How important is it to vaccinate the youngest?

The administration of the vaccine to adolescents has been approved in the United States. And soon the European Union could also take the same decision. What is the rationale? And what is the risk / benefit ratio? Here's what we know so far

(Photo: Unsplash) As expected, the US Food & Drug Administration has just authorized the emergency administration of the Pfizer-BioNTech vaccine to adolescents. A move that could soon be replicated also by the European Union and that will extend the vaccination campaign to other millions of people, and on which the scientific community, net of the results of clinical trials in progress and those to come, is making a reflection of opportunities and cost-benefit ratio. In the first instance, in fact, one might think that, once we are certain that the vaccine is safe and effective on very young people as it is proving to be so on adults, the most natural choice is to proceed to vaccinate everyone, perhaps with the aim ( which in truth appears less and less punishable) to achieve herd immunity. But on closer inspection there are also other, collateral factors to consider, as noted for example by three experts from Emory University in Atlanta and the Center for Infectious Disease Dynamics at Pennsylvania State University in an editorial recently published in the British Medical Journal.

One of the essential points to better understand the question lies first of all in the fact that up to now, undeniably, young people and the very young have been spared (on average) from the most serious forms of the disease: for this reason it comes from wondering what the real benefits of a protection given to a group of people who typically suffer from mild disease, especially by virtue of the fact that even the health systems of the richest countries are trying to sip the available doses and not waste any a. In addition to protection, there is also the issue of transmission: at the moment we do not have enough epidemiological data to allow us to understand if and to what extent young people are spreaders of the disease (and the polarized discussion regarding the opening / closing of schools is a clear example); and finally, experts say, we should also take into account the differences between immunity induced by the vaccine and that induced by natural infection on younger subjects, a subject on which we still know too little.

At the moment, the data we have collected globally suggests that the severity of Covid-19 in children under the age of 12 is similar to that of influenza: "Since the cost-benefit ratio of a vaccination campaign," the researchers write , "Depends on the burden of the disease in the population to whom the vaccines will be administered and on the resources available, and given that health resources are scarce even in high-income countries, vaccination of children is unlikely at this time to be a priorities ".

There are, however, at least two other issues to keep in mind: one, the fact that, although rare, it can happen that a child develops a severe form of Covid-19 (at the moment the estimate of death this is about one case in a thousand, although it is probably lower); two, the problem of variants: now they do not seem to be particularly dangerous for children and adolescents, but different ones could emerge (as actually happened for MERS) and in this case pediatric vaccinations could suddenly become a priority. And, again, always with a view to good resource management, a good idea could be to identify, in the pediatric population (as indeed already done for the general population), particularly at risk subgroups, for example children. who suffer from obesity (which is known to predispose to more severe symptoms of the disease) or those with inflammatory markers such as C-reactive protein or interleukin-6 above normal (which could increase the likelihood of suffering from multisystem inflammatory syndrome after contracting the Covid).

Let's come to what is probably the most important and delicate point, the question of the transmission of the virus: how much do children and adolescents contribute? We know for sure that mass vaccination significantly reduces infections, and we also know that children and adolescents generally have more social contacts than adults: for these reasons, it is reasonable to think that vaccination of younger people can reduce the circulation of the virus by protecting cascading, even the most adult subjects. However, it must also be taken into account that children and adolescents seem to be less susceptible than adults to both infection and transmission (in Norway, for example, it has been possible to keep infections under control while keeping the elementary schools). At the moment, it seems unlikely that the very young are super-spreaders of the virus, and therefore it is difficult to estimate whether their vaccination would have a tangible benefit in terms of reduced transmission; on the other hand, however, it must be considered that the increase in vaccination rates in adults could induce the pathogen to seek new ways of spreading precisely among young people, transforming them into more significant spreaders. We are in the field of hypotheses, of course: however, to prevent new waves and new outbreaks, it is important to put all the possibilities on the table and try to anticipate.


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Topics

Adolescence Children Coronavirus Vaccine coronavirus globalData.fldTopic = "Adolescence, Children, Coronavirus, Coronavirus vaccine"

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