Connect with us

Features

Covid-19 vaccines for very young children

Published

on

Dr B.J.C.Perera 

MBBS(Cey), DCH(Cey), DCH(Eng), MD(Paed), MRCP(UK), FRCP(Edin), FRCP(Lon), FRCPCH(UK), FSLCPaed, FCCP, Hony FRCPCH(UK), Hony. FCGP(SL) 

Specialist Consultant Paediatrician and Honorary Senior Fellow, Postgraduate Institute of Medicine, University of Colombo, Sri Lanka.

In any immunisation programme against an infective disease, the aim is to vaccinate as many of the susceptible population as possible. That is a fundamental principle in epidemiology. There is absolutely no question in the minds of the experts that in the case of the raging COVID-19 pandemic that is causing havoc right round the globe now, there is universal susceptibility of all humans of all nations, all populations and all social groups of the people of planet earth to this miserable blight. There are no worthwhile differences in the ethnic groups, age categories and socio-economic assemblies in their actual propensity for contracting the disease. The virus will get in and infect anyone anywhere. There are only differences in the severity of the illness and the tendency to die from the disease in certain well-understood categories or age groups of people.

It is a well-recognised fact that the coronavirus disease may be quite asymptomatic in a vast proportion of affected youngsters of all age groups, ranging from very young pre-schoolers to adolescents and even young adults. In another significant though rather small proportion of children and young people, the symptoms are quite mild. Only in a very small minority, perhaps as low as 1 to 2 percent of affected children, is the disease is of such severity as to need intensive treatment. In the United States of America, a proportion varying from 0.01% to 1.9% of all affected children needed hospitalisation. Their death rates in children in different states has varied between zero to about 0.25% of all deaths in all age groups from COVID-19. However, this has varied somewhat in different countries due to individual susceptibilities, coexistent other diseases and of course the ‘variants of concern’ such as the Delta strain, as described by the World Health Organisation (WHO).

With all this in mind, one might wonder as to why experts are advocating vaccination of children against COVID-19. After all, it does not seem to be as much of a major problem in children as it is in adults and the elderly. In addition, up to now, there have been only scarce amounts of data regarding the safety and effectiveness of the vaccines in children and it was difficult to arrive at a definitive conclusions regarding the requirements to vaccinate children and young people.

There is no question as to the need to vaccinate susceptible children, such as those who have co-morbid diseases, as they are more likely to get severe complications and die from the disease. Yet for all that, what about the need to vaccinate the other healthy children? In answer to that, there are a few other observations that need to be addressed. Children are more susceptible to catch the disease by virtue of the surroundings that they have to be kept in the classrooms of schools, the risks of catching the disease during travel to school in crowded public or private transport vehicles as well as the inevitable congregations of significant numbers of them in schools and playing fields. Those children who contract the virus can spread the disease even if they are asymptomatic. One must also remember that children and young people form a significant proportion of the population of any country and to arrive at the 70% coverage of the population as the Gold Standard for herd immunity, it is necessary to think of vaccinating them as well.

We, in this emerald isle, have now vaccinated children with comorbidities which make them that much more vulnerable and susceptible to die. Currently children over 15 years and up to 19 years are being vaccinated with the Pfizer vaccine with the trade name “Comirnaty”. As this vaccine is licensed for Emergency Authorisation Usage in children over the age of 12 years, it is most likely that Sri Lankan children from 12 to 15 years may also be vaccinated soon. That decision will be made after careful consideration of several medical details. In contrast to the Pfizer Comirnaty vaccine, the Oxford AstraZenica vaccine is currently licensed to be used only in persons above the age of 18 years. Results of some on-going research trials in the usage of that vaccine in those under 18 years of age are awaited.

The burning question in medical circles at present is what about children under the age of 12 years. Should they be vaccinated? A few weeks ago, closer to a month or so, Pfizer Inc., submitted the data of their clinical trials on the efficacy and safety of their Pfizer Comirnaty vaccine directly to the United States Food and Drug Authority (FDA) for licensing its usage for children over five years of age. They submitted the data before they were peer-reviewed and published in any research journal. That modus operandi came under some flak as the company has a previous history of concerns being expressed in medical circles as a company that uses ‘aggressive pharmaceutical marketing’ and was also alleged to have been involved in several other ethical misdemeanours (https://en.wikipedia.org/wiki/Pfizer).

