Photo Courtesy: UNICEF Bhutan

Bhutan exploring third dose by next year

As Israel started giving booster or third doses for COVID-19 to those above 40 and school teachers and the USA announced it would start giving third doses from 20th September 2021, the government is exploring the possibility of giving third doses to Bhutanese by next year.

The Foreign Minister Dr Tandi Dorji said that Pfizer has indicated to Bhutan that if it wants booster doses by next year then it should place its orders by now. This is before too many countries place orders which can lead to delays.

The initial potential number being looked at was 500,000 doses but this could go up as Bhutan extends its vaccination to children.

The minister explained that Pfizer has far larger capacity than Moderna to produce these vaccines given that it is an older and much bigger company.

Lyonpo said the government will take a final decision on the issue in the next few weeks.

Two important considerations to decide on the third dose is firstly a domestic antibodies study done for people who got the second dose and secondly international medical literature and advice.

Health Minister Dasho Dechen Wangmo said, “Down the line if we require the third dose then when and how and in what manner is yet to decided.”

She said that for Bhutan an important factor will be an ongoing study to see how the antibodies in the body are responding to the second dose.

Lyonpo said that around 4,000 samples had been collected so far which include the young, old, those with comorbidities and also with compromised immune systems. She said more samples are being collected from the school children who have been given the first dose.

Lyonpo said that the study will show the antibodies in different groups of people and and it could be an important factor in what type of approach to take for a booster dose.

Lyonpo said that one possible option is to give the booster dose only to those who are vulnerable in terms of immune systems, age and comorbidities. This approach would take some funds as it would involve measuring the antibodies of people.

The other possible approach is to give the booster dose to everybody.

Lyonpo said that currently there is no minimum threshold for antibodies level to give booster doses so that would have to be looked at.

Lyonpo Dr Tandi Dorji said that right now the WHO has not recommended the booster dose and he said there is not enough data in the medical literature for a booster dose and so far protection had shown to be high after two doses.

The minister said that as a pediatrician he has read medical literature which shows that for people who got infected and got the two doses their antibodies decline faster than those who were not infected and got the two doses.

He said that it has not even been a year since vaccines have been given and it may be too early to conclude on the antibodies. However, he said that Bhutan will take a call in the coming weeks.

Lyonpo said that in the next two years the capacity of the world to produce more vaccines would increase a lot as capacities are put in place and countries get the license to manufacture the vaccines in their own countries.

Apart from Israel and USA countries like Chile and Germany are offering booster doses to the older population.

Israel recently released data showing a reduction in the effectiveness of Pfizer’s COVID vaccine against severe illness among people 65 and older who were fully vaccinated in the months of January or February 2021. In fact, a lot of the breakthrough infections of fully vaccinated people were in this age group.

Until recently US health officials were not advocating for a third dose but the rise of the more infectious delta variant and rising breakthrough infection cases has lead to a change of heart.

A joint state signed by Center for Diseases Control (CDC) Director Dr. Rochelle Walensky, acting FDA Commissioner Dr. Janet Woodcock, White House chief medical advisor Dr. Anthony Fauci and other U.S. health leaders said that it is now very clear that immunity starts to fall after the initial two doses, and with the dominance of the delta variant, they are starting to see evidence of reduced protection against mild and moderate disease.

While keeping its eye on the booster dose, the current focus of the government is to get in enough mRNA vaccines to vaccinate 12 to 17 and then at a later stage 6 to 11 once approvals are granted.

Here Dr Tandi said, “We have approached the Americans and they said they will consider our request but right now since they have already given our share through COVAX, it will have to be in the next phase.”

The Foreign Minister said that Bhutan is also in talks with Bangladesh to swap its AstraZeneca vaccines for the Moderna ones in Bangladesh. The minister said that Bangladesh wants to cooperate but there are certain COVAX facility restrictions and so talks are still going on.

Lyonpo said Bhutan is also watching the recent purchase of 1 million Moderna doses by Australia from Poland and so Bhutan is willing to buy the mRNA doses from countries willing to sell them.

Importantly the Health Ministry is in talks with Moderna to get more vaccines to vaccinate the school children and an important advantage that Bhutan has is that it will be sharing some data on the antibodies results with Moderna.

Bhutan is looking for another 148,000 doses of Moderna vaccines.

Bhutan is also hoping to get 200,000 Pfizer doses by October or November which the country is buying.

Here the hope is that by then Pfizer may get approval in the USA to vaccinate those from 6 to 11 which can then be implemented in Bhutan.

Moderna has also submitted data for its trials and in the 6 to 11 category and could get approval in the next two months in the USA.

When it comes to children the main focus is more on the dosage quantity that is correct for them.

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