As you all know, vaccines have arrived in the country and we are all gearing for the most important event- the second nationwide COVID-19 vaccination starting July 20. In preparation, the experts and officials from all agencies are working round the clock for a successful rollout of the campaign. 

The job this time becomes much easier given the experience and the template from the first nationwide rollout in March this year. 

All through the pandemic, His Majesty’s command is loud and clear- protecting the lives should take precedence over everything else. Besides ensuring livelihood, His Majesty embraced non-compromising approach to save lives, even if it meant endangering His own. This wisdom kept us on track so far. 

For the vaccines allocation too, while we were juggling with numerous factors because of the adequacy and variety of vaccines in stock, the Royal guidance was to base our decision primarily on safety and protective strength (immunogenicity) of the vaccines we have with us. With this, series of discussions among the experts ensued. 

All vaccines that have emergency use approval are equally safe. But on immune protection, even if by a margin, the emerging literature points towards a better immune response for those who have received mRNA vaccine as second dose to AstraZeneca as first dose. 

While this is one of the heterologous regimen, it does not mean homologous mode of vaccination are ineffective, which is why it is also valid to have same vaccine for the second dose. 

Thus, with the available evolving evidence, our recommendation is: 

1. To take Moderna vaccine as second dose for those who received AstraZeneca as first dose. 

2. AstraZeneca will also be made available as second dose for those who insist on it for personal reasons.

3. Given the sufficient doses, the first timers can receive either AstraZeneca, Sinopharm or Moderna. For this group of people, the second dose can be Moderna and Sinopharm vaccine in four weeks or AstraZeneca in 12 to 16 weeks in homologous mode. Heterologous options will also be provided based on availability.

4. A separate package designed to allocate the limited stock of Pfizer available with us to cover children between 12 and 17 years who are:

– living in areas of outbreak Phuentsholing and Samtse

– travelling for treatment outside

– travelling for studies outside

While studies are underway, we are also waiting for evidence to emerge in the coming days for use of Moderna in children below 17 years, for which works are already underway to ensure timely vaccination.

For your reference, I would also like to share a few examples of countries that have adopted similar mode of vaccination. 

1. Canada: Heterologous recommended for all but can opt for AstraZeneca too 

2. Most Scandinavian countries: Heterologous for all ages

3. Germany, Spain and Australia: Heterologous for those below 60 years 

4. France: Heterologous for those below 55 years 

All the above are based on the evolving trends of efficacy, availability of vaccines, and choices made by decision makers and vaccine recipients. We are fortunate that we are also able to offer similar modalities. 

As an update, since we are introducing Moderna for the first time, I will be joining a team of volunteers tomorrow (July 17) to receive the vaccine. In addition to my professional understanding and scientific data, this will help me share my personal experience with you all.  

Finally, my sincere request to everyone is to pay more importance to getting vaccinated than delving into the choice of vaccines.  

The delta-variant of COVID-19 is more contagious. I urge everyone to rise above the circumstances to get vaccinated and add up the number that gives us “herd immunity” faster. For that, we need to vaccinate an arbitrary minimum 80 percent of the total population, in the shortest possible time. 

This will give us the much-desired opportunity to reduce COVID-19 from the public health hazard status to an individual health problem. Thereon, we can design personal protection from COVID-19 like any other disease, since it is here to stay. This is also with the hope that there won’t be emergence of a non-responsive variant. 

Vaccination, and subsequently herd immunity, is the only way to enter the “new normal” era sooner. However, as we consider post-vaccination protocols, same restrictions will continue to be imposed on those who are not vaccinated, given the risk they pose to themselves or others. 

For those who read this message, I request you to take a little extra trouble to reach out to people who will not have access or be able to comprehend the details. Now is the time to play our part in protecting ourselves, our loved ones and our nation from the pandemic. This act of unity, I am convinced, is a great service to the nation.  

Meanwhile, should you have any questions regarding the vaccine and vaccination program, please leave your questions here. I will respond to them via social as well as mainstream media channels in the coming days.

Dr Lotay Tshering