As Bhutan finishes 12 week gap no science yet on 16-week gap

Depending on which day you took your vaccine in March 2021, Bhutan will be finishing its 12-week gap between the 19th and 26th of June with it extending to 29th June for some latecomers.

However, after that Bhutan will have well and completely finished the 12-week gap and it will be heading into uncharted vaccine territory as there is no clinically proven human trails to prove the efficacy of the vaccine at the 16-week gap that some in the government are propounding.

In recent weeks the Foreign Minister Dr Tandi has been pointing to India increasing the gap to 16-weeks and even Canada and Spain.

However, recently three members of India’s National Technical Advisory Group on Immunization (NTAGI) came out in the Indian media to say that NTAGI never recommended the 16-week gap given the lack of scientific evidence.

Even the three studies quoted by a NITAG member did not mention the efficacy of the vaccine at 16 weeks.

The World Health Organization (WHO) and the European Medicines Agency (EMA) both only recommend up to a 12-week interval.

Observers in India say that the 16-week gap is due to the shortage of vaccines and the government there is trying to pass it off as a scientific decision. It is also an indirect admission of India’s focus on delivering the first dose to as many people as possible before an inevitable third wave hits.

In the case of Spain, it is using the 16-week gap to buy itself time to see if mixed vaccine doses work and until then it wants to hold off a second dose.

Canada had gone with the 16-week gap but as more vaccines arrive there the move is to now shorten the gap.

Thailand which had recently announced a 16-week gap again scrapped it and went back to the 12-week interval.

The UK which was one of the original advocates of the longer gap only has a maximum of 12- week gap and even that is being reduced for those above 40 years old to 8 weeks given the spread of the more transmissible and dangerous Delta Variant first detected in India.

Bhutan’s National Immunization Technical Advisory Group (NITAG) member Dr Sonam Wangchuk admitted that there is no peer reviewed medical papers yet on the 16-week gap but he said that countries like Spain and Canada would not have gone ahead without some basis.

He said the important dose is the first dose in preventing strong illness and the second shot is more a booster dose. He, however, expects that at some point there will be papers and clinical trials to show the effectiveness of the 16-week gap too. He said the original recommendation was 6 to 8 weeks and then it moved to 8 to 12 weeks.

He said that as of now NITAG and the Ministry of Health has not changed it’s 12-week gap target and the aim is still to try and vaccinate within this window period.

He said the limitation for Bhutan is it does not have the capacity to do its own clinical trials and so it has to follow the example of bigger countries.

However, Dr Sonam said that if Bhutan cannot absolutely get any vaccines at the 12-week dose then a slight delay would be okay under the circumstances.

The Health Minister Dasho Dechen Wangmo told this paper earlier that Bhutan is still going by the 12-week gap because the second dose is the only long term chance Bhutan has of stopping the Delta variant.

Meanwhile, Bhutan still has not got any vaccines yet for the second dose. The Foreign Minister Dr Tandi Dorji said that Bhutan is continuing to reach out to as many countries as possible.

An official said that the biggest challenge for Bhutan to get the second dose ironically is Bhutan’s success in combating COVID-19 so far and its success with the first dose with some countries saying Bhutan at least got the first dose in while others are yet to even get that.

However, like the health minister pointed out earlier, the official said that the countries are forgetting how vulnerable Bhutan is with a small population with limited medical infrastructure.

Given that situation the only choice before Bhutan is to continue with the methods that worked so far like sealed borders, 21-day and 7-day quarantine, social distancing, masking up, ventilation and hand washing.

In an update on Monday evening  a release from the White House showed Bhutan is included the list of Asian countries to get 16 million doses.  Bhutan’s share is not clear yet though but Bhutan had requested USA for half a million AstraZeneca doses around three months ago.

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