Feature

COVID-19 vaccines’ scarcity: Medical experts disagree on timing of second jab

Gap between first and second vaccination can be extended to three months – Babalola
If there’s break, the anticipated efficacy or potency’ll be compromised, says Odo
Vaccination, not the correct method of control for COVID -19 – Ezeibe

The arrival of vaccines for COVID-19 in Nigeria was greeted with enthusiasm. And immediately, discussions followed about the ethical challenges of how to ensure fair access to it across states. However, about a year after the country got its first batch of the vaccines, many primary health centres are grappling with the problem of shortage of the AstraZeneca brand, especially those needing the second jab. In this report, Isioma Madike, looks at those, who fear that the delay in taking the second dose could impact negatively on the potency of the vaccine

There were fears at the time Nigeria received its first dose of the COVID vaccines that the World Health Organisation (WHO) initiative under which it got the batch may not be in a position to provide the country another round of the vaccine doses in a long time. There were worries also at the rate people were rushing to get the vaccines. Nigerians had fears that the country may likely exhaust the available doses.

If this happens, they said, how would those who already got their first jab be able to take the second dose within the specified period required. These fears have become potent now as many primary health centres across the country are currently grappling with the problem of shortage of vaccines, particularly the AstraZeneca brand. Investigations have revealed that many of these centres are sending back people who are turning up for the second jab.

At the moment, the United States of America, Europe and the European Union (EU) countries where Nigeria gets its vaccine doses from, largely on donation, are still battling with the fourth wave of the pandemic, and may rightly need to take care of their citizens first before making provisions for others. Similarly, India, where the Astra- Zeneca vaccine largest producing company is situated, was recently hit by an upsurge of the disease and was reported to have opened up immunisation to more people, which eventually will reduce vaccine exports. “Last week, I was at the Sango Primary Health centre for my second dose but was turned back.

The officials simply told me there were no AstraZeneca to give at the moment and that I should call the number in the card anytime I intend to come back to check if there are supplies. I was not the only one as many others were told the same thing.

“The unfortunate thing about this is that we were not told in specific terms when the AstraZeneca vaccine would be available even as they said they could not give the Moderna brand said to be available except those who came around for their first jab. However, we are afraid that if not taken at the approved window period, the first jab becomes useless as it will lose its potency. “There is also this fear that the first dose already taken might have expired before giving it to us. Or how else could one explain this dilemma?” asked one anonymous client, who appeared frustrated with the situation.

The case of the client above is not an isolated one. It was the same dilemma at many other centres visited. “When I enquired if I could take the Moderna said to be available, I was told it’s unethical to mix two different brands. They said the Moderna is for those who had come for their first jab.

The dilemma now is that nobody seems sure if the same Moderna will be available by the time people start coming back for the second dose. “Nigeria, if you ask me, is in a mess as far as this vaccine issue is concerned. It’s even worse because the country does not buy but depends on donations from Western countries,” said another, who also refused her name in print.

However, a Public Health Physician and the immediate past president of the Guild of Medical Doctors (GMD), Prof. Olufemi Babalola, attempts to allay the fears of those in this group when he said that the gap between first and second doses can be extended to three months and that that does not necessarily mean that the vaccine will lose its potency.

He said: “The second dose of most of the vaccines available (AstraZeneca, Pfizer and Moderna) should be given within 3-4 weeks of the first dose, but it can be extended to three months. “For logistic reasons it may not always be possible to give the second dose within that window period. Any additional doses are called a booster dose, and the whole idea is to increase the level of antibodies in the system to fight infection.

Too many repeat doses may not however be advisable to avoid hypersensitisation of the immune system.” But, Dr. Doyin Odubanjo, a public health physician, has modified this position slightly by saying that it depends on how long after the person ends up getting the second dose. “It’s known though that at least two doses are required for appropriate immunity to develop,” Odubanjo added. Dr. Abiodun Kuti, President, Guild of Medical Directors, has also said that the first dose taken is to agitate the antibodies, which he called the soldiers that are supposed to fight the virus. While, according to him, the second jab is to ginger the antibodies to be more active.

“Once the first dose has been given, the soldiers that are supposed to fight the virus have been deposited in your body, they have been activated. The second jab is just a backup, he stated. Kuti added: “The time lag doesn’t have any effect on the antibodies.

The most important thing is for the body to stimulate the soldiers to be ready for the virus. The second jab is like getting another group of soldiers from another garrison to come and help in the fight. “There is an MRNA vaccine that is being given. I don’t know if there would be an issue but I know that the two of them are just to agitate the soldiers that we need to fight the virus in the body. Taking two different types of jabs will still do the job but it may just be in different ways. Just like trying to achieve the same aim but through different routes.

“It will still give the same goal, which is to make sure that your body can resist the virus once it gets into the body. The vaccine is just to quicken the action so that you do not get overwhelmed by the virus when it attacks you. “We have different variants now so like it or not, different soldiers in the body will have to be fighting different viruses of the same origin. But you will need the vaccine to boost your ability to fight the virus. “Once you get exposed to the virus and it doesn’t overwhelm your body system that is good because your body will fight it.

It is a situation in which your body systems cannot fight it that there will be a problem.” To the National President of the Association of General And Private Medical Practitioners of Nigeria (AGPMPN), Ambassador Dr. Ugwu Iyke Odo, it’s just like giving somebody regular medication for ailment. “For example, somebody is having fever or pain and you give him paracetamol. You tell him to take the paracetamol every eight hours. It suggests that the paracetamol that you gave now, the effect of it will last for about seven hours and as it is telling off, you boost it by taking another.

