Children’s COVID-19 vaccine rollout becomes delicate balancing act in Japan

By Yohei Takei and Yuichi Negi / Yomiuri Shimbun Staff Writers

16:49 JST, February 11, 2022

A COVID-19 vaccine for children ages 5 to 11 was formally classified Thursday by the health ministry as a provisional shot that can be received free. However, the ministry has also decided that children in this age bracket would be exempt from a legal provision that requires people to make efforts to get vaccinated, so it remains hard to predict just how many parents or guardians will allow their young children to get the vaccine.

Some local governments are struggling over how to handle the rollout of these vaccines, which could start as soon as the end of this month.

Whether parents should be required to make efforts to get children ages 5-11 vaccinated was the main agenda item during a meeting of a Health, Labor and Welfare Ministry expert subcommittee held Thursday.

“There isn’t sufficient scientific evidence showing the vaccine’s effect against the omicron variant of the novel coronavirus,” was one opinion in the subcommittee.

“I think getting public support for such a move will be difficult,” was another opinion.

U.S. pharmaceutical company Pfizer Inc. manufactured this vaccine for children. A clinical trial Pfizer conducted on 2,000 people last summer confirmed the vaccine was 90.7% effective in preventing COVID-19 symptoms. However, the delta variant was dominant at that time, so the ministry is taking a careful approach.

“The vaccine can be expected to have an effect against omicron, but at the moment, we can’t definitively say that it does,” a ministry official said.

Few children have become seriously unwell after catching the novel coronavirus. The omicron variant also apparently has a low risk of causing severe illness. These factors bolstered the views of subcommittee members cautious about legally requiring efforts to vaccinate children with this vaccine.

Respecting wishes

Some subcommittee members felt the legal “duty to endeavor to receive vaccination” should be applied to the 5-11 age bracket.

“It’s possible even more young children will catch the virus, and there are reports from overseas of children who become very sick,” was one opinion.

Another opinion said not applying the legal provision “could give the impression that the vaccination is not necessary.”

Infections have been surging among children under 10 in Japan. According to the ministry, 76,856 such children caught the virus between Feb. 2 and 8.

However, the subcommittee was unanimous in its view that a system should be “quickly put in place” to vaccinate children with a high risk of becoming seriously ill, such as those with heart conditions.

“The wishes of people who don’t want to receive the vaccine must be respected,” said Keio University Prof. Tetsu Isobe, a subcommittee member and medical law expert. “On the flip side, we should create an environment in which people who want the vaccine can get it and make a decision based on information provided.”

The ministry will produce and distribute a pamphlet explaining the effects and safety of the vaccine to help parents better understand the issue.

The decision to exempt young children from the legal provision to make efforts to get vaccinated has perplexed some local government officials.

“We’re concerned that fewer people might come forward for the vaccine,” said an official from the local government of Bunkyo Ward, Tokyo.

The vaccine for children 5-11 is given in a smaller dose and diluted in a different way to the vaccine for people 12 and over. Each vial of the children’s vaccine contains 10 doses, four more than the regular vaccine.

Bunkyo Ward plans to establish vaccination venues exclusively for children 5-11 due to concerns some medical institutions might struggle to bring together 10 children at the same time. Even so, the ward is also worried this approach might have shortcomings.

“If fewer children than anticipated come along, some vaccine might end up getting discarded,” a ward official said.

Edogawa Ward is making arrangements to administer vaccines to individual children at about 80 medical facilities, including pediatric and internal medicine clinics.

“I’m not for making this vaccine subject to the law requiring efforts to get vaccinated,” said the head of one of the target clinics in the ward. “I want guardians to decide for themselves what they want to do for their children, without being swayed by what people around them say.”

Taking steps to deal with bullying or discrimination arising from vaccinations also will be essential.

The Kobe government will push ahead with vaccinating children individually instead of holding mass vaccination sessions at schools. The city was worried these events could lead to bullying because each student’s vaccination status would be known by others at school. Last summer, the city considered holding mass vaccination events for children 12-15, but was forced to drop the plan following a barrage of criticism from parents.

Kawasaki University of Medical Welfare Prof. Kazunobu Ouchi said a flexible approach will be required.

“Giving priority to third shots for the elderly and other people is vital, but there also are concerns that infections could spread further among children,” said Ouchi, an expert on children’s infectious diseases. “Depending on how the infection situation unfolds, the ministry might need to swiftly and appropriately decide to also apply the legal provision stipulating the ‘duty to endeavor to receive vaccination’ to this children’s vaccine.”

Hits plateau also in West

COVID-19 vaccinations of children 5 to 11 years old have already begun overseas, but U.S. parents are far from enthusiastic about the injections, and the rates are low across Europe.

In the United States, the U.S. Food and Drug Administration authorized the emergency use of the Pfizer-BioNTech COVID-19 vaccine for children 5 to 11 in October last year. Since then, children have been vaccinated at children’s hospitals, schools and other places.

However, a tally by the Centers for Disease Control and Prevention as of Tuesday shows that, of the 28 million children who could receive a vaccination, 6.6 million, or 23%, have done so.

According to a survey released in October by the Kaiser Family Foundation, 30% of parents who responded said they would not let their children get vaccinated. Adding them to the 33% who said they would wait and see for now, more than 60% of parents are passive about a COVID-19 inoculation for their children. Concern was voiced by 76% of parents that not enough is known about the long-term effects of the COVID-19 vaccine in children.

Some states have offered incentives for children to get vaccinated, such as a $100 gift card.

In Europe, vaccinations of children 5 to 11 are going on after the European Medicines Agency authorized the use of the Pfizer-BioNTech vaccine to children of that age group in late November last year.

In France, the percentage of children who have been vaccinated at least once as of Monday was 2.8% among those 5 to 9 years old and 8.4% among those 10 to 11.

In Germany, vaccinations of children started in mid-December to continue in-person lessons and to avoid virus transmission by infected children showing no symptoms. As of Wednesday, 19.4% have been inoculated.

According to the Health, Labor and Welfare Ministry, the United States, France and Germany all recommend COVID-19 vaccinations.