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WHAT’S YOUR PICK: Mix and match your first Oxford Astra jab with Russia’s Sputnik prick or China’s Sinopharm vac

The Government is exploring the possibility of rolling out a different brand of vaccine as the second dose to nearly 600,000 people who have already been jabbed with the Oxford AstraZeneca vaccine, it was announced this week.

COVID Minister Sudharshani Fernandopulle told Parliament on Tuesday, that it will be possible to give the COVID-19 vaccine as a cocktail, based on the results of the research which is in progress to ascertain the possibility of giving the second dose with an alternate brand
of vaccine.

“Research is in progress,’’ the COVID Minister said, “on the possibility of giving the second dose with another brand of vaccine to those who were given the first dose with AstraZeneca vaccine. We cannot decide on that. Based on the results of the research, we will be able to give a cocktail in the future.”

“We have an issue of providing 600,000 doses as the second dose. There is nothing to hide.
It is not the issue of the Government. The issue has
arisen due to the manufacturer’s inability to supply the
demand,” State Minister Fernandopulle said.

Obviously, her statement causes concern. Raises the alarm. Provokes anger.

First, it provokes ire since the state minister’s statement in Parliament that the dearth of 600,000 Oxford Astra vaccines is not the fault of the Government and that it has been caused
‘due to the manufacturer’s inability to supply the demand,” will not do.

Even if the shortage is attributed to India’s own home needs given the scale of India’s present COVID crisis, which erupted in full force early April, why was the Government twiddling its thumbs all this time in pathetic inertia? In early January this year, while neighbouring Bangladesh and the Maldives had already announced vaccine rollouts from 26 January, what indeed, was the Lankan Government doing? Was it hoping Dhammika’s paniya would do the trick?

As the SUNDAY PUNCH of January 4th commented five months ago, “While many countries have joined the queue well on time to be in line to receive the life saving, life changing, hope restoring vaccine of vaccines to end COVID’s unchallenged siege in their respective lands, Lanka hasn’t even arrived at the starter’s gate to be whistled out.’

“Instead, she is still in the paddocks making inquiries from potential suppliers without a clue as to which vaccine to order, regardless of its quality; and holding out the begging bowl
for charity from all passers-by
to raise the cash to buy the vaccine that will safeguard the health of her own people, the ultimate responsibility of any government.

‘’For that, she has to depend on her tears not on spot cash, on evoking pity not on credit power, on prayer and hope not from sterling Fitch ratings, on grovelling on all fours for a freebie dose, on even selling off her last few possessions to get the COVID fix for her imperiled citizens.”

Second, the state minister’s statement raises alarm among the 600,000 odd people who fear they may be left high and dry due to the Government’s failure to procure the balance vaccines on time. It has sent shockwaves through these 600,000 people who had taken the Oxford AstraZeneca vaccine as their first dose, knowing full well that they are medically bound to stay faithful to the same brand when it comes to taking the second ‘booster’ dose.

It has placed them in a real quandary. For they now face the forbidding prospect of being called upon to dump their pledged loyalties and seek the protection of another deified vaccine as the second dose to complete the vaccine’s intended course, knowing naught of the adverse side effects that may ensue from embracing such an untried and untested mix and match concoction, even though approved by the expediency dictated convenient tag ‘for emergency use only.’

The Food and Drug Administration (FDA) is the United States’ stringent regulatory body responsible for protecting and promoting public health through the control and supervision of food and drug safety. It is also globally revered for its scientific standards of vaccine safety, effectiveness
and quality. Here’s what it has to say of Emergency Use Authorization (EUA):

‘An Emergency Use Authorization (EUA) is a mechanism to facilitate the availability and use of medical countermeasures, including vaccines, during public health emergencies, such as the current COVID-19 pandemic. Under an EUA, FDA may allow the use of unapproved medical products, or unapproved uses of approved medical products in an emergency to diagnose, treat, or prevent serious or life-threatening diseases or conditions when certain statutory criteria have been met, including that there are no adequate, approved, and available alternatives.’

Thus at the outset it must be clearly understood that the World Health Organisation which more or less use the same FDA yardstick to grant emergency approval to vaccines, grants ‘emergency use only’ certificates to unapproved vaccines not because it is hundred percent safe but only because in a dire life threatening pandemic, there is no viable alternative.

Third, State Minister Fernandopulle’s statement that the COVID cocktail would be rolled out to Lankans only after the results of ongoing research has been released, though reassuring, also  gives rise to concern and worry.

True, the WHO has granted ‘emergency use’ approval to America’s Pfizer vaccine, to England’s Oxford AstraZeneca vaccine manufactured at the Serum Institute of India and this Friday to the China’s Sinopharm vaccine. The Russian Sputnik V vaccine is still awaiting WHO’s ‘emergency use’ though its rollout in Lanka began this week with an initial stock of 15,000 doses

These four vaccines have been developed respectively in American, British, Chinese and Russian labs in isolation, each following their own protocols. Their ‘platforms’ differ, for instance the Pfizer is based on ‘Nucleoside modified mNRA, while the Oxford AstraZeneca is based on ‘Recombinant ChAdOx1 adenoviral vector encoding the Spike protein antigen of the SARS-CoV-2.’ The Chinese Sinopharm is based on ‘Inactivated, produced in Vero cells’ while Russia’s Sputnik V is based on ‘Human Adenovirus Vector-based Covid-19 vaccine.’

Their efficacy ratings also differ, as do their side effects of which little is still known since it is too early to gauge any significant long-term adverse consequences, if any.

