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To beat side effects, Israel considers giving teens just 1 COVID vaccine dose

As US probes possible link between immunization and mostly mild heart problem, proposed compromise seen as way to dodge the risk while retaining shot’s effectiveness

Nathan Jeffay is The Times of Israel's health and science correspondent

In Orange County, America, where teenagers are already receiving COVID-19 shots, Max Cuevas, 12, holds his mother's hand as he receives the Pfizer COVID-19 vaccine (AP Photo/Jae C. Hong)
In Orange County, America, where teenagers are already receiving COVID-19 shots, Max Cuevas, 12, holds his mother's hand as he receives the Pfizer COVID-19 vaccine (AP Photo/Jae C. Hong)

Israel is considering giving children just one dose of the coronavirus vaccine, rather than the usual two, amid reports of mild health problems among some teenagers who received the COVID-19 immunization.

The possible change to regular inoculation protocol is being explored as US health officials probe several dozen reports of mostly mild heart problems — a condition called myocarditis — after young people received vaccines.

The Centers for Disease Control and Prevention’s vaccine safety group is investigating “relatively few” reports of the condition in vaccinated American young adults. The vaccines are believed to have come from Pfizer-BioNtech — the brand given to most Israelis — which is approved in the US for ages 12-plus, and Moderna, which is approved for those 18 and older.

In Israel, an April Health Ministry report into the side effects of the Pfizer-BioNtech vaccine raised concerns of a possible link between the second shot and several dozen cases of myocarditis.

The report said that 60 myocarditis patients were treated and released from the hospital in good condition. Two of the patients, who were reportedly healthy until receiving the vaccination, including a 22-year-old woman and a 35-year-old man, died.

Illustrative image: Middle school student Meredith Rogers, center, waits to receive her first coronavirus vaccination on Wednesday, May 12, 2021, in Decatur, Ga. Hundreds of children, ages 12 to 15, received the Pfizer vaccine at the DeKalb Pediatric Center, just days after it was approved for use within their age group. (AP Photo/Ron Harris)

Israel is sticking to its anticipated launch of teen vaccinations, with a delay of a few days thought to be due to the Israel-Gaza conflict. The first shots will be made available for 12- to 15-year-olds next week, according to coronavirus czar Nachman Ash.

But sources familiar with vaccination policymaking told The Times of Israel that a switch to a one-shot protocol is likely, as the cases of myocarditis are believed to have occurred almost exclusively after young people received their second vaccine dose.

The idea was under discussion at a forum of senior health officials and doctors, chaired by the Health Ministry, which took place on Monday evening. Other possibilities raised at the meeting were delaying teen vaccination until more data on myocarditis is received, and continuing with a two-shot protocol as planned.

Hebrew University epidemiologist Prof. Hagai Levine told The Times of Israel he thinks the one-dose regimen is worth “serious discussion.”

He supports vaccine rollout for teenagers, but stressed that the details of how it should be dosed should be decided carefully. In view of Israel’s very low coronavirus rates, with just 22 new cases diagnosed on Tuesday, he believes that inoculating teenagers is not “urgent” and there is no need for the government to rush to a decision.

“There is currently no urgency in vaccinating young people in Israel against coronavirus, due to fact that risk [from the virus] is currently relatively low and also due to the fact that the vaccinating the young, though it can contribute to the general population’s immunity level, isn’t expected to change it significantly,” said Levine.

Immunologist Prof. Cyrille Cohen, a member of the Health Ministry Advisory Committee on Vaccines, told The Times of Israel that a one-dose approach may have advantages, but could also have downsides.

“The immunity of young people is normally stronger than others, and a one-dose policy provides us with a reasonable therapeutic window,” he said. “So in a situation in which the cases are low in Israel, the level of protection with one dose is desirable, and we limit the possibility of side effects, at least, until we know more about these pathologies.”

Cyrille Cohen (Courtesy)

Cohen, a Bar Ilan University professor, added: “The question remains if one plans on traveling abroad: will other countries recognize a one dose protocol for adolescents? And secondly, will this provide enough long-term protection compared to two doses in the case of outbreaks, if COVID-19 is still spreading?” There are no immediately available answers to these questions.

The Health Ministry did not respond directly to a question about a possible one-shot regimen, but did offer some details on preparations for teen vaccination.

It said: “The director general of the Health Ministry, Prof. Chezy Levy, is holding discussions on the topic with relevant experts, representatives from the HMOs, and the Israeli Pediatric Association in order to prepare the vaccination campaign for the 12-16 age group.

A medical worker collects samples for coronavirus testing in Safed, on February 8, 2021 (David Cohen/Flash90)

“The Pandemic Response Team and the Vaccine Committee will also hold discussions on the topic while focusing on the issues of efficacy and safety of the vaccines and will submit their recommendations to the Health Ministry.

“The Health Ministry and the HMOs are also holding preparatory discussions with the regarding a roll-out of a vaccine campaign for this age group.”

The US Food and Drug Administration expanded its emergency use authorization for the Pfizer-BioNtech  vaccine on May 10 to include adolescents.

By this time, COVID-19 cases in Israel had dropped to very low levels — including among children, who aren’t inoculated — and authorities decided to prepare for a teen vaccine rollout later in the month, but not rush to start as quickly as the US, where incidences of the coronavirus are far more common.

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