SA teens, you’re next in the queue for a vaccine — no parental permission required

South Africa has enough Covid jabs to vaccinate up to half of the country’s 6.5-million children between the ages of 12 and 17 with one dose of Pfizer’s vaccine before they return to school after the December holidays or begin their tertiary education in 2022.  

That’s according to the health department’s acting director general, Nicholas Crisp, who announced on Friday that teenagers will become eligible for one Pfizer shot on Wednesday.

Crisp said the department’s goal is to have 3.25-million children between 12 and 17 years old vaccinated by mid-January. “Matrics will be prioritised, so that they have enough time to recover from possible side effects before their exams [which start on 27 October],” he said.  

Pfizer’s Covid-19 vaccine is the only jab that has received approval from the South African Health Products Regulatory Authority (Sahpra) for use for people of 12 years and older. Johnson & Johnson’s (J&J) jab — the other shot used in South Africa’s roll-out — can, so far, only be given to people 18 or older.

Why are teenagers in line for a Covid jab?

Although teenagerss are less likely than adults to fall seriously ill with Covid, vaccinating them will help to reduce absenteeism in classrooms and lower the risk of Covid outbreaks in schools.

Crisp says teenagers will not be vaccinated at school premises this year, but that the country’s vaccination programme may expand to include such a component in 2022. Instead, adolescents, who make up 11% of South Africa’s population, will, for now, be able to go to any private or public vaccination site to receive their shot.

There’s also no need for teenagers’ parents to approve their immunisations, because children between 12 and 17 years old can consent to medical treatment and surgery, according to the Children’s Act. This age group can, for example, also consent to terminating a pregnancy, the Act stipulates.

Why are teenagers receiving only one dose?

Teenagers will, however, only receive one shot of the Pfizer vaccine — unlike the two doses, six weeks apart, that adults in South Africa currently receive.

This is because the country’s ministerial advisory committee on Covid vaccines wants to allow more time for additional safety data to be gathered about potential side effects in this group, because of a very small risk of inflammation of the heart muscle or outer lining of the heart.

These two conditions are, respectively, also known as myocarditis or pericarditis, and they occur more frequently among boys than girls. 

June data from the US government’s Centers for Disease Control (CDC), shows that over a four-month period, for every million Pfizer second doses given to 12- to 17-year-old boys, between 56 and 69 developed myocarditis or pericarditis; in the case of girls, eight to 10 developed these conditions for every million jabs administered. Most people who develop these conditions as a result of vaccination recover within a few days.

But scientists agree that the benefits of vaccinating teens far outweigh the risks, because studies have shown Pfizer’s jab is safe to use in teenagerss and provides very high levels of protection against developing symptomatic Covid, as well as against Covid-related hospitalisation.

Like South Africa, the UK has also decided to vaccinate teenagers between 12 and 17 years old with only one jab — for now.

The UK’s health officials based this decision on US data, which showed that reports of myocarditis among teens and young men were six to seven times lower after their first dose of the Pfizer vaccine, according to an independent report published by the country’s joint committee on vaccination and immunisation.

UK children with underlying conditions that make them more likely to fall seriously ill with Covid are, however, given two doses eight weeks apart and will be monitored closely.

What happened to the department’s original vaccination plan?

Until now, South Africa’s roll-out has mostly focused on reaching the groups of people who are most likely to end up in hospital or die of Covid-19 (that is, those older than 50 years).

Although it is still important that older people continue to come in for their shots, opening the immunisation programme for younger South Africans can help to increase the overall protection within the population.

At the moment, South Africa is vaccinating about 200 000 people per day. This is only half of the expected daily vaccinations promised by the health department in July.

The country plans to vaccinate 70% of adults (people 18 years and older) with at least one dose of vaccine by the end of the year. With only two-and-a-half months left to go, we’re only halfway with that goal — just more than  35% of adults have received either one shot of J&J or Pfizer.  

