Vaccinations to continue despite uncertainty surrounding next shipment of doses

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By Orville Williams

“There is something not quite – let me use the term balanced – for us to have vaccines available now and not administer them to people who are vulnerable.”

That declaration was made by Health Minister Sir Molwyn Joseph in Parliament yesterday, following a decision by the Cabinet to continue Covid-19 vaccinations, contrary to the advice of the Chief Medical Officer (CMO).

According to this week’s post-Cabinet report, the CMO, Dr Rhonda Sealey-Thomas, proposed during the meeting on Wednesday, that half of the 40,000 vaccine doses secured in February and earlier this month should be “stored so that the second dose can be on hand to be administered in May and June 2021”.

So far, more than 19,000 doses of the two-dose AstraZeneca vaccine have been administered to Antiguans and Barbudans and the CMO’s advice could be viewed as predictable, given the precarious state of vaccine availability across the globe and the uncertainty of arrangements made by the government of Antigua and Barbuda.

Wealthier countries and those with larger populations continue to command the majority of approved vaccines, meaning the 100,000 doses requested from the Serum Institute of India for example, could possibly not arrive for some time, as India’s mass vaccination programme continues.

Further, the COVAX facility – established to provide equitable access to vaccines – has not proved as dependable as many countries would have hoped; it has been hampered by delays due to logistical, approval and availability issues.

The report went on to say the Cabinet debated the CMO’s proposal, but ultimately decided against her advice. As a result, “seven to 10 thousand additional doses will continue to be applied, with the expectation that at least 14,000 doses will be secured through COVAX by the end of April 2021.”

The COVAX facility has come under particular criticism for the slow rollout of its distribution programme, which has essentially forced many developing countries to seek bilateral arrangements with other countries, or directly with pharmaceutical companies. 

In fact, Honduras’ La Tribuna newspaper reported late last month, that Foreign Affairs Minister Lisandro Rosales apologised to the country on behalf of the government, for having placed trust in COVAX to deliver the much-needed vaccines.

Rosales said he regretted that equity with respect to vaccine acquisition did not occur and disclosed that the government was working on a supply system, having moved to obtain fixed prices directly from the pharmaceutical companies.

Despite those concerns abroad, Cabinet spokesperson and Information Minister, Melford Nicholas, explained during Thursday’s post-Cabinet media briefing that the decision to go ahead with vaccinations was based on the government’s confidence in the COVAX programme.

“We have not ignored the recommendation of the CMO. I don’t think that’s the way we would like the public to see it,” he said. “Based on the confidence level that we have in that particular supply arrangement, we are satisfied that the vaccines will get here in time to ensure that all of the existing persons – up to the 19,000 – and those that we will stretch beyond – up to 27,000 – we will have sufficient vaccines to give the persons the second dose.”

The importance of that second vaccine dose has been reiterated around the world, with almost all the major manufacturers noting increased efficacy rates after it is received.

AstraZeneca said last month, analysis of the results of recent clinical trials showed an improvement from 76 percent efficacy after a first dose, to 82 percent after a second dose, with an inter-dose interval of 12 weeks or more.

Similarly, the Pfizer-BioNTech vaccine moved from a first dose efficacy rate of 52 percent to 95 percent after a second dose, and Moderna said its vaccine improved from approximately 80 percent efficacy after its first shot, to 95 percent after a second.

In his address to Parliament, however, the Health Minister voiced the need to look at the more urgent situation, suggesting that the first dose could have prevented some of the country’s Covid-19-related deaths.

“We must pay attention to the deaths, [there have been] over 18 more deaths and if those elderly people had received the vaccines, it is a 100 percent guarantee that they would [have] either avoided hospitalisation, or death. So, that is the reasoning behind [the continued vaccinations].” According to information published by Gavi – co-leader of COVAX, alongside the Coalition for Epidemic Preparedness Innovations (CEPI) and the World Health Organization (WHO) – the programme has so far distributed vaccine doses to African countries including Côte d’Ivoire, Ghana, Nigeria and Rwanda, as well as Afghanistan, Cambodia and the Philippines.

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