With so little known of its individualistic traits and behavioral patterns, ‘emergency use’ authorisation has been granted, nevertheless, solely on the grounds of expediency, because the extremely serious pandemic situation prevalent worldwide so demands its unfettered and immediate use and eclipses its potential harmfulness.

In the circumstances, how much more difficult would it be to predict the outcome of giving a different vaccine as the second dose? Will the Oxford AstraZeneca compliment the Chinese Sinopharm or tango well with Russia’s Sputnik V?

Trials to ‘mix and match’ different COVID vaccines and determine whether it’s safe to inject the same person with two different vaccine jabs have already begun in Britain and elsewhere, but though some investigators have expressed optimism, it has hardly got off the drawing boards.

With many European countries increasingly considering mixed vaccination strategies, the European Medical Agency last month stated that currently there are no guidelines on the ‘mix matching ‘of COVID vaccines. It announced, “The EMA hasn’t issued guidelines relating to mixing and matching of different vaccines between the first and second dose.”

The official take of the WHO on ‘mix and matching’ is: ‘Clinical trials in some countries are looking at whether you can have a first dose from one vaccine and a second dose from a different vaccine. There isn’t enough data yet  to recommend this type
of combination.’

With world research still in its infant stage, it will be a pipe dream to entertain Lankan COVID Minister Fernandopulle’s hope that, ‘based on the results of the research, we will be able to give a cocktail in the future,” By the time, the process has been completed, its findings published and ‘emergency’ approval is granted by the WHO, the 12 to 16 week time frame recommended for the second dose to be taken would have long expired for Lankans who took the Oxford Astra jab in late February and March.

A ray of hope lit Friday’s evening sky, when President Gotabaya Rajapaksa tweeted that he has held a discussion with WHO Director General Tedros Adhanom Ghebreyesus via zoom technology on the current COVID situation, and stated: “I believe he will make effort to fulfil Lanka’s need for 600,000 doses of AstraZeneca for the 2nd  dose of vaccination.”

Hopefully, this piece of good news will come to pass. Or else, many Lankans who have taken the Oxford AstraZeneca as their first dose may have to decide for themselves whether it’s far more desirable to opt out of the vaccine programme and run the risk of COVID infection or dare risk a fate far worse than the plague by playing Russian roulette, ‘mixing and matching’ with either the Russian Sputnik or the Chinese Sinopharm?

THE LANKAN QUARANTINE HUB: ‘Transshipment’ point for COVID ravaged Indian visitors (file picture) Pavithra plucks another folly  from Tourism Minister’s cap Tourism Minister Prasanna Ranatunga who surrounded himself with the dubious kudos for opening secured island doors to tourists from COVID-infested Ukraine when Lanka was having a brief respite from the corona pandemic last December, added another folly to his cap last week by promoting Lanka as a quarantine destination to Indians streaming in from an India reeling under the worst COVID catastrophe, the world has so far seen. The decision was not taken on humanitarian grounds to provide basic medical care and safety to Indian refugees fleeing the Indian subcontinent but to merely offer Indians who could afford the tab a convenient parking lot in Lanka to circumvent entry rules imposed by countries that have banned visitors from India direct. Worse. This short sighted and potentially disastrous move came in the wake when Lanka was experiencing a virulent increase in COVID infections, recording over 1,500 cases per day. This is attributed to a UK variant. The last thing the nation needed was an Indian variant to make Lanka’s own man-made disaster replete. But this prospect seems not to have inhibited nor diminished the Tourist Minister’s and his team’s thirst for the extra dollar. In a report published last Sunday in the Sunday Times/Business, the Tourist Minister said that currently they were permitting Indians to travel to Sri Lanka because Sri Lanka has become an acceptable destination for Indians to seek quarantine facilities prior to proceeding to destinations like West Asia and Singapore. Currently, this facility could be offered to Indians only as Pakistanis and Bangladeshis are banned from travelling overseas. The Sri Lanka Tourist Development Authority gave fulsome echo to the Minister’s sentiments. In a statement listing a new set of regulations issued on April 24 for international arrivals for the purpose of 14-day quarantine en route to other countries, it stated  “Some countries accept quarantine in Sri Lanka as an entry requirement to their country, where direct arrival for the origin country is not permitted. This is a reflection of Sri Lanka’s health and safety regulations.” But will the creditable ‘reflection of Sri Lanka’s health and safety regulations,’ earned due to the tireless efforts  of the nation’s medical sector, remain so for long, if the Tourist Ministry squanders it in this  grossly irresponsible fashion, risking a worst catastrophe than India’s to unfold in the land? But many countries, wising upto this ruse, have now banned anyone who had visited Sri Lanka in the last 14 days from setting foot on their soil. Luckily – even if it came belated – Pavithra’s Health Ministry called a halt to this madness. On Wednesday, it issued new guidelines which banned airlines from disembarking passengers from India or with a 14 day travel history to India. As a result the Civil Aviation Authority — which incidentally comes under Tourism Minister Ranatunga as well for he is also Minister of Civil Aviation — had no choice but to stop the exodus from India under further notice.  Its Additional Director General P. A. Jayakantha said, “The Civil Aviation Authority has decided to suspend all Indian passengers entering the country with immediate effect.” The problem is that the Tourist Minister and his high level panel seem hooked on fishing in troubled waters, blithely divorced from all reality; and tend, perhaps, to forget, in their surfeit of professionalism which, alas, has drowned common sense, that the troubled waters they are fishing in are no one else’s but their own; and the water is rising dangerously high, so ominously high that it threatens to swallow whole not only the minister and his pundits but all of Lanka.