India is going ahead with Covid-19 vaccine trials for children as young as two amid concerns that further mutations of the coronavirus could potentially have a serious impact on them.
Two Indian companies - Bharat Biotech and Zydus Cadila - are at the forefront of trials on children and teenagers, who are currently not eligible for vaccination.
Trials of Bharat Biotech's Covaxin have started for children aged between two and 18 at multiple hospitals, including the All India Institute of Medical Sciences (AIIMS) in Delhi and Patna.
A total of 525 children will be enrolled in the Covaxin trials.
At Patna AIIMS, more than 25 children have received a first dose of the vaccine, with the second dose due 28 days later. The children have been divided into three age groups - between 12 and 18, six and 12, and two and six - in the trials.
It is estimated that vaccines could be made available to children in about six months although Dr C.M. Singh, medical superintendent of AIIMS Patna who is leading the trials at the institute, believes it could be sooner.
"Once there is sufficient evidence that the vaccine is safe for children, there can be emergency approval. It could be that the vaccine will be in the market in three months, though completion of the trial will take 208 days," he told The Straits Times.
In January, Covaxin was approved for emergency use on adults even before the completion of trials.
Separately, Zydus Cadila is testing its Covid-19 vaccine on children aged between 12 and 18, as well as adults.
A senior government official said the firm could apply for a vaccine licence as soon as two weeks.
India went through a devastating second wave that has been attributed to the more infectious and deadly Delta variant of the coronavirus. But the number of infections has come down from a peak of more than 400,000 a day. The figure was 92,596 cases in the 24 hours up to yesterday. India's total caseload stands at 29.1 million.
Dr Bakul Jayant Parekh, a member of the Indian Academy of Paediatrics Covid-19 Task Force, said an analysis of government data indicated that infections among children went up in the second wave.
In the first wave, 3 per cent of total infections were among those below 18, but this figure more than doubled to 6.8 per cent in the second wave, he said. He attributed the jump to greater exposure of children to the virus, which is more infectious.
While around 90 per cent of infected children remain asymptomatic or develop only mild symptoms, Dr Parekh, a paediatrician based in Mumbai, said children are nonetheless "super spreaders" and, if left unvaccinated, can spread infections to vulnerable elderly members of their family.
"Vaccinating children will also ensure that India reaches herd immunity faster because those below the age of 18 account for around a third of the country's population," he told The Straits Times.
Schools have remained mostly shut since March last year, and the possibility of them reopening hinges on vaccination because many parents are waiting for their children to be immunised before sending them back to classes.
Many Indian states have begun priority vaccination for parents with children below the age of 12, in an effort to protect the young.
Dr Digant Shastri, a paediatrician based in Surat, Gujarat, described this as a good strategy and suggested that teachers and other school staff also be vaccinated if schools were to reopen before children are immunised.
"Opening schools before a proper vaccine is offered for children, or before herd immunity develops, can bring chances of cross-infection among children," Dr Shastri said.
Still, a key issue is vaccine availability, said NITI Aayog member for health, Dr V.K. Paul. Vaccinating children between the ages of 12 and 18 alone would require around 260 million doses. Demand is already outstripping supply for the adult population, he noted.
"We can't have some people getting and others not getting," he said at a recent briefing.