Dmitry Lopushov: 'We will take the consent of both the parent and the teenager for vaccination against coronavirus'
Chief visiting epidemiologist of the Ministry of Healthcare of Tatarstan — on topical issues of anti-Covid-19 vaccination of children from 12 to 17 years
The first batch of the vaccine for teenagers Sputnik M has arrived in Tatarstan. Dmitry Lopushov, the chief visiting epidemiologist and specialist in vaccination prevention of the Ministry of Healthcare of Tatarstan, told Realnoe Vremya that children from 12 to 17 years old will be vaccinated with it already today, from Wednesday. Where and how teenagers will be vaccinated, how to sign up for vaccination, and whether it will be voluntary, as well as what contraindications there are — the doctor told in the interview with Realnoe Vremya.
Doctor Lopushov, what kind of drug has been delivered to Tatarstan for vaccination of adolescents against coronavirus?
It is the drug Gam-COVID-Vac M. The letter M means reduced antigen content. It is used to vaccinate children from 12 to 17 years old inclusive. Respectively — up to 17 years, 11 months and 29 days. We are starting to vaccinate this cohort in the near future in Tatarstan.
The prototype of the adolescent vaccine is Sputnik V. This is a vector in the form of adenovirus of the 5th and 26th type, in which separate parts of the coronavirus, specifically the S-protein, are embedded.
Is the concentration in Sputnik M reduced by five times compared to Sputnik V?
The concentration is really reduced. But it is impossible to say definitely, five or several times. The isolation of S-protein virus particles, which are part of the drug, implies an individual technological process. And it is impossible to talk about how many times the concentration is reduced.
What are the contraindications to vaccination of adolescents?
These are standard severe allergic reactions in the past, hypersensitivity to any component of the drug, as well as exacerbation of chronic diseases and acute infectious disease. Vaccination should be done against the background of complete health or remission of chronic diseases. This is the main condition clearly spelled out in the guidelines.
The letter M means reduced antigen content. It is used to vaccinate children from 12 to 17 years old inclusive. Respectively — up to 17 years, 11 months and 29 days. We are starting to vaccinate this cohort in the near future in Tatarstan
What side effects does vaccination cause?
Mainly fever in the first 2-3 days after vaccination and soreness at the injection site.
How many vaccines for teenagers are to be delivered to Tatarstan in total?
All subjects of Russia submit an application to the federal centre. One shouldn't think that this is a pilot project of Tatarstan on vaccination of adolescents. No, they ask us how much vaccine should be delivered to a particular subject. The application must be formed. For our part, we have submitted an application to cover 80% of the child population aged 12 to 17 years — this is about 200 thousand doses. The bar has been announced — in order for the virus to stop circulating, it is necessary to vaccinate up to 95% of the population, but according to the latest data, 80% is enough.
On January 22, the first batch of 2,880 doses arrived in the republic. In the coming days, the drug is going to be distributed to polyclinics of the republic. Approximately, it will be possible to start vaccinating teenagers from Wednesday.
Will vaccination of teenagers be voluntary? There is information that teenagers from 15 to 17 years old must give written voluntary informed consent on their own. What if there are disagreements between children and parents on this issue?
Yes, of course, vaccination against COVID-19 is voluntary. The peculiarity of this vaccination is that we must obtain consent from both parents and the person who is to be vaccinated. On the one hand, according to the law, we can only get consent from teenagers after the age of 15, without parental consent. But taking into account the wide public response, we will take the informed consent of both the parent and the teenager, starting from the age of 12. With any other vaccination, parental consent is not required after the child reaches the age of 15 — only the consent of one teenager is sufficient.
This is done so that there are no questions “Why didn't they ask us” and so on. So we have to get both the consent of the person to be vaccinated and their parents, although we are not required to do this by law. This is an additional item that emphasises the voluntary nature of vaccination.
If the parent gives consent, and the teenager is against it, or the teenager wants to get vaccinated, and the parent does not give consent, it means that in any such controversial situation vaccination will not be carried out.
The peculiarity of this vaccination is that we must obtain consent from both parents and the person who is to be vaccinated
Will children be vaccinated only in polyclinics?
So far, yes, on the basis of polyclinic institutions at the place of residence. The second stage will be schools. There are no clear dates for the involvement of schools, given that less than 3 thousand doses have been delivered to Tatarstan so far. So it is impractical to extend vaccination to a large number of schools. We also do not intend to extend the vaccination of adolescents to vaccination points. Still, this is not a mass category.
