Three vaccines for consideration for the second dose  

Younten Tshedup  

The United States of America government yesterday announced that it has dispatched 500,000 doses of Moderna vaccine to Bhutan. 

The White House Press Secretary Jen Psaki announced this during a press briefing yesterday. 

According to the Press Secretary, the US also shipped three million doses to Indonesia, 1.5 million (M) doses to Nepal. 

This is a part of the US government’s pledge to share an initial batch of 80M US-made vaccines globally amid concerns about the wide disparity in vaccination rates between advanced and developing countries.

With this shipment, besides the AstraZeneca vaccine, which all eligible people in Bhutan received for their first dose, two more vaccine types — Pfizer and Moderna — have been added to the list of vaccines to be used for the second dose in Bhutan.

The country has already received 5,850 doses of Pfizer vaccines from the COVAX Facility on May 25. There are some 60,000 additional Covishield (AstraZeneca) vaccines left over from the first round.

Lyonchhen recently said that the government has secured some 550,000 doses of AstraZeneca vaccines, which includes 250,000 doses from Denmark.

With the US government shipping 500,000 doses of Moderna vaccines yesterday, this puts Bhutan in a very good position to vaccinate its entire population, including children below 18 years.

Kuensel learnt that the government had also secured about 200,000 doses of Pfizer vaccine from the US. 


White House Press Secretary Jen Psaki makes the announcement during a briefing yesterday

The government, for now, has not specified as to which vaccine would be rolled out for the second dose, which is tentatively scheduled in the third week of this month.

The concern now, according to health officials, is to vaccinate all Bhutanese and those living in the country with the second dose, as the 16-week period after the first dose is coming to an end.

Prime Minister Dr Lotay Tshering said that although it was likely that people in the country would get second dose of AstraZeneca vaccine, should the national immunization technical advisory group (NI-TAG) recommend a heterologous (mix-and-match) method of the vaccination, the government has access to both Moderna and Pfizer vaccines.

“Who will get what kind of vaccine is being worked out currently. In the next one or two days, NI-TAG should be ready with their recommendation,” Lyonchhen said yesterday. “There is no reason for us to hide this information from the public. All our decisions will be based on science and recommendation from the experts.”

Developed countries like Spain, Canada, and Germany have already started vaccinating their population with the mix-and-match mode of vaccination, where the initial dose of AstraZeneca has been boosted with a mRNA (Pfizer or Moderna) vaccine in the second. Germany’s Chancellor Angela Merkel and Canadian Prime Minister Justin Trudeau are some of the world leaders to mix their Covid-19 vaccines recently.

The NI-TAG has also recommended a mix-and-match mode of vaccination given the successful outcome globally.


Herd Immunity  

Besides the adequate number of vaccines, secured for now, the most critical part would be achieving an adequate level of vaccination coverage to achieve herd immunity.

Lyonchhen said that the more contagious the disease, the higher the population coverage is required to achieve herd immunity. “In the pre-Delta variant period, during our first vaccination campaign, we required at least 70 percent of our population to be vaccinated. We could manage only about 65 percent then.”

He said that for the Delta variant of the SARS-CoV-2 virus, the required vaccine coverage was a minimum of 80 percent. “If we can’t cover our children below 18 years, it would be really difficult for us to achieve herd immunity.”

Officials said that close to 30 percent of the country’s population were aged 18 years and below. “So, to achieve the 80 percent coverage, every single individual above the age of 18 has to be vaccinated,” said Lyonchhen, adding that it was critical to vaccinate children to achieve herd immunity.

According to the 2017 population and housing census of Bhutan, the projected population of Bhutan in 2021 is 756,129. This would mean that there are about 226,000 people below 18 years.

Currently, the only Covid-19 vaccine certified for children below 18 years is the US’s Pfizer vaccine. However, studies have also shown that the Moderna vaccine was safe and effective among children aged 12-17 years. The company has sought approval from the United States’ Food and Drug Administration (FDA) to use their vaccines in children above the age of 12 years.

Given the urgency, Lyonchhen urged all eligible individuals to come forward and get vaccinated this time. He said that the vaccines had two definite benefits — to prevent people from being infected and from developing serious disease once infected.

However, he cautioned that the vaccines would be effective against only those variants of the virus which are in circulation now.

“With the rate at which new variants of concern are emerging, we are all worried. Following our second dose, if we hurry to relax the protocols and if a new variant of concern emerges, it would overwhelm all of us,” he said.

In the meantime, some 400 Bhutanese had already received their second dose of the vaccine. The recipients are those who had travelled outside the country.

Sowai Lyonpo (health minister) Dechen Wangmo said that the majority of the recipients were students returning to their schools outside. “There were also those who work and live aboard. We started giving the second dose after they completed eight weeks following the first dose.”

Lyonchhen said that none who are still in the country has received the second dose of the vaccine.


Edited by Tshering Palden