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[Exclusive] Why Korea is not in a rush to vaccinate kids

Internal government report suggests cost-benefit trade-offs unclear for children

This stock photo shows a vial of Pfizer`s COVID-19 vaccine. (Yonhap-Reuters)
This stock photo shows a vial of Pfizer`s COVID-19 vaccine. (Yonhap-Reuters)

South Korea is not urging that all children get vaccinated against COVID-19, a stance that contrasts with the one the country is taking for adults. Internal evaluations within the government present net benefits to society, rather than health benefits for the children themselves, as the rationale for vaccinations for those aged 12 to 17.

An internal government report obtained exclusively by The Korea Herald suggested that the expected health benefits of COVID-19 vaccination in minors under 18 years of age were marginal. But considering the resumption of in-person schooling and other social activities, their vaccination provided meaningful benefits to society, the report said.

According to the report, titled “Coronavirus Disease 2019 Immunization in Pediatric Population: Validation and Policy Assessment,” the views presented by the top experts both inside and outside the government on whether children and teens should get COVID-19 shots are far from definitive.

“Rather than universal vaccination, an individualized, risk-based approach may be more advisable” with children, the report said.

The report also noted the relative dearth of literature on the safety and effectiveness of the vaccine for children. In light of that, it said, although the evidence for questioning the vaccine’s long-term safety was “slight,” “caution is necessary.”

Health authorities have said evidence in the report served as the basis for Korea’s vaccination policy for those under 18, announced Monday.

In a televised briefing, the Korea Disease Control and Prevention Agency and the national advisory committee on immunization practices neither encouraged nor discouraged COVID-19 vaccination for children who are not at risk.

Children who are clinically vulnerable were highly urged to get vaccinated. On the other hand, for children who are healthy and without risk factors, whether to get vaccinated should be a “voluntary decision,” they said.

Jeong Eun-kyeong, the national health protection agency’s chief, explained that the COVID-19 situation here was “different from the situation in the US,” whose immunization experts have more unequivocally favored the vaccine’s use in children.

“Compared to Korea, the size of the outbreak among children and adolescents is decidedly larger in the US, so the vaccine benefits and risks can be different,” she said.

Out of the more than 11,000 patients aged 12-17 with confirmed cases in Korea, just three ended up developing severe symptoms. No one younger than 20 has died from COVID-19. All six children who developed a rare inflammatory condition linked with COVID-19, known as MIS-C, made full recoveries.

But the nonmedical harms of COVID-19 for children, such as disruptions in education, also needed to be considered, Jeong said.

The report, which is yet to be published, likewise said although the nation’s immunization experts perceive COVID-19 as “not necessarily harmful to children,” social distancing and other nonpharmaceutical interventions could have a negative impact on children’s overall well-being.

A Delphi survey carried out in August showed that experts agreed the vaccine provided sufficient protection, but they nevertheless remained neutral about recommending it for children, the report said.

In response to a question about how strongly they recommended COVID-19 vaccination for children and adolescents under 18, with a score of 1 indicating “strongly do not recommend” and 5 “strongly recommend,” the average answer was a neutral 3.3.

The average score was the same, 3.3, when the experts were asked if the expected benefits from COVID-19 vaccination were greater than the potential harms in the 12-17 age group in Korea. An answer of 5 meant the benefits were “far greater” and 1 meant the opposite.

When asked about the COVID-19 vaccine’s effectiveness in preventing infections in 12- to 17-year-olds and reducing their ability to transmit the virus to others, the experts were on the positive side of the scale at 4.39 and 4.03, respectively. When the experts were asked about safety, the score did not swing significantly to either side and stood at 3.27.

If they were to recommend vaccination for those aged 12 to 17, the highest proportion of respondents, or 34 percent, said the most signficant reason would be to allow students to attend in-person classes. This was followed by a near tie between personal protection from COVID-19 and protection of at-risk groups through herd immunity.

In a hypothetical scenario where they were to recommend against COVID-19 vaccination for ages 12 to 17, 59 percent replied that it would be due to the potential long-term side effects that are not yet known, while 15 percent cited the risks of inflammatory conditions affecting the heart and other known side effects as possible reasons.

About 19 percent said they would not recommend it because COVID-19 was not that dangerous for children. Other reasons included the urgency of giving older, vulnerable populations booster shots first.

The 43 experts who took part in the survey are from the government advisory committee on immunization practices, the Korean Society of Pediatric Infectious Diseases and the Korean Pediatric Society, or are otherwise recognized in the vaccine field.

Dr. Jung Jae-hun, a preventive medicine professor at Gachon University, said for children and adolescents, the risk-to-benefit ratio was “not as clear as it is for adults.” Jung carried out risk-benefit evaluations of COVID-19 vaccination for different age groups for the government.

“No child or teen has died from COVID-19 in Korea, nor from a vaccine so far. The comparison that can be drawn is in hospitalizations, especially intensive care admissions,” he said.

The youngest people to have received COVID-19 vaccinations in Korea are some 869,500 high school seniors taking national college entrance exams, at least five of whom were admitted to intensive care with vaccine-induced heart inflammation, according to the latest update issued Wednesday.

Jung added that for minors, unlike adults, the only vaccine available is Pfizer’s and the absence of an alternative was factored into the equation.

“That’s the level of recommendation that can be given at the moment -- it is recommended, but no one is saying all children should get it,” he said. “The vaccine is believed to be beneficial for children overall, but for them its benefits do not far surpass the potential risks.”

By Kim Arin (arin@heraldcorp.com)

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