Covid and our Kiwi Kids - Part 2

'Two Shots for Summer' was the New Zealand government's edgy tag line to get young people vaccinated. The only problem was that it was contrary to the health advice.

Photo by Fusion Medical Animation on Unsplash

‘Two Shots for Summer’

By early October 2021 the media started to run stories that promoted the New Zealand government’s new Covid line - ‘Two Shots for Summer’ - meant to encourage all young people to get their two doses of Pfizer vaccine in order to be able to enjoy their summer with some freedoms after months of lockdown.

One such article in RNZ began: “That’s the edgy, and somewhat boozey, tag line the government’s relying on to encourage better vaccination rates in our younger population”.

The only problem was that that was not what the government’s technical experts were recommending. In fact, the minutes from the 7 December meeting of the Covid-19 Technical Advisory Group (CV TAG) and its subsequent memo setting out their recommendations to government represented their strongest worded advice during all of 2021. Minutes from 7 December state:

An update was provided on the memo advising that those aged under 18 should not be required to have two doses of vaccine under vaccine mandates.

• CV TAG does not want to see two doses of vaccine absolutely required to under 18s to be able to work

• STA outlined the current status of the draft memo, aimed at clarifying the CV TAG advice that vaccine mandates should not apply to those under 18

• Policy, health, legal and crown law will continue working with STA and CV TAG

On 9 December the Chair of CV TAG, Dr Town, issued a strongly worded memo setting out the medical advice of our experts to the Director-General of Health, Dr Bloomfield. It was titled ‘COVID-19 Vaccine Technical Advisory Group (CV TAG) position statement: Vaccination mandates in those under 18 years of age’.

It has ramifications not only for people under 18 who were subject to workplace mandates but also for children who were subject to ‘quasi-mandates’ that restricted their access to sports and after-school activities, amongst other things.

I have set the memo out below as it needs to be read in order to gauge its full import.

The memo notes that initial advice was provided by CV TAG to Bloomfield on 11 November which highlighted that “younger age groups are more at risk than older age groups of myocarditis after the second dose of Pfizer vaccine, while a robust antibody response and early limited clinical effectiveness data indicate some protection from COVID-19 after a single dose of Pfizer vaccine in these younger age groups”.

It goes on to state “consequently, CV TAG expressed concern about vaccine mandates requiring younger age groups (e.g. <18 years) to be vaccinated with 2 doses of the Pfizer vaccine and stated: ‘consideration should be given to permitting younger people who have had one dose to be permitted to work or undertake other activities covered by the mandate’. This particular detail has not been carried through to the implementation of this advice”.

CV TAG notes “the individual risk to young people of severe disease is very low. For them to make an informed decision not to get a second dose of the vaccine eg, due to potential myocarditis risk is justified.”

“Risks associated with the transmission of COVID-19 throughout Aotearoa New Zealand among those aged <18 years are insufficient to justify mandating a 2 dose schedule of the Pfizer vaccine prior to working in any environment.”

“The 2 dose schedule, particularly when administered in the shortest possible clinical timeframe, may add unnecessary risk to increasing the likelihood of myocarditis as an outcome in this population.”

The memo concludes by recommending “Those aged <18 years only being required to have received 1 dose of Pfizer vaccine to meet the vaccine requirements for employment.”

Together with its earlier memo of 21 July recommending an eight week dose interval to the under 30s, this memo of 9 December seems to most accurately represent CV TAG’s views on the vaccination of young people and teenagers. Importantly it refers to informed decision-making although it is surprising that this didn’t feature more prominently in earlier discussions.

Coincidently, on 15 November - 4 days after CV TAG had provided its initial advice to Dr Bloomfield regarding what ‘fully vaccinated’ meant and which recommended a single dose for the under 18s - National’s Chris Bishop asked Minister Hipkins, via a Written Parliamentary Question, whether he was aware that some countries only vaccinated children aged 12 to 15 with a single dose of Pfizer vaccine. The response from Hipkins was that “the decision to use two doses of the Pfizer vaccine in children aged 12 to 15 years old was based on Medsafe approval and expert advice provided by the Covid-19 Vaccine Technical Advisory Group.”

How does Hipkins reconcile his answer with the advice provided by CV TAG to Dr Bloomfield on and from 11 November (i.e. before Bishop’s question was asked) which culminated in the 9 December memo set out above? Or with CV TAG’s recommendation on 21 September that the decision to vaccinate all children aged 12 to 15 be revisited or that a single dose for that age group be considered?

The paediatric vaccine for children aged 5 to 11

By way of contrast, the current Ministry of Health recommendations for vaccination of 5 to 11 year olds is two paediatric doses, eight weeks apart. This is consistent with the advice of CV TAG which specifically required the eight week dose interval to address the myocarditis risk.

