Vaccinating children is a nice gesture but a bad plan

As the world races to achieve immunity from Covid-19 with effective vaccination drives, immunisation campaigns are in progress in Bangladesh as well—albeit with some hiccups. We all remember how the government's special mass vaccination campaign—between August 7 and August 12—ended in a disappointing disarray, as a lot of the vaccine seekers were turned away due to shortage of supply.

Despite the limitations and uncertainties in the vaccine supply chain, the government is now contemplating inoculating adolescents aged 12-17 years (it had earlier lowered the bar for vaccination of students to 18). This comes as the government is set to reopen schools and colleges in phases starting from next week. Since March 2020, all educational institutions have remained shuttered and been only operating online to tackle the spread of Covid-19.

While the adolescent inoculation plan is still in the pipeline—awaiting recommendation from World Health Organization (WHO) and the country's National Technical Advisory Committee (NTAC) on Covid-19—the plan raises certain questions. First of all, how safe are vaccines for children? Only a handful of countries around the world have opted to or thought of vaccinating children, including the US, the UK and some other European countries. And only the Pfizer-BioNTech vaccine has been recommended by the WHO Strategic Advisory Group of Experts on Immunization to inoculate children as young as 12.

However, in July, the British government decided against vaccinating most children—except those at higher risk of contracting Covid-19, including those with Down syndrome, immunosuppression, learning disabilities—due to lack of sufficient safety data. The decision was based on advice by the country's Joint Committee on Vaccination and Immunisation. The British government has yet to take a final call with regard to adolescent vaccination, but a decision is expected within days.

As of September 5, 2021, the Reuters Covid-19 Tracker suggests that "Bangladesh has administered at least 27,715,325 doses of Covid vaccines so far. Assuming every person needs two doses, that's enough to have vaccinated about 8.5 percent of the country's population." With only less than 10 percent of the country's eligible population vaccinated (by Reuters's estimate), how wise it is to start offering vaccine shots to children remains a question.

While it is understandable that more and more children are contracting the Delta variant of the coronavirus, and reopening school would expose them further, the infection and fatality rates remain much higher among the adults.

Moreover, the people belonging to the lower rungs of the social ladder—those who do not have the means to register for the vaccines or are largely not aware of its importance—remain outside immunisation coverage. Many of them work in factories or in the overall informal sector, and with the lockdowns lifted, they have to go to work—every day. As long as these people remain unvaccinated, they—along with their co-workers, families, and neighbours—will remain at a high risk of getting infected by Covid-19.

These people should remain at the top of the government's Covid-19 inoculation plan, along with aged people with comorbidities and frontline fighters. The government should specifically target the urban poor—day labourers, hawkers, low-paid workers, factory workers, construction workers, domestic workers, and others—for immediate vaccination. It is these people who have to brave the threat of Covid-19 every day and go outside of the house to earn their sustenance. Without bringing them under the vaccination coverage, offering vaccine to adolescents seems like a ludicrous idea, to say the least.

A case can even be made about the timing of reopening educational institutions, coming as it does amid the warning of another wave of Covid-19. Public health experts have recently expressed fear that the gross flouting of Covid-19 safety protocols by the masses might unleash a new wave of the disease in the country. This made the headlines in almost all the news outlets; the authorities concerned are also well aware of this concern. Even if the schools can be made to run under strict health protocols following reopening—which seems like the best course of action right now—that concern isn't going to go away. What is the government's plan in this regard? Do they even have one?

Another major bottleneck in inoculating children is the availability of the Pfizer vaccine. On September 1, the country received a shipment of one million doses of the Pfizer vaccine under the COVAX arrangement. However, it is not clear when the next batch would arrive and what the quantity would be. With this limited number of doses, how many children does the government plan to inoculate? How would the government do the mapping? What is the adolescent inoculation strategy? Who would get the shots first?

Moreover, even if the government secures sufficient doses of the Pfizer vaccine to inoculate all the adolescents in the country—and that's a big "if", mind you—it would be a mammoth challenge for them to take the vaccine to the children at the grassroots level as we lack sufficient storage facilities for the Pfizer-BioNTech vaccine, which requires a cold-chain facility for storage.

With the 26 special fridges received from Unicef, the country now has the capacity to store more than 10 million doses of the Pfizer vaccine, but would that be sufficient to cover all 64 districts? And how are the adolescent children going to register for the vaccine, especially those who do not have access to internet facilities? How is the government going to keep track of whom they are vaccinating? These are important questions that need to be assessed and answered before we embark on a vaccination plan for adolescents.   

Since the beginning of its mass Covid-19 vaccination programme, Bangladesh has gone through myriad obstacles and about-faces, often as a consequence of a lack of sound planning. From the failure of the Serum Institute of India (SII) to keep its end of the bargain by ensuring constant supply of the Oxford-AstraZeneca vaccine to the country as per agreement, to the recent debacle of the mass vaccination drive in August, which had to be stopped due to the shortage of shots—the fiascos don't seem to end. In the middle of all these struggles, this new adolescent vaccination plan seems impractical, logistically speaking. Also, the government needs to rethink its plan to reopen educational institutions if it's going to take the same laissez-faire attitude to enforcement of health guidelines that it has demonstrated after lifting the lockdowns and reopening the economy.

Any reopening of schools and colleges, and even universities, without strict and sustained enforcement of the health safety protocols will inevitably increase the risk of exposure to the coronavirus for the students. And with all the chaos going on in terms of vaccination supply and delivery, the least the government can do is revisit its Covid-19 immunisation programme to make it more realistic, science-based and ambitious only to the extent necessary, and to cover on a priority basis the already vulnerable adults, rather than enabling the creation of a new vulnerable category: students.

Vaccinating children, as the heading of an analytical report by The Daily Star puts it succinctly, is a plan simply "divorced from reality." We shouldn't jump on the bandwagon simply because some countries, who are far more capable and prepared than us, have decided to do so, and because doing so will most likely mean taking away vaccines from the more deserving ones.

Tasneem Tayeb is a columnist for The Daily Star.

Her Twitter handle is @tasneem_tayeb