All You Need to Know about Covid Vaccines in Pakistan
By Sumaira Jajja
Registration for the coronavirus vaccine opened up for people aged 30 and above on Sunday, May 16. Pakistan has so far approved five Covid vaccines: Sinopharm, Cansino, Sinovac, Sputnik and AstraZeneca.
As the government's vaccine drive picks up pace, Dawn.com reached out to Dr Bushra Jamil, the president of the Medical Microbiology and Infectious Diseases Society of Pakistan and a professor at Aga Khan University Hospital on queries related to getting the Covid jab.
Dr Jamil is a pro bono adviser to the National Command and Operation Center (NCOC) on the Covid-19 pandemic and has devised vaccine-related guidelines currently employed by the health ministry.
Q: Do Covid-19 vaccines reduce the ability to make antibodies or affect the immune system?
A: No, vaccines do not reduce the ability to make antibodies and do not suppress the immune system.
Q: Is the vaccine safe for patients with diabetes, high blood pressure and arthritis?
A: Vaccines are recommended for people with diabetes, hypertension, heart diseases, etc. These are high-risk groups that must get vaccinated.
Q: Should people getting dialysis, taking insulin, or those with pacemakers and transplants get vaccinated?
A: People on insulin, dialysis and transplant recipients must get vaccinated. Dialysis patients and transplant recipients have a weaker immune system and as more information becomes available, vaccination schedule may be modified for these groups. For now, follow the current guidelines.
Q: Should people with hepatitis, tuberculosis and HIV get vaccinated?
A: People with tuberculosis, HIV and chronic hepatitis must get vaccinated. Discuss your condition with your doctor in detail.
Q: I am a married man/woman and plan on starting a family soon. Will the Covid vaccine affect my fertility?
A: Coronavirus vaccine, like all other vaccines, has no effect on fertility. None of the vaccines developed and in use for preventing childhood and adult infections have any effect on male or female reproduction.
Vaccines induce immunity against bacteria and viruses and not against human cells and tissues. Scientifically, it is impossible to induce infertility through the administration of a vaccine.
Q: Is it safe for pregnant or lactating women to get the jab?
A: All vaccines are safe for lactating mothers. Almost all vaccines are safe in pregnancy. However, for some vaccines, recommendations on risk versus benefit will be updated as more information becomes available.
Q: Is there any category that should not be vaccinated?
A: Vaccination should be deferred in acutely ill, hospitalized patients and those with acute Covid-19 infections.
In addition, those with a history of severe allergic reactions to vaccine preservatives/stabilizers in the past. It is important to check vaccine guidelines.
Q: Why are children not being vaccinated?
A: There is currently not enough safety data available. Generally, children are the last group to be subjected to clinical trials.
However, some preliminary data is available which suggests that Covid-19 vaccines may be safe and effective in children. We need to wait for more information and recommendations regarding this.
Q: Why is Covid vaccine being given to people over the age of 60? Wouldn’t it be too strong for their immune system?
A: The age group most at risk for severe disease is 60 and above. Therefore, this is the priority group that must get vaccinated.
Q: I and my wife are getting vaccinated while my parents, both above 60 and with Type2 diabetes, are refusing to vaccinate. I have young children at home. What’s the way out?
A: Explain the risks of disease transmission and the increased chance of serious disease and death if Covid-19 infection is acquired by someone who is over 60. Convince your parents and the elderly to get vaccinated.
Q: I got the Sputnik/Pfizer shots. Should I also go for the Chinese vaccines for added protection?
A: If a complete course of one vaccine has been administered, it is not recommended to go for another type of vaccine.
Q: Should a person over 50, who has recovered from Covid, get vaccinated?
A: It is recommended that people who have recovered from Covid- 19 should get vaccinated. Immunity after recovery from infection needs to be boosted with the vaccine.
Q: How long after recovering from the virus should one get vaccinated?
A: Soon after complete recovery from infection.
Q: How long does it take for antibodies to develop and how long does vaccine protection last? Do I need a booster dose in the future?
