The Israeli Ministry of Health’s Vaccination Advisory Committee voted overwhelmingly – 73 out of 75 members – to recommend vaccinating five- to 11-year-olds against Covid-19.

Israeli HMO clinics began offering the shots November 22, following the arrival of child-specific doses of the Pfizer-BioNTech vaccine over the previous weekend.

“The reason for vaccinating children mentioned in all our discussions is their own health, nothing else,” said committee member Dr. David Greenberg at a recent press conference, laying to rest the notion that the primary consideration is to protect adults.

Greenberg is chief of the Pediatric Infectious Disease Unit of Soroka University Medical Center in Beersheva, professor of pediatrics and infectious diseases at Ben-Gurion University’s medical school and a member of the Israel National Vaccine and Infectious Disease Advisory Board.

“Vaccination rates in Israel are really high, but the epidemiology shows that 55 to 60 percent of all confirmed cases in the last wave were in children under 19 and mainly under 11 years of age. This includes many hospitalizations and complications,” Greenberg said.

Although Covid-19 usually causes mild symptoms in children, he added, “many children get infected, so even if 1% get seriously ill it’s a lot of children.”

Long Covid

Moreover, Ministry of Health data show that up to 47% of recovered children are suffering “long Covid” effects such as loss of concentration, sleep disturbances and muscle aches.

“We are treating many recovered children in our outpatient clinic who had a mild case. We even had asymptomatic children who ended up [later] in intensive care,” said Greenberg.

A mathematical model presented to the committee predicted that if Israel had started vaccinating five- to 11-year-olds in July 2021, some 100,000 cases of Covid-19 could have been averted as well as 13% of Covid-related deaths, said Greenberg, “but this was not the reason we decided to recommend it.”

“As a vaccinologist, I believe prevention is better than cure. We don’t want anyone to be infected and then medicated. This disease causes death and long-term complications,” said Greenberg.

Will parents hesitate?

The committee’s discussions were guided by available data on the vaccine, outlined in a document published by the Israeli Society for Pediatric Infectious Disease, he added.

Pediatric infectious disease expert Dr. David Greenberg. Photo courtesy of Soroka University Medical Center

“We really believe in the vaccine and its efficacy and safety because of the data,” he said.

He was referring to data Israel has gathered on vaccinated 12- to 17-year-olds as well as Pfizer data indicating 91% efficacy in disease prevention among five- to 11-year-olds, which led the United States to approve the vaccine for emergency use in this age group in late October.

The Pfizer study did not look at vaccine-related myocarditis, a short-term and uncommon side effect seen more in ages 16-19 than in 12-15, said Greenberg.

But because the dosage for ages five to 11 is one-third of the adult dose, the Israeli committee believes “there will be fewer adverse events and it will be even safer for this young group.”

Greenberg acknowledged that many parents may want to wait for follow-up studies on how younger children react to the inoculation.

“I think 50 to 60 percent of parents will vaccinate their children in the next month or so, and more will do it when there is some data. We will collect all the data and will publish it as soon as possible,” he said.

“We are not forcing anyone to be vaccinated; we are recommending it loud and clear. We are willing to have parents make the decision and we will help them do that by providing as much information as we can.”

The Ministry of Health plans to reach out to leaders of Arab and ultra-Orthodox Jewish communities – which Greenberg said had the highest incidence of disease and low vaccination coverage — to explain the recommendation to parents.

The world is watching

“We are not the first country to recommend vaccinating children ages five to 11,” said Greenberg.

“One million of them are already vaccinated in the US. We’ll be the fourth or fifth country to implement the recommendation, depending on when the actual vaccinations begin.”

However, having lectured in European and South American countries about the Covid vaccine in children, Greenberg said he knows that “others are looking at our decisions and processes and they want to learn from our experiences based on the quality of data to be published.”

Future data also will help answer unresolved questions to guide Israeli and world policy, including whether children will need booster shots and when.

“I believe we’ll need it … but we’ll have to follow the serology and epidemiology to make that decision,” Greenberg said, noting that 4 million adult Israelis have gotten the booster.

Another question regards children who have recovered from Covid-19.

“We know that those who recovered need to be vaccinated,” said Greenberg. “The amount of time after recovery until vaccination, and whether to vaccinate once or twice, is still to be decided.”