With the reopening of physical school, as expected, there has been an uptick in new COVID cases, especially among children. In most cities, a bulk of the adult population have already received two inoculations of the COVID-19 vaccine. Children, however, remain unprotected.
With the resumption of physical school, it is now, more than ever, imperative that all children be vaccinated irrespective of whether they have contracted the virus before or not.
India has been rolling out the vaccines in a phased manner based on scientific and epidemiological evidence. In the first phase, we saw healthcare and frontline workers, along with the elderly, being given the vaccine on priority as they were the most at-risk and exposed individuals.
COVID-19 vaccination for minors in India kicked off on January 3 this year for children between 15-18 years of age. Thereafter, this was further expanded in March to include children aged 12 years and over.
The National Drug Controller has granted emergency use authorization (EUA) to Covaxin by Bharat Biotech for the ages 6 to 12 years and Corbevax from Biologicals E to be administered to children between the age of 5 to 12 years. This authorisation has been granted on the basis of data collected from numerous trials conducted by the vaccine manufacturers.
The EUA does not, however, mean that you can walk into any hospital (be it government or private) tomorrow to vaccinate your children who are above the age of 5 years. The vaccines are still to be approved at numerous levels. First, the National Technical Advisory group, which provides guidance to the government, will have to grant the vaccines its green signal. After that, the National Expert Group on vaccine administration for COVID-19 will make a recommendation to the Health Ministry for the roll-out of these vaccines to the masses.
Since the start of the pandemic and the initiation of worldwide vaccination drives, it has become clear that vaccination does protect against severe disease and mortality rates. Hence, with our children returning to normal life and school, vaccination is necessary to reduce incidences of severe cases of COVID-19.
In the Americas as well as Europe, children over five years are being vaccinated with the Pfizer and Moderna vaccines.
India is currently using four vaccines for immunisation for adults and children over 12 years. These are AstraZeneca + Serum Institute’s Covishield; Bharat biotech’s Covaxin; SputnikV; Biological E’s Corbevax. ZyCOV-D vaccine (the first Covid DNA vaccine by Zydus) has been given emergency approval but is not yet available.
The other two possible vaccines are Johnson & Johnson vaccine that Biological E is reportedly planning to bring into the Indian market, and Moderna, which supposedly Cipla is in talks with to introduce to the Indian market. It is, however, unclear as to when these two would be available in India.
India has recorded a small rise in new COVID cases over the past few weeks with the capital accounting for more than half of them. However, the lower number of hospitalisations can be attributed to the successful vaccination drive. We have managed to fully vaccinate nearly 80 per cent of the adult population at this time and booster dose or precautionary dose is also available now for all adults. The lion’s share of the vaccinations administered is Covishield by Astrazeneca/ Serum Institute.
The Indian Market has four COVID-19 vaccines available with some differences in composition as under:
This is a recombinant, replication -deficient chimpanzee adenovirus vector encoding the SARS-CoV2spike glycoprotein. After vaccination, the genetic material of part of the corona virus is expressed into the body, which stimulates an immune response. It is administered as two doses 8-12 weeks apart. It is stored between 2 -8 degrees Celsius.
India’s indigenous COVID-19 vaccine by Bharat Biotech is developed in collaboration with ICMR and the National Institute of Virology. This vaccine is developed using WHOLE Virion Inactivated Vero cell derived platform technology. Inactivated vaccines don’t replicate, and hence pathological side effects are less. The virus is dead so incapable of infecting people but will still mount an immune response. It is administered as two doses four weeks apart. Covaxin has demonstrated 77.8 per cent efficacy against symptomatic COVID infections and 93 per cent against severe COVID. It is stored between 2 -8 degrees Celsius.
This is India’s first indigenously developed Receptor Binding Domain protein Subunit vaccine against COVID-19. It is administered in a twodose schedule 28 days apart by intramuscular route. Like the other two vaccines above, it is stored between 2 -8 degrees Celsius.
It is built on a subunit platform instead of the whole virus. Corbevax includes an antigen developed by Texas Children Hospital Centre for vaccine development. This vaccine has been granted emergency use authorisation for administration to cildren in the 12 to 18 age group.
Covovax is produced by Serum Institute of India under license from Novavax. It requires two doses given three weeks apart.This vaccine uses a novel platform and is produced by creating an engineered baculovirus containing a gene for a modified SARs-COV2 spike protein.
ZyCoV-D from Zydus Cadilla has been given emergency use authoriwation for administration to children above 12 years. It’s a three-dose plasmid DNA vaccine injected intradermally using a needle free system called TRopis. After the first dose, the second and third are given on day 28 and day 56.
Other vaccines in the pipeline
Other vaccines in the pipeline are a nasal vaccine by Bharat Biotech and an mRna vaccine made by Genova, a Pune based company in collaboration with Seattle -based HDT Biotech Corporation.
Experts have stressed that preference should be given to children with comorbidities, irrespective of whether or not they have had a previous infection in the past.
(Dr Saroja Balan is consultant neonatologist and paediatrician at Indraprastha Apollo Hospital. Her column appears every fortnight)
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