Moderna recommended for second dose for better immunity

With the available evidence, the government recommends to take the Moderna vaccine as the second dose for those who received AstraZeneca as the first dose. However, AstraZeneca will also be made available as a second dose for those who insist on it, for personal reasons.

In a test rollout 613 people led by the Prime Minister took the Moderna dose on Saturday and only two people reported some side affects like headache and pain at the site of injection otherwise they were all fine.

Given the sufficient doses, the first timers can receive either AstraZeneca, Sinopharm or Moderna. For this group of people, the second dose can be Moderna and Sinopharm vaccine in four weeks or AstraZeneca in 12 to 16 weeks in homologous mode. Heterologous options will also be provided, based on the availability of vaccines.

The Health Minister Dasho Dechen Wangmo said people can choose either Moderna or AstraZeneca since there are enough vaccines stocked up in the country for a second dose. The health team in the vaccination post will not even ask the reasons for choosing any vaccines. If they want AstraZeneca, they will be provided with AstraZeneca, and similarly, Moderna will be provided if they prefer the Moderna vaccine.

The National Immunization Technical Advisory Group (NI-TAG) recommends heterologous vaccination (mixed dose), purely based on the evidence of boosting immunity.

Dr Sonam Wangchuk of NI-TAG said there are people who still prefer AstraZeneca because the advocacy is not over yet. However, there is still time and NI-TAG will provide all the evidence on heterologous vaccination and hopes that preferences may change. Despite all the advocacy and evidence, if people still prefer AstraZeneca then people will be provided with the AstraZeneca vaccine.

The ministry could not go with the online registration for those who prefer AstraZeneca given the limited time, so with some assumption and calculation, the ministry will mobilize vaccines in different parts of the country. AstraZeneca vaccine will be made available, but in case the people predominantly go all out for AstraZeneca then the ministry might have to send backup doses.

Dr Sonam said given the situation, evidence, disease outbreak and new variants emerging, a mix and match of vaccine has no safety issues, and it is better than AstraZeneca. Moderna has reported no serious side effects and there are a number of reports that have been carried out in developed countries, like Germany, France, Italy and Spain.

The Press Release from the Prime Minister’s Office (PMO) stated all vaccines that have emergency use approval are equally safe. But on immune protection, even if by a margin, the emerging literature points towards a better immune response for those who have received mRNA vaccine as second dose to AstraZeneca as first dose.

While this is one of the heterologous regimes, it does not mean homologous modes of vaccination are ineffective, which is why it is also valid to have the same vaccine for the second dose.

Few of the countries that have adopted a similar mode of vaccination are Canada, with heterologous recommended for all, but can opt for AstraZeneca too. Most Scandinavian countries opted heterologous for all ages, Germany, Spain and Australia opted heterologous for those below 60 years, and France opted heterologous for those below 55 years.

All the above are based on the evolving trends of efficacy, availability of vaccines, and choices made by decision makers and vaccine recipients.

Meanwhile, Prime Minister Dasho (Dr) Lotay Tshering requested everyone to pay more importance to getting vaccinated than delving into the choice of vaccines. The Delta-variant of COVID-19 is more contagious, and therefore, he urges everyone to rise above the circumstances to get vaccinated, and add up the number that gives the country “herd immunity” faster.

To achieve herd immunity, the country needs to vaccinate an arbitrary minimum 80 percent of the total population, in the shortest possible time.

Vaccination, and subsequently herd immunity, is the only way to enter the “new normal” era sooner. However, considering post-vaccination protocols, the same restrictions will continue to be imposed on those who are not vaccinated, given the risk they pose to themselves or others.

The main challenge with the now prevalent Delta variant is that it reduces the efficacy of vaccines and so studies show that while a double dose is much better than a single dose a mixed dose offers more protection.

The National roll out started from 20th July.

WHO Chief Scientists words misunderstood

While many developed countries have adopted the mixed regime including the German Chancellor Angela Merkel who took a first dose of AstraZeneca followed by a shot of Moderna there was some misunderstanding over the out of context quote of the WHO Chief Scientist Dr. Soumya Swaminathan.

She was quoted out of context as warning against mixing and matching vaccines.

However, according to CBC news of Canada she in a press briefing was answering a reporter’s question about whether or not there is a need for potential third doses — or booster shots — of COVID-19 vaccines. 

The report says that as part of a lengthy response, Swaminathan warned against individuals deciding for themselves whether or not they need extra doses.  

“There is a tendency now for people in countries with enough availability of vaccines to, you know, voluntarily start thinking about an additional dose,” she said. 

“It’s a little bit of a dangerous trend here where people are in a … data-free, evidence-free zone as far as a mix and match,” she said. “It will be a chaotic situation in countries if citizens start, you know, deciding when and who should be taking a second, or a third or a fourth dose.”

But CBC said the headline that emerged in a short story by wire service Reuters that was picked up by other media was, “WHO Warns Against People Mixing And Matching COVID Vaccines.” 

A day later, Reuters issued a clarification on Twitter. The wire service also updated the headline on the story to read: “WHO Warns Individuals Against Mixing And Matching COVID Vaccines.”

“At our Global press conference on COVID 19, Dr. Soumya Swaminathan explained that individuals should not decide for themselves, public health agencies can, based on available data,” WHO said in a statement to CBC News on Tuesday. 

Swaminathan also sent out a tweet to clarify her position when the misleading story was shared on Twitter.

She said individuals should not decide for themselves, public health agencies can, based on available data.

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