SINGAPORE - My son turned five in the middle of last month.
It meant that besides growing another year older, he would also be eligible for vaccination against Covid-19.
Singapore approved the Pfizer-BioNTech vaccine for children aged five to 11 a few days before his birthday. Was I enthusiastic about the news? Not exactly.
My son was four for most of 2021, so I never had to consider the possibility of him getting a Covid-19 jab. And he would be among the youngest in Singapore – and the world – to be vaccinated against the disease if we signed him up.
My husband and I are fully vaccinated. He has also received his booster and I am waiting for mine. But our initial reaction to the news was still apprehension.
Why was the qualifying age five, and not six? Does a five-year-old child's body and immune system work the same way as an 11-year-old pre-teen?
I was also concerned as my son has a lifelong medical condition known as primary bile acid synthesis disorder. It is a rare genetic disorder that requires him to be on daily medication to supplement his body with cholic acid, which it does not produce naturally.
What the science says
So far, the vaccine has been shown to be safe for young children, and the United States Centres for Disease Control and Prevention (CDC) granted unanimous approval for the Pfizer/BioNTech vaccine to be given to kids aged five to 11.
Pfizer and BioNTech said their vaccine showed 90.7 per cent efficacy against the coronavirus in a clinical trial of children aged five to 11. According to the US Food and Drug Administration, no serious side effects were detected among more than 3,000 children in the age group who received the vaccine.
Common side effects included a sore arm, fatigue, headache, fever and swollen lymph nodes. These were generally mild to moderate and most went away within one or two days.
Separately, as at Dec 30, the CDC has reported 11 cases of myocarditis, an inflammatory heart condition, among children aged five to 11 who got the vaccine. The cases were mild and found among over eight million vaccine doses given at the time that the data was examined.
Why parents are hesitant
In Singapore, about 20,000 children have received their first dose since Dec 27, the first day of the vaccination exercise for younger kids. As at Jan 2, more than 60 per cent of Primary 4 to 6 pupils have registered for the vaccination.
Children younger than that will get their jabs from early January.
The data looks good, and many adults have had the vaccine themselves, so why do some parents remain uneasy?
Some feel the studies done so far are insufficient. Doctors say that there is no reason to believe that the jab has any effects on children's long-term development. But they also say only time will tell whether this is certain.
Hence some parents are choosing to wait and see, hoping that more data will be released soon. I am curious to see the results of local trials like the one by KK Women's and Children's Hospital, which is conducting a study to assess the antibody levels and immune responses in children aged five to 11 who receive the vaccine.
I know of parents who worry that the Covid-19 shot might interact with existing conditions their kids have, such as allergies, asthma or eczema.
Some see the adverse reactions that happened among adolescents and adults, and wonder if their child would be an outlier too, even if the risk is extremely low.
Others think that children are not exactly a high-risk group in terms of Covid-19, and wonder if the risks of potential unknown side effects in the long run outweigh the risk of Covid-19 disease itself.
These sentiments are not unique to parents in Singapore – polls done overseas have shown that parents are a divided group and a proportion of them are undecided.
Dealing with uncertainty
The chances of any adverse reactions to the vaccine are very low, but we are no stranger to rare occurrences, with my son's five-in-a-million condition.
We wrote to his specialist doctor to ask if he would be medically eligible and she gave the green light.
Still, some fears may not be entirely rational. I asked my husband last week what he felt about all these trains of thought. Something he said stuck with me: In the end, we are making the decision based on imperfect knowledge.
We will never know the answers to some questions, no matter what the doctors or experts say.
We do not know for sure how all children will react to the jab – as is the case for adults –but we know that they, too, can contract Covid-19, and Singapore is seeing more children below 12 being infected in recent months. Even if their symptoms are mild, they can also pass on an infection to vulnerable people, like their grandparents.
We know that vaccination can prevent infection and transmission to a certain extent.
But by far, the most important outcome of vaccination seems to be that it greatly reduces the odds of developing severe illness.
According to a National Geographic article in November, paediatric cardiologists agree that cardiac complications seen with multisystem inflammatory syndrome (MIS-C) as a result of a Covid-19 infection are more serious than the myocarditis seen from the vaccine.
MIS-C is a condition where different body parts, including the heart, lungs, kidney, brain and eyes, can become inflamed. A handful of cases have been found here.
The doctors in the article said they had encountered more severe heart issues among kids and teens from Covid-19 than from the vaccine.
We also know that Singapore is preparing for a new wave of Omicron cases, and the mRNA vaccines have been found to be effective in protecting against severe illness caused by this variant.
We also discovered that five is not a magic number, but that children that age are eligible for the jab because the age group of five to 11 was used in the clinical trials.
Making a choice
The health and education ministries organised a webinar to address parents' questions about the vaccine last month (December). It drew some 700 participants who asked about the vaccine's safety among other topics.
More of such sessions can help to allay parents' fears and address their concerns, instead of their instinctively being judged or dismissed as being "overprotective".
Ultimately, the decision is for every family to make, and it is understandable that normally decisive adults would hesitate to take the same risks for their children as for themselves, given the lack of perfect knowledge.
No one wants his or her child to be exposed to harm.
For the same reason, we will eventually sign our son up for vaccination in the year ahead, having read a little on the risks and benefits, and in the absence of more data to show why we should not do so.
We have seen how Covid-19 cases in his childcare centre have disrupted learning now and then, and we would like for him to be better protected, so that he also does not bring home the virus.
This is important to us as we live with my parents, who are in their 60s and 70s. We also do not want our younger eight-month-old daughter to fall sick and be hospitalised.
While it may seem like a logical decision for some, it is not one that we made easily. We make decisions for our children regularly and this was not one that could be taken lightly.