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Fight against Corona What speaks for and against child vaccinations

Status: 06/22/2021 8:57 a.m.

The debate about whether children should be vaccinated against Corona is in full swing. Companies are pressing ahead with their studies for the approval of a vaccine for young children as well. What is the current state of research?

From Axel John, SWR

Just a few steps from the magnificent Gendarmenmarkt in Berlin is the rather inconspicuous Hausvogteiplatz. But what is sensational is what happens there in a sober office building. The Association of Research-Based Drug Manufacturers (VfA) has its headquarters here. The experts maintain contact with pharmaceutical companies all over the world – also when it comes to corona vaccine research, which is still under high pressure.

Particularly strict requirements for tests with minors

A team of specialists is constantly collecting the latest data from all over the world. Rolf Hömke is also there. The biochemist is an expert in research and drug safety. “When developing a new drug, it is standard that the preparation is initially only tested on adults. If these results are correspondingly good, studies with minors follow.” However, a prerequisite is a medical benefit in children and adolescents. Hömke gives an example: “A new antibiotic, for example, is also needed for children – but a preparation against prostate cancer is not.” Even higher requirements would apply to the tests in order to avoid stress in young people as far as possible. Both parents must have agreed together. The conditions also demanded that the children also say yes as soon as possible. “Money cannot be earned with such participation. The test subjects receive an expense allowance. The participants are mostly idealists or sick people who hope for an effective treatment.”

Intermediate results of the vaccine test series for children under twelve years of age BioNTech / Pfizer started a study in March 2021 with children aged six months and younger than twelve years. In the first phase, a small number of minors initially received different doses. In the current phase II, around 4500 young people are to be tested for the effectiveness of the vaccine in more than 90 facilities in the USA, Finland, Poland and Spain. Here researchers analyze the respective immune response. Results could be available from September.

Moderna reported the start of the phase II / III study in March. More than 6,700 children between six months and under twelve years of age in the United States and Canada are expected to participate. Here, too, it was initially about the best dosage. The effectiveness is then checked in the further course.

With the vaccine from AstraZeneca investigations began at Oxford University in February. Several hundred young people and children between the ages of six and under 18 should take part. The study has been temporarily stopped by the British authorities after reports of very rare side effects with thrombosis.

Janssen / Johnson & Johnson started testing his vaccine with adolescents aged twelve and over in April 2021. If the interim results are good, younger test persons should join the group. However, this study is also currently on hold.

Sinovac has been testing its CoronaVac vaccine in China since the beginning of May. In phase II, minors between the ages of three and 17 are to be tested here.

Source: VfA

STIKO sees no rush

Professor Dr. Fred Zepp follows vaccine development with great interest. On the one hand, Zepp is a member of the Standing Vaccination Commission (STIKO). The committee drew up the recommendations for the sequence of corona vaccinations. Zepp was also director of the Center for Pediatric and Adolescent Medicine at the Mainz University Hospital for many years. He believes it is imperative that vaccines be developed for minors as well. This is particularly important for high-risk patients such as children with chronic cardiopulmonary diseases, emphasizes Zepp. “The mRNA vaccine process is an impressive development with excellent prospects. But we do not yet have any broad experience with children,” explains Zepp. For him it is important that the development of an adult’s organism is differentiated. The acute side effects can usually be recognized in the first twelve to 16 weeks. “With infants or children, on the other hand, I have an organism that is subject to constant development. That is why I say: We are currently under no time pressure in this group and should wait for further study results.” In addition, there are hardly any children in Europe who are seriously ill with Covid-19. Less than 80 children in Germany were being treated in an intensive care unit because of Corona. There have also been very few deaths that are even below the rate of flu. Zepp is also referring to a few cases in adolescents in the USA who developed heart muscle inflammation after the second vaccination with BioNTech. The authorities are currently investigating whether there is a connection. “The coronavirus will continue to change. I expect that the older population could also be affected here.”

“The pathogen spreads unhindered, especially in children”

In Munich, Matthias Kromayer leans over the latest results from corona vaccine research in children. The microbiologist recommends vaccinating minors according to the relevant studies and approvals – regardless of the vaccine. Kromayer works on the board of MIG AG. The company is currently investing in 30 start-ups. In 2008, BioNTech received a good 13 million euros as an initial investment from MIG.