However, in this instance, Pfizer appears to stand vindicated because the results of the study have now been published in the reputed New England Journal of Medicine on 09th November 2021. It is an on-going research study in children over six months of age, going up to 11 years of age. The paper presents very convincing data in children over five years of age going up to 11 years. The company has not provided analytical data for children under five years of age. The entire project consists of an Open-Label Phase 1 dose-finding study, together with on-going Phase 2 and 3 randomised placebo-controlled studies.

In the Phase 2–3 trial, participants were randomly assigned in a 2:1 ratio to receive two doses 21 days apart of either the Pfizer BNT162b2 Comirnaty vaccine at the dose level of 10-μg, identified during the open-label Phase 1 study, or placebo, respectively. Immune responses 1 month after the second dose of the vaccine were immunologically bridged and compared to those in 16-to-25-year-olds from the pivotal trial of two 30-μg doses of BNT162b2. Vaccine efficacy against Covid-19 at seven days or more after the second dose was assessed. They also looked at the adverse effects profile and the researchers found no significant incidence of any serious side-effects of the vaccine, including even the rare myocarditis and pericarditis.

Based on the results, the researchers concluded that “A Covid-19 vaccination regimen consisting of two 10-μg doses of BNT162b2 administered 21 days apart was found to be safe, immunogenic, and efficacious in children five to 11 years of age”. It must be noted that the dose used is one third of the 30-μg dose used for adults and the elderly. In addition, one may speculate that Pfizer had decided to present the data directly to the FDA before the paper was published in a journal because of the unavoidable delay in publishing the accepted articles in scientific medical journals. One could now well understand that as a reason for the pathway that Pfizer Inc., had elected to take in the very recent past.

Taking into account all this information, the local experts in the medical field will have to make appropriate decisions regarding COVID-19 vaccination in children under the age of 15 years. It will necessarily involve serious consideration being given to many complex aspects of the entire scenario. It would indeed be a daunting task for the decision-makers, very specially the Sri Lanka College of Paediatricians, which is the premier academic organisation principally involved in child healthcare. However, it must be unequivocally stated that a prerequisite for such decisions would be the mandatory licensing of any vaccine against COVID-19 by internationally recognised licensing authorities for the under 12-year age group.


  • All News Advertisement





Continue Reading
Click to comment

Leave a Reply

Your email address will not be published. Required fields are marked *

Features

Relief without recovery

Published

on

A US airstrike on an Iranian oil storage facility

The escalating conflict in the Middle East is of such magnitude, with loss of life, destruction of cities, and global energy shortages, that it is diverting attention worldwide and in Sri Lanka, from other serious problems. Barely four months ago Sri Lanka experienced a cyclone of epic proportions that caused torrential rains, accompanied by floods and landslides. The immediate displacement exceeded one million people, though the number of deaths was about 640, with around 200 others reported missing. The visual images of entire towns and villages being inundated, with some swept away by floodwaters, evoked an overwhelming humanitarian response from the general population.

When the crisis of displacement was at its height there was a concerted public response. People set up emergency kitchens and volunteer clean up teams fanned out to make flooded homes inhabitable again. Religious institutions, civil society organisations and local communities worked together to assist the displaced. For a brief period the country witnessed a powerful demonstration of social solidarity. The scale of the devastation prompted the government to offer generous aid packages. These included assistance for the rebuilding of damaged houses, support for building new houses, grants for clean up operations and rent payments to displaced families. Welfare centres were also set up for those unable to find temporary housing.

The government also appointed a Presidential Task Force to lead post-cyclone rebuilding efforts. The mandate of the Task Force is to coordinate post-disaster response mechanisms, streamline institutional efforts and ensure the effective implementation of rebuilding programmes in the aftermath of the cyclone. The body comprises a high-level team, led by the Prime Minister, and including cabinet ministers, deputy ministers, provincial-level officials, senior public servants, representing key state institutions, and civil society representatives. It was envisaged that the Task Force would function as the central coordinating authority, working with government agencies and other stakeholders to accelerate recovery initiatives and restore essential services in affected regions.

Demotivated Service

However, four months later a visit to one of the worst of the cyclone affected areas to meet with affected families from five villages revealed that they remained stranded and in a state of limbo. Most of these people had suffered terribly from the cyclone. Some had lost their homes. A few had lost family members. Many had been informed that the land on which they lived had become unsafe and that they would need to relocate. Most of them had received the promised money for clean up and some had received rent payments for two months. However, little had happened beyond this. The longer term process of rebuilding houses, securing land and restoring livelihoods has barely begun. As a result, families who had already endured the trauma of disaster, now face prolonged uncertainty about their future. It seems that once again the promises made by the political leadership has not reached the ground.