The CV TAG memo dated 15 December 2021, titled ‘Decision to use the Pfizer mRNA COVID-19 vaccine for children aged 5-11 years: COVID-19 Vaccine Technical Advisory Group (CV TAG) recommendations’ addressed to Dr Bloomfield states:

There may also be a connection between shorter intervals and increased reactogenicity or adverse events, and one pre-print paper on individuals aged 12 and over has shown a statistically significant increase in myocarditis if the second dose was given at a shorter interval of less than 30 days. Australia and Canada have recommended an 8-week interval between doses for 5-11 year olds, noting this may improve immunogenicity and reduce side effects. Having a longer interval would also allow greater time to monitor international safety data.

The approval of the paediatric vaccine was challenged in the Wellington High Court last year in MKD & Seven Others v Minister of Health. It was a judicial review which required Dr Bloomfield to submit written affidavits to the Court. In his affidavit dated 10 June 2022 Dr Bloomfield notes that CV TAG recommended that the paediatric vaccine be rolled out to children aged 5 to 11. In paragraphs 51 and 52 of Bloomfield’s affidavit he states:

In accepting CV TAG’s recommendation in December 2021, I asked CV TAG to undertake a formal safety review in February 2022 to confirm the recommended eight-week interval between doses.

CV TAG provided me with its updated recommendations on 16 February 2022. A copy of CV TAG’s memorandum to me is annexed and marked ARB-17. CV TAG confirmed that a minimum eight-week interval between doses was appropriate.

Indeed CV TAG’s memo dated 16 February 2022, titled ‘Use of the paediatric Pfizer COVID-19 vaccine in 5-11 year-olds – second dose and dosing interval: COVID-19 Vaccine Technical Advisory Group (CV TAG) recommendations’ does reconfirm the rationale for the eight week dose interval, stating:

The manufacturer’s recommended schedule for the paediatric Pfizer vaccine is 2 doses, 3 weeks apart.

Research conducted in adults into extending the dosing interval (e.g., to 8 weeks or longer) has shown that longer intervals between the first and second Pfizer dose can lead to higher humoral and cellular immune responses, improved vaccine effectiveness, and potentially a longer duration of protection compared with the standard interval. In addition, data from adults show that an extended dosing interval may also reduce the risk of myocarditis and pericarditis after vaccination.

Extended dosing intervals has not yet been studied in children, but it is expected that similar effects would be observed to those after extended dosing intervals in adults, such as improved immunogenicity and the potential for a lower risk of serious side effects. The recommendation for an 8-week interval between doses is consistent with other international advisory groups, such as in the UK, Canada, and Australia.

In paragraphs 63 and 64 of his June 2022 affidavit, Bloomfield states:

I am a medical practitioner and public health medicine specialist by training. The whole point of the Covid-19 Immunisation Programme is to protect the health and well-being of New Zealanders. There is no prospect that I would have recommended that a vaccine be rolled out to children, if I did not consider that it was supported by the expert scientific and medical advice.

I accepted and agreed with the advice of CV TAG which recommended that this vaccine be offered to all children aged 5 to 11 years. That advice was noted by Cabinet.

Bloomfield’s statement is obviously political rhetoric of little meaning but nevertheless it is a justification that he uses to defend the government’s position.

Can Dr Bloomfield, as the Director-General of Health at the time, sign an affidavit confirming that he accepted and agreed with the advice of CV TAG to extend the dose interval for people under the age of 30 to at least eight weeks in order to reduce their risk of myocarditis, or that he accepted and agreed with the advice of CV TAG that the under 18s should only be required to have a single dose for the purpose of workplace mandates? Perhaps he can or perhaps he can’t.

Either Bloomfield didn’t accept these recommendations, or he did and they weren’t adopted by Cabinet.

What we know with certainty is that the Prime Minister’s claim that the New Zealand government followed the advice of our medical experts on these issues is not accurate.

Questions for the Ministry of Health

The issues set out above clearly raise serious questions regarding the government’s implementation of New Zealand’s Covid-19 vaccination programme during the second half of 2021.

In particular it affects those people in the 12 to 30 year old age group.

It raises serious questions about the manner in which workplace mandates were implemented for those people under the age of 30 and whether a longer dose interval should have been permitted.

It raises serious questions about the manner in which vaccine passports were implemented for children under the age of 18 and whether they should have been permitted a single dose. This concern extends to the operation of ‘quasi-mandates’ that restricted children’s access to sports and after-school activities, whether they were enforced by private enterprises or via the government’s traffic light orders.

It calls into question whether the New Zealand government diligently followed the advice of its medical experts as it claimed, or whether it cut corners on matters of safety as it juggled competing pandemic strategies.

It also calls into question whether the government communicated with the public in a manner which was consistent with the health advice that it was receiving from its experts and which adequately described to the public the risk of myocarditis, stratified by age and sex, so that fully informed consent could be obtained.

I contacted the Ministry of Health last week for comment. Their response was that they had decided to treat my questions as an Official Information Act request and would therefore revert within the relevant statutory time period. I will publish their response if and when I receive it.