Nearly a year on since the first COVID-19 vaccine jab was administered in New Zealand, children aged between 5 and 11 will become eligible on Monday to receive their first shot.
More than half a million doses of the children's Pfizer vaccine - a paediatric version of that which adults received - arrived in New Zealand last weekend ahead of the rollout.
The vaccine has been through a rigorous testing process. It's been approved - and rolled out - in a number of countries overseas. It has received the thumbs up from Medsafe as being both safe and effective for the age group, and signed off by Cabinet who took the advice of New Zealand's COVID-19 Technical Advisory Group.
They're a group of health professionals from across the country assessing COVID-19, the vaccines and the best responses to the pandemic.
About 476,000 children will become eligible on January 17 for their first dose with their second dose available eight weeks later. Parents or legal guardians will need to accompany their children to their vaccine appointment to provide consent, but the vaccine is free.
But, as a Government-commissioned survey in December highlights, getting children vaccinated can make some parents anxious.
The poll found more than a quarter of caregivers were reluctant or unsure about whether they'd have their kids jabbed.
Paediatrician Dr Danny de Lore told Newshub that, as a parent, he understands the uncertainty. But he encourages parents to consider both the direct and indirect benefits of having their children vaccinated.
The direct benefit that Dr de Lore speaks of is regarding the child's individual health.
Children typically experience no symptoms or only mild symptoms if they catch COVID-19, but there have been cases when youngsters have got very unwell with the virus, including in New Zealand.
Ministry of Health data shows that of 14,848 people who are recorded as having COVID-19 in New Zealand, 2504 were younger than 10 and 2214 were aged between 10 and 19. Of those in the lower age bracket, 45 were hospitalised. One Kiwi child with COVID-19 has died, though the exact cause of death is unclear.
"It's really clear that COVID is more dangerous, much more dangerous, because of the risk of developing illness that will lead to you going to hospital or having life-threatening illness, even for children," Dr de Lore said. "Even though that's rare, we know that that does happen for a proportion of children."
A study published on Wednesday in the Journal of the American Medical Association followed 10,300 children tested for COVID-19 at emergency departments across 10 countries, including in New Zealand.
Of about 3200 children who tested positive for COVID, 107 (or 3 percent) had severe outcomes, including cardiac issues like myocarditis and respiratory problems, and 745 (23 percent) were hospitalised. Four children died.
Professor Stuart Dalziel, the study author from the University of Auckland, said this is important information ahead of the children's vaccine rollout as it highlights the severity of illness some children with COVID-19 face and "dispels the myth children are being vaccinated solely to protect adults".
"There is a perception that COVID-19 is only a very mild infection in children," said Prof Dalziel. "However, as the pandemic has progressed, we are seeing greater numbers of children being infected and presenting to hospital worldwide. Unfortunately, for some of these children, COVID-19 results in severe disease."
Clinical trial results amongst those aged between 5 and 11 found the Pfizer vaccine was 90.7 percent effective against getting COVID-19 symptoms and no participants had severe COVID-19.
While having children vaccinated to reduce the chances of them catching COVID-19 and passing it on to loved ones is not the sole reason for them to be jabbed, it is still a major consideration. That's particularly noteworthy when considering kids are about to head back to school, which have had outbreaks in the past.
"You can have schools or other places where children congregate, where that just becomes a hub of infection and that can be part of a transmission chain that ends up with a child who has chronic illness or a child who is on immunosuppression or to adults who have similar risk factors for severe disease," Dr de Lore said.
Paedatrician Dr Owen Sinclair told Newshub he views vaccinating children as the final step in a strategy of creating a "wrap-around web of protection".
"The process of immunising our entire community, including children, is a way of protecting everyone," he said.
"It's a way of protecting themselves, it's a way of protecting the friends, it's a way of protecting their whanau, their classmates and trying to keep the world as normal as possible so that we can stop COVID ravaging through our community and keep on doing the things that we want to do."
Dr Sinclair, who works for the Waitematā DHB, said vaccinating children and therefore protecting the community also helps "stop our health system getting completely overwhelmed".
