Inoculating children against Covid-19: How soon is too soon?

The month of September saw the opening of educational institutions in Bangladesh after an 18-month hiatus starting in March 2020. The reopening, which does not include universities, has been carried out in phases. Concerned by the impact of school closures on students, heartened by the falling Covid-19 cases and lulled by the promises of vaccine supply, the government decided to open public schools and colleges.

But the plan has not been without its own set of challenges. School opening meant vaccinating teachers and students, and with a dwindling vaccine supply, this translated into less vaccines for many eligible adults, long waiting periods, and many asking if vaccinating children and opening schools was necessary when many eligible adults have had to go without.

The science on vaccinating kids is clear: children are part and parcel of the chains of Covid transmission and are infected in large numbers. At the same time, Covid infections in children are very mild or asymptomatic, and that is one side of the story. Hence, a pragmatic decision (on vaccination of children and adolescents) can be taken only by balancing the supply and the potential eligibility.

As children congregate in schools, they can quickly become super-spreaders. If infected, they are likely to be asymptomatic or experience only mild symptoms, but that does not mean all children can brush off the disease easily. In the US, hospitalisations of children and adolescents rose nearly five-fold during late June to mid-August 2021, as the Delta variant was becoming dominant, according to data from the US Centers for Disease Control.

Children are also at risk of long Covid, with prolonged symptoms after infection, and mostly suffering from headaches and fatigue. One of the most devastating consequences of a pediatric coronavirus infection is called MIS-C—an inflammatory condition that appears several weeks after a child first encounters the virus. Thankfully, this complication has been rarely observed in young patients thus far.

A study conducted in July in Chattogram found the widespread presence of the Delta variant amongst children admitted in the Maa O Shishu Hospital. While none of the children suffered any serious health concerns, the report presented a warning of the easy transmission of the new variant. With unvaccinated children no longer being cloistered as vigilantly at home, the virus transmission is imminent and the more transmission you have, the more cases you have, and the more you're going to get bad outcomes.

Given these factors, it makes sense to inoculate children, even those without underlying conditions, and more and more countries have started to offer vaccines for children under 12. These countries have two thing in common, however—they have a high percentage of their adult population who are fully vaccinated and have a steady supply of Covid-19 vaccines.

Bangladesh, unfortunately, has neither. The government has been successful in vaccinating around 20 percent of the population, with 30 percent receiving at least the first dose. Nevertheless, it is unlikely to meet its target of fully vaccinating 80 million people against Covid-19 by December if the nationwide vaccination campaign continues at the current rate.

That is not the only concern. Virologist Dr Nazrul Islam, member of the National Technical Advisory Committee (NTAC) on Covid-19, mentioned in a report that little is known about the efficacy period of the vaccines. If it takes a long time to vaccinate the whole population, first recipients might need the vaccine again before the programme ends. So, vaccination campaigns will not only have to target the unvaccinated, but also provide booster shots to those vaccinated in the first round, especially the more vulnerable populations. He also warned of possible resurgence of the virus next year in March, which would make it doubly critical to vaccinate a majority of the population. Hence, even though infection rates are down and the second wave has subsided, it will not be fair now to say that the worst is over, especially since many countries are facing a third wave.

In October, Health Minister Zahid Maleque assured all that the government would have a stock of at least 37.5 million vaccine doses by November, while a further 50 million doses were set to arrive in December under the Covax facility and from China. Promises of vaccines from Covax and donor countries are plenty, but with multiple demands on the vaccine and the issue of booster shots, it could become difficult to protect the target population in Bangladesh.

As for students, the vaccination drive for 12 to 17-year-olds started at eight schools in Dhaka on November 1. Students of schools that have centres, as well as students from other schools, received the vaccine. The eight schools, Motijheel Ideal School, Hurdco Int'l School, South Point Int'l School, Chittagong Grammar School, Mirpur Commerce College, Kakoli School, South Breeze School, and Scholastica School, Mirpur, each had 25 vaccination booths.

The original plan was for each centre to vaccinate 5,000 students per day, but they have only managed to vaccinate 2,000 to 2,500 students each day. The plan has since been revised to increase the number of vaccination centres for students with the aim of getting closer to the target of vaccinating a total of 40,000 students each day. The vaccine supply had a snafu almost immediately, and on the first day of the vaccination drive, 400 students were left waiting at the centre as supplies ran out. Infuriated parents and students worried about attending school unvaccinated, and those with the first shot worried about the availability of the second.

As much as the problem of limited vaccine supply persists, the big issue of learning loss also looms large. A multi-phase telephone survey was conducted by the BRAC Institute of Governance and Development, which spoke to 4,872 people in rural and urban slums twice, first in March and August 2021, to examine changes in the educational life of children. The survey reported that 22 percent of primary school students and 30 percent of secondary school students suffered learning losses during school closures, while an alarming 34 percent of boys at the secondary level became involved in child labour. The problem worsens for female students, who are more likely to drop out and be married off while still being underage.

However, there is a silver lining for children. The new variant appears to be following the trend that kids are, on average, more resistant to the coronavirus's effects. Although Delta is a more difficult version of the virus till date, researchers don't yet have evidence that it is specifically worse for children, who are still getting seriously sick only a small fraction of the time. In America, less than two percent of known pediatric Covid-19 cases result in hospitalisation.

Vaccines can still tame variants, but only one-fifth of Bangladeshis have gotten the shots they need for protection against Covid-19. And those jabs have been doled out unequally, focused on certain age groups, geographical regions, and communities privileged by wealth and educational attainment.

Hence, while Delta is a substantial enemy, it is not an undefeatable one. To protect children, the government must support the same approach that protects adults: combining masks, hygiene, physical distancing, access to testing, and vaccines for everyone who's eligible. This tag-team tactic will be especially important as kids head back to school in greater numbers this month and the next, and sit for their long-awaited exams.

Nasirra Ahsan is a private sector development consultant with the World Bank.