A government officer explained that the public service was highly demotivated. According to him, many officials felt that they had too much work piled upon them with too little resources to do much about it. They also believed that they were underpaid for the work they were expected to carry out. In fact, there had even been a call by public officials specially assigned to cyclone relief work to go on strike due to complaints about their conditions of work. This government official appreciated the government leadership’s commitment to non corruption. But he noted the irony that this had also contributed to a demotivation of the public service. This was on the unjustifiable basis that approving and implementing projects more quickly requires an incentive system.

Whether or not this explanation fully captures the situation, it points to an issue that the government needs to address. Disaster recovery requires a proactive public administration. Officials need to reach out to affected communities, provide clear information and help them navigate the complex procedures required to access assistance. At the consultation with cyclone victims this was precisely the concern that people raised. They said that government officers were not proactive in reaching out to them. Many felt they had little engagement with the state and that the government officers did not come to them. This suggests that the government system at the community level could be supported by non-governmental organisations that have the capacity and experience of working with communities at the grassroots.

In situations such as this the government needs to think about ways of motivating public officials to do more rather than less. It needs to identify legitimate incentives that reward initiative and performance. These could include special allowances for those working in disaster affected areas, recognition and promotion for officers who successfully complete relief and reconstruction work, and the provision of additional staff and logistical support so that the workload is manageable. Clear targets and deadlines, with support from the non-governmental sector, can also encourage officials to act more proactively. When government officers feel supported and recognised for the extra effort required, they are more likely to engage actively with affected communities and ensure that assistance reaches those who need it most.

Political Solutions

Under the prevailing circumstances, however, the cyclone victims do not know what to do. The government needs to act on this without further delay. Government policy states that families can receive financial assistance of up to Rs 5 million to build new houses if they have identified the land on which they wish to build. But there is little freehold land available in many of the affected areas. As a result, people cannot show government officials the land they plan to buy and, therefore, cannot access the government’s promised funds. The government needs to address this issue by providing a list of available places for resettlement, both within and outside the area they live in. However, another finding at the meeting was that many cyclone victims whose lands have been declared unsafe do not wish to leave them. Even those who have been told that their land is unstable feel more comfortable remaining where they have lived for many years. Relocating to an unfamiliar area is not an easy decision.

Another problem the victims face is the difficulty of obtaining the documents necessary to receive compensation. Families with missing members cannot prove that their loved ones are no longer alive. Without official confirmation they cannot access property rights or benefits that would normally pass to surviving family members. These are problems that Sri Lanka has faced before in the context of the three decade long internal war. It has set up new legal mechanisms such as the provision of certificates of absence validated by the Office on Missing Persons (OMP) in place of death certificates when individuals remain missing for long periods. The government also needs to be sensitive to the fact that people who are farmers cannot be settled anywhere. Farming is not possible in every location. Access to suitable land and water is essential if farmers are to rebuild their livelihoods. Relocation programmes that fail to take these realities into account risk creating new psychological and economic hardships.

The message from the consultation with cyclone victims is that the government needs to talk more and engage more directly with affected communities. At the same time the political leadership at the highest levels need to resolve the problems that government officers on the ground cannot solve. Issues relating to land availability, legal documentation and livelihood restoration require policy decisions at higher levels. The challenge to the government to address these issues in the context of the Iran war and possible global catastrophe will require a special commitment. Demonstrating that Sri Lanka is a society that considers the wellbeing of all its citizens to be a priority will require not only financial assistance but also a motivated public service and proactive political leadership that reaches out to those still waiting to rebuild their lives.

 

by Jehan Perera

Continue Reading

Features

Supporting Victims: The missing link in combating ragging

Published

on

A recent panel discussion at the University of Peradeniya examined the implications of the Supreme Court’s judgement on ragging, in which the Court recognised that preventing ragging requires not only criminal penalties imposed after an incident occurs but also systems and processes within universities that enable victims to speak up and receive support. Bringing together perspectives from law, university administration, psychology and students, the discussion sought to understand why ragging continues to persist in Sri Lankan universities despite the existence of legal prohibitions. While the discussion covered legal and institutional dimensions, one theme emerged clearly: addressing ragging requires more than laws and disciplinary rules. It requires institutions that are capable of supporting victims.