"If our hospitals are completely overwhelmed and bombarded, if people, children, elderly or anyone get other illnesses, it makes them much harder for them to access for those things. There are these other things we need to worry about rather than just the virus.
"It's harder for us working in hospitals when we have these massive surges of illness."
As with all medical treatments and vaccines, there are risks with the Pfizer COVID-19 vaccine.
However, the vaccine has been through a process both internationally and in New Zealand to ensure it is safe and effective for tamariki.
There can be some small side effects, like a sore arm after the injection or a headache, but more serious issues are very rare. In clinical trials, myocarditis, an inflammation of the heart, was not found to be a side effect amongst 5-11-year-olds.
But, as Dr de Lore notes, parents don't have to just consider the results of medical trials, but can instead also look at real-world data.
"For the 5 to 11-year-olds, before Christmas, they had given seven million immunisations in the US and it's looking really safe and even the myocarditis, which is a concern for young adults and adolescents, it's very, very low rates of that in children reported so far much, much lower than young adults.
"There's actually very little in terms of risks to young children that we're seeing so far. It's looking like a really safe vaccine."
A report released by the US Centers for Disease Control and Prevention on December 31 looked at reports of adverse effects from the Pfizer vaccine among those aged between 5 and 11.
After 8.7 million doses of the vaccine had been administered in this age group, authorities received 4249 reports through their Vaccine Adverse Event Reporting System, with 4149 (or 97.6 percent) not being serious. Most reports related to how the vaccine was administered while serious events included fever and vomiting.
There were 12 reports of seizure and 11 verified reports of myocarditis. All 11 children with myocarditis were recovering or had recovered at the time the report was released. Two deaths were reported, but no link was found between the vaccine and the deaths.
According to research, such as that done by Oxford University researchers, people are up to 40 times more likely to get myocarditis after contracting COVID-19 than after being vaccinated.
Weighing risks and benefits
Dr Sinclair recognises some parents are still concerned and shared a personal story about what he considered ahead of the vaccination of his 13-year-old son.
"If we just put the myocarditis risk in context, and it is a risk-benefit calculation that people have to do, if your child gets COVID they are 10 to 20 times more likely to get myocarditis. It's almost certainly going to be a worse sort of myocarditis than if they got the immunisation.
"Those are the things I weighed up, particularly with my 13-year-old son who was born with cardiac disease. We had a discussion about this and we decided that the controlled way of giving him the immunisation was a much safer thing for him and provided much more protection than the risk of a wild type, uncontrolled COVID infection that he might get."
Dr de Lore said the risk of not being vaccinated "really dramatically outweighs the risk of being vaccinated".
"Definitely much more likely to get those sorts of problems, myocarditis or the other effects, risky things that happen with COVID, it's much more likely to happen with COVID than with the vaccine. It's dramatically different. From both ways of looking at it, direct and indirect, it's really heavily weighted in favour of vaccination."
Speaking to those you trust
As much as information from scientists and health professionals can help ease concerns, some people wish to learn from those they trust in their own community.
Dr de Lore and Dr Sinclair, both Māori paediatricians, said encouraging that dialogue is important.
"What I would encourage Māori to do, just as I would encourage everyone, is to go and speak to someone they trust and they know very well," said Dr Sinclair. "For school aged children, there's a number of people, it could be your GP, it could be a kaumatua, but the other service that's going to be very good on this is school."
He said a homogenous message for everyone doesn't work in health and he hopes lessons have been learnt from issues with the vaccine rollouts to Māori adults last year that messages need to be tailoured for specific audiences.
Dr de Lore agreed, saying that there is a network of Māori health providers set up to help their people on the ground.
"They are really well placed now to deliver 5 to 11 year old vaccinations to that community. I'm just really impressed with how advanced and professional and knowledgeable a lot of the groups that I've been communicating with are.
"If you want to achieve equitable outcomes, you have to deploy your resources to where you're going to get the best return and for Māori for Maori the children, Māori communities, that means investing a lot of those resources, which is having the data available, which is having management systems or delivery systems."