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'Prudent' to extend COVID-19 protection to children now, experts say

'Prudent' to extend COVID-19 protection to children now, experts say

A teacher explains to students the new protocols for taking recess breaks and daily temperature checks at Yio Chu Kang Secondary School, as schools reopen amid the coronavirus disease (COVID-19) outbreak in Singapore Jun 2, 2020. (Photo: REUTERS/Edgar Su)

SINGAPORE: It would be prudent to extend COVID-19 protection to children now, experts told CNA, ahead of a vaccination drive for students aged 12 and above that was set to begin on Thursday (Jun 3).

More than 400,000 of these students will be invited to receive the vaccination, starting with graduating cohorts from secondary schools and at the pre-university levels.

On Tuesday, the first day of registration, around 26,000 students signed up - more than half of those invited so far, said Education Minister Chan Chun Sing.

It is not yet known when children below the age of 12 will be vaccinated.

“We have always had the intent to extend the vaccination to children when the data suggest it is safe to do so,” said dean of Saw Swee Hock School of Public Health Dr Teo Yik Ying. 

There is also data that the Pfizer-BioNTech COVID-19 vaccine “remains safe and effective” for those aged between 12 and 15, he noted. 

“We see a number of community clusters in Singapore include children, and some of them have gone on to infect other children, so it is prudent now to extend the protection to children given the safety and efficacy data,” said Dr Teo. 

The United States and Canada have also approved the use of Pfizer-BioNTech for vaccinating 12 to 15-year-olds, he added. 

The decision to vaccinate younger students is significant as it expands the cohort of vaccinated individuals, said President of the Asia Pacific Society of Clinical Microbiology and Infection Paul Tambyah. 

“It is a bit controversial as the data (is) limited and children including teenagers are at low risk of serious disease. Some would argue that the vaccines should be saved for the more vulnerable elderly,” he added. 

The emergence of clusters in tuition centres, schools and a polytechnic might have influenced the decision to vaccinate students, said Dr Tambyah. 

This was to make sure Singapore “had options” if the number of COVID-19 cases in those below 16 years old went up, he added. 

Vaccination is meant to minimise the chance that anyone who is infected with the coronavirus goes on to develop severe symptoms, which may come with higher risks, said Dr Teo.

“So vaccinating children in this age group is meant to ensure their overall wellbeing, given that we see some of them being infected in learning environments such as schools and tuition centres,” he added. 

“When most of the children are vaccinated, I expect we will be able to allow classes to resume safely and not worry about children being infected, and reduce transmission to older family members or teachers.” 

READ: More than 26,000 students sign up for COVID-19 vaccinations on first day of registration

READ: More than 400,000 students aged 12 and above to receive COVID-19 vaccination invite from Jun 1

Severe disease due to COVID-19 is less common in adolescents, but "it still can" happen, said infectious diseases expert Professor Dale Fisher. 

“COVID-19 is here to stay and will circulate just as (the) flu does. Anyone unvaccinated will be vulnerable (to) severe disease,” said the chair of Infection Prevention and Control at the National University Health System (NUHS).

“Further, reducing mild disease will also aid in reducing the overall burden of circulating virus in the future. Children also get a unique condition called multi-system inflammatory syndrome and this should be less likely in vaccinated children too.” 

The vaccine was authorised by the Health Sciences Authority (HSA) to be used for children between 12 and 15, Health Minister Ong Ye Kung announced earlier in May. This is the first COVID-19 vaccine authorised for use in Singapore for this age group.

"Both teams have assessed that the Pfizer-BioNTech COVID-19 vaccine demonstrated high efficacy and safety for this age group of 12 to 15 years old, which is consistent with what we have observed for the adult population," he said at the time. 

The “main reason” why Singapore is seeing more positive COVID-19 cases in children is because the country has “vaccinated so many adults”, said Prof Fisher. 

“With the recently produced safety data it’s now time to protect our teenagers.” 

READ: Children aged 12 to 15 to receive Pfizer-BioNTech COVID-19 vaccine in Singapore

FAQ: What you need to know about the COVID-19 vaccination exercise for students


The level of herd immunity needed for the vaccination to be effective among children “is not significantly different” from that of adults, said Prof Fisher. 

“It’s arguable that more dense settings need a higher level of immunity.” 

“Given the extent of close interactions between children in a schooling environment, and the fact that children in general do not cope well with having to wear their masks properly for an extended time, we should aim for the highest possible vaccination rate for all medically eligible children,” said Dr Teo. 

There have been very few reported school-based outbreaks of COVID-19 in Singapore or elsewhere in the world, Dr Tambyah noted. 

“As such, it is not known how many children need to be vaccinated. We would need to wait for data from countries rolling out the vaccine to children to know the answer to these questions,” he added. 

READ: Will taking a painkiller before the jab help? Your COVID-19 vaccine questions answered

The Education Minister said on Tuesday there was no "specific target" as to the number of students to be vaccinated during the June school holidays.

“Our goal was really to offer to all the students that are eligible medically to do so, and we hope that they will sign up as soon as possible, because that will allow us to create a safer environment for everyone before they return back to school,” said Mr Chan.

“So we would want to achieve as high a number as possible.”

In assessing the vaccine for those aged 12 to 15, the expert committee on COVID-19 vaccination considered the safety, efficacy and tolerability of the vaccine, and the study design of clinical trials for this age group, MOH said at the time. 

“The data showed that the Pfizer-BioNTech COVID-19 vaccine demonstrated high efficacy consistent with that observed in the adult population,” the Health Ministry said. 

“Its safety profile is also consistent with the known safety profile in the adult population and the standards set for other registered vaccines used in the immunisation against other diseases."

The side effects noted in the trial included pain at the injection site, fatigue, headache, chills and fever, said HSA at the time, adding that the side effects resolved on their own within a few days.

HSA's review of the clinical data for this "subgroup" also found that the Pfizer-BioNTech vaccine “induced a robust immune response” and demonstrated "high vaccine efficacy of 100 per cent", the authorities said at the time of approval. 

There was a clinical trial where 2,260 children were enrolled - half of them were given the vaccine and the remaining half were not, said Dr Teo. 

Eighteen of those who were unvaccinated were subsequently infected with COVID-19, while none of the children who were vaccinated developed an infection, he added. 

“The neutralising antibody response was also observed to be sufficiently strong,” said Dr Teo. 

If the vaccine “induced a robust immune response”, this means that the antibody, or the serology test results, were “strongly positive” in the children studied, said Dr Tambyah. 

“It means that there is really no difference in the effect in children. As with adults, the evidence suggests it is very effective and safe,” said Prof Fisher. 

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Source: CNA/hw(hs)