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by Shilpa Patel, Lead Practice Pharmacist

As a clinical pharmacist who is heavily involved in the rollout and the promotion of the Covid Vaccination Programme in Brighton and Hove, you would assume I would be encouraging all parents to get your children vaccinated. Yet, as a parent of a 13-year-old boy, this morning, I found myself just as confused as the rest of the parents, when we received an email asking for consent for our year 9 children to be vaccinated.

I have been vaccinating patients, friends & family – and honestly any arm I can get hold of – since the very first day this year and have always felt privileged to be part of the largest vaccination programme this country has seen. I have a taken a major interest in learning about the pharmacology, side effects and contraindications of each vaccine on offer, so I can confidently respond to the thousands of questions our GP surgery received during the initial stages. Not only have I studied every brand of the vaccine, but I have also scrutinised every word in the Green Book Chapter 14a (The clinical Covid vaccine bible).

A couple of months into the vaccination rollout, I found myself promoting the uptake of the Covid vaccine within targeted communities by recording press releases for refugees and translating advice for our Asian communities. This helped alleviate concerns and encouraged many groups of people to take up the covid vaccine. I have been a promoter, an encourager and one of the first in the country to receive my Covid vaccination very early this year.

But when I receive the consent form for my 13 year old child to be vaccinated, something did not feel right. I did not feel ready to inject my little sweetheart with this foreign substance, knowing very well that coronavirus rarely causes severe symptoms in healthy children. If I, the promoter, the encourager, the driven vaccinator, have my doubts, then how must other parents feel? So, here are my thoughts on the matter.

I’ll go through the cons first and weigh them up against the pros, so to understand the full picture be sure to read this article to the end.

Covid Vaccine prevents disruption

My main concern is that, back in July, the government’s vaccine advisory group, the Joint Committee on Vaccination and Immunisation (JCVI) advised us the benefit of vaccinating healthy 12 to15-year-olds was too marginal and recommended jabs only for clinically vulnerable children in that age group, or those living with people at high risk from the disease. A range of experts from the Royal College of Paediatrics and Child Health to regional directors of public health were consulted during the decision-making process. Even though the JCVI advised against vaccinating, the approval was granted, and the government were advised to press on with Covid vaccinations for all children aged 12 to 15.

We know that almost all children and young people are at very low risk from Covid-19; Data suggests about 25 children died from Covid in the first 12 months of the pandemic. The majority of them had severe health problems; only six had no recorded health conditions. In the year to 31st August 2021, Public Health England statistics suggest there were around 50 deaths among under-19s.

So, the only reason for this change of advice was that with cases expected to rise through the autumn and winter, the vaccinations will help reduce Covid transmission and outbreaks in schools thus preventing transmission to the rest of the UK public. The vaccine was approved for 12 to 15-year-olds, not because it was shown to be safe, but because it will prevent disruption from the disease.

The covid vaccination was approved in 12 to 15-year-olds not because of the health grounds but to help society.

Heart conditions

My second concern is the very small risk of the heart conditions; myocarditis; and pericarditis. According to the Medicines and Healthcare products Regulatory Agency, in the UK, the rate of myocarditis after both first and second doses is 6 per million shots of Pfizer and even lower for pericarditis. So, even though the chances are minimal, and the majority of cases seen so far appear after the second shot, how serious is this condition?

Myocarditis is an inflammation of the heart muscle, while pericarditis is the inflammation of the lining outside the heart. The inflammation can reduce your heart’s ability to pump and cause rapid or abnormal heart rhythms. Interestingly, myocarditis is usually caused by a virus, so your child is just as likely to develop this condition as a result of the coronavirus or any other common viral infection. One study suggests that for male teenagers, the risk of myocarditis is indeed six times higher from Covid than it is from the Pfizer vaccine.

It is also worth noting that should your child be unfortunate to get this condition, it will usually resolve after a few days. Also, around a three times lower rate of myocarditis has been reported with Pfizer compared with Moderna – and our children are being offered the Pfizer vaccine. Lastly, the reported rate appears to be highest in those between 16 and 25 years of age and in males, and after the second dose.