In September, the health department said teenagers would have to wait for health workers and older people to receive booster shots before they would become eligible for a vaccine.

On Friday, the department announced that health workers who were vaccinated with one dose of J&J between February and May during the Sisonke implementation trial will be receiving a second J&J booster dose, as part of a new leg of the Sisonke study, as soon as Sahpra has approved the trial’s updated protocol. 

But boosters for older people are not yet available, although the vaccine ministerial advisory committee has advised that people with compromised immune systems — for instance, those who have had organ transplants or are undergoing dialysis, be offered additional vaccine doses (although no date has yet been announced).

What’s slowing down SA’s vaccine uptake?

Crisp says the country has enough unused vaccines to begin vaccinating teenagers.

A 13 October health department report notes several reasons why jabs are not being used fast enough, including reluctance to be vaccinated from people between the ages of 18 to 34 in some provinces, and the cost of transport to vaccine sites. In Mpumalanga, the high unemployment rate may be behind slow uptake, the report says, because people may be focusing on finding work first.

Misinformation is also hampering the uptake of Covid jabs in Namaqualand in the Northern Cape. The report recommends that communication teams need to be sent out to such areas urgently to dispel myths and create more demand for vaccines.

Nonetheless, Crisp says the department has noticed that families are coming in to get their jabs together, particularly in cases where extended families live together.

Vaccinating teenagers will also allow matriculants to be protected ahead of their final exams, says Crisp, and help to reduce absenteeism in classrooms. 

“There is no reason not to proceed with vaccination of this group,” he says. 

They may be less likely to die of Covid — but kids can still spread it

At the beginning of the pandemic, children were thought to be at lower risk of being infected with SARS-CoV-2, the virus that causes the disease Covid-19. They were also not seen as the main drivers of transmission, meaning that kids were believed to be less likely to spread the virus to others.

​​But newer studies have since overturned this assumption, according to the CDC. Although children are unlikely to fall seriously ill with Covid, they can still spread the SARS-CoV-2 virus to other people. The CDC detected outbreaks among children, particularly at camps or schools, proving that younger people are still able to be infected and to spread the virus.

The main pro for getting children on board in the vaccine roll-out, the CDC says, is that it can help to reduce the spread of the virus within the general population. That’s because the jabs make people less likely to spread Covid, because the vaccines reduce transmission of the SARS-CoV-2 virus.

The CDC’s data from February 2020 until May 2021 shows that children have comparable infection rates to adults aged 18 to 49, and they are more likely to be infected and to develop symptomatic disease than people who are 50 years and older.

But children are still less likely to develop severe disease when they become infected. The CDC’s studies, for example, found that those younger than 17 years are far less likely to be hospitalised or die of Covid-19.

In South Africa, almost 12% of Covid cases are in children under the age of 19 — this age group accounts for about 5% of hospital admissions in the country, August data from the National Institute for Communicable Diseases (NICD) shows. At the same time, fewer than 1% of in-hospital deaths are among children.

Variants of the virus could pose a higher risk to children

Some studies show that a higher proportion of children are becoming infected with the Delta variant — the form of the SARS-CoV-2 virus that drove South Africa’s third wave and is still the dominant variant in the country — than with the Beta variant, which dominated South Africa’s second wave; or the original form of the virus, which dominated the first wave. But although kids are more easily infected with Delta, the variant doesn’t make them sicker (that is, cause more severe disease), data from the UK shows.

During South Africa’s first wave, in June last year, people of 19 years and younger accounted for 8.7% of all Covid cases. But by the end of the third wave in August, this age group made up 13.7% of cases.

Although children were almost 12 times less likely to be hospitalised for Covid than adults, there was still a spike in infections among this age group. The NICD report found that more people under the age of 19 began testing positive for Covid, particularly when schools were open — with cases in teenagers between 15 and 19 years old actually surpassing those in adults by mid-August.

