Bhutan gears up for second round of mass vaccination

The Prime Minister received the Moderna vaccine on Saturday, 17 July

Bhutan will go with the mix-and-match mode of vaccination as the government plans to administer the Moderna vaccine as the second dose during the second nationwide vaccination for COVID-19 that will begin from July 20.

Prime Minister Dr Lotay Tshering received the Moderna vaccine on Saturday, 17 July along with a team of volunteers.

“In addition to my professional understanding and scientific data, this will help me share my personal experience with you all,” Lyonchhen said.

 The National Immunization Technical Advisory Group (NI-TAG) of the country has recommended a mix-and-match mode of vaccination for the second dose.

 According to the message posted by the Prime Minister on his official Facebook page yesterday, 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 the mRNA vaccine as the second dose to the AstraZeneca as the first dose. While this is one of the heterologous regimens, 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. 

Thus, the government recommends taking the Moderna vaccine as the second dose for those who received the AstraZeneca as the first dose.

However, the AstraZeneca vaccine will also be made available as the second dose for those who insist on it for personal reasons. 

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

It has also been recommended to design a separate package to allocate the limited stock of the available Pfizer vaccine to cover children between 12 and 17 years who are living in areas of outbreak such as Phuentsholing and Samtse, travelling for treatment outside, and travelling for studies outside.  

“While studies are underway, we are also waiting for evidence to emerge in the coming days for use of the Moderna in children below 17 years, for which works are already underway to ensure timely vaccination,” states the PM’s message.  

NI-TAG member, Dr Sonam Wangchuk said that the heterologous regimen which is a mixing of vaccines was found to be more effective and have more efficacies and in the wake of the Delta variant, which is spreading very fast, the immunity is better. 

He added that clinical trials and studies conducted in several developed countries have shown that mixing of vaccines was not only effective against the emerging variants of concerns but it was also safe. 

He said that the mixing of vaccines is not a new idea and it is not done for the first time. Heterologous prime-boost vaccination was also given for other diseases such as HIV, Tuberculosis, Malaria, cancer therapy and Ebola. 

“The side effects from the mix-and-match will be similar to the first dose. But the severity will depend on a person’s immunity level,” he said. 

As per studies so far, 13 countries in the world have adopted the heterologous schedule.  

Countries like Germany, France, Sweden, Norway, Finland, Denmark, Canada and South Korea have adopted the AstraZeneca vaccine as the first dose and the Pfizer as the second dose. Bahrain and UAE have adopted the Sinopham as the first dose and the Pfizer as the second dose. The Middle East has adopted the Sputnik V as the first dose and the Chinese vaccine as the second dose. The United Kingdom has adopted the AstraZeneca as the first dose and the Sputnik V as the second dose. The US has adopted full dose of the mRNA.  

Going by age criteria for countries that have adopted the heterologous regimen, Germany and Australia adopted it for people above 60 years, France for people above 55 years, Norway and Denmark for all ages, Finland and Sweden for people below 65 years, Italy for people below 60 years and the UK for people above 30 years. 

Health Minister Dasho Dechen Wangmo said that the ministry has not decided the mix-and-match approach because of the shortage of vaccines, but it is because the NI-TAG has decided that it has adequate evidence of its efficacy from research and clinical trials. 

Lyonpo also mentioned that by now with more than 2,000 cases in the country, there should be a maximum of ten mortalities in the country. “It is not there because of timely vaccination of the first dose,” Lyonpo said.  

Lyonpo urged people to come forward for the second dose of vaccination so that we will have herd immunity coverage of 80% of the total population in the shortest period of time.

The Prime Minister mentioned that vaccination and subsequently herd immunity is the only way to enter the “new normal” era sooner. However, as we consider 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 Opposition Party, Druk Phuensum Tshogpa, also issued a press release yesterday stating that the government should clarify the doubts and apprehensions hovering over the issue of mix and match of COVID-19 vaccines.  

“We have the duty to provide complete information and transparency to the people.” 

The press release states that under the peerless guidance and leadership of His Majesty The King, the government has made commendable success with both sourcing of vaccines and vaccination drives. “We remain appreciative of the government’s efforts.” 

However, the Opposition Party stated that with the widespread news on apprehensions and concerns in the international arena on the mix and match of vaccines, from respectable experts, institutions and countries, they feel the concerns and apprehensions of the people have become genuine. 

“We advise the government to inform the nation of its findings and professional views on those claims and apprehensions, and provide necessary sensitization and guidance to the people prior to administration of the second dose,” states the Opposition Party.

Dechen Dolkar from Thimphu