It’s time to decide on boosters

The country started offering the first COVID-19 vaccines that the Philippine government received starting in end-March to frontline health workers. Subscription was not with enthusiasm, the doses offered being the Chinese-made Sinovac-CoronaVac, all 600,000 of them donated by the Chinese government.

At that time, it was well known that Pfizer’s and Moderna’s vaccines were A-grade, promising efficacies of above 90 percent, whereas Sinovac’s was a mere 50 percent. The Pfizer and Moderna vaccines had also been approved for emergency use by the US FDA; not so with Sinovac.

It’s understandable that, at the Philippine General Hospital where the ceremonial first vaccination was held, many health workers opted to wait for “the other” vaccines. This choosiness would also be apparent for senior citizens and those with co-morbidities as the vaccine rollout extended to their groups.

To be fair, there have been very few complaints of adverse reactions with the Sinovac vaccines, which comprised majority of the 26 million vaccine doses jabbed to date into Filipinos’ arms. What is worrisome, though, is its efficacy, mainly through the experience of other countries that have heavily relied on it.

Indonesia, Thailand, and Malaysia are now recommending a booster shot for their health workers who have received Sinovac after scores of health workers contracted COVID-19 recently. Just what follow-up shot will be recommended is now at the center of a large debate, especially in Asia where Sinovac use is high.

Booster options debate

A six-month period appears to be the longest protection that Sinovac gives, compared to commonly acknowledged eight months of the Pfizer or Moderna shots. Data for the Johnson & Johnson’s one-dose vaccine is still being compiled and studied.

Applying efficacy data currently available on Sinovac, the Philippines’ vaccine experts will need to decide soon on whether to recommend a third booster same-vaccine shot or take a mix-and-match route.

As with most things about this pandemic, understanding how the virus changes and the effect of various vaccines is an evolving matter. Some say that it’s better to stick to one vaccine design, i.e., following up boosters with the same brand that was first used so as not to “confuse” the body.

The reasoning is borne from the fact that Sinovac is based on an inactivated or dead virus introduced in the body to produce immunity reactions, much like the principle used in polio, measles and typhoid vaccines; while Pfizer and Moderna’s involve injecting parts of the virus’ live genetic code (which partly explains the sub-zero handling temperatures required).

The tricky part for governments is to place orders for the third shot, recognizing that there continues to be a global production shortfall in vaccines versus the need in poor countries with huge populations that have not secured enough supplies to reach herd immunity levels.

Supply problem

For the Philippines, aside from resolving its booster shot choice, it also means having to find the money to purchase the additional jabs which could cost up to P45 billion. For many frontline health workers who had early on gotten Sinovac, the six-month efficacy period ends around October.

Hurdling supply issues, however, will be a bigger problem, and any new orders will likely be shipped out only next year. This could leave those who received their shots in the first half of the year vulnerable, especially if new more virulent coronavirus variants emerge.

A more sensible tack would be to “re-allocate” arriving shipments to cover for the necessary third jab, especially of frontline health workers and the most vulnerable sectors of the community. The government having ordered just enough vaccines to cover 70 percent of the country’s population, this would mean relegating the aspired herd immunity to a much later date.

Conscience-pricking

The World Health Organization (WHO) continues to prick the conscience of countries that have decided to offer their vulnerable citizens with booster shots, citing the still large world population that needs a first dose.

Israel is in the process of a third-shot rollout. The US recently announced that booster shots would be available by September to the most vulnerable sectors of society, while the UK, Germany, and France had announced their intentions even earlier.

The reaction of these countries to sidestep the WHO plea is understandable, given the risk of possible consequences arising from deadlier coronavirus variants, and the need to support earlier declarations to reopen their economies.

As a last resort, the WHO is insisting that the vaccine distribution for the less vulnerable of developed countries’ population be held off because the vaccine – or any of its recognized vaccines, for that matter – still gives protection from serious illness and intensive care hospitalization.

Note that vaccine manufacturer Pfizer, on the other hand, continues to recommend a shorter six-month interval, citing that this would boost antibody levels five to 10 times higher than what has been given by the first two shots.

Vaccine passports

While the global health experts and governments calibrate their responses to the virus through vaccines, the Philippines should seize the chance afforded by these third (and perhaps even a fourth or fifth) shot by implementing a uniform and credible vaccine passport system.

It is highly likely that our Christmas celebrations this year will still be under the health strictures demanding limited family gatherings with plenty of social distancing, open-air dining conditions, and other preventive measures. The way things are turning out, even in countries that have inoculated more than 80 percent of their population, the virus still reigns supreme.

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