We welcome the recommendations of the Indian Academy of Pediatrics Advisory Committee on Vaccines and Immunization Practices (IAP-ACVIP) during the COVID-19 pandemic [1]. These recommendations are likely to assuage the doubts of pediatricians as well as parents. The Government of India is planning to layout the distribution of COVID-19 vaccine soon. In such times, the guidance from IAP-ACVIP regarding immunization of children with the COVID-19 vaccine is much desirable.

Recently a few vaccines have completed phase 3 trials and are likely to be available for the general population very shortly (Phase 4) [2]. Though the efficacy of these vaccines is impressive in trials among adults, there is apprehension for their safety and efficacy in children. Recently a group of experts stated that the wait shall be prolonged for the pediatric age group due to the lack of clinical trials of COVID-19 vaccine in children and their vulnerable status [3]. However, explicit guidance from the Government of India on this aspect is not yet available. It is high time that the panel considers it as an urgent public health issue and advocates the right decision for children that is based upon robust scientific evidence and strong ethical aspects.

In a scientific view, the decision for vaccination should depend upon the overall disease prevalence and associated mortality and morbidity. For COVID-19, all these three aspects are relatively less severe in children, though due to the unknown status of the long-term implications, the situation remains grave. Another scientific aspect is the efficacy and safety of the vaccine in a given population. Unfortunately, similar to other therapeutic trials for COVID-19, the children are ostracized from vaccine trials too. Hence, this data is lacking at present and is unlikely to be available in the next few months.

The ethical view advocates that the decision must be coherent with the principles of medical ethics (non-maleficence and beneficence, equity, justice, fairness, and transparency) [4]. All of the principles except non-maleficence and beneficence advocate for the equal share of children among COVID-19 vaccine recipients. In ethics, non-maleficence and beneficence supersede others therefore; vaccinating children cannot be advised unless it has been proven safe.

Since we have a large amount of short-term data on the implications of COVID in children, there is a need to analyze it properly to make an informed decision. Once, phase 4 vaccination trials begin, and we have sufficient data about its safety and efficacy in the general population, children should be enrolled in the ongoing vaccine trials. The results of the phase 3 trial done in children will serve as the best guide for further decision making.

The role of IAP has always been instrumental in all national policies about children. Now it’s time to continue that advocacy by giving its representation to the national steering committee for the COVID vaccine so that the children are not ostracized again.

1. Kasi SG, Dhir SK, Verma S, et al. Immunization During the COVID-19 Pandemic: Recommendations from Indian Academy of Pediatrics Advisory Committee on Vaccines and Immunization. Indian Pediatr. 2020;57:1147-52.

2. Zimmer C, Corum J, Wee S-L. Coronavirus Vaccine Tracker. The New York Times. 2020. Accessed on December 5, 2020. Available from: https://www.nytimes. com/interactive/2020/ science/coronavirus-vaccine-tracker.html

3. Fauci JM. COVID-19 vaccines for children must ‘strike a balance’. AAP News. 2020. Accessed as of December 5, 2020. Available from: https://www.aappublications.org/news/2020/10/03/nce2020fauci100320

4. Bell BP, Romero JR, Lee GM. Scientific and ethical principles underlying recommendations from the advisory committee on immunization practices for COVID-19 vaccination implementation. JAMA. 2020;324:2025-26.