As the pediatrician removed the needle from the 4-year-old boy's arm, he gently praised the child as he sat on his mother's lap.
"All done. You were brave," the doctor said at a vaccination center for children in Minato Ward, Tokyo, on Tuesday morning.
The ward was among the local governments that started administering COVID-19 vaccinations for children aged between 6 months and 4 years that day. About 20 children accompanied by their parents or caregivers visited the vaccination center.
"Children lick their toys and they can't wear masks," said a 29-year-old woman who took her 1-year-old son to get his shot. "I've heard that even young children are at risk of getting seriously ill, so I wanted to get him immunized as soon as I could."
However, the vaccination rate among children has remained low. The nation's vaccination program was expanded to include children aged from 5 to 11 in February, but only 20% of children in this age bracket had received their first shot as of Monday. This is significantly lower than the vaccination rate of 76% for children aged 12 to 19.
In a survey the Tokyo metropolitan government conducted on 2,400 caregivers of children aged 5 to 11 in April, 61% of respondents indicated an unwillingness to have their children vaccinated. Some respondents said they "did not want their children vaccinated," and others said they "want to watch how the situation unfolds and think more about it."
The most common reasons cited for not wanting their children immunized were concerns about side effects and doubts over the vaccine's effectiveness. Dispelling these concerns will be key to boosting the vaccination rate.
Changing views
This reluctance to vaccinate appears to have been influenced by the government's initial decision to exempt children aged 5 to 11 from a legal provision that requires people to make efforts to get vaccinated.
The government made this decision because clinical trials were conducted in the summer of 2021, when COVID-19's delta variant was dominant, and there was insufficient data on the vaccine's effectiveness against the omicron variant. In September, the government had accumulated enough data to change tack and state that people now had a duty to endeavor to get children vaccinated.
In August, the Japan Pediatric Society also changed to a more positive stance on vaccinating children aged 5 to 17 against the novel coronavirus. Instead of saying these vaccinations are "meaningful," the society now "recommends" children in this age bracket get jabbed. The society is preparing to adopt an approach that recommends younger children also get vaccinated.
However, Niigata University Prof. Akihiko Saito, a council member at the society, suggested these steps might not be enough.
"The significance of the changed approach taken by the government and the Japan Pediatric Society has not been properly conveyed to the public," Saito said. "The view that children are unlikely to catch the virus, and will suffer only mild symptoms if they do, has become deep-rooted."
Infection risk rising
The risk of children catching COVID-19 is growing.
According to the Health, Labor and Welfare Ministry, children aged under 10 accounted for 7% of cases during the fifth wave of infections. This proportion jumped to 16% during the sixth wave and 13% during the seventh wave, about the same as for other age brackets.
Alongside this growing number of cases is a noticeable emergence of severe symptoms and deaths. According to the National Institute of Infectious Diseases, 41 people aged under 20 died after contracting COVID-19 between January and August this year. Details about 29 of these cases are known, and of these, the majority had no serious underlying health condition.
Furthermore, 15 of the 29 were old enough to be vaccinated, but only two had received their shots.
"The aim of vaccinating to prevent serious illness is the same for these children," Saito said. "The government and local authorities need to carefully explain the risks and advantages of getting vaccinated."
In September, the Hyogo prefectural government established a dedicated consultation service to help boost understanding among parents and caregivers. Minato Ward also has implemented such measures as setting up a 24-hour consultation counter for parents who have vaccinated their children.
Young children get inoculated against chicken pox and receive the BCG vaccine used against tuberculosis, among other shots. Adding the coronavirus to the congested vaccination schedule presents another problem. Children aged from 2 months to 2 years receive at least eight routine vaccinations for free. Many of these vaccines involve three or four shots. An interval of at least 13 days is needed between receiving a coronavirus inoculation and other shots, except for the influenza vaccine.
"Taking steps to combat the coronavirus is important, but so are regular vaccinations that can save lives," said Tadashi Kataoka, a pediatrician and a board member of Know VPD, a nonprofit organization that conducts activities to raise awareness about vaccine-preventable diseases among children.
"If a parent is struggling to coordinate their child's vaccination schedule, they should discuss the matter with a pediatrician," Kataoka said. "If possible, children who spend a lot of time around others at places such as nursery school should get vaccinated."
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