Hot Topics: Covid-19 vaccines for Hong Kong children aged 5 to 11

Secretary for the Civil Service Patrick Nip Tak-kuen, who heads the city’s inoculation drive, spoke to a radio programme earlier this month. To boost vaccinations, Nip said services at three existing community vaccination centres and about 1,000 private clinics offering Sinovac jabs would be extended to those aged five to 11.

Last week, the government announced that a similar extension for the German-made BioNTech vaccine would start from February 16, with bookings to open on February 9. Children in this age group will receive a third of the adult dose for the jab.

According to government data, Hong Kong has about 400,000 children aged between five and 11.

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Earlier this month, the government’s Advisory Panel on Covid-19 Vaccines said children aged five to 11 should be offered a smaller dose of the BioNTech vaccine given to adults. The government in November approved the use of Sinovac on children as young as three, though priority was given to adolescents at the time.

As the Omicron variant of Covid-19 rages around the world, a surge of child infections and hospitalisations has prompted calls by some governments to vaccinate young children.

Sir Terence Stephenson, a professor at the Great Ormond Street Institute of Child Health at University College London, said: “I think the reason we’re seeing large numbers of children [hospitalised for Covid-19] is that in most countries, immunisation of children is at a lower level than that of adults.”

Mainland China has been administering the Sinovac and Sinopharm vaccines to children as young as three. Singapore, the United States, Britain and the European Union are among countries and regions vaccinating children as young as five with BioNTech.
Staff writers

Question prompts:

• Why might authorities want younger children to get vaccinated before Lunar New Year?

• Based on Context, explain how the spread of Omicron raises pressure on governments and policymakers to vaccinate young children.

• Describe two general trends shown in the graph.

• To what extent can the graph help explain Hong Kong health officials’ move to open Covid-19 vaccines to the city’s young children aged five to 11? Explain your answer using the graph and Context.

The Advisory Panel on Covid-19 Vaccines said earlier this month that children aged five to 11 should be offered 10-microgram doses of BioNTech – a third of an adult dose – resorting to an “off-label use” amid supply shortages for a paediatric formulation.

“Having reviewed the relevant efficacy and safety data published, the advisory panel suggested allowing children aged five to 11 to receive a fractional dose ... of the [BioNTech] vaccine for adults for off-label use,” the body said in a statement.

Fosun Pharma, distributor of the BioNTech vaccine in Hong Kong, has not applied to local authorities to lower the age limit of the drug – which currently covers those aged 12 or above. Because it is not formally cleared for those aged five to 11, and only a portion of the full adult dose would be administered, it would technically be given in what is known as an “off-label” manner.

Asked why the experts made the suggestion despite no application from Fosun, Chinese University Professor David Hui Shu-cheong, a member of the advisory panel, pointed out Hong Kong was not alone in doing so.

“The UK is already doing this. They cannot buy the paediatric formulation, so they are also using one-third of the adult version – it is technically not a problem,” he said. “The data is already available ... but Fosun cannot find a supply line for Hong Kong.”

Hui added that Queen Mary Hospital had successfully prepared the paediatric dose using the adult version of the vaccine.

“Paediatricians normally administer smaller doses of adult drugs to children,” he said. “They’ve done it for many years.”

Separately, William Chui Chun-ming, president of the Society of Hospital Pharmacists, said, “It is believed manufacturing plants are at full production making the adult BioNTech vaccine, so they don’t have the capacity for paediatric ones.”
Staff writers and Bloomberg

Question prompts:

• Why is the government panel recommending “off-label use” for the BioNTech vaccine for children aged five to 11? Use Context and News to identify and explain TWO reasons.

• Identify ONE potential concern parents might have about the BioNTech jab for those aged five to 11 after reading News, and explain what the advisory panel might say in response.

Vaccinating children against the coronavirus will enable Hong Kong to exit its tough zero-Covid policy, medical experts have said, even as parents raised concerns about giving the German-made BioNTech jab to children as young as five.

Earlier this month, paediatrician Professor Lau Yu-lung, member of the government’s Advisory Panel on Covid-19 Vaccines and Scientific Committee on Vaccine Preventable Diseases, said high inoculation rates for all age groups could help the city reach a Covid-19 exit plan.

While children generally developed milder symptoms from Covid-19, overseas studies found that those with chronic illnesses were more vulnerable.

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Those who were previously healthy and contracted Covid-19 could be affected by a rare but serious condition called multisystem inflammatory syndrome in children, or MIS-C, Lau said.

“Getting vaccinated can reduce the chances of MIS-C, loss of smell or taste, severe conditions or death,” he said.

But some parents remained sceptical about vaccinating young children, citing concerns over Sinovac’s efficacy and unknown long-term effects of the BioNTech shot.

Sylvia Ho, who has a six-year-old son, said: “My child is still growing ... I don’t know what the impact [of the BioNTech jab] will be on his health.”

She also voiced worries about the quality of the Sinovac vaccine, even though the technology involved – use of an inactivated virus – had been employed for years.

A mother of a five-year-old boy, who only gave her surname as Yiu, raised similar fears about BioNTech.

She questioned the need for a jab at all, saying hygiene measures such as masks and handwashing had successfully kept her son free from infection. She also pointed to the mild symptoms in children.

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Separately, Sir Terence Stephenson, a professor at the Great Ormond Street Institute of Child Health at University College London, said that Covid-19 was similar to diseases such as flu, where vaccinating children could stop them passing it to the elderly and other vulnerable groups.

Stephenson added that while most children only suffered mild symptoms, Covid-19 disrupted their lives.

“One of the big arguments for vaccination is that it stops them having to isolate and be absent from school, and I think that’s a perfectly good reason,” he said.
Staff writers

Question prompts:

• Based on Issue, News and Context, make a list of all the pros and cons of vaccinating Hong Kong children aged five to 11.

• Using the list you have made, elaborate on whether the benefits outweigh the risks of vaccinating this group of people.

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1. Covid-19 vaccine: a vaccine intended to provide acquired immunity against severe acute respiratory syndrome coronavirus 2 (Sars‑CoV‑2), the virus that causes coronavirus. In Hong Kong, the Chinese-produced Sinovac and German-made BioNTech vaccines are approved for use.

   According to third-phase clinical trial results from manufacturers, the BioNTech was found to be 95 per cent effective, compared to 50.7 per cent for Sinovac.

2. BioNTech vaccine: uses messenger RNA (mRNA) technology. It teaches our cells to produce a protein that triggers our immune system to recognise the virus that causes Covid-19 and produce antibodies to fight it.

3. Sinovac vaccine: uses unreactive coronavirus particles to stimulate our cells to produce antibodies as an immune response. Other common vaccines that use similar methods include the polio, hepatitis A and rabies vaccines.

4. Multisystem inflammatory syndrome in children: also known as MIS-C. This is a rare but serious illness that can occur after Covid-19 infection and affects mostly school-age children. It causes different body parts such as the heart, lungs or brain to become inflamed.

5. Off-label use: refers to the use of pharmaceutical drugs for a medical condition or age group it is not approved to treat, or in an unapproved dosage or method of administration