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Third COVID wave imminent; but is India prepared to protect its children?
Experts and researchers have warned that the third wave is more likely to affect children
India is all set to start clinical trials on the efficacy of Covaxin in children between 2-18 years of age amid reports of a potential third wave of the COVID-19 pandemic. The vaccine, produced by Hyderabad-based Bharat Biotech and backed by the Indian Council of Medical Research, has already been approved by the Drugs Controller General of India for phase II and III clinical trials in children.
In a health ministry briefing on Tuesday, Niti Aayog member (health) V.K. Paul said the trials of Covaxin would begin in next 10-12 days. His statement came on the same day when Delhi Chief Minister Arvind Kejriwal urged the Centre to work on vaccine alternatives for children on priority basis.
Experts and researchers have warned that the third wave is more likely to affect children, but there seems to be little clarity on how exactly the government plans to tackle it, given that the country has still not vaccinated its elderly and the working adults yet.
Earlier this week, Congress leader Rahul Gandhi lashed out at the central government on the country's “lack of preparedness” in ensuring its children get vaccinated for COVID-19, especially at a time when countries all over the world are taking steps to approve vaccination in children. The US has approved Pfizer-BioNtech shot in adolescents and rolled out vaccination for those aged 12-15 on May 14.
India has also begun taking steps in the right direction, although a bit late. The ICMR has selected 21 institutions for the clinical trial of Covaxin on children between 2-18 years and that is expected to take place in over 500 volunteers through intramuscular shots in a gap of 28 days, beginning June.
Even though in some countries vaccination of those over the age of 12 has started, experts believe that "the dose administered to adults (0.5ml) cannot be given to kids, especially those below 12”.
In India, the Bharat Biotech has started the process of vaccine trials and has divided children into different categories based on their age—12-18 years, 6-12 years, and six months to six years—for the trials. The company is recruiting participants for trials which may take at least eight months. They will first begin trials for the 12-18 age group at three sites namely, AIIMS New Delhi, AIIMS Patna and AIIMS Nagpur. This will be followed by phase 2/3 trials to study the safety, immunogenicity, side effects, and efficacy of the vaccine.
The other contenders across the world such as Pfizer, Moderna and Johnson and Johnson are also working on the trials. So far, the international companies conducting trials have reported the same side effects in children as for adults.
"We cannot extrapolate the impact of vaccines from adult studies on children. Pfizer's technology that led them to achieve 100 per cent efficacy in children is based on mRNA. In India, the Covaxin is based on the 'kill virus' principle. That is a traditional method of vaccine production. The efficacy of Covaxin after two doses is 81 per cent,” says Dr Tushar Parikh, consultant neonatologist and paediatrician, Motherhood hospital, Pune.
Dr Parikh says the AEC receptor which is the entry point for the virus in human cells are not expressed well in children as they are in adults. This means that the virus does not get too many entry points to infect a large number of cells.
“This is the reason why children are not falling ill badly and will not, in the future either. They will only have generic symptoms like dehydration or fever or less food intake. There will be no lung complications or the need for oxygen and ventilators. The number for severe cases will be less," he says.
“So, until the child is protected with the vaccine, use the cocoon strategy,” says Dr Parikh. This means, all the adults in the family have to compulsorily get vaccinated so as to protect the child.