Vaccinate Highest-risk Groups Before Children, PAHO Says

Matías A. Loewy

October 21, 2021

Editor's note: Find the latest COVID-19 news and guidance in Medscape's Coronavirus Resource Center.

As countries move to expand COVID-19 vaccination to children younger than 12 years, the Pan American Health Organization (PAHO) stresses that the most vulnerable populations should be fully vaccinated first, although it acknowledges that countries have the right to decide which populations to prioritize.

"Vaccine strategies must have very clear objectives. The first objective in COVID-19 was to save lives, so WHO recommended that the first vaccines be used to protect older adults and health professionals to keep services running," said Jarbas Barbosa, MD, PhD, assistant director of the PAHO, during the October 6 weekly COVID-19 briefing.

"Adolescents and children were not a priority group at the beginning because the vast majority of serious illnesses and deaths were concentrated in adults and older adults," he added.

"A country that has already vaccinated its entire adult population and has vaccines available for adolescents must continue with that population, starting with those who have comorbidities and are at greatest risk. But all countries must have vaccination phases, so as not to start vaccinating lower-risk groups before completing vaccination in higher-risk groups," Barbosa said.

That comment came a few days after regulatory authorities in Argentina authorized the immunization of children 3 years and older with the Sinopharm vaccine, from the China National Pharmaceutical Group, and Nicaragua authorized the immunization of children 2 years and older with the Abdala, Soberana, and Soberana 02 vaccines, all from the Center for Genetic Engineering and Biotechnology in Cuba.

Three other countries in the region had already adopted similar measures.

On September 3, Soberana 02 was authorized for emergency use in children 2 to 18 years of age by the Cuban Center for State Control of Medicines, Medical Equipment and Devices (CECMED).

On September 6, CoronaVac (also known as Sinovac, and developed by the Chinese company Sinovac Biotech) was authorized for emergency use in children older than 6 years by the Chilean Institute of Public Health.

A week later, Nayib Bukele, president of El Salvador, announced, on Twitter, the authorization of CoronaVac and Comirnaty (Pfizer–BioNTech) for children 6 to 11 years of age.

So far, the only vaccination that has been announced as "suitable for use by people age 12 years and above" by the World Health Organization's Strategic Advisory Group of Experts is the Pfizer–BioNTech vaccine, although other vaccines, such as Moderna, Sinovac, and Sinopharm, are currently being evaluated in younger people, Barbosa noted.

On October 7, Pfizer asked the US Food and Drug Administration to approve Comirnaty, at one-third the adult dose, for children 5 to 11 years of age. That request will be considered at a meeting scheduled for October 26.

Medical Societies React

When Carla Vizzotti, MD, Minister of Health in Argentina, where more than 3 million adults are still unvaccinated, announced approval of Sinopharm for children during an October 1 press conference, medical societies were taken by surprise.

The next day, the Argentine Society of Pediatrics issued a statement in favor of vaccination for children younger than 12 years "with safe vaccines, as a tool to protect their own health, in the case of currently vulnerable individuals; as a general epidemiological need to reduce community viral circulation and as an important factor to guarantee safe school attendance," but added that they hoped to have access in the following days to the evidence that justified this authorization. The Argentine Society of Pediatric Infectiology (SADIP) expressed a similar sentiment.

Officials and sectors associated with the government reacted with irritation. "Before going out and raising doubts with society, what these institutions should do is the serious and responsible work of consulting with the authorities," Nicolás Kreplak, Minister of Health of the province of Buenos Aires, told the media.

Finally, on October 5, after a meeting with authorities, the Argentine Society of Pediatrics issued a statement saying it had received unpublished but very important information on the safety and immunogenicity of the vaccine for children 3 to 11 years of age, and declared all doubts resolved.

But not everyone agrees. Carlos Kambourian, MD, former director of the Juan P. Garrahan Pediatric Hospital in Buenos Aires, who has been very critical of the government, asserted on Twitter that the vaccine still does not have "adequate" approval and he will not recommend it "until it is approved by WHO."

In Nicaragua, where there are no reliable data on COVID infections, hospitalizations, deaths, or vaccinations, the approval of vaccination for children has also been received with some distrust.

"From a scientific standpoint there is little information; it is not being given to anyone of that age in the world. Children under 12 years have a different physiology, different functioning of the immune system...[and] vaccines need to be adapted to those ages. Being a vaccine that is given only in Cuba and a few countries, such as Venezuela and Vietnam, generates more doubts than certainties," José Antonio Delgado Alvarado, MD, master in public health, gynecologist, and presenter of the television program Health in Your Hands, declared in an Artículo 66 podcast.

This article originally appeared in the Spanish edition of Medscape.

Follow Matías A. Loewy of Medscape in Spanish on Twitter @MLoewy.

Follow Medscape on Facebook, Twitter, Instagram, and YouTube



Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.