Younten Tshedup  

It is officially confirmed. Bhutan, if available, would go for ‘mix-and-match’ regimens for the second dose of the Covid-19 vaccination.

This means that Bhutanese who have received Covishield (Oxford-AstraZeneca) vaccine for their first dose could now get a different vaccine for the second dose.

This comes after multiple studies and research found the technique, also known as heterologous prime-boost immunization, was found to be more effective in producing an immune response against the SARS-CoV-2 virus.

A member of the national immunisation technical advisory group (NI-TAG), Dr Sonam Wangchuk, said that given the shortage of vaccines and the delay in getting the same vaccine used in the first dose, the NI-TAG was now recommending mixing of vaccines.

He said that based on the emerging evidence it was found that when two different vaccines were mixed, in particular the AstraZeneca and Pfizer or Moderna vaccines, the immune response was observed to be better. 

“A double dose of vaccine always produces a better immune response against any virus. However, the mixing of the AstraZeneca and Pfizer or Moderna vaccines were found to be effective even against the new and concerning variants of SARS-CoV-2 virus including the Delta variant.”

Prime Minister Dr Lotay Tshering in an interview with Reuters had said that he “has no problem in mixing-and-matching Covid-19 vaccine doses” to immunize the country’s eligible population.

Lyonchhen said: “Knowing immunology, knowing how our body reacts to vaccines, I am comfortable to secure a second dose of any vaccine that is, of course, approved by the WHO.”

He had said that the government had reached out to the manufactures of Moderna and Pfizer vaccines. “There are no countries that don’t face vaccine problems … I will have to be frank with my people,” Lyonchhen said, adding that he would be “the happiest person” to take a second dose of any other vaccine.

The prime minister was the second person to receive the Covishield vaccine on March 27, earlier this year.

Time is running out 

As Bhutan enters week-13 after the first dose, many are already concerned if the delay would make the first dose ineffective and that the process would need to start all over again.

With several debates on the gap between the two doses, NI-TAG members yesterday had a virtual conference with officials from the United Kingdom-based AstraZeneca company on the duration of the gap.

Dr Sonam Wanghcuk said that the manufacturer of the vaccine had initially recommended 4 to 12 weeks of gap between the two doses. He said that the same duration still holds today. However, during the conference yesterday, the UK-based company said that they found evidence where the first dose of the vaccine was still effective even after the 23rd week.

“The evidence found that individuals were still adequately protected at week 23rd after the first dose,” he said. “However, this is not a recommendation from their side. The company has said that it would depend on the respective country’s NI-TAG members to decide.”

He said Bhutan, for now, was following the World Health Organisation’s recommendation of 8 to 12 weeks gap between the two doses. “Although majority of Bhutanese who received their first dose would be completing their 12 weeks gap on Monday, a delay of a few weeks should not be a problem.”

Dr Sonam Wanghcuk said that the ‘few weeks’ delay would mean two to three weeks. “If the delay stretches, then we might have to decide on something.”

He said that the NI-TAG recommends starting the second dose of vaccination as soon as the government is able to secure the doses. For now, he said that there was no indication from the government as to when the programme could begin.

Other options?

Meanwhile, some are questioning why the government is finding it difficult to arrange half a million doses, which is comparatively nothing to the global demand. “We know we will not get it easily from India as they are fighting a second wave,” said one. “We have good relations with many advanced countries that would be willing to contribute knowing our situation. What is our foreign ministry doing?”

Another said that Bhutan has good relations with countries like Japan who could come to our rescue. “Our diplomats should have started exploring as soon as we understood the situation in India, our only hope then,” said another. “In a few days we will complete three months after the first dose. Despite the justifications, we are worried that the first round would go to waste if the government fails to arrange the second dose,” he said. “time is running out. We should seek help from the international community.”