“Should I take the Covid-19 vaccination?” As a gastroenterologist, this is the most common question patients have asked me over the last six months.

According to the American Gastroenterology Association and American Association of the Study of Liver Diseases, the two most esteemed digestive specialist organisations in the world, patients with digestive and liver diseases should receive the Covid-19 vaccination.

So my answer to patients is a simple one: Yes, please do, as recommended by experts in the digestive field.

In my own family, my wife, my two aged parents and parent-in-law and myself have all been vaccinated with the Pfizer-BioNTech mRNA vaccine.

My son turned 12 years of age in May, and he is eligible for the Pfizer-BioNTech vaccine.

But I can’t force him to be inoculated and he himself must agree to it.

My wife and I have been discussing Covid-19 with our son since the beginning of the pandemic.

He is upset with the disruptions caused by Covid-19.

He did not like home-based learning and was very excited when school reopened after the circuit breaker and other periods of home-based schooling. He missed his teachers, friends and school activities.

But he was disappointed when he went back to school.

All schools have implemented numerous safe management measures such as disallowing mixing between different classes, separating seats where they take their snacks during recess, and disallowing physical contact. 

Even his favourite part of the school, the fish pond, was closed to avoid interaction between students.

My boy was in the school choir. They were devastated when they could not take part in the inter-school competition during the biennial Singapore Youth Festival.

School choir activities resumed after the circuit breaker, but the format has changed. Instead of singing in a group, they sing individually at home, using Zoom.

It is the best that the choir conductor could do, but it is dissatisfying to all. Similarly, his other friends who have trained hard in sports could not compete for the schools either.

And my son hates wearing a face mask in school. Given Singapore’s warm and humid weather, wearing a mask from 7am till 2pm without a break is not easy for most kids.

So we were all excited when we read about the Pfizer-BioNTech vaccine being approved for children 12 to 18 years old.

As a parent, I should be rational and logical, rather than emotional in making decisions for my boy.

As a medical doctor, I ought to make decisions based on medical evidence, weighing the pros and cons and assessing the risk-benefit ratio.

There were excuses for not vaccinating my son.

First, Covid-19 seems to spare children and adolescents more. 

Most infected people are adults, especially older ones. Scientific studies showed children may have lesser affinity to the virus in their respiratory tract. And even if children are infected, most have mild disease.

Besides, many studies showed that Covid-19 hardly spreads in schools.

Two boys in my son’s primary school were infected with Covid-19, resulting in the whole class and its teachers being quarantined for two weeks.

But after extensive swabbing and testing, no one else was found to be infected. The first patient was believed to have contracted it from his mother, who contracted the infection at her workplace. So it was an infected adult who spread to the child, not the other way round.

Lastly, the Centers for Disease Control and Prevention (CDC) in the United States had reported increased cases of myocarditis (inflammation of the heart muscle) and pericarditis (inflammation of the lining outside the heart) after mRNA Covid-19 vaccination, particularly in adolescents and young adults.

In fact, I have personally managed a patient, aged 48 years, with myocarditis developing five days after his first Pfizer vaccination.

To be sure, this is actually a rare event, with the CDC reporting that it happens at a rate of 1.8 per 100,000 adolescents aged 12 to 17 who received a Covid-19 vaccine. And no death has been reported so far.

The CDC continues to recommend Covid-19 vaccination for those aged above 12 given the benefits outweigh the risk. 

This is a similar stance that Singapore has taken.

My family also discussed arguments in favour of vaccination.

First, adolescents can also get infected, especially with the Delta variant.

In fact, Malaysia just reported three deaths in children from Covid-19 infection a few weeks ago. In the US, the proportion of adolescents being infected is rising too. This is partly due to the fact that adolescents and children now form the unvaccinated group.

Secondly, children infected with Covid-19 can become very ill. CDC reported more than 4,000 cases of Multisystemic Inflammatory Syndrome in Children, or MIS-C, among infected children. Children with MIS-C can become very sick, requiring intensive care support. They can also develop myocarditis and heart failure.

Even after resolution of the illness, about 25 per cent of patients could develop the long Covid syndrome.

Patients continue to have symptoms like those associated with the Covid-19 infection even though the virus is no longer present. Patients report lethargy, breathlessness, loss of appetite, weakness, insomnia, loss of taste and even smell, for more than 12 weeks of duration.

We also touched on herd immunity, which refers to resistance to the spread of an infectious disease within a population that is based on pre-existing immunity of a high proportion of individuals as a result of previous infection or vaccination.

For societal benefits, all eligible residents ought to be vaccinated, so as to develop herd immunity to protect everybody. It is only when we reach herd immunity that we can safely open up our society.

My boy deliberated for a few days. 

Interestingly, he was not particularly worried about the above issues. He seems to be more concerned about the immediate side effects such as fever and pain at the injection site.

Yes, I have seen this in many patients. While doctors are thinking hard to choose the best treatment for a particular condition, patients often are more concerned about minor side effects that we consider unimportant.

Nothing is absolutely safe in medicine, and in life. We should weigh the pros and cons of each intervention. For Covid-19 vaccinations, our conclusion is that the benefits outweigh the risks.

My boy chose to be vaccinated, as he himself could see that the benefits of vaccination for him and the community exceed its risks to him. 

The process was smooth and surprisingly painless. And he had no fever or any serious side effects after the vaccination.

Making a decision on getting the Covid-19 vaccination for our child was not easy. I can understand the emotions that other parents go through.

I urge all parents to deliberate all these issues and have a good discussion with your adolescent.

For yourself and for Singapore, do go for vaccination if you are eligible.

ABOUT THE AUTHOR:

Dr Desmond Wai is a gastroenterologist and hepatologist in private practice.