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Europe is grappling with one of the most ethical decisions of the pandemic – extending vaccinations to children or donating vaccinations to those who need them most in the rest of the world.
So far, no EU country has committed to postponing vaccinations for children and sending those vaccines elsewhere, although the pandemic is still raging in many other parts of the world, including South Asia and South America.
Instead, countries across the bloc are preparing to start vaccinating their adolescents after the European Medicines Agency approves the BioNTech / Pfizer vaccine for children ages 12-16, with several EU countries having a start date in keep an eye on this month. This move appears to contradict the guidelines of the European Center for Disease Prevention and Control (ECDC), which noted Tuesday that “equity issues surrounding the availability and access of vaccines in deciding on the expansion of COVID-19 – Vaccination on groups with smaller individuals must be carefully considered ”. Risk of serious illness. “
Germany plans to open dates for children aged 12 and over on June 7, France from June 15. Lithuania is hoping to start this month for those over 16, and Italy’s pediatricians are also preparing for the vaccinations.
On Friday, UK regulators approved the vaccine for children aged 12 and over, but the committee advising the government on introducing vaccinations has not yet made any recommendations.
Elsewhere in the world, such plans seem like a distant dream. Many low- and middle-income countries have not even vaccinated 1 percent of their population. Kenya, with a population of over 50 million, had not administered a million vaccines as of June 2. Nigeria – with a population of over 200 million – has only just passed the 2 million dose mark.
For Keymanthri Moodley, director of the Center for Medical Ethics and Law at Stellenbosch University in South Africa, this is simple mathematics.
She takes the US example, where kids 12 and older can go to their local pharmacy and get the BioNTech / Pfizer vaccine. There are roughly 25 million children in this group, which means around 50 million doses would be required for full coverage – not taking into account that the vaccine could be approved for younger children later this year. These 50 million doses can be compared to the total number of doses administered across the African continent: 33 million.
“It robs the world pot of vaccines,” Moodley said.
But others point out that it is not easy to divert a sting intended to go into the arm of an American teenager into the arm of a health worker in Ghana. Logistics, the complexities of running vaccination campaigns, expiration dates, and science make things more complicated.
While scientists (and governments) largely agree on the importance of vaccinating adults, it is not so clear-cut when it comes to vaccinating children. Commission President Ursula von der Leyen touched on this dilemma when she recently stated that vaccinating children was “not a political decision, but a clear one” [an] evidence-based, scientific decision. “
But in the UK, the government’s scientific advisors seem to be saying the opposite and passing the money on to politicians. And some public health experts are pushing back.
Imposing a vaccination on children when they are not really needed would be “the wrong thing,” said Adam Finn, a member of the UK vaccination recommendation committee and professor of pediatrics at the University of Bristol. He told Times Radio Monday that the committee “really needs a little more evidence before it can give any clear advice.”
Research shows that children are much less likely to get seriously ill with COVID-19 and that deaths are rare. But there are cases in which children get very sick, including the so-called pediatric multi-system inflammation syndrome, which is a “critical, serious illness,” explains Verina Wild, professor of medical ethics at the University of Augsburg.
In addition, as well as adults with comorbidities who need vaccine priority, there are children who may need earlier protection, Moodley said. “It’s not just about looking at age, it’s also about risk stratification for different age groups,” she said.
Despite these exceptional cases, the “argument for vaccination” [children] is not 100 percent clear if you look at the individual case, “said Wild. This statement reflects the ECDC guideline that the individual direct benefit of vaccinating children is likely to be limited compared to the elderly.
But what if children could help a country achieve herd immunity? Do they have a bigger role to play?
Most scientists agree that vaccinating children can be crucial here. It will ultimately depend on what percentage of the population needs to be vaccinated to achieve herd immunity, said Anita Shet, director of child health at the International Vaccine Access Center and senior researcher at the Johns Hopkins Bloomberg School of Public Health.
Estimates of vaccination coverage required vary between 60 and 90 percent, she notes – and when it’s closer to 90 percent, it’s important that children get stung.
There is another area where vaccinating children can be important – rooting out new varieties.
If you let the virus spread largely undeterred, new variants will emerge. So one countermeasure is to “vaccinate and protect so many people within a population so that the virus has less room to grow and spread,” Shet said. “That means we have to provide vaccines to the majority of the population regardless of age.”
If new varieties can be eradicated in countries with high vaccination rates, Shet adds, “it will benefit the world”.
Coincidentally, it is the same argument that experts make for the donation of these cans, which are intended for children, to other countries.
“Every country wants to immunize everyone to protect the entire country,” Moodley said. “But this is not an infection that is restricted to certain countries, it is a global pandemic – so keeping a country 100 percent immune is not the solution.”
WHO Director General Tedros Adhanom Ghebreyesus has similarly warned that if the virus spreads anywhere, it “has more opportunities to mutate and potentially undermine the effectiveness of vaccines anywhere”.
“We could end up in first place again,” he warned.
Tedros was one of the loudest in this camp. “Countries that vaccinate children and other low-risk groups are now doing so at the expense of health workers and high-risk groups in other countries,” he said on Dec.
In India, devastated by the recent spate of cases, vaccine donations to teenagers in the United States could provide vital protection and “quick save lives,” several researchers in the Atlantic recently argued.
Shet, on the other hand, takes a slightly different stance, arguing that it is not a “fair question” whether wealthy countries should donate doses rather than vaccinate their children. Vaccines may be limited, but that is “not the whole picture”.
For one, there are the difficulties with distributing the BioNTech / Pfizer – the only vaccine that can currently be given to children – due to its ultra-cold storage requirements. That means it is not suitable for all places in the world.
The difficulties countries face in adopting vaccines also recently became apparent when several countries had to destroy or return vaccines after they could not be used before their expiration date. The reasons for their inability to distribute the vaccines in a timely manner are complex, but some include a lack of funds, vaccinations, and training to support the introduction.
Shet also points out that some rich countries are now able to vaccinate domestically and globally. While the US is vaccinating its children, it is also planning to donate cans and has set a plan for the first 25 million.
The EU has now pledged to donate 100 million vaccines: France and Germany have each offered 30 million, Spain donates 22.5 million, Italy has pledged 15 million, Belgium donates 4 million, Denmark and Sweden have each provided 3 million and Romania gives 2 million.
There is another uncomfortable truth for Europe: the moral dilemma it is now facing could have been avoided.
A truly global campaign was the goal of COVAX: To have a huge pool of vaccines and to distribute them fairly around the world according to risk groups.
The plan was that when the world faced limited vaccine supplies, every country would get enough vaccinations for 20 percent of its population – covering the priority groups of the elderly, frontline health workers, and those with comorbidities. The second phase should address countries with vulnerable health systems and particularly high case numbers.
While wealthy countries, including EU states, pledged COVAX cash, they did not rely on cutting vaccine agreements, but preferred to make their own agreements with vaccine developers. That meant COVAX was just one of many in line to negotiate with drug manufacturers over the limited pot of vaccines.
WHO’s Tedros said the resulting bilateral agreements drove prices up and were an attempt to “jump to the top of the queue”.
“We should have had a global distribution plan right from the start,” says medical ethics professor Wild. “It would have made so much sense to vaccinate the elderly and their carers around the world first and then go downstairs.”
Wild stressed that she strongly supported the argument for vaccinating health workers in front of children in Europe. But she also points out that the debate has only now come to a head, with children being offered a vaccine rather than when there were low-risk 25-year-olds.
“We could have started this discussion much, much earlier,” she said.
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