Doctors divided on covid19 vaccines for primary school children

Health professionals are divided as to whether or not covid19 vaccination should be put on the list of required vaccines for children to attend school.

Paediatrician Dr David Bratt explained that vaccination against certain diseases to attend school became law after TT’s fourth and last polio outbreak in 1972.

In fact, the Public Health (Nursery Schools And Primary Schools Immunisation) Act became legislation in 1973 and was amended in 1975, 1993, and 1995.

It says, "Notwithstanding any rule of law to the contrary, no person may be admitted into any nursery school or primary school unless he produces to the principal thereof a certificate of immunisation with respect to every communicable disease, save that where a person produces a certificate of a medical practitioner certifying that immunisation against any particular communicable disease or communicable diseases is not advisable on medical grounds, no certificate of immunisation is required to be produced with respect to that communicable disease or those communicable diseases, as the case may be."

It added that any school principal who admits an unvaccinated student was liable to receive a $1,000 fine, and the schedule of vaccination could be amended by the Health Minister “from time to time.”

The schedule includes poliomyelitis (polio), diphtheria, tetanus, yellow fever, and measles.

Bratt said, “After 42 years in the business I can tell you vaccinations have helped. When I came back to Trinidad, although we were not seeing polio, we were seeing diphtheria, whooping cough, tetanus, measles, mumps, meningitis, brain-damaged children German measles, and so on.”

Even so, he does not believe in obligatory vaccination of children against chickenpox or flu as they are usually not serious for children under the age of 12.

He said all vaccines have side effects – some mild and some bad – but diseases also have side effects so parents should speak to their health care providers and decide on a course.

“You always have to weigh up the balance. Is giving the vaccine safer than having the disease? And that’s what we have to start doing with the covid too. We have to weigh how dangerous is covid for children as far as death is concerned and how dangerous are the long-term side effects as opposed to how good is the vaccine.”

He acknowledged that the covid19 vaccines have not been around long enough to be able to monitor long-term effects. But, he said the good thing is, vaccine side effects usually occur in the first few months after vaccination and generally do not have long-term side effects.

“The problem is the technology used to create some of these covid19 vaccines is relatively new technology. We think it’s going to be safe but we don’t know for sure so I understand why some people don’t want to give their children the vaccine.”

He noted that the Oxford-AstraZeneca and Janssen/Johnson & Johnson covid19 vaccines are vector vaccines, and Sinopharm and Sinovac are whole virus vaccines. Both types are established technology.

However, Pfizer-BioNTech, which is WHO-approved for use in children five years and over, and Moderna were messenger RNA (mRNA) vaccines that were created using newer technology.

Therefore, he said, covid19 vaccinations should not be mandatory for children but should be recommended especially for children with chronic diseases including asthma, leukaemia, epilepsy, and heart problems. Vaccination for healthy children should be discussed with the child’s doctor.

He added that he does not see a problem having both vaccinated and unvaccinated children learning together in the same space.

“A lot of people who have been vaccinated against chickenpox have immunity either because they got it as a child or were vaccinated so there is a level of herd immunity that is enough to disrupt the transmission, which probably is what’s going to happen with covid in the next few years with everybody getting covid.”

Infectious disease specialist Dr Peter Chin Hong, at the University of California, San Francisco, disagrees.

He believes it is risky to mix vaccinated and unvaccinated primary school children because, at that age, it may be difficult to enforce mask-wearing, social distancing and regular hand sanitisation.

“I think eventually that’s where it will settle down (placed on the childhood vaccination list). After the adults around the world become immune due to vaccination or getting the virus, it will become a childhood disease because everybody else would have immunity and the kids would be left vulnerable in the future.

“We can’t say what will happen because this virus has changed so many times, so it depends on what’s the next variants. We don’t know what they would look like so people are playing covid roulette with their children’s lives if they don’t get them vaccinated.”

He stressed that the main point of the vaccine is to prevent serious illness and death rather than preventing infection. He compared it to a property with a gate and a house. Covid19 may slip past the guards or anti-bodies at the gate and enter the property but the symptoms would be mild.

“The real power of the vaccines,” he said, is if covid19 tries to get in the house. The “guards” trained by the vaccine would either prevent the virus from entering or kick it out soon.

Chin Hong told Sunday Newsday there were discussions in the US as to whether or not to add the covid19 vaccination to the list required to enrol a child in public school.

Immunisations for diseases such as Hepatitis B, rotavirus, diphtheria, and polio are mandatory, but the specific vaccines required as well as exemptions differ from state to state.

According to the National Conference of State Legislatures website, all states allow for medical exemptions but California, Maine, Mississippi, New York and West Virginia do not grant religious or philosophical exemptions.

Chin Hong gave the example of California which has strict vaccination laws.

He said it is difficult to get any exemptions in California because there are many anti-vaxxers in the state leading to a measles outbreak that started in Disney Land a few years ago.

The state now has a law making covid19 vaccinations mandatory for students by the next school year if the FDA approves it for children ages five to 15 by that time.

Policymakers are also working on a bill that would allow children over the age of 12 to get vaccinated without parental consent and another would make getting exemptions even more difficult.

He said there is no federal or country-wide legislation, and many republican states oppose vaccine mandates.

“On one hand you have states trying to ban the institution of any mandate around covid vaccines while there are states trying to make these laws for covid vaccinations. In fact, one in three states is trying to make laws prohibiting it so it’s like a tug of war.”

There are also different rules for teachers and staff in different school districts as some states give the state health officer or department of health the authority to change school requirements through an administrative rule.

Concerning TT, Attorney General Faris Al-Rawi said the ministers of health and education were seeking views on the matter of vaccination regarding schools. He is focusing on vaccination in the public and private sector and therefore was not in a position to discuss the government’s options immediately.

“Those are policy considerations still to be entertained by the Cabinet and, of course, all the consultations that are going on right now would factor into all of these questions.”

The health ministry is currently in consultations on vaccinations of children 5-11.

However, one lawyer, who spoke on the condition of anonymity, said the legislation refers to a schedule of “communicable diseases” while President Paula-Mae Weekes' proclamation on January 31, 2020, declared covid19 a “highly infectious and dangerous disease.”

“The framework of the Public Health (Nursery Schools And Primary Schools Immunisation legislation that we have right now does not deal with anything that is not considered a communicable disease so that may be a sticking point.

“Mandatory vaccination of children as a prerequisite to attend school is not something that is unknown to the laws of TT. The question is if we do decide we want to go in that direction, what kind of legal substratum would we have to create to accomplish that?”

They added that public health laws straddle both law and science so they could not be certain, but they believe if that act is to be used to make covid19 vaccination mandatory for children to attend school, the law may have to be amended to make covid19 a communicable disease before it could be added to the schedule of vaccines.