The longer you wait, the longer your child will have to wait for a booster – and this could prove risky if a nasty variant emerges and a new round of vaccination is needed

I am worried about myocarditis and pericarditis as a side effect for my child following the Pfizer vaccination. 

Myocarditis is an inflammatory condition of the heart muscle that can range from mild to serious. 

Risk of myocarditis in individuals with Covid-19 infection is 6-34 times higher compared to those who received the mRNA vaccine.  That is, the Covid-19 VIRUS causes myocarditis both much more frequently and more severely than the vaccine (different studies will quote different rates ranging from 6-34 times more). 

In one study (Buckley, Harrison et al  Eur J Clin Invest Nov 2021) of 718,365 patients with Covid-19, 5% of patients developed new onset myocarditis and 1.5% new onset pericarditis.  A separate study (Diaz, Parsons, Gering et al JAMA 2021) reported that in a population of over 2 million individuals receiving Covid-19 vaccination, myocarditis occurred primarily in younger male individuals a few days after the 2^nd vaccination at an incidence of 4.8 cases per million (that is, 0.0000048%).

No one is trying to convince you that the vaccines have no side effects. 

In fact side effects (like fever, muscle aches, sweats, fatigue) of this vaccination are very common, occurring in up to 60% of people after the 2^nd vaccination. 

What we (the vast majority of paediatricians and medical professionals) are trying to make sure people are aware of in weighing up the benefits vs the risks, is that on opening the borders, this virus is SO contagious and virulent, it is inevitable that many if not ALL people will catch it at some stage.  The disease is MUCH LESS SEVERE and MUCH, MUCH LESS LIKELY TO KILL YOU if you are vaccinated – because in vaccinated individuals, the immune system is primed and ready to block and fight off the virus.

The suffering and mortality caused by the SARS-Covid-19 virus is so very much higher than that caused by the vaccine, that in my mind, to vaccinate or not to vaccinate –  is a complete no-brainer. My children are aged 6 and 8 years and will be getting vaccinated as soon as they are able to. Like any other mum or parent, I worry about the risks associated with vaccination (or any medical intervention for that matter), but in all reality, the health risks of the vaccine are so much lower than the health risks of them catching Covid whilst unvaccinated.

I really hope that this article has helped answer some of your concerns and questions about vaccinating your children and alleviated some of your anxiety about deciding to get your kids immunised.  As many as there are people out there who are anti-Covid-vaccination, there are impassioned medical health professionals who believe in and strongly advocate for protection of our population and vulnerable individuals within it. I am one of the latter.