Pfizer approved for children: But when can they be vaccinated?

On Friday Australia’s drugs regulator, the Therapeutic Goods Administration, approved the Pfizer vaccine for children aged 12 to 15 years. This means the independent experts that advise the TGA have assessed enough of the international evidence, where children are already being vaccinated, to feel confident the vaccine is safe for this age group.

Previously, the Pfizer vaccine had only been approved for use in Australia for people aged 16 years and over. So what happens next, and when can children be vaccinated with Pfizer?

Not all children will be eligible at once

As with all vaccination decisions, the Australian Technical Advisory Group on Immunisation [Atagi] will now consider the TGA approval and provide expert advice on which groups of adolescents should be prioritised for the rollout. They will also give advice about how and when it should be administered, for example through GPS, in-school programs, or vaccination hubs.

Atagi members include independent epidemiologists, nurses, infectious diseases physicians, consumer advocates and public health experts, and they meet with global experts to help inform their advice to government. The national Covid-19 Vaccines Taskforce has already begun planning how to logistically support the rollout of the vaccine to children to avoid any delay once the Atagi advice is finalised.

Atagi might decide that immunocompromised children with pre-existing health conditions, or those living with and helping to care for vulnerable adults, should be prioritised first. On Friday the health minister Greg Hunt said this was the most likely scenario.

“What is more likely, on the early advice I have, is that they will fast track vaccines for 12-15-year-olds for the immunocompromised children, or those with underlying health conditions, and then they’ll review the incoming data over the course of the next month on the general population,” he told Channel 7’s Sunrise program.

Even though children age 16 and above were already eligible for Pfizer before Friday, only those who meet other criteria, such as being vulnerable, a carer, or employed in a high risk profession are eligible to receive it.

There is an urgency

As NSW grapples with an uncontrolled outbreak of the Delta variant, the state’s chief health officer Dr Kerry Chant said it was younger people who were especially at risk, because they often worked in essential industries such as the food supply chain that continue to operate through lockdowns. But many are not yet eligible for vaccination. She has urged the national cabinet to consider the NSW situation as a national emergency and allocate resources, including vaccines, accordingly.

“I am arguing that we need to use Pfizer for those young people to stem the transmission chain because we know that that will provide individual benefit to them and prevent them also from spreading it on,” Chant said. “What we are seeing is people are bringing it into their household and then infecting their older relatives.”

We may start to see national cabinet make different, state-specific recommendations whereby those age 12 and above in NSW become eligible before other states. Unlike other variants, Delta seems more easily transmitted to and by children. A vaccination communication expert with the University of Sydney, Prof. Julie Leask, said “it’s definitely something to consider”.

“They should also consider geographic ring fencing, like they did with smallpox, where they bring the vaccine into specific zones or communities and make sure those rings around those communities are vaccinated,” she said.

Supply may be an issue

The demand for Pfizer in Australia has been relentless and supply issues continue despite GP practices being given a greater allocation of doses. If children are eligible, and those in NSW are prioritised, there may be further strains placed on supply.

But on Friday Hunt said the government is expecting to receive one million doses per week from now until the end of September, when supply will be boosted again.

“What we’re seeing is very high numbers of people coming forwards, commensurate with the increase in the volume of vaccines,” he said.

In the UK, only high risk children are eligible for Pfizer, and head of the Australian Medical Association Dr Omar Khorshid said he expects the Australian Atagi advice to be similar initially.

“That would only have limited impact on supply,” he said. He said he expects children overall who are not vulnerable, and those under 12, to remain the last group to be recommended for vaccination.

“I think longterm for children, though, we have important ethical questions to consider. I have mentioned to Greg Hunt that once most adults and people over 16 have been vaccinated and we’re potentially opening up our borders, we need to consider what happens when we expose our children to Covid before they are vaccinated or not.

“That important question will be a very hot topic as we get close to the time of reopening.”

Are there any side effects for children from vaccination?

According to the experiences of health regulators already administering Pfizer to children, the key side-effects from vaccination are mild and similar to those reported by adults; fever, chills, muscle pain, fatigue, and pain where the vaccine was administered.

The US Centers for Disease Control [CDC] reports that cases of myocarditis [inflammation of heart tissue] and pericarditis [swelling of heart tissue] in adolescents and young adults have been reported more often after getting the second dose than after the first dose of the vaccine. “These reports are rare and the known and potential benefits of Covid-19 vaccination outweigh the known and potential risks, including the possible risk of myocarditis or pericarditis,” the CDC says.

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