Sri Lanka enacted the Prohibition of Ragging and Other Forms of Violence in Educational Institutions Act No. 20 of 1998 following several tragic incidents in universities, during the 1990s. Among the most widely remembered is the death of engineering student S. Varapragash at the University of Peradeniya in 1997. Incidents such as this shocked the country and revealed the consequences of allowing violent forms of student hierarchy to persist. The 1998 Act marked an important legal intervention by recognising ragging as a criminal offence. The law introduced severe penalties for individuals found guilty of engaging in ragging or other forms of violence in educational institutions, including fines and imprisonment.

Despite the existence of this law for nearly three decades, prosecutions under the Act have been extremely rare. Incidents continue to surface across universities although most are not reported. The incidents that do reach university administrations are dealt with internally through disciplinary procedures rather than through the criminal justice system. This suggests that the problem does not lie solely in the absence of legal provisions but also in the ability of victims to come forward and pursue complaints.

The tragic reminders; the cases of Varapragash and Pasindu Hirushan

Varapragash, a first-year engineering student at the University of Peradeniya, was forced by senior students to perform extreme physical exercises as part of ragging, resulting in severe internal injuries and acute renal failure that ultimately led to his death. In 2022, the courts upheld the conviction of one of the perpetrators for abduction and murder. The case illustrates not only the brutality of ragging but also how long and difficult the path to justice can be for victims and their families. Even when victims speak about their experiences, they may not always disclose the full extent of what they have endured. In the case of Varapragash, the judgement records that the victim told his father that he was asked to do dips and sit-ups. Varapragash’s father had testified that it appeared his son was not revealing the exact details of what he had to endure due to shame.

More than two decades after the death of Varapragash, the tragedy of ragging continues. The 2025 Supreme Court judgement arose from the case of Pasindu Hirushan, a 21-year-old student of the University of Sri Jayewardenepura, who sustained devastating head injuries at a fresher’s party, in March 2020, after a tyre sent down the stairs by senior students struck him. He became immobile, was placed on life support, and returned home only months later. If the Varapragash case exposed the deadly consequences of ragging in the 1990s, the Pasindu Hirushan case demonstrates that universities are still failing to prevent serious violence, decades after the enactment of the 1998 Act. It was against this background of continuing institutional failure that the Supreme Court issued its Orders of Court in 2025. Among the key mechanisms emphasised by the judgement is the establishment of Victim Support Committees within universities.

Why do victims need support?

Ragging in universities can take many forms, including verbal humiliation, physical abuse, emotional intimidation and, in some instances, sexual harassment. While all forms of ragging can have serious consequences, incidents involving sexual harassment often present additional barriers for victims who wish to come forward. Victims may hesitate to complain due to weak institutional mechanisms, fear of retaliation, or uncertainty about whether their experiences will be taken seriously. In many cases, those who speak out are confronted with questions that shift attention away from the alleged misconduct and onto their own behaviour: why did s/he continue the conversation?; why did s/he not simply disengage, if the harassment occurred as claimed?; why did s/he remain in the environment?; or did his/her actions somehow encourage the accused’s behaviour? Such responses illustrate how easily victims can be subjected to a second layer of scrutiny when they attempt to report incidents. When individuals anticipate disbelief, minimisation or blame, silence may appear safer than disclosure. In such circumstances, the presence of a trusted institutional body, capable of providing guidance, protection and support, become critically important, highlighting the need for effective Victim Support Committees within universities.

What Victim Support Committees must do

As expected by the Supreme Court, an effective Victim Support Committee should function as a trusted institutional mechanism that places the safety and dignity of victims at the centre of its work. The committee must provide a safe and confidential point of contact through which victims can report incidents of ragging without fear of intimidation or retaliation. It should assist victims in understanding and pursuing available complaint procedures, while also ensuring their immediate protection where there is a risk of continued harassment. Recognising the psychological harm ragging may cause, the committee should facilitate access to counselling and emotional support services. At a practical level, it should also help victims document incidents, record statements, and preserve evidence that may be necessary for disciplinary or legal proceedings. The committee must coordinate with university authorities to ensure that complaints are addressed promptly and responsibly, while maintaining strict confidentiality to protect the identity and well-being of those who come forward. Beyond responding to individual cases, Victim Support Committees should also contribute to broader awareness and prevention efforts, within universities, helping to create an environment where ragging is actively discouraged and students feel safe to report incidents. Without such support, the process of pursuing justice can become overwhelming for individuals who are already dealing with the emotional impact of abuse.