The existing evidence base shows that most patients with myocarditis post vaccination respond well to standard treatment, and the prognosis of the myocarditis is good. However, although these conditions are rarely incurable, in some cases of non-Covid-19 vaccine-related myocarditis, the disease can progress to dilated cardiomyopathy and chronic heart failure, with evidence implicating myocarditis in 12% of sudden deaths in adults aged under 40. Likewise, the long-term prognosis of pericarditis is good, but it can become recurrent and rarely patients may develop constrictive pericarditis.

There is a possibility of long-term consequences and studies are in progress to further understand these.

Fertility and menstruation

There is no evidence that the Covid-19 vaccines have a negative effect on fertility. In fact, in the recent COVID-19 clinical trials, equal numbers of pregnancies occurred in the group given the vaccine as in the group given a placebo. Theories about COVID-19 vaccines impacting fertility have no scientific basis. Claims that mRNA vaccines will cause the immune system to attack genes or proteins important for reproduction are unfounded and have been refuted by reproductive scientists across the world.

A small number of women have reported experiencing temporary menstrual changes after getting a Covid-19 vaccine. A small study has also shown that some women experienced temporary menstrual changes after getting COVID-19. It is not clear if getting COVID-19 or a COVID-19 vaccine causes these changes and further research is being carried out. Keep in mind that many things can affect menstrual cycles, including infections, stress, sleep problems and changes in diet or exercise.

Now let’s consider the main drawbacks of not vaccinating our children.

Multisystem Inflammatory Syndrome (MIS)

Although, most children who become infected with the coronavirus only have mild illness, we know that a few children have developed more serious symptoms. MIS is a serious condition where some organs and tissues – such as the heart, lungs, blood vessels, kidneys, digestive system, brain, skin, or eyes – become severely inflamed. This syndrome seems to be linked to coronavirus disease. MIS is rare, and most children who have it eventually get better with medical care. But some kids rapidly get worse, to the point where their lives are at risk.

A large study of children and young people who caught coronavirus has found that as many as one in seven (14%) may still have symptoms 15 weeks later. However, this figure is lower than in some studies that have reported a prevalence of long covid as high as 51% in children and young people.

This is pretty serious. Children seem to be fairly well-protected from the most severe symptoms of coronavirus. According to the European Centre for Disease Prevention and Control, the majority of children don’t develop symptoms when infected with the coronavirus, or their symptoms are very mild. However, it is becoming increasingly apparent that a large number of children with symptomatic and asymptomatic covid-19 are experiencing long-term effects, many months after the initial infection.

This syndrome can be prevented by the vaccine.

Long Covid

Symptoms of long covid were first thought to include fatigue, muscle and joint pain, headache, insomnia, respiratory problems and heart palpitations. Now, support groups and researchers say there may be up to 100 other symptoms, including gastrointestinal problems, nausea, dizziness, seizures, hallucinations, and testicular pain. Most long covid research is based on adults. There is less information about under-18s, in part because it takes longer to get ethical approval to study children.

Most medical bodies say it normally takes a few days or weeks to recover from covid-19, and that most will make a full recovery within 12 weeks. That is 3 months of your child’s normal day to day life being disrupted. There is a UK advocacy group called Long Covid Kids, who currently have 1200 children registered with long covid from 890 families in England. And according to their spokesperson, “none of these children has returned to their previous health, and most are unable to do their normal activities.”

The consequences of long covid in children can be debilitating.

New variants

Since the beginning of the pandemic, the SARS-CoV-2 coronavirus that causes COVID-19 has mutated. Currently, there are four variants of concern which are labelled using letters of the Greek alphabet; Alpha (first documented in the UK), Beta (first documented in South Africa), Gamma (first documented in Brazil) and Delta (first documented in India) variants. Each has mutations which are thought to make them infect people more easily than the predominant global strain of the virus. Data also suggests that the Alpha variant is associated with an increased risk of death, and since the Delta variant arose, you will notice that the cases of COVID-19 have been increasing among children. Reducing viral transmission by getting children vaccinated reduces the virus’ chance to mutate into new variants that may be even more dangerous for them.

When a virus is circulating widely in a population, it will replicate more and the likelihood that variants will appear increases. Virus transmission provides a chance for the virus to mutate and create a new variant that might prove more infectious or resistant to the available vaccines and therapies. The most effective way to stop more variants is to prevent the spread of COVID-19. Variants are seen more often when virus transmission levels are high, so we need to bring these levels down. Current measures to reduce virus transmission work and will also curb the number of variants, including handwashing, good ventilation, physical distancing, mask wearing and preventative treatments, such as the covid vaccines.

