• Next week, the United States is expected to allow vaccination for those over 12 years old.

  • A vaccination that Europe is also looking at, while schools are still suspected of being one of the most important sources of contamination.

  • Should the vaccination of children be prioritized to fight against this potential cluster?

According to the

New York Times on

Monday, everything suggests that next week, the United States, through the Food and Drug Administration (FDA), will authorize Pfizer-BioNtech's vaccine for adolescents aged 12 years. or more.

The European Medicines Agency (EMA) is also looking into the subject with regard to the EU and the coronavirus vaccination for minors.

Should minors be vaccinated as a priority? 

20 Minutes

takes stock.

What do we know about vaccination in children?

Vaccination in children has long remained an unknown, as the Pfizer-BioNtech vaccine test groups consisted only of people over 16 years of age. Thus, the phase 2/3 trial (where the vaccine is tested on a voluntary population) of the Pfizer vaccine was carried out with 43,448 people over 16 years of age, without a history of Covid-19, with a median age of 52 years. Vaccination was not yet considered for children at the time, and Covid causing many more serious forms and deaths in the elderly, the interest of this target was limited. In contrast, 21.4% of participants were over 65 years of age, and 35% of participants suffered from obesity, two major risk factors.

Once the vaccine has been validated, and in particular with the aim of achieving collective immunity (which should count between 60 and 90% - depending on the variants - of the total population, not only of age), the question therefore arose on minors.

The American-German laboratory has therefore launched clinical trials on 12-15 year olds, with 2,260 American volunteers in this age group.

Eighteen unvaccinated adolescents have had Covid, compared to zero among those vaccinated.

The vaccine has sometimes caused side effects that are harmless and similar to those seen in young adults.

The EMA has also started its assessment with 12-15 year olds, and "will communicate the results of its assessment, expected in June, unless additional information is required," she said on Monday.

What is the point of vaccinating children?

Children are much less affected by hospitalizations and severe forms of the coronavirus, the overwhelming majority being asymptomatic. Thus, on May 3, 2021, of the 28,950 hospitalized patients, only 149 were under 20 years old. There were also only 30 people under 20 of the 5,630 intensive care patients. Vaccinating them to protect them therefore seems to be of extremely limited interest.

However, childhood immunizations can be used for two reasons. First, as already mentioned, achieving collective immunity is impossible without them. In France, according to Statista, those under 20 represented 24% of the population in 2020. Difficult to reach even the 60% of the vaccinated population without them, especially given the number of skeptics or anti-vaccines. "This is an unrealizable objective, all the more so since the appearance of more contagious variants", notes Laurent Chambaud, director of the School of Advanced Studies in Public Health.

Second, schools and school canteens.

According to the Institut Pasteur, indoor contaminations represent 95% of all contaminations.

However, the canteens are closed places and without masks, one of the last places where this has been allowed since October and the closure of restaurants and bars.

Viral circulation is therefore important at school.

Just before the schools closed on March 26, the incidence among 10-19 year-olds was 496 cases per 100,000 inhabitants, compared to the national average of 313.

A closure which also coincides with a sharp drop in cases, hospitalizations and even resuscitations, which had only increased until then.

Should children be prioritized in immunization?

In fact, should we totally change the vaccine strategy? Instead of targeting the most vulnerable populations, try to target the populations with the most impact in order to limit the viral circulation. It is now estimated that the vaccine decreases the transmission capacity of the virus, in fact, being able to vaccinate people who are more likely to transmit the virus could reduce contamination more effectively than vaccinating the most vulnerable.

Only here, it remains very theoretical. “Vaccinate a fragile person and you are sure to protect them. Vaccinate a person likely to contaminate it, and you are not sure of the effectiveness, ”confirms Laurent Chambaud. For him, "there is nothing in the state of affairs to change the vaccine strategy", a strategy adopted by all the countries of the world - prioritize by criterion of fragility.

In reality, the debate may not have time to arise.

The EMA having planned to deliver its verdict in June, the vaccination will normally have already reached all or almost all of the people at risk, "and there will be no more prioritization or problem of quantity of dose", hopes Laurent Chambaud .

The end of June also coincides with the arrival of the summer school holidays, which should settle for two months the problem of giant meals in closed places in canteens.

"Of course the question will arise for the vaccination of children, that it will probably be an essential complement, but we must not rush things", concludes Laurent Chambaud.

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