Will COVID-19 vaccination rates for children be still low in the future?

Giao Huynh, Kimberly H. Nguyen, Han Thi Ngoc Nguyen, Tuan Diep Tran, Pham Le An

1Faculty of Public Health, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam

2Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA

3Infection Control Department, University Medical Center Ho Chi Minh City, Ho Chi Minh City, Vietnam

4Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam

5Family Medicine Training Center, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam

COVID-19 pandemic has been ongoing for over two years since the first case was reported in the end of January 2020. Vietnam has successfully controlled the pandemic, through its vaccination campaign, targeted messages and applying various public health interventions including physical or social distancing, quarantining,masking, hand washing and so on, which have made some significant achievements in reducing hospitalizations and deaths[1].

The COVID-19 vaccine has demonstrated to be safe and effective in protection against severe disease, hospital admission and death, in addition to reducing the transmission of new variants[1]. Millions of individuals have been safely vaccinated with a variety of vaccines.The mass COVID-19 immunization became available in Vietnam in mid March 2021 for individuals aged 18 and older. The government has put forward various strategies to enhance the vaccination rate,especially making immunization available to the population free of charge and convenient locations to access vaccines. Till October 2021, vaccines were approved to vaccinate children aged 12 years and older and those aged from 5 to under 12 years were also launched in April 2022. As of August 2022, almost all adolescents aged 12-17 years have received a series of two doses, while 82.0%and 52.9% of children aged 5-11 years received the first dose or are fully vaccinated respectively[2]. While the government issued booster dose guidance for children aged 12 years and older, 50.91% of this age group received a booster dose[2]. Despite declining COVID-19 morbidity and mortality due to increased vaccination coverage,hesitancy toward the vaccine persists, particularly toward the booster vaccine, even though it can protect against the new variants. Previous studies found that the main reasons for parental vaccine hesitancy for their children were beliefs regarding side effects of the vaccine, a desire to delay and follow up on the safety of the vaccine, and fear of new vaccines[3,4].

Generally, children and adolescents are at lower risk of infection as compared to adults and their signs and symptoms tend to be milder than adults[5]. However, children have an increased risk for severe morbidity and mortality if they have risk factors including older age,obesity, and current morbidity conditions [type 2 diabetes, severe asthma, heart and pulmonary diseases, seizure disorders, and other neurologic diseases, neurodevelopmental (e.g. Down syndrome)]and neuromuscular illness[6]. Furthermore, children infected by SARS-CoV-2 have experienced prolonged clinical symptoms,known as long COVID-19[7]. Because of the low percentage of children receiving the COVID-19 vaccine, along with re-opened schools for face-to-face teaching with the relaxing of public health measures (like the relaxation of physical distancing, suspension of screening for students in schools), it is possible that COVID-19 cases will increase in the community, especially the new Omicron variant and its subvariants, which are now dominant worldwide, are more transmissible due to its shorter incubation period. As a result,it is more likely to cause reinfection, particularly in unvaccinated population, overwhelm an already overloaded healthcare system, and cause interruptions to the other essential services[8].Therefore, the high risk of having shut down is likely to repeat,which contributes that children may miss out on basic childhood vaccines[9]. Experiences from other countries show that decreased immunization (i.e. measles vaccines) has led to a significant increase in the incidence and mortality of vaccine-preventable diseases[10].Furthermore, children may be exposed to the virus in daycare centers or schools and may subsequently spread the virus to their family members and community. Evidence showed COVID-19 outbreaks were more likely to occur in secondary schools and daycare centers where preventive measures such as social distancing and masks were not practiced[11].

The Government has strengthened vaccination coverage efforts for children and adolescents, including implementing many mobile vaccination teams to allow for vaccination to occur in convenient locations such as schools, health stations and so on. This will also offer more opportunities for delivery on weekdays, by collaborating with schools and also using social media in reminding parents and their children about upcoming vaccinations, which means translational research is required. It is likely that SARS-CoV-2 will continue to evolve, and it is not possible to predict how infectious or severe new variants of the virus will be. Therefore, it is critical to achieve and maintain the high rate of vaccination coverage across all communities. Moreover, vaccination contributes to minimizing the risk of shutting down schools and education facilities, causing disruptions to educational services, and affecting the children’s mental health in Vietnam. Even though the COVID-19 vaccine might become the victim of its own success in controlling the pandemic and people may become complacent, the vaccination rate can be still low in the future. As a result, it is strongly recommended that children and adolescents be vaccinated against COVID-19 as soon as they are eligible (including booster doses) to protect their health as the CDC recommendation.

Disclaimer

The author, Giao Huynh, as the Deputy Editor-in-Chief of the Journal, contributed to this article in her personal capacity. The views expressed are her own and do not necessarily represent the view of the institutions she is affiliated with.

Conflict of interest statement

The authors declare that there is no conflict of interest.

Funding

The authors received no extramural funding for the study.

Authors’contributions

The conceptualization was done by HG and PLA. The literature and drafting of the manuscripts were conducted by HG and NTNH. The editing and supervision were performed by NKH, TDT and PLA.All the authors substantially contributed to drafting and revising the manuscripts, as well as the final approval of the version to be submitted.