FYI: Investigates

Vaccine trials begin for children

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A COVID-19 vaccine study began this week with children. But what for, when the virus mainly affects older people? FYI presenter Tilly Lockey investigated with a panel of young people – Ruby from Kettering, Oliver and Trey from London, Nikita from Walsall and Farrah from Pontypridd, Wales. They put their questions to Dr Grace Li, part of the Oxford University AstraZeneca vaccine team.

TILLY: The team behind the Oxford AstraZeneca vaccine is doing what’s known as a clinical trial. It’s to make sure that their vaccine also works for children as well as it works for adults. Right now, we’re being joined by one of the lead investigators in this, Dr Grace Li. And we’ve also got a panel of some of our own FYI viewers who have a lot of burning questions. I’m going to start by asking how exactly is this trial going to work?

DR GRACE LI: So we’re going to recruit 300 children aged between six and 17 years of age, based at four different centres. One of them is here is in Oxford. The other three are in Bristol, Southampton and St George’s in London. So we’re going to recruit 75 children from each of these places. We’re going to start off by enrolling teenagers who are aged between 12 and 17. So, older teenagers. And then after that, we’re going to recruit younger children aged between six and 11 years. And how the trial works is that we do what we call blinding, so we don’t let you know which vaccine you’re going to get in the trial. But we either give you the COVID vaccine or a different vaccine, the vaccine for the meningitis B infection, and then we compare those.

TILLY: Should this trial obviously be successful, when do you think children above the age of five will be able to get vaccinated?

DR GRACE LI: That’s a really good question. So the trial at the moment is meant to be running over approximately a year, so we’re going to take blood tests from children over the next 12 months or so. And, as we’ve seen in the adult trial, sometimes you can get some results early, and that means sometimes that the vaccine can be approved before the end of the trial. But, at the moment, we’re hoping that they will last a year.

TILLY: Now, let’s go ahead and take some questions from some of our viewers starting off with Ruby in Kettering.

RUBY: So, if all the adults are protected and most children don’t get very ill from coronavirus, should we actually make a vaccine for children?

DR GRACE LI: So, actually, in the first wave, you’re right, most people who got admitted to hospital were mostly grandparents and older people who got really sick. What we haven’t seen as much in the news is that there were a few children, mostly children who already had what we call pre-existing medical conditions. And, there were some who got very sick and got admitted to children’s intensive care. So, it might be that the vaccine is used in a really small group of children who are very vulnerable. Also at the moment, we’re still finding out quite a lot about how coronavirus affects both adults and children. We’re not sure, for example, whether there are long term effects of COVID on our health. There are some people who say they still have symptoms a couple of months later. And, also there are lots of other things we don’t know about how coronavirus spreads yet. And, so actually, this trial is going to look at how effective the vaccine is.

RUBY: And what if a child is afraid of needles? Will it be made compulsory for them to take the vaccine?

DR GRACE LI: You get vaccines when you’re in school as well. So, the majority of the time it’s down to an individual basis, isn’t it? So, I guess if you’d like to have the vaccine at school and you’re scared of needles, you’re allowed to refuse it in the same way as you refuse any other vaccine. But, for the majority of children, we hope that, because you’ve had vaccines before and you realise that they don’t hurt, this one won’t hurt any more than any other vaccine.

OLIVER: I know recently there’s been some concern about whether or not the Oxford vaccine will be able to defend against different strains of COVID around the world. Is that something that you’re potentially worried about?

DR GRACE LI: It’s not something that we’re going to be able to look at in this study. So the study is going to use the vaccine, the same vaccine which we used in the adult trials of the Oxford AstraZeneca vaccine 12 months ago. This trial is what we call the phase two trial. So it’s looking primarily at how safe the vaccine is. This trial isn’t actually going to look at how effective it is in terms of different variants. At the moment, I think we’re still gathering information on different variants. So it’s really hard to say right now. The UK is in this amazing position where we have some of the best sequencing and capabilities in the world. So I think that’s something we still need more information about.

OLIVER: And do you think that in regards to the future, that a vaccine would become perhaps a regular requirement in order to keep the spread of COVID down?

DR GRACE LI: Again, it’s something that we still are watching and waiting to see how the coronavirus behaves as it evolves. I’m sure you will have learned at school that viruses often try to escape from immunity. So they try and make sure that they can reproduce as effectively as possible. And one of those is to escape the immune response in the body. And we’re not entirely sure how the coronavirus is going to behave in this respect. So we are watching and waiting to see whether it’s going to turn into the sort of virus that might need a regular vaccine, or it might not. And it’s something we don’t quite know yet. And I think in the next six months, we’re going to find out a lot more.

NIKITA: I’m just wondering when everyone has been vaccinated, obviously adults and children, does that mean we can finally start living normal lives again, and this pandemic is over?

