The Bhutanese Leading the way.
Rest could be met by other countries, GoI and possibly Moderna
The Danish government announcing 250,000 AstraZeneca doses for Bhutan on Thursday has come as a major boost for Bhutan’s second dose efforts whose 16-week gap now ends by the end of July.
The Prime Minister Dasho Dr Lotay Tshering said that Bhutan is in touch with various European countries for the second dose for Bhutan and many have informally declared that they will send vaccines, but that they would make the official announcements.
Lyonchhen said this is because the countries have to complete various formalities and there also sensitivities involved as there are other countries and also COVAX asking these countries to donate vaccines too.
The Prime Minister said that around 300,000 to 350,000 doses are expected from European countries if not more.
Lyonchhen said that Ambassador Tshering Gyaltshen Penjor in Bhutan’s Embassy in Brussels and Ambassador Tenzin Rondel Wangchuk in Bhutan’s Permanent Mission to the UN have been working hard and meeting with many EU countries and giving updates on vaccines on an hourly basis.
Lyonchhen said the Ambassadors are also working on how to reach the vaccines to Bhutan in either a plane going from Bhutan to pick it up, Paro airport facilitating a foreign plane to land there or Bhutan picking it up from a nearby airport.
On the remaining 200,000 or so doses Lyonchhen said the Government of India has always been there to support Bhutan. He said if worst comes to worst then the GoI has assured to fill in the remaining vaccine gap.
Lyonchhen said that as per His Majesty’s command India needs the vaccine more than Bhutan and so Bhutan has not formally asked for the second dose recently but GoI has indicated support if Bhutan cannot get vaccines from elsewhere.
Last week the Indian news portal The Print said that depending on the scale of production of vaccines within India, New Delhi is aiming at July-end or August 2021 to at least release those vaccines that have been bought by Bangladesh, Sri Lanka and Nepal and are now in pending status.
The supplies to Bhutan, which received vaccines from India as grants, will be prioritized too according to The Print.
Foreign Minister Dr Tandi Dorji had told the paper last week that the vaccines from other countries are important as if they come in then it would also be easier for India to fill the remaining gap.
The PM said that Bhutan has also approached non EU countries like Japan and others.
In addition to that he said Bhutan is also in talks with Moderna to see if the company can send some vaccines early for a mixed-vaccine dose and Bhutan has also offered to buy them.
The PM said Bhutan’s National Immunization Technical Advisory Group (NITAG) has already prepared a template for the mixed dose vaccination which decides who will get AstraZeneca for both doses and an AstraZeneca and Moderna mix.
The PM said that with mixed vaccines the immune response is a bit better than the same ones.
So the preparation here could be around 300,000 AstraZeneca vaccines and the rest getting Moderna vaccines.
Bhutan has also asked COVAX to frontload Bhutan’s 108,000 vaccines coming to it through America. Bhutan has already requested USA to include more of Pfizer doses which are approved for use for children from 12 to 18.
Lyonchhen said that the main argument that Bhutan is using is that it wants to gain herd immunity by vaccinating everyone in one go and so any number of vaccines that come in will have a major impact.
Bhutan has already been told by Pfizer that its order of 200,000 Pfizer vaccines will come in by the end of the year but Bhutan is requesting that if this can be fast tracked so that children can be vaccinated too.
One aim is to start vaccination of children from July.
Given that COVID-19 is expected to last a few years and with talk of a third booster dose being needed in the future, the PM said that Bhutan is in talks with Moderna.
What makes Moderna interesting is that it is similar to the Pfizer vaccine as a RNA vaccine and it has applied for clearance to be used in children from 12-18 years of age which is also expected to come.
Talking about the 16-week gap the PM said that the priming dose has already been given and the second dose will be a booster dose.
He said that that initially the gap was thought to be one month but as AstraZeneca and others followed up they found the immune system was still strong at 12 weeks and the gap got extended to 12 weeks. He said the company has said that it is still effective at 16 weeks gap too.
While there is no peer reviewed papers on this yet a recent Oxford Study that is yet to be peer reviewed found greater immunity as a longer gap is maintained.
The PM said that all vaccines have gone through the similar development with the only difference for COVID-19 vaccines being that that it was approved in a shorter time and has come under a stricter media glare. He said the other vaccines went through a similar process and was then approved.
On the issue of the third booster dose the PM said that nobody really knows how long immunity will last after the second dose and the best guess right now is six months and up to a year if there is no substantive change in the virus.
However, the PM said that could change if the virus undergoes mutations and so here the vaccines themselves may have to undergo changes.
The PM gave the example of the flu vaccine which he said changes every year to deal with the mutations.
The Prime Minister said that in addition to the support assured by GoI, it had also put in a good word for Bhutan with other countries while approaching them.
