Govt. considers the option to vaccinate entire population at once

Younten Tshedup 

While at least six Covid-19 vaccines were approved for emergency use so far, the Covid-19 national taskforce is considering the Oxford-AstraZeneca, Pfizer/BioNTech and Moderna vaccines.

Although it is not confirmed when the country would receive the vaccines, the health ministry has detailed a deployment plan for all the three vaccines.

Senior programme officer with the public health department, Sangay Phuntsho, said that the vaccine deployment plan broadly considers two scenarios.

The first scenario would be adopted if the country receives the vaccine in tranches. This is likely under the COVAX Facility, of which Bhutan is a member. The Facility would deliver vaccines to cover 20 percent of the population for free, however, in tranches. The first tranche would cover around three percent of the total population.

Under this scenario, priority groups would receive the limited doses in a phase-wise manner. The ministry’s national immunisation technical advisory group (NI-TAG) has identified high-risk workers in the healthcare facilities in the first phase of the distribution. The group would include close to 6,000 individuals.

The group would also consist of about 35,000 active frontliners such as police and army personnel, and DeSuups. Over 41,000 elderlies above the age of 60 years and 34,000 plus people living with comorbidities will also be included in the first phase of vaccine distribution.

As and when the next tranche of the vaccine is received, the second and third phases of distribution would begin covering the rest of the population.

The second scenario is if the country receives enough doses to vaccinate the entire population at once. This is an option the government is considering with India, as the country recently approved the emergency use authorisation of two vaccines including the Oxford-AstraZeneca.

Sangay Phuntsho said that under this scenario, vaccines would be rolled-out at the same time across the country. “The vaccination would be completed within two weeks after it starts.”

He said that the strategy would be similar to that of the flu vaccination programme. Under this strategy, he said that every health facility has their own micro plan covering the vaccination sites, human resource and consumable requirements, and tentative dates.

“We would be aligning our strategy with the zoning system,” he said, adding that should the outbreak continue as today, based on the technical advisory group and national taskforce’s instruction, families would be called out in their respective zones with their movement cards to get the vaccines.

Even otherwise, he said that if the situation improves, vaccination would be carried out through multiple vaccination sites to avoid crowding and in line with the current health preventive measures.

The three vaccines  

Sangay Phuntsho said that logistically, it would be better if the country manages to procure either of the Oxford-AstraZeneca or the Moderna vaccines. This is because the two vaccines can be stored at a regular fridge temperature.

He said that although the Moderna vaccine requires a -20 degree Celsius storage facility, it has a shelf-life of a month if kept at regular fridge temperature (2-8 degree Celsius). “It would take us at least a week to distribute the vaccines and another two weeks to administer it. So, there is no major issue with Moderna.”

It was learned that the Pfizer/BioNTech vaccine had some logistical issues as it required storage temperature of -70 degree Celsius. However, Sangay Phuntsho said that if the Pfizer vaccine is procured in tranches, there won’t be any major logistical issues.

He said that there are two facilities in the country where a -70 degree Celsius temperature storage was available — the national referral hospital and the Royal Centre for Disease Control in Thimphu.

“But once out of the -70 degree Celsius, we can keep the Pfizer vaccine in 2-8 degree Celsius only for five day. So, if we receive vaccines for the entire population at once, it would be logistically difficult to deliver them to all,” he said.

However, the ministry has worked up a plan. In absence of refrigerated vans for transportation, helicopters would be used to reach the vaccines to the identified strategic locations. Besides Thimphu, some of the strategic locations are Mongar and Samdrupjongkhar in the east, Bumthang and Gelephu in the centre, and Phuentsholing in the south.

Sangay Phuntsho explained that health officials from rest of the dzongkhags would have to be present at the strategic locations so that as and when the helicopter arrives, they pick their share of the vaccine and return to their respective locations on the same day.

Similarly, other far-flung locations would also have to be present at the respective locations on the same day to collect the vaccines and return to their stations. “This is not the most ideal method, but it is doable. And we don’t have other options with the Pfizer vaccine.”

He said that because it was still unsure when the country would start receiving the vaccines, including the type of vaccine and the number of doses, the ministry had come up with strategies to immediately deploy the vaccines without wasting any time. “We’ve made a plan that is comprehensive in all situations irrespective of the type of vaccines we get.”

The plan was presented to the national Covid-19 taskforce on January 11.