DR GRACE LI: That’s a really good question. At the moment, I’m sure all of you are aware that one of the biggest problems we have with the vaccine is the supply. So, if we could vaccinate everybody, absolutely everybody, then that possibly could be one reason why we might be able to get back to normal life. But, at the moment, vaccine supply is really what’s one of the biggest stumbling blocks to recovering from this pandemic. At the moment, that’s not something that we are able to really consider. And we have to really target certain parts of the population, the ones we know are the most vulnerable and the ones we know are the most likely to get really sick. We have to really prioritise those people because we just don’t have enough. We can’t make it fast enough for the whole world. So, at the moment, if there are children who are very vulnerable, as we mentioned, there are some children who have pre-existing medical conditions, then those are the ones who we should prioritise for vaccines.

NIKITA: And when I do get this vaccine, will I have any side effects from it?

DR GRACE LI: So, if you are enrolled in the trial we’re starting this week, and if you did receive the COVID vaccine, the side effects we’d expect to be very similar to adults. So, I’m sure you’ve also read in the news about some of the side effects that adults get. So some of them might feel a little bit of pain at the site where you inject the vaccine and others might have a bit of a temperature or you have some muscle aches shortly after. But, often these only last for a couple of days and often they are better after you take some paracetamol. So they’re very similar to all the other side effects that you get when you take other vaccines.

FARRAH: Will it be dangerous for kids to take part in the vaccine trial?

DR GRACE LI: So the vaccine trial that’s taking place now, we planned initially when we started all of the adult trials 12 months ago, so it was always our intention to do a trial on children. And, at the moment, we’ve got safety data from over 25,000 adults, both in the UK, in Brazil and also in South Africa as well. So, we’ve got data from 25,000 adults, which shows that the vaccine is really safe and works really well in adults. So, that makes us really confident that actually there will be almost no safety concerns when we’re going into a trial with children. So we don’t expect there to be any concerns, no. And, the way that safety is monitored in the study is that we very carefully watch and we ask people to put into a diary any side effects that they might have from the vaccine. And, if there are any worries at all, then we obviously chat and we think about whether or not we can get on with the study.

FARRAH: And will we need vaccines every year as a sort of top up, or would one just be enough for a lifetime?

DR GRACE LI: So, we’re not sure about this yet because we’re not sure about the way that the COVID will behave as it evolves. As I mentioned earlier, that often viruses try and escape our immune responses by changing a little bit. So we’re not quite sure how coronavirus is going to change in the next six months. It might be that we need annual vaccinations, but we can’t be sure yet. So we have to do some more observations of the virus and how it behaves in the wild before we can decide.

TREY: So, what about the summer before children are vaccinated? Do you think it will be safe for us to go on holiday with our families?

DR GRACE LI: I think that’s the million dollar question that everyone would love to answer for this summer. I think there are a few questions that we really need to answer before we’re able to make any progress towards going on holiday and thinking about going back to school. And, one of them is really making sure that we’ve protected all the most vulnerable people. And so at the moment, we’re doing that by starting with the eldest people in the country and moving down to those who are least vulnerable. And, the next issue is thinking a bit more about knowing how it spreads. So, we still don’t know very much about how coronavirus spreads, and we’re still learning a lot about how it spreads from one person to another and especially around children because, although children don’t get very many serious symptoms from it, we know that there still might be some spreading and we’re still trying to figure that out. So we need to do a bit more research before we’re able to confidently say go back and go back to school and go back on holiday. I think we need a bit more time and a bit more information.

TREY: So they say children are asymptomatic, but we still spread the virus. So, would having the vaccine stop us from spreading the virus?

DR GRACE LI: That’s a really tricky experiment, actually, to prove. So, obviously, if you don’t have any symptoms but you spread it, it makes it really difficult to know which people to test. And this has been one of the biggest problems in the study so far. I’m sure some of you might have had friends or family when you get notes through the post asking you to do a swab regardless of whether you have symptoms? So, what they’re trying to do in those swabbing tests is to figure out how many people actually have COVID but don’t have any symptoms and how does that change across different ages. So, those tests that they’re sending out around the country, they’re testing different ages and different symptoms and trying to get a picture of how many people who actually do have COVID don’t have any symptoms. And, that’s an incredibly huge study to do, if you can imagine how many people you need to test and how many swabs you need to do every week. So, this is the biggest problem they’re trying to solve right now is what exactly does transmission look like? What sort of numbers are involved and what does this mean for school and going on holiday?

FARRAH: So BAME is stated to be more at risk, so there remains a concern in the black and minority ethnic community as to whether these trials will be safe. I’m just wondering if the clinical trials in children will have a diverse population tested.

DR GRACE LI: I’m really glad you asked that question. Absolutely. We’re really actively encouraging children from BAME backgrounds to be recruited into the study. So, on all of our promotional material and all of the websites, we clearly state that we really love anyone who’s from any minority background to take part. And, we have a website where you can sign up for the study and we really, really want you there.

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