India started COVID-19 vaccination among children aged 12 to 14 years with Biological E’s COVID-19 vaccine Corbevax on March 16, 2022. Prof. J P Muliyil, a highly respected epidemiologist and a key member of the National Technical Advisory Group on Immunization (NTAGI), commented that NTAGI had made no recommendation advocating children’s vaccination. Government sources have not issued any denial yet. The decision of the expert panel of the Drug Controller General of India, dated April 21, 2022, to recommend emergency use authorization for Corbevax for children in the 5–12 years age group has caused understandable concern among many health professionals. No specific data is available in the public domain on the safety and efficacy of the vaccine among children.
Global data suggests that COVID-19 infection among children and young people (CYP) is mild in nature. The COVID-19 mortality rate is very low (2 per million COVID-19 cases) compared to the all-cause mortality rate in children and young adults. Although few children develop multisystem inflammatory syndrome (MIS-C), the reported incidence rate of MIS-C was very low in persons younger than 21 years (316 per 1 million SARS-CoV-2 infections).
Vaccines developed against COVID-19 have shown high efficacy against infection, severity, and death among adults during clinical trials. Most of the vaccines seem to be safe and cause mild symptoms. COVID vaccines, like any other drugs or vaccines, may have some short-term and long-term adverse consequences. The ChAdOx1 nCoV-19 vaccine was banned for persons younger than 30 years of age in numerous countries due to the reported increased risk of thrombocytopenia (incidence rate ratio = 1.33). Many European countries, like Sweden, Norway, Denmark, Finland, Iceland, etc., have restricted the use of mRNA vaccines in younger populations due to myocarditis and pericarditis associated with this vaccine in the younger population. The US-CDC reported that out of 52 million doses administered to persons aged 12–29 years, 1,226 cases of myocarditis or pericarditis were reported till June 11th, 2021. This number further escalated to 1,822 by the end of November 2021.
The Indian Council of Medical Research (ICMR) conducted a nationwide SARS-CoV-2 serosurvey from June to July 2021. The seropositivity rate among children younger than 18 years was 60%. The serosurvey conducted in Delhi in October 2021 reported a seropositivity rate of more than 80% among children younger than 18 years of age. Both these surveys were conducted before the onset of the Omicron wave that started in January 2022. Due to the highly infectious nature of the Omicron variant, it is reasonable to assume that most of the susceptible children would have been infected. Therefore, most of the CYP in India would have been infected with SARS-CoV-2.
Global evidence has demonstrated that the natural COVID-19 infection provides better and longer-lasting protection against COVID-19 or even life-long immunity.[6,7] There is no compelling evidence that COVID vaccines provide better immunity than natural infection. Further, vaccinating already infected individuals most likely provides no additional benefit but may cause harm due to some known and unknown serious Adverse Events Following Immunization (AEFI). We also do not know the impact on MIS-C if an already infected CYP is given a COVID-19 vaccine.
Most children in India have good natural immunity due to their past exposure to SARS-CoV-2 infection. They are unlikely to derive any additional benefit due to COVID-19 vaccination. However, they may be at an increased risk of serious AEFI event associated with COVID-19 vaccination. The risk-benefit analysis of vaccinating CYP at the moment is unfavorable. Therefore, we feel that COVID-19 vaccination for CYP in India should be deferred until more conclusive evidence emerges of a favorable risk-benefit ratio.
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