For Kromayer, a vaccination rate of 70 to 80 percent in the population is the goal. “Then there is a good chance of paralyzing the spread of the virus and mutated variants. The pathogen spreads unhindered, especially in children. They are closer together and cannot yet adhere to the hygiene rules,” explains Kromayer. According to the Federal Statistical Office, there are more than 8.5 million people under the age of twelve in Germany. For Kromayer, this group is so large that it should not be ignored in the fight against pandemics. At the same time, children have a much stronger immune system that can deal with Corona much better. In this way, fewer pathogens would presumably be transmitted: “The vaccine side effects in children are likely to be very limited, but the resulting protection for other population groups is high. That should be weighed up.”

Politicians do not want to commit themselves yet

In Berlin, too, the Federal Ministry of Health has long since registered the emerging debate. Whether and to what extent children should also be vaccinated in the fight against Corona is still silent. Upon request, the press office simply declares: “The results of studies and possible approval by the European authorities remain to be seen.”

According to BioNTech / Pfizer, reliable results from the currently ongoing study series can be expected from September onwards. By then, at the latest, the discussion about the best vaccination strategy will really start

Corona protection in companies Are employers allowed to force vaccination?

Status: 08.06.2021 7:13 p.m.

Since the beginning of the week, company doctors have also been able to vaccinate against Covid-19. But what about legally? Can companies require their staff to be vaccinated? And are they allowed to grant privileges to those who have been vaccinated? From Jens Eberl, WDR The companies have a great interest in preventing infections with the coronavirus and sick leave. This is why many employers want their employees to be vaccinated. With the start of vaccinations by the company doctors, various legal issues between employers and employees come to the fore. An overview.

Can the employer oblige his staff to vaccinate?

Employees only need to be vaccinated if there is a legal obligation to do so. There is no statutory vaccination requirement with Covid-19. “However, special features apply in facilities such as hospitals, prevention or rehabilitation facilities and medical practices,” says the Brühl-based specialist lawyer for labor law, Michael Felser. “They must ensure that all measures required by the state of the art of medical science are taken there to prevent infections and the spread of pathogens. Curiously, however, this does not apply in care facilities for the elderly, although the problem here is likely to be comparable”, so Felser. In the health care facilities mentioned, the employer cannot force employees to vaccinate either. However, he must ensure that non-vaccinated people pose no risk to patients. Patient protection can therefore make it necessary that non-vaccinated people can no longer work in certain areas.

Do employees have to inform the employer about their vaccination status?

Actually, there is no obligation to provide information about the personal vaccination status to the employer. However, the Gelsenkirchen labor lawyer Arndt Kempgens emphasizes that companies have to take corona protective measures for their employees. But they could only do that if the corona vaccination status was known. Kempgens concludes from this that in connection with Corona, under labor law – as an exception – there could be an obligation on the part of employees to notify the vaccination status and, under certain circumstances, to prove it.

Are vaccination incentives such as bonus payments from the employer permitted?

Employers could pay a “vaccination bonus”, for example through a one-off sum of money, vouchers or extra vacation days. Lawyer Felser says: “This is not entirely uncritical, because rewards can exert undue pressure not to exercise one’s rights. For example, courts have only declared rewards for employees who rarely get sick to be admissible under strict conditions.” The trade unions consider incentives for those willing to vaccinate to be permissible. However, they have a say in any case, as such a bonus is subject to co-determination. Kempgens emphasizes, however, that it must be fair: “There must not only be a bonus for those who don’t like vaccinations as an incentive to vaccinate, but if so, then for everyone.”

Can the employer exert “vaccination pressure”? Can the staff defend themselves against this?

If there is no statutory vaccination requirement, the employer cannot exert any pressure, neither with instructions nor with threats such as transfer or even warnings and dismissal. Such measures would be illegal. However, attorney Kempgens reports: “We are currently hearing more and more of such cases in legal practice. Pressure is exerted to convince those unwilling to vaccinate.” In extreme cases, employees can even defend themselves against this with an action for an injunction before the labor courts.

