Road-map to Child COVID-19 Vaccination in India

Novel Corona Virus, causing Severe Acute Respiratory Syndrome (SARS) in human, has spread rapidly around the globe since 2019. Though the face of this pandemic (Declared by WHO on 11th March, 2020) mostly are the adults, children of all ages are also susceptible to COVID-19 infection and can manifest severe symptoms.[1] Though majority of COVID-19 cases in children are mild or asymptomatic, like 18.4/100,000 children of 0-4 years of age and 10.6/100,000 children of 5-17 years of age required hospitalization ,[2] of which one-third required intensive care.[3] Presence of risk features like co-morbidities, early neonate, late adolescence and obesity enhance the chance of intensive care admission among children.[4] S. Bhopal et al has stated in their study, by collating the data of child death due to COVID from all seven heavily affected countries, that only 0.03% of children had died from COVID infection, which is far less than all the other causes of child death (Unintentional injury, Lower Respiratory Tract Infection related deaths etc.).[5] Despite this fact, life of every child is important to us, so vaccinating them against novel corona virus disease can mitigate the adverse health events among them. Other benefits of vaccinating children are to curtail the transmission of corona virus (British children aged from two to around twelve are given nasal spray for flu, largely to protect their grandparents)[6] and also to envisage the negative social impact of COVID upon them.

India, the second most populous country (1.39 billion) in the world with its diverse ethnicity and population had faced quite a huge challenge in vaccinating the adult citizens. The COVID-19 vaccine drive in India was launched on Jan 16, 2021. From May 1, 2021, all adults aged 18 years and above are eligible in phase 4 of the vaccination drive. By July 20, 2021,326 4 million people in India (234% of the population) had received the first dose of the vaccine, and 85·4 million people (6·1% of the population) had received the second dose.[5] [Till date (10.12.21) more than 1 billion citizens had got their jabs] So, these numbers prove a prolonged wait-time for the second dose vaccine due to lack of resources. So beside the genuine struggle of continuing vaccine logistics supply-distribution and battling the huge pressure for sustaining the treatment of critically ill COVID patients, another challenge was to gain trust of citizens for the newly launched vaccine.[6] Such vaccine hesitancy is prominent particularly in rural and indigenous population (Adivasi) population of India.[7,8] Before jumping into the vaccine roll-out for children, such hurdles which had been faced previously during adult vaccination must be kept in mind.

Countries like USA had already started giving vaccines to their children, older than 12 years of age and even the age group of 5-11 years. The FDA gave Pfizer-BioNTech COVID19 vaccine emergency authorization for using in children ageing 5-11 years. Clinical-trial data showed that the Pfizer-BioNTech vaccine is about 91% effective at preventing symptomatic SARS-CoV- 2 infection among this age group.[9] Under such circumstances India also is taking steps to vaccinate children. The Zydus Cadila’s Covid- 19 vaccine (ZyCoV-D) is waiting to get it’s approval for emergency use in children aged 12 years and above, from the Drug Controller General of India (DGCI). Before taking the leap of such vaccination programme among children, plans are needed to be made in order to save resources. India owns one of world’s largest immunization programmes with an annual reach of over 26 million children and 29 million pregnant women.[10] This programme work-force can be utilized well to vaccinate children against COVID-19. Simultaneously, the Routine Immunization (RI) programme, which had been severely disrupted during this pandemic, can get back into track again. A study by A Seth et al has already marked the issue of a substantial decrease in routine immunization services relative to the previous year, indicating that in March 2020 at least 100 000 and 200 000 children missed their BCG and pentavalent. [11] The systems of spontaneous digital registration for vaccinating children may not be accessible to the parents across the length and breadth of our country . So integrating this COVID vaccination with RI programme or arranging door to door vaccination like Pulse Polio Immunization may bring the success. But before initiating such efforts, the issue of mistrust and vaccine hesitancy among parents has to be dealt with. Even studies from USA had suggested such barrier (33% parental vaccine hesitancy).[12] India has already achieved 1.2 crore of adult vaccination, likewise it is also possible to attain in case of children if plans are made in righteous way.