Many parents still doubt whether it is necessary to vaccinate children. They claim that the vaccine for teenagers is still being tested on volunteers, but the drug has already been put into circulation.
The vaccine enters civil circulation only after the completion of preclinical trials and the end of the 1st and 2nd phases of clinical trials. This is the basis for the vaccine to be introduced into a wide civil circulation. Now the 3rd phase is continuing.
Monitoring continues throughout the use of any vaccine. This applies in principle to any drug. While the drug or vaccine is being used, they continue to be monitored.
Are more and more children getting infected with COVID-19 in Tatarstan now? What proportion of the infected are teenagers?
Yes, now children are getting infected more often. In the total structure of cases, children from 0 to 18 years old occupy 10 percent of the total number of infected. However, there are no reliable statistics on how many of them are teenagers from 12 to 17 years old. We will get the full picture after the end of the next rise in morbidity.
There are no clear dates for the involvement of schools, given that less than 3 thousand doses have been delivered to Tatarstan so far. So it is impractical to extend vaccination to a large number of schools
How do children experience the disease, do they often need hospitalisation?
A lot depends on individual characteristics. Even the same high temperature is tolerated by children in different ways. If a child gets to the hospital, usually it is hospitalisation for several days to relieve the high temperature caused by the new coronavirus infection, after which the child is discharged. As for children with health disorders, COVID-19 is quite difficult for them. There were cases in Tatarstan when such children were placed on a ventilator. This mainly affects risk groups with chronic diseases. In general, COVID-19 for children is an increase in temperature, colds of the type of viral respiratory infections and pneumonia in a small percentage of cases.
Then why is vaccination of adolescents necessary if they experience the disease easily enough?
Any vaccine works in three directions: to prevent the disease, limit the spread and eliminate the virus. If we talk specifically about the coronavirus, vaccination works to prevent the disease, however, not in full. But in any case, vaccinated people get sick much easier.
As for limiting the spread, children are the source of infections. Due to their age characteristics, they cannot fully comply with isolation and restrictive measures. It is almost impossible to force a small child to put on and wear a mask, observe social distance. In this case, by vaccinating children against COVID-19, we significantly reduce the circulation of the virus among them. Eliminating the disease — there is such goal of general vaccination. That is why we involve three such directions.
By reducing the circulation of the virus among adolescents, and ideally we should vaccinate all children, and this is what we are going to do, we will reduce the spread of the virus in the population. It is possible that after a while there will be another vaccine for children from 5 years old, or we will get the test results and be able to lower the age limit for Sputnik M. In many foreign countries, children have been vaccinated since the age of 5. A nasal vaccine is also being developed in Russia, and it is possible that it can be used starting from the age of 6 months.
Children are a source of infections. Due to their age characteristics, they cannot fully comply with isolation and restrictive measures. It is almost impossible to force a small child to put on and wear a mask, observe social distance
What does it mean to include vaccination of adolescents from 12 to 17 years of age against coronavirus in the national vaccination calendar for epidemic indications?
To begin with, it is worth explaining that the national vaccination calendar is a regulatory legal act that sets the timing and procedure for vaccination. The national calendar is divided into two parts: the national calendar of preventive vaccinations of Russia and the national calendar of preventive vaccinations for epidemic indications. The national calendar includes vaccinations against 12 major infections. And vaccination against 18 infections is included in the calendar for epidemiological indications. At the same time, either persons who, by the nature of their activity, have a high risk of the disease, or persons with a complication of the epidermis are vaccinated.
Accordingly, vaccination against the new coronavirus infection is included in the calendar for epidemiological indications. The COVID-19 vaccine is indicated when the epidemiological situation worsens, when there is a massive rise in morbidity, as at present. Then there are grounds and the right to apply this vaccine to both adults and children. Previously, we did not vaccinate children against COVID-19 because there simply was no such vaccine.
What other vaccinations are included in the national calendar for epidemiological indications?
For example, vaccination against cholera, which belongs to the group of particularly dangerous infections. Normally, we don't vaccinate anyone against cholera. But if there is a deterioration of the epidemiological situation, which was observed for cholera in Kazan in the early 2000s, we begin vaccination against cholera. Vaccination against tularemia (zooanthroponous infection with natural nidality — ed.) is also included in the calendar for epidemiological indications. This disease is transmitted by rodents. In normal times, we vaccinate only people who work in meat processing plants, wool dressing, and so on.
Given the sentiments in society, can we assume how many teenagers will be vaccinated against COVID-19?
It's difficult to guess yet. We have started our work — we explain, we collect consent. And then we will consider.
Would you vaccinate your children against COVID-19?