Children in India should be vaccinated against COVID-19 if the supplies are available after vaccinating eligible adults, says an expert.

He also called for a robust surveillance system to address safety concerns. National policies on vaccinating children have to address global inequities and priority setting in the context of demand-supply mismatch, he said.

Dr Reddy, who is President, InOrder, South Asia, a non-profit institute working to strengthen systems to secure health, pointed out that governments across the world are adopting a policy of giving priority to people at risk for higher rates of hospitalization and death in the face of vaccine supplies not commensurate to the needs.

Global bodies are also urging nations to consider priority setting in the global context and not just in national or subnational context as the world is not safe until enough proportion of the world population has immune protection.

"Children should be vaccinated if the supplies are available after vaccinating eligible adults. Though children have very low risk for developing moderate to severe illness, infected children can continue the viral transmission to unvaccinated vulnerable adults. In addition, it will enable children to attend their schools as before. Long term physical, mental and scholastic effects of prolonged absence from schools on child development will be known only in coming years."

All approved or emergency use authorized vaccinations have demonstrated ability in protection against moderate to severe COVID illness in people above 18 years of age. mRNA-based vaccine by Pfizer (BioNTech) has been given emergency use authorization in the United States for children above 5 years of age.

In-activated virus-based vaccine (Covaxin) and DNA-based vaccine (ZyCoV-D) have been tested in children in India. While Covaxin is tested in children aged 2 to 18 years, ZyCoV-D is tested in children aged 12 to 18 years. ZyCoV-D has received emergency use authorization in children aged 12 to 18 years.

Subject Expert Committee (SEC) of the Central Drugs Standards Control Organization (CDSCO) has recommended Covaxin for use in children aged 2 to 18 years in October. However, it is awaiting the approval of drug regulator, says Dr Krishna Reddy.

"This ranges from 65 to 85 per cent of the population according to the reproduction rate (R0) of the viral variant. Children aged 18 years and less constitute nearly 40 per cent of the population in India. Hence, it is critical that enough children also have immune protection for the country to reach herd immunity to stop the pandemic," the health expert said.

The issue of booster doses is also playing on policy related to vaccinating children. It is now apparent that the immunity wanes over time after vaccinations.

Evidence is gradually mounting that points to a need for annual boosters against COVID illness akin to flu vaccines. Booster doses to adults may take priority over vaccines for children in near future.

Dr Reddy said post vaccination surveillance has to be more robust in children to identify potential safety issues in future. The risk to benefit ratio will be different in children compared to adults given the very low risk of developing moderate to severe illness in children.

Given weak surveillance systems in India, it is highly critical that a good surveillance system is in place before taking the policy on vaccination in children, he added.

(This story was published from a syndicated feed. Only the headline and picture has been edited by FIT.)