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No cause for alarm, though second dose AstraZeneca vaccine ideal 12 weeks after first one —Physicians

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Lara Adejoro

Medical experts say that there is no cause for alarm for those who took the first dose of AstraZeneca COVID-19 vaccine, as the government says only two million Nigerians would be fully vaccinated due to the scarcity of vaccines.

Chairman of the Presidential Steering Committee on COVID-19, Boss Mustapha, had, on Thursday, said that with the government’s inability to get more vaccines, only two million Nigerians would be fully vaccinated.

This is even as Mustapha called on the United Kingdom and other developed countries to assist with vaccines as soon as possible to enable Nigeria to vaccinate more people and prevent the third wave of the virus in the country.

Mustapha said the initial plan of the government was to vaccinate 40 percent of the population in 2021 and another 30 percent in 2022.

He said with the latest development, one percent of the estimated population would be fully vaccinated by the time the exercise would be completed, noting that Nigeria is at risk of serious community transmission of COVID-19.

He stated this while receiving the British Deputy High Commissioner to Nigeria, Ambassador, Gill Atkinson, in Abuja.

According to the Director-General of the National Primary Health Care Development Agency, Faisal Shuaib, Nigeria had hoped to receive up to 70 million doses of the Johnson & Johnson COVID-19 vaccine this year through the African Union, amid concerns about delayed deliveries of AstraZeneca vaccines.

On March 2, Nigeria had received the first batch of 3.9 million doses of AstraZeneca’s COVID-19 vaccine from the Serum Institute of India through the COVID-19 Vaccines Global Access, abbreviated as COVAX — a worldwide initiative aimed at equitable access to COVID-19 vaccines directed jointly by Gavi, the Vaccine Alliance, the Coalition for Epidemic Preparedness Innovations, and the World Health Organisation.

In the same month, telecoms company, MTN, had also delivered 300,000 doses of AstraZeneca COVID-19 vaccines to Nigeria.

And on April 7, Nigeria also received 100,000 doses of COVID-19 vaccines from India through its Covishield arrangement. The ‘Covishield’ is the Oxford/AstraZeneca vaccines manufactured by the Serum Institute of India.

It may be recalled that, sometime in March, India — the world’s biggest vaccine maker — said it would prioritise domestic supply because of the virulent cases of COVID-19 being experienced, prompting fears of delays in the export of AstraZeneca doses under the World Health Organisation-backed COVAX scheme to supply vaccines to poorer countries.

Last March 29, Johnson & Johnson had promised to supply the African Union with up to 400 million doses of its single-dose vaccine beginning in the third quarter of the year; with Shuaib stating that Nigeria expected to receive 30 million doses of the J&J vaccine in July through the African Union.

“We’re hoping that we’ll be able to get up to 70 million doses of the Johnson & Johnson this year. This is yet to be finalised, but these are some of the advanced conversations that are going on between Nigeria and the African Union,” he had said.

Mustapha, who is also Secretary to the Government of the Federation, stated that with the percentage of people vaccinated so far, Nigeria is far from achieving herd immunity, adding that the country is in danger zone and that mass community transmission of the lethal virus looms in the country.

He said, “The clear indication and signal is that Nigeria is still in the danger zone.

“The chances of mass community transmission are still there because by the time we complete this phase of vaccination, only one percent of the population would have been fully vaccinated.

“We need support because our initial schedule was that we would try as much as possible to vaccinate, through the support of COVAX and Harvard facility, 40 percent in 2021 and 30 percent in 2022. What we are succeeding to do now is a far cry from that.”

On Thursday, the WHO said that Africa needs at least 20 million doses of the AstraZeneca  vaccine within six weeks if those who have had their first vaccination are to get the second in time.

“Africa needs vaccines now,” said the WHO Regional Director for Africa, Dr. Matshidiso Moeti. “Any pause in our vaccination campaigns will lead to lost lives and lost hope,” she said.

Speaking with PUNCH HealthWise, a Professor of Medicine at the University of Ilorin, Emmanuel Okoro, said Nigeria’s inability to get more vaccines will not have any adverse health consequence for those who had taken the first dose of the AstraZeneca vaccine, even if they miss out on the second dose.

The interval between the first and second dose for AstraZeneca vaccine is between eight and 12 weeks.

Indeed, a recent study published in the medical journal Lancet found greater efficacy for the Oxford-AstraZeneca vaccine, which is sold under the brand name of Covishield in India, when the second dose is administered after a gap of 12 weeks.

Prof. Okoro said of those who might miss out on the second dose of AstraZeneca vaccine in Nigeria, “It is not likely to have any adverse health consequence, even for those most vulnerable. Nigeria should not be making policy decisions based on other peoples priority but what is best for its population and needs-based on evidence.”

Continuing, Okoro said, “It seems most likely that many Nigerians had acquired natural immunity from silent exposure, even without knowing it; and this seems as good as that induced by current vaccines,” the physician said.

Also speaking, a Professor of Public Health and former National Chairman of the Association of Public Health Physicians of Nigeria, Prof. Tanimola Akande, said that even if there is vaccine scarcity, there is provision for those who took the first dose of the AstraZeneca vaccine to take the second dose.

He, however, said with the scarcity of vaccines, covering Nigeria with COVID-19 vaccines will be low and make it hard to achieve herd immunity required to control the pandemic.

“We hope there won’t be a third wave in Nigeria. There is danger to citizens if there is third wave and with low percentage of those protected by vaccines.

“Compliance to non-pharmaceutical interventions like use of face masks, hand washing and physical distancing becomes imperative. Testing must also be scaled up,” Akande noted.

As reported by Nature in March, the interim results from AstraZeneca do not add more clarity on how to optimise dosing, because all participants were given two doses four weeks apart.

An infectious-disease physician at the University of Rochester in New York, Ann Falsey, who co-led a trial on blood-clotting associated with AstraZeneca vaccine, says that a longer gap would probably induce a stronger immune response, but a briefer interval is more practical in the middle of a pandemic.

The WHO recommends an interval of eight to 12 weeks.

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