Why we must now adjust the vaccination strategy against COVID-19? Op-Ed by Ala Tocarciuc

Group immunity is an end, but it is also a good reward if the vaccination campaign is carried out correctly and on time. That's why we have to do everything we can, do it at the right time, do very well! ..."

At the beginning of January, the vaccination plan against COVID-19 was made public in Moldova. According to the published plan, at the first stage was expected to vaccinate medical staff and older people. This strategy was actually a copy of the general recommendations issued by the WHO to all countries.

Do we have the courage to admit that we have the wrong strategy?

A month after the start of the vaccination campaign in many countries, voices began to be heard saying that "we have wronged the strategy in the vaccination campaign". We started with vaccinating medical staff and those older than 65. We had to start with the medical staff and the young people. The virus is carried away to the old by the young. If we vaccinate the young, they will no longer carry the virus to the old. At the same time, if we vaccinate the young, they can go back into business and we can relaunch the economy.

In addition to the voices that spoke of strategic mistakes, there were also voices, who talked about the need to change the tactics of vaccination. Tactical changes include an increase in the time between doses, the combination of vaccines from various manufacturers, the administration of a single dose of vaccine to those passed through the disease, the increase in the number of vaccination points, and so on.

The increase in the time period between administered doses has been proposed in many countries

The proposal started from the fact that vaccine doses are not enough to vaccinate a larger number of the population. At the same time, studies have shown a high level of antibodies after the first dose of the vaccine. If we don't get enough doses of the vaccine, we give the first dose to a larger number of people and give them protection. In the UK it was decided that the second dose should be given 12 weeks after the first dose, instead of 28 days according to the approved instruction.

One dose of vaccine instead of two

More recently, only one dose of vaccine is recommended in France for those who have been passed through the disease.

This proposal is supported by the presence of a titre of antibodies in the body of those who have been passed through the disease. A single dose of vaccine is sufficient to increase it. The goal was to not expose the immune system to multiple shocks.

Administration of vaccines from various manufacturers

In most large countries vaccination began at the end of December 2020 with the Pfizer vaccine. After receiving the first doses, problems with vaccine stocks arose. One of the proposed solutions was to administer the next dose of vaccine from another manufacturer. The thought of combining Pfizer vaccines with Moderna or Astra Zeneсa vaccines with Sputnik V is still under scientific debate.

Some scientists say it is possible to combine vaccines because it does not matter which carrier will bring the spike protein into the human body. Others, more conservative, say that the combination of various products in clinical trials has not been studied.

A clinical trial is currently being initiated to combine Astra Zeneсa vaccine with Sputnic V. Results will come towards the end of 2021. Until then, it is practically permissible to increase the period between doses, but combinations of vaccines from different manufacturers are not allowed.

Approval of vaccines for new mutations

It is already proven that the virus tries to adapt to Humans and produces many mutations. Some already approved vaccines are not effective on some new mutations. Existing vaccines will be required to be adapted to new mutations. This week the EMA (European Medicines Agency) announced the preparation of a new procedure for approving vaccines in versions that also cover new mutations of COVID-19. These changes in EMA regulations will allow to shorten the authorization time and open the early access for the consumer to the new vaccines.

When we have enough vaccine -we increase vaccination capacities

At the first stage of vaccination we do not get enough vaccine. At the second stage of vaccination, we have enough vaccine, but we don't have enough vaccination capacity. That's what countries that tend to reach first to herd immunity have noted. Tactical changes in these cases are geared towards increasing vaccination capacities.

Vaccination capacities are increased in the UK and the USA, for example, by opening vaccination points in pharmacies. Vaccination points are activated in 40,000 community pharmacies in the USA. In the USA, it is intended to vaccinate 100 million people over 100 days, or 1 million people per day. At this speed we could vaccinate the entire population of Moldova in 3 days.

What about the vaccination plan already approved in Moldova?

We still do not have the vaccines delivered to Moldova and we still have time to adjust our vaccination plan based on accessible information and the experience of other countries.

It is known that the Astra Zeneсa vaccine, which will be delivered in large quantities to our country, has not been studied for people older than 65 years of age. Therefore, at the stage one we will not be able to administer this vaccine to those in this age group. An adjustment of the age census is required for the first stage of vaccination so that we do not lose any dose of vaccine. Alternatively, we should think how we can start vaccinating the young and those who have not been passed through the disease? So, how we can reopen the economy?

It is known that many health workers have already gone through the disease. How many doses will be given to those who have been passed through the disease, two or one? Clinicians should decide!

It is known that we will receive the Astra Zeneca vaccine from COVAX and other vaccines may come later. Are we going to allow the period between doses to be increased? Are we going to allow vaccines from different manufacturers to be combined? There are questions that are required being answered now.

Questions about national authorization procedures and admission to use of current and further modified vaccines remain no less important. Let us not find ourselves bogged down in local and external bureaucratic processes.

The vaccination strategies and tactics against COVID-19 recommended by the WHO are in the midst of practical testing in many countries. Moldova could study these strategies and tactics. Based on studies of these experiences Moldova could adjust the existing vaccination plan.

Group immunity is an end, but it is also a good reward if the vaccination campaign is carried out correctly and on time. That's why we have to do everything we can, do it at the right time, do very well!

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