A: Antibodies may take three weeks to develop after the second dose. However, immunity is a complex phenomenon and there are other mechanisms in the body which provide protection.
Therefore, monitoring antibodies post-vaccination is not recommended. Immunity may decline in 6-7 months. Booster doses may be required but there are no formal recommendations available regarding this as yet.
Q: Why is AstraZeneca's Covid-19 vaccine allowed in Pakistan?
The decision is based on available data, compiled and vetted by experts. The guiding principle to halt the pandemic is to weigh risk (adverse effects) versus benefit (preventing death and disability). Astrazeneca vaccine is authorized in the EU and many countries of the world to prevent Covid-19. The benefits of this vaccine far outweigh its risks in adults of all age groups. It is effective at preventing hospitalizations, intensive care unit (ICU) admissions and deaths due to Covid-19.
The benefits of vaccination increase with increasing age and when infection rates are high. The most common side effects are usually mild and get better within a few days. The most serious side effects are very rare cases of unusual blood clots with low blood platelets, which are estimated to occur in 1 in 100,000 to 250,000 vaccinated people.
In view of limited vaccine supplies worldwide, Pakistan is offering Astrazeneca vaccine to all adults over 40 years of age. This decision is based on WHO's recommendation of considering local epidemiology (including incidence and mortality from COVID-19 disease), age groups targeted for vaccination, data on vaccine adverse effects and the availability of alternative vaccines.
Guidelines for use of this vaccine will continue to be updated as new information becomes available. Overall, the currently available Covid-19 vaccines in Pakistan are very safe and effective at preventing infection. It is imperative that all adult citizens get their first available shot as soon as possible given the ongoing third wave of the virus in Pakistan and the real risk of spread of infection from neighboring countries.
The vaccines — a snapshot
Following is brief information about the five vaccines approved by the Ministry of Health in Pakistan:
Sinopharm
The Sinopharm vaccine has been developed by the Beijing Institute of Biological Products (BBIBP), a subsidiary of China National Biotec Group (CNBG). The BBIBP-CorV vaccine — popularly known as Sinopharm — is a chemically-inactivated whole virus vaccine for Covid-19. Sinopharm announced that the vaccine has an efficacy of 79.34 per cent.
Phase III trials with over 60,000 participants were carried out in Argentina, Bahrain, Egypt, Morocco, Pakistan, Peru, and the United Arab Emirates (UAE) in late December 2020. BBIBP-CorV shares similar technology with CoronaVac (Sinovac) and BBV152 (developed by Bharat Biotech) and uses inactivated virus vaccines for Covid-19.
On May 7, 2021, WHO listed the Sinopharm Covid-19 vaccine for emergency use, giving the green light for this vaccine to be rolled out globally. “The addition of this vaccine has the potential to rapidly accelerate Covid-19 vaccine access for countries seeking to protect health workers and populations at risk,” said Dr Mariângela Simão, WHO Assistant-Director General for Access to Health Products. “We urge the manufacturer to participate in the Covax facility and contribute to the goal of more equitable vaccine distribution.” In the case of the Sinopharm vaccine, the WHO assessment included on-site inspections of the production facility, a report on the WHO website said.
Sinovac
Developed by the Chinese company Sinovac Biotech, CoronaVac, popularly known as Sinovac in Pakistan, is an inactivated virus Covid-19 vaccine. Phase III clinical trials have been conducted in Brazil, Chile, Indonesia, the Philippines, and Turkey. It relies on traditional technology similar to Sinopharm, BBV152, and other inactivated-virus Covid-19 vaccines.
Data from a real-world study in Chile showed that the Sinovac vaccine was 67pc effective in preventing symptomatic infection. "The CoronaVac vaccine was 85pc effective in preventing hospitalizations and 80pc effective in preventing deaths," the Chilean government said, according to a media report.
“The Covid-19 vaccine produced by China’s Sinovac Biotech is efficacious in preventing Covid-19 in adults under 60 but some quality data on the risk of serious adverse effects is lacking, World Health Organization experts have found. The independent experts on the WHO’s Strategic Advisory Group of Experts (SAGE) reviewed Sinovac’s CoronaVac jab from Phase III clinical trials in China, Brazil, Indonesia, Turkey and Chile,” a Reuters report, published on May 6, 2021, said.