“If you fail to boost your dose at the time you should, the pain will come back almost in full force. But if you are able to continuously fill in that gap, you may stay without pain for days and the pain may disappear from there. “Certainly vaccines are supposed to be boosted to have their full impact or effect.

If they are not, it means that the anticipated efficacy or potency will be compromised and that could lead to what we call resistance. “It’s just like treating someone for malaria and you are supposed to give that person a certain dose of the anti- malaria drug daily for three days and you give it for only two days. We know that it is only when you have completed the full course that the parasite will be finally subdued.

If you stop midway, what do you end up doing? You will make the parasite weak; they too will become sick and hibernate. They go on holiday and recover. When they recover, they become more dangerous. Similar things can happen with the vaccine. “The way out is that while we are thanking the government for the efforts that they are making to protect Nigerians by acquiring the vaccines, they should do their best to make sure that what they are doing is done the right way, because if you do the right thing the wrong way, you achieve the wrong results.

“They should do their best to make the vaccines available so that people can follow the prescribed protocol, meet the timing of the dosing to have the highest efficacy. “The other time when they started this AstraZeneca, they made sure that they stopped at the number that was half of what they had so that they will be able to give the second dose to the same person, which was good control,” Odo said.

However, The WHO recommends an interval of 3–4 weeks between the first and second dose of vaccination. According to the World body, if the second dose is administered less than three weeks after the first, the dose does not need to be repeated. But if administration of the second dose is delayed beyond four weeks, it should be given at the earliest possible opportunity, it said. WHO said: “We know that having the second dose is essential to ensure the best effect of the vaccine, and to maximise protection against new variants.

So, it’s important to get your second dose as soon as you are offered it. “Generally the second dose of the COVID vaccine, whether Pfizer/ BioNTech, Oxford AstraZeneca, or Moderna, will be effective after two weeks. This can vary slightly from person to person, depending on your immune response. Most studies of the vaccines have measured effectiveness 21 days after the first dose and 14 days after the second dose, and have found significant increases in effectiveness after the second dose. “However, if you had the Oxford/ AstraZeneca vaccine for your first dose, you should have the same for your second.

Very rarely, someone might have had a serious reaction to their first dose of the vaccine. This is extremely rare but if this does apply to you, speak to a healthcare professional about whether your second dose should be a different vaccine.”

Dispelling the fears that the country may not get the second batch of the vaccine any time soon, the Nigerian Institute of Medical Research (NIMR) DG, Prof. Babatunde Salako, believes the government will receive more doses to effectively continue the vaccination.

Though there was nothing tangible to support this assertion, Salako said with confidence that many more people will be vaccinated when their second jab is due. Professor Maduike Ezeibe, a Veterinary Medicine and Clinical Virology at Michael Okpara University of Agriculture in Umudike, Abia State, in his summation decided to look at the issue of vaccines differently. Ezeibe told one of our reporters on the telephone that he had always feared that vaccines may not solve the problem of COVIDd-19.

He thinks that vaccination is not the correct method of control for COVID -19. Ezeibe said that WHO should approve medicines that can achieve quick cure as a method of control for the pandemic. With such medicines, the professor said, fear of the disease will vanish and infected people will be quickly treated to reduce spread. He said: “The health minister in his last interview with Channels Television answered the question I have been asking (how long does protection from vaccines last?). He said that ‘full protection’ from the vaccines lasts for only three months. What that means is that every vaccinated person or animal will after three months have underdose of the antibodies.

So, if such individuals contract the virus, it will establish infection. “Once a virus experiences a drug or antibody from a vaccine and still survives, it changes (mutates) to a different form (variant). It means that COVID-19 requires vaccination being repeated every two months otherwise vaccination as a method of control will continue to cause the rapid evolution of new variants already being experienced. But can the world afford vaccination of all persons and all susceptible animals every two months under the present condition of lack of vaccines and hesitancy? “I think vaccination is not the correct method of control for COVID-19.

The current claim that vaccination makes the disease less severe is unscientific. Vaccine is supposed to prevent infection, not to reduce severity of disease. Those vaccinated people who get infected have become media for mutation and new variants that emerge from them would be resistant to the vaccines used to vaccinate them. “WHO should approve medicines that can achieve quick cure as a method of control for the pandemic? With such medicines fear of the disease will vanish and infected people will be quickly treated to reduce spread. “Our Medicinal Synthetic Aluminum Magnesium Silicate (MSAMS) has repeatedly achieved a quick cure of COVID-19.

The latest feat is a 90-year old man treated by doctors from the medical centre of Michael Okpara University of Agriculture, Umudike, who recovered after four days (don’t forget that the elderly hardly survive COVID). “Science has no race. Mopping viruses (electrically charged) with Nanomedicines that have opposite electrical charges is an effective treatment for COVID-19 and other viral diseases. Our government should tell the world ‘our scientists have developed the theory and the MSAMS for COVID-19’ while WHO should pay equal attention to scientists from all over the world.”

He added: “Did you see the news on Channels Television recently, ‘Research shows 4th jab ineffective against Omicron’. What that means is that the Omicron variant is significantly different from variants existing vaccines are made to fight against. Mutation should take decades to occur but current worldwide abuse of vaccines and vaccinations has made it to be occurring within a few months.

“Nigeria should take the lead to call WHO to reason scientifically. It is wrong to use vaccines that protect for such a very short period (three months against ten years of Yellow fever vaccines) to attempt controlling a virus that changes and spreads so fast. “What is wrong in WHO adopting the opposite charges of electrostatic attraction propounded by Nigerian scientists so that electrically charged Nanomedicines such as The Medicinal Synthetic Aluminum Magnesium Silicate can be used to mop the virus to achieve quick cure.”

Additional report from Appolonia Adeyemi

 

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