Focus/Spotlight

Covid-19 vaccination programme: Countries looking at third dose booster 

  • With all vaccines including Covid vaccines, protection declines with time 

  • Focus at present in SL is on two-dose vaccination for 60% of the population 

  • Ensuring required quantities of vaccines for first and second doses priority  

  • President urges ordering of stocks if third dose booster necessary 

 By Yumiko Perera  

 

Middle Eastern countries such as the United Arab of Emirates (UAE) have recently begun administering a third dose of the Covid-19 Sinopharm vaccine, also known as the “booster” shot, or top-up vaccine, to further strengthen the immune response of its populations against the novel coronavirus. 

While the health authorities in these countries seem to believe the booster shot would aid in combating new variants of Covid-19, the UK has also recently launched an extensive trial that will assess the effects the booster shot would have on individuals who are fully vaccinated with the first and the second jabs. 

The third dose is reserved for the highly vulnerable groups, especially those who have not developed enough antibodies even after the second dose of the Covid-19 vaccine. 

Speaking with The Sunday Morning, Institute of Health Policy (IHP) Executive Director and Fellow Dr. Ravindra P. Rannan-Eliya stated: “With all vaccines, but Covid-19 vaccines especially, the immune protection declines with time. This seems to be the case for almost all Covid-19 vaccinations, and it becomes significant after a few months. This is not surprising because immunity to other coronaviruses does not appear to last a long time.” 

Pointing out that nearly one-quarter of common colds are caused by coronaviruses, and the reason we keep on having colds all our lives is because immunity wanes, Dr. Rannan-Eliya reiterated: “One implication of this is that the higher efficacy vaccines are better because their protection will last longer, which means that if you want vaccines to provide, say, an average of 60% protection for the population, you will need to revaccinate at some point.” 

Whilst immunity weakens at a slower rate for vaccines with higher efficacy, according to Dr. Rannan-Eliya, whether the country would opt to revaccinate would depend on its strategy to tackle Covid-19. 

“If the strategy is to maintain zero transmission – i.e. the strategy in New Zealand, Australia, Singapore – then, the country may be able to go longer without revaccinating. However, if the country does not aim for zero transmission, which means that the virus is constantly circulating, higher levels of vaccine protection are needed to prevent more people from falling sick, and control the number of deaths.” 

Stating that rich countries have decided they can afford to revaccinate frequently, Dr. Rannan-Eliya went on to say: “The UK has already bought 60 million Pfizer vaccines to administer to everyone in the UK, the third booster later in 2021. The US and other European countries are also planning on the assumption that regular boosters will be needed. The rich Gulf countries, like the UAE, Qatar, and Bahrain, can also afford to do this, and, I am sure, will. 

“In our situation, however, the decision about a third booster shot in the next 12 months is academic because we will not be able to give everyone even their first vaccine until early 2022. 

“After that, if we have not been able to stop the spread of the virus or leaks through our borders, then I think we will need to revaccinate everyone from mid-2022 onwards.” 

Speaking with The Sunday Morning, senior consultant, paediatrician, and Association of Medical Specialists President Dr. Lakkumar Fernando stated: “At this point of time, we need to concentrate not on the third dose, but to complete two doses for 60% of the population.” 

According to Dr. Fernando, only 3% of Sri Lanka’s population have been fully vaccinated with both doses and only 10% of the population have been administered with a single dose. 

“The third booster shot is not something we can even think about right now. People after two doses can still get infected but at least the risk of death is significantly less as of now. 

“By the time we reach the point where we want to be, with both doses covering a large number of our population, the science and the arguments for and against a booster may not be the same, as things with Covid are very dynamic with many ‘new’ findings and developments every day. 

“Unfortunately, the rich and the more privileged countries have still not realised the need to vaccinate the ‘other countries’ if they and the world are to survive this pandemic. They need to be as worried as those poor countries about the vaccination coverage in the world.” 

