Protecting children from Covid-19 means New Zealand should keep a tight grip on the virus, rather than let it wash through our communities, experts say.
In a new study, a team of health experts considered childrens' oft-overlooked part in the pandemic and what could be done to better shield them, calling for an approach dubbed "tight suppression".
"Children have been invisible in pandemic strategy right from the start," said the study's lead author, Otago University epidemiologist and child health expert Dr Amanda Kvalsvig.
A case in point, she said, was the fact that vaccination percentages currently only included the eligible population, or people aged over 12 years.
"That makes the percentages look great, but younger children are left out completely. And we know now that children do get infected and pass the infection on so that immunity gap really matters," she said.
"Children have experienced huge impacts on their lives during the pandemic and they're keen observers of what's happening, but their voices and their solutions are generally missing from the national conversation."
Although children had a lower risk of direct health impacts from Covid-19 than older age groups, it could still bring serious consequences - particularly for kids with compromised immune systems or significant respiratory conditions.
Research was showing that even people with a mild dose of Covid-19 could develop inflammation in multiple organs.
"That's concerning and it's particularly an issue for children because they're still growing and developing," she said.
"It'll be a while before we can have good evidence about long-term effects of Covid infection so the best approach is prevention until we have a better handle on the risk."
Because all of the major infections of childhood had the potential for long-term effects, there was little reason to expect Covid-19 to be any different.
"Luckily, long-term effects from infections in childhood are usually rare, but when all children in a country are exposed to an infection, those small percentages can translate into large numbers experiencing significant illness," she said.
"A far better plan for Covid-19 is to take a precautionary approach so that we'll be in a position to make good decisions later on when the facts are clearer."
In the study, which has been published online ahead of peer review, Kvalsvig and co-authors Dr Jin Russell, Carmen Timu-Parata and Professor Michael Baker suggested a new framework to be used for future health impact assessments.
"From now on, all Covid-19 policies should be evaluated in a systematic way to understand their impacts on children," Kvalsvig said.
In the proposed framework, decision-makers would be prompted to describe and measure impacts on children caused by the infection itself or by the pandemic response, and to understand whether those worked directly on children or had effects in other ways.
"For example, school closures are a direct impact of the response, but if children lose a parent or other family member to Covid-19 that would be a very powerful indirect impact of the infection," Kvalsvig said.
"Presenting this thinking as a framework is a useful way to make sure that important impacts don't get forgotten about and dropped out of the frame when policy is being designed."
The framework could also remind the Government of its obligation to put multiple protections in place for children.
"We urgently need to see coherent pandemic policy that's built around children's needs and rights."
As well, the experts appealed for tight suppression – a strategy close to elimination, but with one key difference.
"Although there's a fairly high level of effort to stamp out community transmission, like using widespread testing and contact tracing, the response will stop short of using the most intense measures, the ones that are highly effective but also highly disruptive, like lockdowns," she said.
"What that means is that outbreaks should be much smaller than if you were doing nothing at all, but the cases are unlikely to come down to zero."
"With a suppression strategy, zero new cases in the community might actually happen if the level of suppression is tight enough to push the reproduction number really low - but that would be a bonus effect rather than a deliberate aim."
Instead, the aim of a tight suppression approach was to keep cases down as much as possible.
"Politicians prefer suppression to elimination because stringent restrictions are unpopular, but that surface convenience hides a deeper problem which is that with suppression you can never really stop the control measures," she said.
"With elimination you can, because the infection is gone. I've said before that when the Government stepped away from alert level 4, they also lost the way back to alert level 1."
She and her colleagues had concluded that, while tight suppression was better than just letting Covid-19 spread through communities, it was still a poor second to elimination in preventing ongoing impacts of the response.
"For example, we've seen in other countries that children are likely to miss out on much more school time when there's a continuous level of community transmission, with children regularly needing to stay home because they're isolating or in quarantine," she said.
"That situation creates additional worry as well as social and educational impacts for children, and it makes the day-to-day operation of schools and early childhood facilities very difficult."
The study comes after it emerged the Ministry of Health initially didn't want the new traffic light system to be used until at least 90 per cent of the population aged 5 and up, as well as among Māori and Pasifika, were fully vaccinated.
The Government instead opted for a 90 per cent target in each DHB region before the new system would be implemented, a benchmark it eventually scrapped.
MedSafe is expected to approve the pediatric vaccine for five to 11-year-olds next week, clearing the way for the childrens' roll-out to begin in January.
"It seems absolute common sense to vaccinate children as soon as the data from overseas have indicated that it's safe," Kvalsvig said.
"But there are large gaps in the traffic light system that will need to be addressed as well. The traffic light system is highly dependent on vaccination, but there are many other effective ways to reduce spread."
One was better indoor ventilation.
"Good air quality not only has the potential to prevent viral spread in public settings, it can also improve mental focus and concentration in workplaces and schools," she said.
"There's so much more we should be doing for children's wellbeing during the pandemic and beyond."