Sputnik V
Developed by Russia’s Gamaleya Research Institute of Epidemiology and Microbiology, Sputnik V is an adenovirus viral vector vaccine for Covid-19. The vaccine uses a modified viral vector to deliver genetic material coding for a desired antigen into the recipient's host cells. Published in The Lancet, an interim report from the trial indicated 91.6pc efficacy without unusual side effects. In December 2020, countries including Russia, Argentina, Belarus, Hungary, Serbia and the UAE allowed emergency use of the vaccine.
According to the manufacturer, Sputnik V is one of the three vaccines in the world with efficacy of over 90pc. “The Vaccine’s efficacy is confirmed at 91.6pc based on the analysis of data on 19,866 volunteers, who received both the first and second doses of the Sputnik V vaccine or placebo at the final control point of 78 confirmed Covid-19 cases,” it adds.
WHO technical experts started the next round of their review of Russia's Sputnik V vaccine against Covid-19 jointly with the European Medicines Agency on May 10.
CanSino (AD5-nCOV)
Developed by the Chinese military and Tianjin-based CanSino Biologics, AD5-nCOV, trade-named Convidecia, is a single-dose viral vector Covid-19 vaccine. Trials data, shared in February 2021, showed that the vaccine had a 65.7pc efficacy in preventing moderate symptoms of Covid-19, and 91pc efficacy in preventing severe disease.
Phase III trials have been conducted in Argentina, Chile, Mexico, Pakistan, Russia, and Saudi Arabia with 40,000 participants since late 2020.
AstraZeneca
The Oxford–AstraZeneca Covid-19 vaccine, brand names Vaxzervia and Covishield (codenamed AZD1222), is for people aged 18 years and older. The AstraZeneca vaccine has a modified adenovirus containing the gene for making a protein from SARS-CoV-2. The vaccine, which does not contain the virus itself, cannot cause Covid-19.
AstraZeneca Covid-19 vaccine showed effectiveness of about 62pc in preventing symptomatic Covid-19 disease beginning two weeks after the second dose.
The vaccine has been associated with an increased risk of blood clots in combination with low levels of blood platelets. According to the European Medicines Agency, as of April 4, 2021, 222 cases of blood clots have been reported from the European Economic Area and the UK, where around 34 million people have received the vaccine.
However, the Ministry of National Health Services in its guideline has said that the vaccine must not be used for adults below 40 years of age (pending safety data), people with a history of severe allergic reaction to any component (e.g. polysorbate) of the vaccine formulation, those having active GI bleeding disorder or seizures as well as those with history of heparin-induced thrombocytopenia and thrombosis (HITT or HIT type 2) amongst other conditions.
Who should receive AstraZeneca
- All adults over the age of 40 years
- Eligible adults with diabetes, hypertension, heart disease and other stable chronic disorders
- Those with mild Covid-19 can receive the vaccine once the isolation period is complete
- Those with severe Covid-19 can receive the vaccine once they become stable
- Those chronically immunosuppressed may receive the vaccine, though efficacy may be lower
Who should NOT receive AstraZeneca
- Adults below 40 years of age (pending safety data)
- People with a history of severe allergic reaction to any component (e.g. polysorbate) of the vaccine formulation
- The vaccine is not recommended for people younger than 18 years of age pending the results of further studies
- People who developed clotting disorder with the first dose of AstraZeneca vaccine
- Individuals running a fever at the time of coming for vaccination (can be rescheduled after the illness is settled)
- Individuals on short-term immunosuppressive medication should wait for 28 days after the medication ends
- Those with active GI bleeding disorder or seizures
- Those with a history of heparin-induced thrombocytopenia and thrombosis (HITT or HIT type 2)
- Those with a history of major blood clot occurring at the same time as having low levels of platelets after receiving any Covid-19 vaccine - Dawn
