Bangladesh vaccinates children with Pfizer. Is one dose effective enough – and safer?

With several countries administering only the first dose of Pfizer-BioNTech’s COVID-19 vaccine to children aged above 12 years amid fears of side effects, Bangladesh is facing questions over how many doses it should apply to adolescents.  

Obaidur Masumand Osham-ul-Sufian Talukderbdnews24.com
Published : 28 Oct 2021, 07:17 PM
Updated : 28 Oct 2021, 08:10 PM

The schools are sending lists of students to the government for an upcoming drive to inoculate children against the coronavirus as the educational institutions have reopened after closure for one and a half years in the pandemic.   

The authorities administered the vaccine to 120 students of several schools in Manikganj in a test run on Oct 14. The vaccination of the children, aged 12 to 17, will initially open at 12 centres in Dhaka on Nov 1.

The vaccine, made by US drugmaker Pfizer and German partner BioNTech, has been authorised for use in children as young as 12 in Europe, the United States and Canada. They receive the same dose as adults: 30 micrograms.

The 5 to 11-year-old children in these countries are given two shots of a 10-microgram dose of the vaccine, a third of the dose size given to people 12 and older.

Vaccine experts have said that Pfizer’s lower dosing could mitigate risks. “We always like to use the least amount of vaccine that’s needed to generate an immune response,” said Dr Kathryn M Edwards, a professor of paediatrics in the division of infectious diseases at Vanderbilt University School of Medicine, according to The New York Times. “Because it’s generally associated with fewer adverse events.”

In a trial of 2,260 adolescents aged 12 to 15, there were 18 cases of COVID-19 in the group that got a placebo and none among those who received the vaccine, resulting in 100 percent efficacy in preventing the illness, Pfizer and BioNTech said.

Inoculating children and young people is considered a critical step toward reaching "herd immunity" and taming the COVID-19 pandemic.

Still, scientists in the United States and elsewhere are studying the possibility of a link between heart inflammation and mRNA vaccines, particularly in young men. Both Pfizer and Moderna's vaccines are mRNA shots.

While children have a lower rate of death from COVID-19, many face illness and long-term symptoms that are still being studied.

COVID-19 itself may cause heart problems in young people.

Some Bangladeshi experts have suggested using a single-dose regimen of the Pfizer vaccine on children considering the side effects and availability of shots. 

Some others believe the government should give the children both doses following the World Health Organization guidelines. The authorities also said they will follow the WHO advice.

WHAT THE WHO SAYS 

Children and adolescents tend to have the milder disease compared to adults, so unless they are part of a group at higher risk of severe COVID-19, it is less urgent to vaccinate them than older people, those with chronic health conditions and health workers, according to the WHO. 

It says more evidence is needed on the use of the different COVID-19 vaccines in children to be able to make general recommendations on vaccinating children against COVID-19.

WHO's Strategic Advisory Group of Experts has concluded that the Pfizer/BioNTech vaccine is suitable for use by people aged 12 years and above.

Children aged between 12 and 15 who are at high risk may be offered this vaccine alongside other priority groups for vaccination.

Vaccine trials for children are ongoing and WHO will update its recommendations when the evidence or epidemiological situation warrants a change in policy.

WHAT OTHER COUNTRIES ARE DOING

The US, Israel and some European countries have rolled out vaccinations to children more broadly, but England, Norway and some other countries have held off giving children aged 12-15 a second dose of a vaccine against COVID-19 until they have gathered more research, partly due to the rare side effect.

The Norwegian health ministry said there was no urgency given that children have a low risk of falling seriously ill from COVID-19 and because a single dose of a vaccine offered a protection rate of 85 percent against the disease for up to 16 weeks.

A second vaccine dose is also linked with a higher risk of pericarditis and myocarditis, especially among young men and boys, the Norwegian Institute of Public Health said.

The Chief Medical Officers, or CMOs, of England recommended that children aged 12-15 in Britain get a first shot of the Pfizer-BioNTech vaccine. The CMOs said second doses would not be offered to the age group until at least spring as they would wait for data to build up internationally.

WHAT EXPERTS SAY

Professor Dr Sayedur Rahman Khasru, chairman of Bangabandhu Sheikh Mujib Medical University’s pharmacology department, said the children should be given a single dose of the vaccine – a practice the UK is following, considering the side effects.    

He also believes the government should have planned vaccines for children after inoculating all of those on the priority list, such as the older population, people with diabetes and other diseases, and the health workers. 

“I also favour vaccinating the children, but only when we can reduce the number of people who are at greater risk of getting sick or dying [after contracting COVID-19]. Only then it would have been logical to take a programme to vaccinate the children.”

Dr Mushtuq Hossain, an adviser to the government’s disease control agency IEDCR, noted that although the WHO has not recommended coronavirus vaccines for children, it has advised giving both doses if a country rolls out the Pfizer shot for the adolescents.   

“Besides the children, other members of the family should receive the vaccine, because the children will become vulnerable if everyone is not vaccinated.”    

WHAT OFFICIALS SAY

Dr Meerjady Sabrina Flora, additional director general of the DGHS who heads the national vaccine deployment committee, said Bangladesh is administering two doses of Pfizer vaccine to children following the WHO advice.     

“We are following the WHO guidelines. It has not yet said anything separately on the matter.”

She said she is aware that some countries are using the single-dose regimen on children. “But the WHO makes the guidelines taking everything into account. And we have been following the WHO guidelines since the beginning.”    

Dr Be-Nazir Ahmed, a member of the National Immunisation Technical Advisory Group or NITAG, said they are emphasising the advice of the WHO, the US Food and Drug Administration, the European Medicines Agency, and the UK’s Medicines and Healthcare products Regulatory Agency to determine how Bangladesh should vaccinate the children.

“NITAG believes the government should vaccinate all the people above 18 years first. If the children are given the vaccine, they should get both doses.”

“Many countries are doing it differently. But we are following the advice of the WHO and other recognised organisations. Given that, the children should get two doses.”

[With details from Reuters and The New York Times]