Making Victim Support Committees work

According to the Orders of Court, these committees should include representatives from the academic and non-academic staff, a qualified counsellor and/or clinical psychologist, an independent person, from outside the institution, with experience in law enforcement, health, or social services, and not more than three final-year students, with unblemished academic and disciplinary records, appointed for fixed terms. Further, universities must ensure that committees consist of individuals who possess both expertise and genuine commitment in areas such as student welfare, psychology, gender studies, human rights and law enforcement, in line with the spirit of the Supreme Court’s directions, rather than consisting largely of ex officio positions. If treated as routine administrative positions, rather than responsibilities requiring specialised knowledge, sensitivity and empathy, these committees risk becoming symbolic rather than functional.

Greater transparency in the appointment process could strengthen the credibility of these committees. Universities could invite expressions of interest from individuals with relevant expertise and demonstrated commitment to supporting victims. Such an approach would help ensure that the committees benefit from the knowledge and dedication of those best equipped to fulfil this role.

The Supreme Court judgement also introduces an important safeguard by giving the University Grants Commission (UGC) the authority to appoint members to university-level Victim Support Committees. If exercised with integrity, this provision could help ensure that these committees operate with greater independence. It may also help address a challenge that sometimes arises within institutions, where individuals, with relevant expertise, or strong commitment to addressing issues, such as violence, harassment or student welfare, may not always be included in institutional mechanisms due to internal administrative preferences. External oversight by the UGC could, therefore, create opportunities for such individuals to contribute meaningfully to Victim Support Committees and strengthen their effectiveness.

Ultimately, the success of the recent judgement will depend not only on the directives it issued, the number of committees universities establish, or the number of meetings they convene, or other box-checking exercises, but on how sincerely those directives are implemented and the trust these committees inspire among students and staff. Laws can prohibit ragging, but they cannot by themselves create environments in which victims feel safe to speak. That responsibility lies with institutions. When universities create systems that listen to victims, support them and treat their experiences with seriousness, universities will become places where dignity and learning can coexist.

(Udari Abeyasinghe is attached to the Department of Oral Pathology at the University of Peradeniya)

Kuppi is a politics and pedagogy happening on the margins of the lecture hall that parodies, subverts, and simultaneously reaffirms social hierarchies.

by Udari Abeyasinghe

Continue Reading

Features

Big scene … in the Seychelles

Published

on

Mirage: Off to the Seychelles for fifth time

Several of our artistes do venture out on foreign assignments but, I’m told, most of their performances are mainly for the Sri Lankans based abroad.

However, the group Mirage is doing it differently and they are now in great demand in the Seychelles.

Guests patronising the Lo Brizan pub/restaurant, Niva Labriz Resort, in the Seychelles, is made up of a wide variety of nationalities, including Russians, Chinese, French and Germans, and they all enjoy the music dished out by Mirage, and that is precisely why they are off to the Seychelles … for the fifth time!

The band is scheduled to leave this month and will be back after three weeks, but their journey to the Seychelles will continue, with two more assignments lined up for 2026.

In August it’s a four-week contract, and in December another four-week contract that will take in the festive celebrations … Christmas and the New Year.

Donald’s birthday
celebrations

According to reports coming my way, it is a happening scene at the Lo Brizan pub/restaurant, Niva Labriz Resort, whenever Mirage is featured, and the band has even adjusted its repertoire to include local and African songs.

They work three hours per day and six days per week at the Lo Brizan pub/restaurant.

Donald Pieries:
Leader, vocalist,
drummer

Led by vocalist and drummer Donald Pieries, many say it is his

musical talents and leadership that have contributed to the band’s success.

Donald, who celebrated his birthday on 07 March, at the Irish Pub, has been with the group through various lineup changes and is known for his strong vocals.

He leads a very talented and versatile line up, with Sudham (bass/vocals), Gayan (lead guitar/vocals), Danu (female vocalist) and Toosha (keyboards/vocals).

Mirage performs regularly at venues like the Irish Pub in Colombo and also at Food Harbour, Port City.

Continue Reading

Trending