Are professional disadvantages possible if you don’t get vaccinated?

If there is no compulsory vaccination, the employer cannot differentiate according to whether someone is vaccinated or not or whether they have not wanted to be vaccinated in the past, as long as there was no obligation to do so. In medical institutions, however, the employer can reject applicants if they are not vaccinated and do not want to be vaccinated. Lawyer Kempgens, however, restricts: “Unvaccinated employees require other protective measures in the company and also lead to disagreements among the employees. For this reason, non-vaccinated employees will certainly not be preferred in the company in the near future.”

Are employers allowed to distinguish between vaccinated and non-vaccinated people?

“In my opinion, they even have to,” says Kempgens. “As with official measures, labor law restrictions are more difficult to justify for vaccinated people, while labor law protective measures have to be stronger for non-vaccinated people.” Felser believes privileges are conceivable, such as the earlier return of vaccinated employees from the home office to the office or the use of communal facilities such as the canteen. However, the incentive or pressure from such preferences should not be disproportionate.

From Ingrid Bertram, WDR At the toilet paper manufacturer Hakle in Düsseldorf, the machines run in three shifts. 250 employees work here. With the corona crisis, no employee can be dispensed with anymore. And at the latest when one of his engineers was in the intensive care unit, Managing Director Volker Jung knew that no other of his employees should experience that. He has been trying to get the vaccine since January, but so far in vain. The tents for the vaccinations are ready, extra rooms are reserved and the company doctor has recruited doctors who are actually retired for the vaccinations. Basically, it could start – but patience is required instead. Will it all pay off? Probably not on paper: the company has already spent 300,000 euros on the PCR tests. The vaccination route will cost a lot less. But Volker Jung believes that two thirds of his workforce are willing to vaccinate. At least he wants to offer them something. He doesn’t want to lose anyone.

Persuasion by company doctors

Ralf Stoffels also has to be patient. He heads the BIW Isolierstoffe company. He would like to organize the vaccination through the company medical center. Not only his 550 employees, but even the entire Hagen-Ennepe-Ruhr industrial park could be supplied via this. But here, too, the vaccine is missing. Ralf Stoffels, who is also President of the North Rhine-Westphalia Chamber of Commerce and Industry, is convinced that companies can better reach many people with vaccinations. “Many of the employees do not even accept the voluntary offers,” says Stoffels. He’s already observing this in the voluntary tests. In other words, everything that costs time and does not fit into everyday work becomes a hurdle. “In the company it would be organizationally easier for many, and the company doctor could still do some persuasion.” Because most of Stoffel’s employees work in shifts, come from Eastern Europe or are refugees and trained in the company. Knowledge of the how and why of vaccination is often rudimentary.

Previous illnesses mostly unknown

But even if there are some arguments in favor of immunization at the company doctor – even Anette Wahl-Wachendorf from the Association of German Company and Company Doctors does not know when the first vaccinations will arrive in the company. “Many companies are in the starting blocks,” says the organization’s vice president. But there is actually still a lot to be clarified: For example, it must be ensured in the companies that they are regularly supplied by large pharmacies, as the mRNA vaccines can only be stored in the refrigerator for a few days. In addition, it has not yet been clarified who is liable in the event of vaccination reactions or side effects. “For that there should now be a basic state liability,” said Wahl-Wachendorf. And ultimately it must also be clear that the prioritization in the company no longer applies automatically, because after all, a company doctor can vaccinate according to age, but cannot take previous illnesses into account, as he usually does not know them. The company doctor believes that it would be better to first consider those who have the most customer contacts. But above all, none of this should entail any further bureaucratic effort. Because now it is a matter of vaccinating as many people as possible.

From Notker Blechner, tagesschau.de So far it has seemed that children are largely spared from Corona. Many who were infected with Covid-19 had asymptomatic or mild disease. Serious illnesses were rare. “I haven’t had a bad case so far,” says pediatrician Axel Gerschlauer from Bonn, regional spokesman for the professional association of paediatricians. But there have also been deaths in children in connection with a corona infection. Long-term effects are even more common. More than 250 cases of the PIMS syndrome (“Pediatric Inflammatory Multisystem Syndrome”) have already been counted. This is an immune reaction that occurs a few weeks after infection, especially in children, and can be life-threatening.

