Gap between AstraZeneca doses may be widened amid vaccine supply uncertaintyIndia on May 13 increased the gap to 12-16 weeks citing vaccine shortage. ‘Real-world data from the UK’ reportedlyshowed the AstraZeneca vaccine is 65-88 percent effective if the interval is three months or more.
With no signs of additional doses of Covishield, the AstraZeneca type vaccine manufactured by the Serum Institute, arriving anytime soon, there is uncertainty when the over 1.3 million people above 65 would be able to take their second shots.
They had taken their first doses between March 7 and March 15, and as per the government’s own schedule, they should have been administered the booster doses from May 16.
Now with no vaccine at hand, the government is discussing increasing the gap between the first and second doses of the vaccine to 12-16 weeks.
As per the government’s earlier plan, the two doses were to be administered between 8 and 12 weeks.
“We are holding discussion at the National Immunization Advisory Committee about widening the gap between the two doses,” said Dr Janak Sharma Gautam, chief of National Immunization Programme at the Health Ministry. “No decision has been taken yet though.”
According to him, the committee will make necessary recommendations to the Health Ministry, which will take a decision on the matter.
Despite becoming one of the first countries in the world to launch the vaccination drive on January 27, Nepal’s inoculation campaign has come to a grinding halt now after the government failed to acquire vaccines on time, largely due to red tape, indecision, blame-game among officials and domestic politics as well as geopolitics
Officials say India, where the vaccine is manufactured, too has recently increased the gap between the two doses of AstraZeneca vaccine to 12-16 weeks, hence a decision in Nepal along that line is likely very soon.
Initially, the gap between the two doses of the AstraZeneca vaccine had been fixed at 4-8 weeks weeks and it was later increased to 8-12 weeks.
Accordingly, for those 438,000 people who had taken the first shots between January 27 and March 5 were administered their booster doses from April 20 to April 24. However, according to government data, only 370,000 people took their booster shots.
As the 1.3 million people’s time for second shots came, the government could not acquire additional vaccines. The Serum Institute which had already received the payment for supplying 2 million doses delivered just half the order and expressed its inability to provide the remaining doses.
According to the Health Ministry, it currently has just 90,000 doses of Covishield.
COVAX, an international scheme led by the United Nations to share vaccines to poor countries, had supplied 348,000 doses of Covishield. But the Covid-19 crisis in India has hit COVAX as well, thereby affecting the vaccine supply to Nepal under the facility.
A new UK government research suggests two doses of the Covid-19 vaccine are essential to provide strong protection against symptomatic infection from the coronavirus variant first identified in India, according to a report published in the Financial Times.
Two vaccine doses provided 81 percent protection against the B.1.617.2 variant first identified in India, and 87 per cent against the B.1.1.7 strain first found in England, according to the Public Health England data.
The data showed that one dose offered 33 percent protection against symptomatic infection from B.1.617.2, and 51 per cent against B.1.1.7 suggesting vulnerability for only using a single dose.
The Indian government’s decision on May 13 to increase the gap between the two doses of AstraZeneca vaccine from 8-12 weeks to 12-16 weeks, according to the Mint newspaper, was based on “real-world data from the United Kingdom which showed that the vaccine was 65-88 percent effective if the interval was three months or more.”
The paper cited a study published in the British Columbia Medical Journal, a peer-reviewed medical journal published by the British Medical Association.
According to the journal, although there is a lack of data to directly support a 16-week gap compared to shorter intervals, in the current setting of vaccine scarcity, it appears reasonable to accept the risk of an extended dosing interval in order to more rapidly provide protection to a greater proportion of the population.
Officials in Nepal are well aware of the need for a second dose.
“We know that the first dose gives protection for three months and nobody knows whether it gives protection beyond that period. Even if it does not give full protection beyond three months, we can safely say that immunity will not be zero after three months,” said Shyam Raj Upreti, coordinator of the Covid-19 Vaccine Advisory Committee at the Health Ministry. “If the protection weakens after three months, people who had taken the first dose may be vulnerable after three months until second doses are taken.”
Many in India, however, have attributed the gap extension between the two does to the current shortages of vaccines.
India is currently battling a devastating second wave of the coronavirus. Until a few days ago, the country was reporting over 350,000 new infections a day. Though the number of new daily cases has come down lately, the World Health Organisation and experts have warned against complacency, saying case positivity rate was still high.
With the Indian government’s decision in the third week of March to put a halt to exports of the AstraZeneca vaccine, the Serum Institute halted supplies of Covishield. Last week the Serum said it could resume export of theCovishield vaccine only by the end of this year.
If the gap between two doses is extended to 16 weeks, those over 1.3 million people would have to take their booster shots of Covishield between June 27 and July 5, and officials say by then the government might be able to acquire doses for them.
The government is working to secure additional doses of the vaccine as early as possible, said officials at the health and foreign ministries.
Officials say they are hoping to get some doses from the United States as well, which on May 17 announced that it would share 80 million doses including 60 million doses of the AstraZeneca type to help countries battling the pandemic, by the end of June 2021.
“This equates to all of its manufactured 60 million AstraZeneca vaccine doses as soon as they are reviewed by the Federal Drug Administration, as well as at least another 20 million doses of vaccines that are authorised for use in the United States,” the US State Department said in a press statement. “We will continue to donate from our excess supply as that supply is delivered to us.”
If Nepal manages to receive vaccines from the US, it would be a great boost for the country’s vaccination drive, say officials, but the immediate need is Covishield to administer the second shots to those who have taken their first jabs.
“If Nepal fails to secure the vaccine early, the government should try to be among the early recipients of the US vaccines,” said Upreti. “Even if the gap is extended by one month, getting the US vaccines in late June also will be a huge relief for Nepal because the second dose gives full security. Our only concern is if the people will be vulnerable if the gap between the two doses goes beyond three months.”
Foreign Minister Pradeep Kuymar Gyawali told the Post that the government has been making an all-out effort to secure vaccines from India so that those taking their first doses can be inoculated within three months.
“We have been asking the Serum Institute through both the diplomatic channel and directly, to provide us at least one million doses for which we have already paid for,” Gyawali told the Post on Saturday. “The company has responded saying that they have not been able to deliver the vaccine due to an export ban imposed by the [Indian] government.”
Gyawali said the government has also made requests to other companies which produce the AstraZeneca type vaccine.
“We have also requested the United States and the United Kingdom to share their surplus AstraZeneca vaccine with us,” said Gyawali, adding, “So that we can at least fully inoculate our elderly population that has received the first dose.”