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Sri Lanka Medical Association moots Pfizer, AstraZenica, Moderna as third doses

06 Sep 2021

  • Asks to prioritise over-60s and immunosuppressed over-12s
  • Noncommittal on vaccination of schoolchildren
By Pamodi Waravita The Sri Lanka Medical Association (SLMA) yesterday (5) stated that their recommendations to the Government on the next steps of the Covid-19 vaccination plan include the administration of third doses to those over the age of 60 years and have received two doses of the Sinopharm vaccine, and to all immunosuppressed individuals over the age of 12 who have received two doses of any vaccine. At a press conference held yesterday, Sri Lanka Medical Research Institute (MRI) Department of Immunology Head Dr. Rajiva de Silva said that these recommendations have been made by the SLMA Expert Committee on Covid-19 to the Health Ministry. “All vaccines save lives. Thus, our recommendations are made with the objective of reducing the number of deaths and the number of those who face complications due to the virus. The first priority must be given to everybody over the age of 60 years and those over the age of 18 years who are living with comorbidities. After this prioritisation is fulfilled, the next step is to consider a third dose for selected groups, which we have scientifically deduced and recommended,” said Dr. de Silva. Accordingly, the SLMA is recommending that those over the age of 60 years who have received two doses of the Sinopharm vaccine be administered a Pfizer, Moderna, or AstraZeneca shot as the third dose at least 28 days after the second dose has been given. “This is based on scientific research done around the world. A study done in Bahrain has noted that a small number of those over the age of 60 years who have been fully vaccinated with the Sinopharm vaccine have faced complications or death due to the virus later. A study done in Sri Lanka has stated that about 7% of those over the age of 60 years who received the Sinopharm vaccine did not develop immunity. This is why we are recommending a third dose of the Pfizer, Moderna, or AstraZeneca vaccine for the population in that category. However, this does not mean that the Sinopharm vaccine is not effective,” said Dr. de Silva. The SLMA’s report of recommendations, publicised across their social media channels, highlights that a third dose is “given to some individuals who may not have mounted a sufficiently strong immune response after the primary series and would need an additional dose to acquire protective immunity”. On the other hand, a booster shot is defined as a “vaccine dose to be given after the primary (two-dose) vaccination for the purpose of increasing immunity when the initial immune response wanes.” The SLMA is also recommending that the Pfizer, Moderna, or AstraZeneca vaccines be given as a third dose to all immunosuppressed individuals over the age of 12 that have received two doses of any Covid-19 vaccine, at least 28 days after the second dose. The report states that immunosuppressed people are those receiving active cancer treatments, have undergone an organ transplant and are on medications to suppress the immune system, have received a stem cell transplant within the last two years, with moderate or severe primary immunodeficiency, with advanced or untreated HIV infection, and/or on active treatment with high-dose corticosteroids. The Morning learnt that the government health authorities are currently deliberating the vaccination of all immunosuppressed individuals over 12 as a first step in the country’s plan to vaccinate children. Sri Lanka has not yet administered a Covid-19 vaccine to anybody below the age of 18 years.  Additionally, the SLMA has recommended that the most widely available vaccine (currently Sinopharm in Sri Lanka) be given to those between the ages of 18 and 60 years who do not fall into the aforementioned categories. Furthermore, it has recommended the Pfizer vaccine be given to unvaccinated children with comorbidities between the ages of 12 and 18 years. Commenting on the discussion of whether all school-going children be vaccinated presently, SLMA President Dr. Padma Gunaratne said that the debate surrounding the topic is very complicated. “Medical experts are divided on the subject. While some experts believe that schoolchildren can bring the virus home to adults, other experts argue that if all adults are vaccinated, the risks are reduced. Our country’s health authorities are yet to decide on the matter,” she said. The administration of the Pfizer vaccine in army-run vaccination centres to those over the age of 20 years in the Hambantota district received criticism from the Government Medical Officers’ Association (GMOA) over the weekend. A Health Ministry circular, a copy of which was tweeted by Samagi Jana Balawegeya (SJB) MP Dr. Harsha De Silva, stated that 50,000 doses of the Pfizer vaccine have been given to the Army to be administered in the Hambantota District, allegedly without prior advice from the GMOA, which has stressed that schoolchildren be prioritised for this vaccine. However, the Minister of Youth and Sports Namal Rajapaksa, responding to these criticisms, said that the national vaccination programme is not being conducted with the objective of gaining political mileage. The final recommendations by the SLMA with regard to the vaccination programme state that the Pfizer, Moderna, or AstraZeneca vaccine be given as a booster shot for all those over the age of 60 years, six months after the primary schedule is completed. Furthermore, the association has recommended that one dose of the Pfizer, Moderna, or AstraZeneca vaccine be administered as a second dose to those who have received the Sputnik-V vaccine as the first jab and are waiting for a delayed second jab of the same vaccine due to vaccine shortages in Russia, its country of production. “We hope that these recommendations are useful to the Health Ministry’s medical experts when making future decisions,” said Dr. Gunaratne. The Government’s vaccination programme, whilst being praised for its currently rapid rate of inoculation, has also received criticism from various quarters of the medical community for not having recognised and prioritised the correct groups at the beginning of this year, which has allegedly led to more deaths. As of 4 September, the Presidential Secretariat’s vaccination summary report states that 78.33% of the total population over the age of 30 years has received both doses of a Covid-19 vaccine, whilst 35.01% of the total population between the ages of 20 and 30 years have received one dose.

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