Some children suffer from long-term effects

Surveys from abroad are also alarming, according to which numerous children and adolescents suffer from “long covid”, i.e. post-viral symptoms weeks or months after the infection. According to recently published data from Great Britain, 15 percent of adolescents between the ages of eleven and 16 complained of persistent headaches, sudden learning disorders or a drop in performance in sports five weeks after the corona illness. In a study by a clinic in Rome, it was even found that almost half (43 percent) of the children infected with Corona had at least one symptom that was affecting them four months later. “Children are not the drivers of the pandemic,” said Jörg Dötsch, President of the German Society for Child and Adolescent Medicine. However, since February the incidence among the youngest has also increased significantly in Germany. On the one hand, this may be due to the numerous tests that were carried out in schools. On the other hand, the proportion of people over the age of 70 in cases of illness has fallen significantly, as they have largely been vaccinated. Pediatricians consider it important to vaccinate children and adolescents as quickly as possible – especially in view of the mutated South African, British and Brazilian corona viruses. This is the only way to achieve herd immunity. Experts now believe that 80 to 90 percent of the population should be vaccinated to ensure collective protection. Because the more contagious the virus, the higher the vaccination rate must be. “If vaccination is not carried out across all population groups, extensive immunity cannot arise in the general population,” says Thomas Fischbach, President of the Association of Pediatricians. Heinz Hilgers, President of the Child Protection Association, also says: “We will not get out of this pandemic without vaccinations for children.”

Schoolchildren in Israel already vaccinated

Vaccine manufacturers understand the importance of children and teenagers. “Younger children, who make up a large part of the world’s population, play a crucial role in our fight against Covid-19,” said BioNTech and Pfizer recently. The German-American company duo wants to accelerate the development of vaccines for children and adolescents. BioNTech boss Ugur Sahin spoke of promising studies at the analysts’ balance sheet conference. A phase III study in 12 to 15 year olds was particularly successful. The vaccine has been shown to be safe and effective in this age group. None of the vaccinated 2260 participants in the study was sick with Covid-19, it said. “The first results of the study in adolescents indicate that children are particularly protected by the vaccination,” said CEO Sahin. BioNTech-Pfizer plans to apply for emergency approval in the USA and the European Medicines Agency (EMA) in the coming weeks. Pfizer boss Albert Bourla is confident that the first young Americans will be vaccinated in the US before the start of the next school year. So far, the drug has been approved for people aged 16 and over in countries such as the USA and Israel. In Israel, the first pupils under the age of 18 were vaccinated.

The very little ones still have to wait

Now there should also be clinical tests for vaccines in children between six months and eleven years. If the study is positive, the vaccine could be used in the youngest from the beginning of 2022. The US company Moderna and the British-Swedish pharmaceutical company AstraZeneca were faster. They had started testing their corona vaccines on younger children even before BioNTech-Pfizer. The results of the Moderna study for the vaccine in 12 to 17 year olds are expected in the middle of the year. The US FDA has approved Moderna tests on children aged six months to twelve years. AstraZeneca began a study of its vaccine in 6 to 17 year olds in the UK in February. Johnson & Johnson is also planning its own pediatric studies. The European Medicines Agency has obliged the four major suppliers to also test their vaccines for children.

BioNTech and Pfizer clearly ahead

But so far BioNTech-Pfizer has been ahead in the race for children’s vaccines. Analysts like Daniel Wendorff from Commerzbank are convinced of this. The Mainz vaccine is so far the only one that has been proven to be effective in 12 to 15 year olds. BioNTech and Pfizer would have such great market power anyway that the two companies could quickly increase production. When it comes to absolute vaccination doses and the availability of data, BioNTech-Pfizer is a leader, says Wendorff. The EU is increasingly relying on BioNTech-Pfizer. Brussels is about to finalize a huge order for 1.8 billion cans, the majority of which are for children and young people. The rest are booster vaccinations that are likely to be required in the years to come.

First approval in late summer?