Moreover, a June study in the Journal of the American Medical Association collected data on children admitted to more than 800 hospitals in the US and found that certain underlying health conditions, such as diabetes and heart problems, increased their risk of falling seriously ill with Covid-19.

The vaccine is safe for kids: Here’s what we know

In August, Pfizer’s Covid vaccine was fully approved by the US government’s medicines regulator, the Food and Drug Administration, for use in the US in people aged 16 and older — with the same dosages as for adults.  

Children between the ages of 12 and 15 are not included in the full approval; these age groups are being vaccinated in the US under an emergency use authorisation.

This decision was based on data from a US clinical trial of about 2 000 children between the ages of 12 and 15, half of whom were given the vaccine, with the remainder receiving a placebo or dummy drug. The study found that children between 12 and 15 years of age had a similar reaction to the vaccine as those who were 16 years and older and that the benefits of vaccinating these teenagers outweighed the risks of doing so.

Pfizer’s jab was originally only approved for emergency emergency use in South Africa for people 18 years and older. But in September, Sahpra approved the use of the jab, known as Comirnaty, for everyone 12 years and older. This approval recommended that everyone who uses it gets two shots. 

As a precautionary measure, the vaccine ministerial advisory committee has, however, advised that children be given only one dose of the Pfizer jab — for now. This way, South Africa makes sure that more safety data on second shots can be gathered about potential side effects among teens. Once the committee is satisfied that there is enough information, it will decide if and when teenagers should return for their second dose.

Why are there concerns about second shots?

Some cases of myocarditis and pericarditis have been observed in a small proportion of people (particularly young men) receiving two Pfizer shots. Both are typically your body’s response to an infection, and people who develop these symptoms after being vaccinated tend to fully recover within a few days.

It’s extremely rare for people to experience myocarditis or pericarditis after vaccination, but it can occur.

CDC data shows 2 574 people in the US reported that they experienced some form of heart inflammation after being vaccinated, as of 18 August. This was most commonly seen in those who had been immunised with two Pfizer shots, with men at higher risk than women. Most cases occurred in men between the ages of 12 to 24.

To put that into perspective, June data from the CDC found that only 1 226 people of the nearly 300-million people vaccinated reported heart inflammation. That means this extremely rare side effect was found only in 0.0004% of vaccinated people.

Two recent studies from Israel published in the New England Journal of Medicine have also confirmed that the risk of heart inflammation after vaccination is extremely low.

One study found 304 reported cases among about five million people who received two shots of  Pfizer’s vaccine; 136 of the cases were linked to the vaccine itself, with 95% of cases being mild.

The second study looked at about 2.5-million people older than 16 years who had been immunised with two doses of the Pfizer jab — only 54 cases of heart inflammation were reported in the group.

The risk of experiencing heart inflammation post-vaccination seems to increase after receiving two shots of the vaccine. The CDC’s June data showed that among the just more than 1 000 cases reported, about three-quarters were in people who had received their second dose of either Pfizer or Moderna.

A September presentation from the CDC reported that two of a million men (aged 18 to 28) experienced myocarditis after their first dose. That increased to 24 of a million after the second dose of the Pfizer vaccine. This data also showed that men in this age group were 12 times more likely to develop heart inflammation than their female counterparts.

Will children be able to travel internationally with one shot of Pfizer?

Crisp says parents will have to check with the country their teen is travelling to if it will accept one Pfizer shot as proof of full vaccination for adolescents, because all governments have their own policies.

But, he says, because several countries, including Hong Kong, the UK and Norway, have recommended only one dose of Pfizer’s vaccine for children between 12 and 17, they’re likely to have adjusted definitions of “full vaccination” for this group that will allow for entry into those countries.

This story was produced by the Bhekisisa Centre for Health Journalism. Sign up for the newsletter.

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Bhekisisa team
Bhekisisa Team
Health features and news from across Africa by Bhekisisa, the Mail & Guardian's health journalism centre.

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