Thread by @ShamezLadhani

1/ I was asked by @TheLancet to write an editorial on #COVID19 vaccines for 5-11 year-olds: 6 months on, what have we learnt?

Importantly, what is the endgame?
Preventing infections? Severe disease? Long covid? And at what cost?

My tuppence worth …🧵

👉thelancet.com/journals/lance…

2/ My editorial was based on an Italian study on #COVID19 vaccines for 5-11y during Jan-Apr 2022:

VE ⬇️ from 65% (95% CI 62–68) in the 2 weeks after 2 doses to 12% (8–16) by 28-34 days

VE against hospitalisation was 41·1% (22·2–55·4) after 2 doses

👉 thelancet.com/journals/lance…

3/ This risk of severe #COVID19 in 5-11y was based on 644 hospitalisations (15 ICU, 2 died) which translated to:

- hospitalisation risk 0.08%
(84/100,000 infections)
- ICU risk 0.002%
(2/100,000)
- fatality risk 0.0003%
(0·3/100,000)

👉 I mean, how low can you go?🤷🏻‍♂️

4/ We also know that PIMS-TS/MIS-C cases (hyper-inflammatory heart complication 2-6 wks after #SARSCoV2) in kids have been falling since delta variant & even more so with omicron - even before #COVID19 vaccines were widely available for kids in England

👉medrxiv.org/content/10.110…

5/ What about long covid? This is still the best systematic review showing very low risks in kids when compared to control group without covid. Also, unlike adults, there is no evidence that #COVID19 vaccine prevents or reduces long covid risks in kids

👉 journalofinfection.com/article/S0163-…

6/ We also have to consider that most children have already been infected by #SARSCoV2 over the 2.5 years since the start of the pandemic.

What is the added benefit of vaccinating - or even boosting - kids who have already been exposed to the virus? No data for kids 🤷🏻‍♂️

7/ Remember also, contrary to rumors floating on social media, reinfections with #SARSCoV2 have not been more severe in kids & there is no evidence that reinfections have any effect on the risk of long covid in kids

👉 thelancet.com/journals/lanch…

8/ So, the question is: what are we trying to achieve with #COVID19 vaccines for 5-11y? Protection against infection is moderate & wanes rapidly. Some countries are offering 3rd dose, but experience in adults tells us this too will wane within few weeks

👉nejm.org/doi/10.1056/NE…

9/ #COVID19 vaccines do provide some protection against hospitalization, but this risk is already very low in 5-11y

Most kids hospitalised with severe #covid have underlying conditions - this group should always be prioritized for vaccination

👉 journalofinfection.com/article/S0163-…

10/ While many criticize the UK for delaying #COVID19 vaccine for kids, some countries (Sweden) recommended against vaccinating 5-11y due to marginal risk-benefits, while others (Norway) simply made the vaccine available if parents wished to vaccinate their kids

11/ We sometimes forget that such a large-scale vaccine programme comes with both financial & opportunity costs - e.g. diverting staff from routine services could jeopardize national childhood immunisation programme with potentially more severe consequences than #COVID19 in kids

12/ To conclude, with #COVID19 vaccines now available for under 5s, risk benefits will be even more marginal, especially when most kids will already have been exposed to #SARSCoV2. Let’s hope that countries learn from experiences with older kids when making their decisions

13/ PS. Whatever decision each country makes, it is important that the messaging of risk/benefits of #COVID19 vaccination for kids is clear, or we risk losing public confidence in vaccines & trust in those advocating for vaccines to prevent other more serious diseases …/End