Thomas Mertens, the chairman of the Standing Vaccination Commission (Stiko), has shown confidence that in Germany Corona vaccine available for children at the end of the year will be. Association president Dötsch even hopes that “we will get a vaccine for 12 to 15 year olds in late summer or autumn at the latest, for smaller children it will probably take longer”. However, other experts warn against being too optimistic. “Children are not little adults,” says pediatrician Gerschlauer. You can’t give them half the dose just because they’re half the size of adults. The immune system of the little ones is completely different. In addition, there is the problem that it is more difficult to find children as test subjects for studies. Smarter would like to see a vaccine approved for the youngest of our society as soon as possible. Because children in particular are the biggest losers in the corona pandemic. In his practice he currently counts more young patients with mental disorders than ever before. “Many have eating and sleeping disorders or even depression.” This is confirmed by Jörg Dötsch, President of the German Society for Child and Adolescent Medicine: “70 to 90 percent of children are under severe psychological stress from the pandemic,” he estimates. “We’re really worried about the little ones.”

By Jochen Braitinger, SWR At the fan manufacturer EBM-Papst with headquarters in Mulfingen, Baden-Württemberg, people have been thinking for months about how their own workforce could be vaccinated – purely organizationally. The plans have long been in the drawer, right through to the shuttle service. “It’s about 3,500 employees who would have to come from different plants,” says Ralf Stehle from the company’s pilot vaccination center working group. “We have our own bus routes that we want to use for this.” Stefan Brandl, the boss of EBM-Papst, applied to the Prime Minister of Baden-Württemberg Winfried Kretschmann last month: as a “pilot company for Covid-19 vaccinations”. After three weeks of waiting, the rejection came. The companies should start vaccinations when the vaccine is no longer in short supply, writes the state ministry of the state. There is no need for a model project in a company. The initiative at EBM-Papst does not seem to be desired, at least in the short term.

EBM Papst boss Stefan Brandl wants more flexibility in the vaccination campaign. Image: dpa

Company doctors could accelerate the rate of vaccination

In the VW plants in the state of Saxony, on the other hand, vaccination against Corona is already taking place. It is a model project on behalf of the German Red Cross, writes Volkswagen AG in a press release. The aim is to vaccinate a clearly defined risk group in the workforce from the Vogtland district – a high incidence area. Company vaccinations could help to accelerate the vaccination coverage of the population, according to the Federation of German Employers’ Associations (BDA). With the use of company doctors, according to BDA estimates, the working hours of 6,000 full-time doctors could also be contributed. In addition, it would be easier to organize vaccination within the company for the approximately 31 million employees.

Larger amounts of vaccine expected from May

If the forecasts of experts are correct, more vaccine against the coronavirus will be available from May this year. According to the Association of German Company and Works Doctors (VDBW), there would then be nothing in the way of a nationwide vaccination, including in companies. However, after more than a year of the corona pandemic, many questions are still open: It is still not clear how company doctors should be rewarded, who is liable and how the vaccine gets into the factories, says VDBW President Wolfgang Panter.

Mark Shiring, the US boss of EBM-Pope, taking a vaccination selfie in the drive-through. 30 percent of his employees there are already vaccinated. Image: SWR

Company wants to keep applying pressure

At the EBM-Papst headquarters in Mulfingen, there is a great longing for normalcy. At the moment, employees are given a Corona self-test twice a week, on Mondays and Wednesdays. 50,000 test kits are in stock, another 50,000 have been ordered. But CEO Brandl would prefer a vaccinated workforce. He is the boss of a total of 15,000 employees. The company also has plants in China and the United States. Far more employees are currently vaccinated abroad than in Germany, according to Brandl. “We have probably now reached a capacity of over 30 percent at our location in the USA. This shows that the Americans are much less bureaucratic, faster – and that would of course also be nice if we could do that in Germany.”

Companies keep applying pressure

The pilot vaccination center working group at EBM-Papst around Ralf Stehle is disappointed by the rejection of its own pilot vaccination center, but is not discouraged – even if the decision of the state government and the lack of vaccines forces them to wait and see. Meanwhile, company boss Brandl continues to apply pressure: “If we want to bring speed into the vaccination campaign, then we need the companies. And we will not let up and continue to work at the ministry that it can be done quickly and that we can quickly get involved in this strategy.” . “