Concurring with Dr. Fernando’s views, Ministry of Health Deputy Director General (Education and Research) Dr. Hemantha Herath said: “We still don’t have enough vaccines to immunise our people. That is the most important limiting factor at this moment. Our main priority is to make sure that sufficient quantities of vaccines are coming into the country. Scientific analysis is also essential to understand how many doses of the vaccine would be required to get the primary immunisation.” 

Stating that this is a constantly evolving subject, Dr. Herath went on to say: “With the collection of data and evidence, even if certain conclusions are made, we need to understand that the subject matter is constantly evolving. 

“What they are calling the third dose or the ‘booster’ dose is administered to those who have completed the primary immunisation – that is, the first and the second doses of vaccines. 

“Scientifically speaking, we would have to monitor the antibody levels and see whether people require further immunisation. 

“This is a process that requires time, and we are reviewing available evidence, but we are yet to give a final recommendation on this issue. At this moment, even if we recommend a booster dose, we would find it difficult to provide the vaccines.” 

He further noted that what Sri Lanka has to do right now is focus on immunising its entire population.  

“If the evidence says that a booster dose is indeed required, then we would administer it. What needs to be kept in mind, however, is that those who have been given the first jab can go on for another two or three months. 

“There are certain logistical issues that we are facing at the moment, but we are trying our best to overcome these obstacles and obtain the necessary vaccines, provided that we need to scientifically analyse and see whether it is a requirement and a priority,” Dr. Herath concluded. 

Against this backdrop, while stressing the importance of being transparent and methodical with regard to Covid-19 vaccinations, President Gotabaya Rajapaksa on Thursday (10) urged the authorities to order the necessary stocks immediately if a third dose is required.

While Sri Lanka is still seeking to secure vaccines from several countries, Sinopharm, Sputnik V, and AstraZeneca’s Covishield vaccines are being administered to Sri Lankans at present. 

As per the Epidemiology Unit statistics, 355,177 doses of the Covishield second jab have been rolled out, with over 600,000 people still awaiting the second jab. 1,209,276 doses of the Sinopharm vaccine have been rolled out as the first jab, along with 78,025 vaccines as the second jab. 64,986 doses of Sputnik V vaccinations have also been administered to Sri Lankans as of 11 June.

 


Islandwide vaccination programme 

 

At present, vaccines are being administered in the Gampaha, Kalutara, and Colombo Districts of the Western Province; the Galle and Matara Districts from the Southern Province; the Kandy District from the Central Province; and the Kurunegala District from the North Western Province. 

However, vaccine rollouts began across 12 more districts in the country, from Tuesday (8). 

People in the Matale, Nuwara Eliya, Kegalle, Hambantota, Trincomalee, Badulla, Anuradhapura, Puttalam, Ampara, Batticaloa, Monaragala, and Polonnaruwa Districts would be administered the China-made Sinopharm vaccine, The Sunday Morning learnt. 

 


Any changes to the priority lists? 

 

According to Ministry of Health Deputy Director General (Education and Research) Dr. Hemantha Herath, while there haven’t been any significant changes made to the priority list, those who are above the age of 60 are still considered to be the main priority. 

Whilst healthcare workers along with public workers above that age limit also fall under the same category. 

“If we had enough vaccines available to immunise the entire population, we would have done it without any complication; we could have given it to everybody above 30. 

“Unfortunately, now that we are getting vaccines in small quantities, we have to prioritise; that is, from time to time, we have to categorise and say that these are the priority groups, depending on the situation and the requirement.” 

Furthermore, the first Covid-19 vaccination rollout for expectant mothers took place on Wednesday (9), by the Medical Officer of Health (MOH) Office in Piliyandala, and across several other districts in the country, to prevent any major complications expectant mothers may face due to Covid infection. 

Speaking on the vaccine rollout for expectant mothers, Dr. Herath said: “We do not recommend those who are having an early pregnancy to be vaccinated. However, there can be certain other contraindications which may prevent expectant mothers from getting the vaccine. If contraindications or any other complications are not there, expectant mothers are eligible to get the vaccine, and they are also considered a priority group.”