The vaccine works! There are now many evidences that show how the vaccine significantly reduces disease and mortality from Covid-19. Post-marketing studies have also shown great efficacy in reducing hospital burdens and in reducing infections, albeit to a lesser extent. Precisely for this reason it must be given priority to who and where it is needed and cannot be used as blackmail for the school in the presence. Rather than focusing on “vaccinating everyone” it is important to vaccinate those who are most at risk due to their age or concomitant diseases or who are exposed to situations that are most at risk (for example, healthcare personnel). The vaccine is very useful as an individual protection for older people, but the risk-benefit ratio decreases more and more in young people. When we say “we all vaccinate” we must consider that not all are the same, not all run the same risks. Of the patients who died in Italy, 85.8% were over 70 years old, 9.9% between 70 and 60 years, 3.3% between 60 and 50 years, 0.8% between 50 and 40 years and only 0.2% (296 patients) under 40 years of age, also considering that over half of the people who died in this age group had significant previous pathologies (source: Iss). Also recently in an editorial in “Nature” it is reiterated that deaths among young people from Covid are “incredibly rare”. In the period March 2020-February 2021 3,015 people of the over 12 million under 18 years old in the United Kingdom died, of which only 25 (0.8%) due to related Covid disease.
The Istituto Superiore di Sanità indicates 27 deaths in the period from March 2020 to May 26, 2021. Although the cumulative data on hospitalizations and intensive care is not available, at the peak of infections in 2021, on March 8, 21 boys between the ages of 0 and 19 (out of 10.5 million) were hospitalized in intensive care (1 out of 500 thousand), while 368 were hospitalized in the ordinary ward (1 out of 29 thousand). Precisely for these reasons, the Joint Committee for Vaccinations and Immunizations (JCVI) in England declares that, given the current scientific evidence, mass vaccination in young people cannot be recommended because it cannot be guaranteed that the benefits in children and adolescents of Covid-19 vaccination outweigh the potential risks. The Robert Koch Institut for the age group between 12 and 17 also recommends the vaccine only to subjects with previous illnesses. Caution is called for with respect to mass vaccination in young people, due to the lack of consolidated data on the risks, also because according to the data of the Koch Institut the latter would not have a significant impact on the trend of infections.
Like Koch in Germany, the JCVI in England also recommends vaccination with Pfizer to young people most at risk and, precisely, “to children aged 12 to 15 with severe neurodisabilities, Down syndrome, immunosuppression and multiple or severe learning difficulties” . According to the CDC guidelines, children and adolescents at greatest risk of serious disease related to Covid-19 are those with genetic, neurological, metabolic conditions or with congenital heart disease with obesity, diabetes, asthma or chronic or immunosuppressed lung disease. According to the JCVI, even young people aged 12 to 17 living with an immunosuppressed person should receive the vaccine in order to indirectly protect cohabiting family members who are at a higher risk of serious Covid-19 disease and / or can generate an immune response that is not complete on vaccination. In general, based on current scientific evidence, there is no reason to recommend vaccination for minors outside these groups. Data on the safety of vaccines in young adults are currently limited, but there have been reports of rare forms of myocarditis (inflammation of the heart muscle) and pericarditis (inflammation of the membrane around the heart) following the use of Pfizer and Moderna vaccines in millions of subjects. Post-marketing surveillance of vaccinations has recently started; information on rare but dangerous events could arise over the years. The approval for emergency use by the US FDA for Pfizer is based on about 1,000 young people and therefore the safety information that can be deduced cannot exclude rare adverse events, with an incidence of less than 1/500. The conclusion reached by the JCVI is that until more safety data is available and evaluated, a precautionary approach is preferable.