Fewer overall infections among the population means less chance of dangerous coronavirus variants emerging.

Wellbeing & Education

The COVID-19 pandemic has weighed on all of us, but many children and teens have had an especially tough time coping emotionally. Many children in the UK have lost a parent to COVID-19, for example. Many families have also lost financial stability during the pandemic. At the same time, children have had vital supports including school, health care services, and other community supports interrupted by the pandemic.

Have you noticed a sudden deterioration of the mental health of the teens and young adults around you? The pandemic has deprived them of their sports activities, after-school clubs, birthday parties and casual meetups. They have been sat down in front of their computers, laptops, and iPads, X-boxes, and PlayStations for almost two years now. This is having devastating effects on their wellbeing and their social skills.

And what is the impact of extended disruption to our young one’s education? The uncertainty and disruption of their academic years is likely to have long term effects on their prospects in life. It is widely accepted that the learning process is instrumental in shaping one’s personality and the way he/she deals with situations of life. Our children are being deprived of the key to gaining well-rounded development. Education is a basic necessity for human beings after food, clothes, and shelter.

School is not only important for socialising for a child, but it is where sociable practices such as empathy, friendship, participation, assistance are instilled, and these skills turn out to be important in their adulthood. Can we really let this carry on? Can we allow our children to continue to live their most vital years in this environment, with this constant fear and stress?

The vaccine has been shown to be 100% effective in the 12 to15 years old age group and it will stop this constant disruption of their education.

Final thoughts

A reason to strongly consider a COVID-19 vaccine for your child is to protect the health of those living and working in your area. Each child or adult infected with the coronavirus can transmit the virus to others in the community. If this happens some of the people so infected will become quite sick themselves or further spread the virus to others. Whilst we should still be concerned that the covid vaccine was approved for society’s benefit and not for our child’s health and there may still be long term side effects unexplored, we should be more worried about the likelihood of MIS and long covid if our child does gets the virus. And more importantly the soaring rate of depression amongst our children and the disruption to their normality.

Perhaps we need to turn take a step away from the facts and figures and look at the bigger picture. No medicine is completely safe, and all are a balance of risk and benefit. So, in order to avoid Long Covid, the risk of MIS and to ensure I give my child and their friends the best chance of improved welfare, mental balance, and fortune and to give them the best prospects for successful futures, to protect their grandparents and everyone else in our locality I am filling out my child’s consent form today, and I hope to share this knowledge with you all to make a more informed decision. I am by no means certain about my decision, but by weighing up the pros and cons I feel we have no choice but to play our part and give this young generation a brighter future.

Uncertainty is part of the world we now live in but I cannot and will not allow this pandemic to continue, allowing people to be very sick or even die – all because of a preventable infection. Let’s allow our children to be free again.

 

References

The Green Book Chapter 14a

https://www.bmj.com/content/374/bmj.n2157

https://www.gov.uk/government/publications/covid-19-vaccination-myocarditis-and-pericarditis-information-for-healthcare-professionals/information-for-healthcare-professionals-on-myocarditis-and-pericarditis-following-covid-19-vaccination#treatment

https://www2.hse.ie/screening-and-vaccinations/covid-19-vaccine/get-the-vaccine/deciding-on-vaccination-for-12-to-15-year-olds/

https://yalehealth.yale.edu/covid-19-vaccine-faq-children-12-15-years-old

https://www.theguardian.com/world/2021/sep/13/how-will-covid-vaccines-rollout-12-15-year-olds-uk-work 13 sept 

https://www.bbc.co.uk/news/health-57888429 15 sept 

https://www.bbc.co.uk/news/health-57781637 9 July

https://www.reuters.com/world/uk/uk-advisers-decide-against-covid-vaccines-healthy-12-15-year-olds-2021-09-03/ 

Covid-19 vaccination: your questions answered
https://www.hopkinsmedicine.org/health/conditions-and-diseases/coronavirus/covid19-vaccine-what-parents-need-to-know
The importance of school education in child development