Israel’s dilemma on children’s COVID vaccines: How much to pressure parents?

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Public health experts in Israel are deliberating over the extent to which parents should be encouraged to vaccinate their children against COVID-19, as the country’s infections decline and the U.S. Food and Drug Administration meets to debate approval of vaccinations for kids aged 5-11.

The FDA was meeting on Tuesday to consider allowing the vaccination of children aged 5-11 at a lower dosage than for people 12 and older – 10 micrograms per vaccine, compared to 30 micrograms for everyone else.

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If vaccinations for younger children are approved in the United States, and then in Israel, about 1 million more Israelis could potentially be vaccinated – about 11 percent of the population.

Vaccinating children by the time they begin kindergarten would have several advantages in terms of the public’s overall immunity, but there are questions about the urgency of giving the vaccine immediately after its approval – and how to sell it to the public. Decision-makers will have to choose whether to run a determined and quick campaign, or whether to conduct it as a slower and more measured process. The first meeting on the matter by the country’s coronavirus task force is expected to be held next week, if the FDA gives its approval this week.

“There is a difference between allowing the vaccine and conducting an active vaccination campaign with all the tools we have to incentivize and encourage people to be vaccinated,” said Prof. Hagai Levine, the new chairman of the Association of Public Health Physicians. “Of course, we will want to see Pfizer’s data, but actually as someone who supported the booster during the time of the outbreak because we didn’t have time to wait, at the present time the infection situation in Israel is less severe, and even if the vaccine is approved in the United States, I wouldn’t rush ahead for an aggressive vaccination campaign.”

The vaccine was approved for those aged 12 to 15 in the U.S. at the end of May. Israel was seeing a lull in infections at the time and approved the vaccine for this age group only three weeks later, when the delta variant led to another wave of infections. One of the reasons for the delay in Israel was the appearance of myocarditis, an inflammation of the heart muscle, as a side effect among some people under 30 who had been vaccinated – mostly males – which required examination. Since then, it has been found that myocarditis is rare: according to the Health Ministry, there were 12 cases out of 256,000 people aged 12-15 who received two doses of the vaccine. Most of these cases were mild and did not require hospitalization. Despite the data showing the side effect is rare, the fear of myocarditis became a major argument among parents who did not want their children to be vaccinated.

The low level of infection in Israel is now giving medical professionals time to consider their next recommendations, and a longer examination process will presumably contribute to the public’s faith in the health system. But what could nonetheless accelerate the process is pressure from Prime Minister Naftali Bennett and other political leaders to vaccinate children as soon as possible. The health maintenance organizations have still not received official instructions, but they are preparing to vaccinate children soon, if necessary.

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Information campaign on the way

At the present level of infection, with a low R number and restrictions in place at schools, the sense of danger from the virus has been dissipating among parents and children.

From the beginning of the pandemic until the middle of this month, 2,660 children were hospitalized with COVID. Out of this number, 398 were in moderate, serious or critical condition. The Knesset Committee on the Rights of the Child was presented with data this month showing that 31 children aged 5 to 11 had contacted the coronavirus and been in serious or critical condition – and that three had died.

But while most children infected with the virus had mild symptoms, the effects of “long COVID” are also part of the debate. This involves various symptoms such as nerve and lung damage, as well as digestive system problems.

A Health Ministry survey showed that 11 percent of who had contracted the virus developed “long COVID.” Among children aged 3 to 6, the percentage of cases who suffered from the symptoms of long COVID half a year after they recovered was 1.8 percent. For children aged 6 to 12, the number stood at 2.4 percent. But doctors also say “long COVID” is underdiagnosed and seems to be more common than the data shows.

Another side effect that continues later in children is pediatric inflammatory multisystem syndrome, which is serious and can be life-threatening for them. Roughly 120 such cases have been reported in Israel so far, and one of the questions that still needs to be clarified is how much the vaccine can prevent “long COVID” symptoms.

Pfizer’s clinical trial included 2,268 children, and the data the drug company presented to the FDA showed it to be 91 percent effective in preventing symptomatic disease among them. “According to the information we have received so far, it seems the vaccine for children up to 11 is safe and effective. For now, it seems the risk from the disease is greater than that of the vaccine,” said Prof. Nadav Davidovitch, the outgoing chairman of the Association of Public Health Physicians. Many parents are waiting for approval of the vaccine and are interested in vaccinating their children, he added.

An opinion poll conducted at the beginning of the month by Liora Shmueli of Bar-Ilan University, found that among 894 parents of children aged 5 to 11, 57 percent expressed willingness to vaccinate their children against the coronavirus this coming winter if the vaccine is approved and available. Among those parents who do not plan on vaccinating their children, 66 percent said they were worried about the vaccine’s safety, 61 percent feared severe side effects, and 57 percent worried that the clinical trials and approval were conducted too quickly for political reasons.

“I certainly don’t think that we need to do things under duress, but I think that between half and two-thirds of the parents very much want to vaccinate their children,” said Davidovitch. “They are sick and tired of the tests and isolation and the fears the child will be infected and infect grandma and grandpa.”

“When the infection drops in the face of the vaccines, like now, it is very hard to estimate what will be the effect of the vaccine on children,” said Hila De-Leo of the biomedical informatics lab at the Technion – Israel Institute of Technology. “The infection rate may have fallen, but we already know that the minute a class has a child confirmed [as having COVID] and continues to study as usual, there are islands of outbreaks. In the present situation, I don’t know when we will feel the drop in infection, both because we don’t know how many will be vaccinated and because a month will pass from the time of the vaccination until the level of maximum protection. Many things can change.”