Tedros Adhanom Ghebreyesus, WHO Executive Director, underlined another essential point, speaking of a moral catastrophe: “In rich countries – he said – children and adolescents are offered the vaccine, while health workers in poor countries do not they have… In a handful of rich countries that have bought most of the supply of vaccines, low-risk groups are now being vaccinated. ‘ Ghebreyesus urges states to donate non-risky vaccines to Covax, a project (run by WHO and other organizations) that aims to ensure developing countries have access to vaccines. Currently only about 1% of the population of developing countries is vaccinated (https://www.gavi.org/covax-vaccine-roll-out). “In some parts of the world, people at risk may not be immunized until 2024, so vaccines need to be targeted at those most in danger rather than children, whose risk of getting sick is very low,” he stressed.
The reflection on the issue of vaccination in minors is based on two different reasons:
– doctors: the non-dangerousness of the related Covid disease in the age group between 0 and 19 years (mortality of 0.0003%) which is accompanied by a very low prevalence of infections in school (on average less than 1% of positives in the population school) and an equally rare transmission of the infection from minors to adults;
– ethical: we make ours the appeal of the WHO director against the selfishness of rich countries that allocate an important resource such as that of the vaccine to population groups with almost no risk of developing serious Covid-19 disease and deny the same resource to Poor countries where millions of elderly and frail people are waiting to be vaccinated.
We add that from the data provided by ISS to avoid a death among the elderly it is sufficient to vaccinate 365 of them, while as regards the young it is necessary to vaccinate 362 thousand. For young people, therefore, it is better to vaccinate according to the risk categories, as suggested by Jcvi and Koch. Some colleagues believe that the risks of multisystem inflammatory syndrome justify vaccination even in minors. However, multisystem inflammatory syndrome is an extremely rare event. The incidence of Mis-C was estimated to be 5.1 people per 1,000,000 person-months and 316 people per 1,000,000 SARS-CoV-2 infections in people under the age of 21. There is no evidence that this justifies the vaccination of healthy, non-at-risk children (https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2780861).
Many argue that vaccinating young people is strategic and essential for the safe reopening of the next school year. However, from various studies published in Italy and abroad and from the screenings carried out, we know that schools represent one of the safest places (https://www.thelancet.com/journals/lanepe/article/PIIS2666-7762(21) 00069-7 / fulltext). It is estimated that under the age of 20 the susceptibility to infection is about half that of those over the age of 20. In various scientific publications it has been found that young people are infected less and infect less than adults. In short: blackmail is no longer acceptable with respect to school. Face-to-face education should be considered a basic necessity. Because if there is one thing that has become evident all over the world it is the inadequacy of online lessons, from all points of view, educational and health. For this reason, WHO has recently underlined the importance of safeguarding educational levels and the social and mental well-being of students, taking care of the most vulnerable schoolchildren, involving students in all decisions and keeping schools open. In the 2020-2021 school year, we witnessed the biggest break in education in human history. We now have the evidence and the tools to ensure that children and young people can go back to school. Even the US Cdc (Federal Agency of the Health Department) reiterated that the unavailability of sufficient space to maintain the distance should not be a reason for reducing attendance: in those cases all other safety measures should be strengthened.
The same tests carried out in Italy showed that distance learning (Dad) worsened a situation that was already critical and led to a general, significant lowering of skills in particular for Italian and mathematics. Nationally, 44% of students in the last year of high school do not achieve “adequate results” in Italian (+ 9% compared to 2019), a percentage that rises to 51% in mathematics (+ 9% compared to 2019). In all subjects, the greatest learning losses are observed in a much higher way among students coming from the most difficult socio-economic-cultural backgrounds, with almost double percentages among students coming from a disadvantaged background. In southern Italy as regards Italian, students who do not reach the minimum level of skills in Italian are 64% in Campania and Calabria, 59% in Puglia, 57% in Sicily, 53% in Sardinia and the 50% in Abruzzo. While for mathematics, 73% in Campania, 70% in Sicily and 69% in Puglia. The presence school preserves the health of young people and the future of the country, perhaps even more than the vaccine.
Gandini is an epidemiologist and biostatistician
Novara is an educator