Export proportion of Covid-19 vaccines to be determined

The National Vaccine Committee (NVC) has approved in principle determination of an export proportion against locally manufactured Covid-19 vaccines to ensure vaccine availability in the country, whereas the mix and match use of different doses of vaccines has also been approved for future use

The vaccine subject to such the determination has not been publicly addressed during the press conference held by the committee’s secretaries, but the conference is understood to have referred to locally manufactured AstraZeneca by AstraZeneca’s subcontractor, Siam Bioscience, of which the amount of 10 million doses is expected to be delivered here per month from this month on.

Since the virus struck the country, the government has placed hopes on such local production of the vaccine, saying Thailand would have sufficient vaccines to fight the disease as they would be locally manufactured here. The expected amount from local AstraZeneca was first set at 61 million doses out of 100 million doses of Covid-19 vaccines, or over half, the government has targeted for this year.

The first month of delivery last month, the British-Swedish company had managed to deliver six million doses of its locally manufactured AstraZeneca to the Thai government for use. This month, the amount delivered has not yet been confirmed by concerned agencies. Instead, they have rushed to get Covid-19 vaccines elsewhere including more orders for China’s Sinovac.

This has prompted a lot of frustration among the public members, who have been waiting for the jabs amid an increasing threat from the Delta variant, which has spread to every province this week, as reported by the Center for COVID-19 Situation Administration today.

At the press conference today, Dr. Nakhon Premsri, director of the National Vaccine Institute (NVI), the committee’s joint secretary, confirmed the decision made by the NVC, although the ratio has not yet been settled. This, he said, needs to be figured out among concerned authorities including the Department of Disease Control, which earlier proposed the amounts needed for control of the spread of the virus.

“What was originally agreed with the company was the delivery of “one-third” of the production capacity, not the number of doses set per month, so I cannot say how many doses would they be, depending on the company’s production capacity at that time,” said Dr. Nakhon when asked about the vaccine dosed to be negotiated with the company.

The NVI and the DDC will discuss with the company before proposing the committee to issue the ministerial regulation to determine the limits for export of the locally manufactured vaccine doses later, he said. This will be done under the law’s Article 18 (2), which gives power to a Public Health Minister with the committee’s endorsement to determine a proportion of vaccines for export while taking the needs of the country into account.

During the press conference on July 2, Dr. Nakhon had revealed that the Thai government did secure a deal with AstraZeneca for those 61 million doses this year, but the number of doses to be delivered each month was not committed.

The company’s sub-contractor, he had said, had a production capacity at 180 million doses per year or around 15 million doses, but these must be shared with “foreign countries”. So, AstraZeneca’s executives had informed the concerned authorities that the company would deliver to the Thai government around five to six million doses of the vaccine a month.

Thailand needed 10 million doses of Covid-19 vaccines per month from July onwards, so it needed to seek extra vaccine doses, he had said, either by asking the company to boost more of its production capacity or finding other vaccines elsewhere.

Dr. Nakhon had also said of the possible enforcement of the vaccine security law to determine or limit the proportion of Covid-19 vaccines for export, saying it would affect relations with countries placing orders for the vaccine from Thailand, and concerned agencies needed to take this into account.

This prompted some medical practitioners including those under the grouping of the Rural Doctors Club to step out to demand enforcement of the vaccine security law to limit a proportion of the Covid-19 vaccine for export by two-thirds.

The NVC has eventually held the meeting and approved in principle the determination of a proportion of vaccines for export today, suggesting the forthcoming curb on export on locally manufactured AstraZeneca, although the ratio has not yet been settled.

Mix and match Covid jabs

The DDC, meanwhile, has revealed its academic committee’s decision to endorse the use of mix and match jabs of Covid-19 vaccines to boost more immunity.

The meeting, where WHO Thailand’s representative was also present, has endorsed mix and match use of China’s Sinovac and AstraZeneca as the first and second jabs, in line with the resolution of the National Communicable Disease Committee, chaired by the Public Health Minister.

Dr. Somwang Danchaiwijitr, Chair of the academic committee, said the decision was based on the studies here and approved by the committee and its experts for maximum benefits of the people.

The mixed-use of Covid-19 vaccines has become an issue as the World Health Organisation’s expert, Dr. Soumya Swaminathan, warned about it during the press briefing on Monday, before later adding her remarks that she meant to direct it to individuals.

As reported by Reuters, which later added her remarks in its report, Dr. Swaminathan had said it’s a little bit of “a dangerous trend” and it would be a chaotic situation in countries if citizens start deciding when and who will be taking a second, a third and a fourth dose. She had also called the mixing a “data-free zone” before later clarifying her remarks in her Twitter account.

“Individuals should not decide for themselves, public health agencies can, based on available data,” she said in the tweet. “Data from mix and match studies of different vaccines are awaited – immunogenicity and safety both need to be evaluated.”

Mixing and matching Covid vaccines has been subject to an experiment in various forms. In June, the WHO’s Strategic Advisory Group of Experts on vaccines said the Pfizer vaccine could be used as a second dose after an initial dose of AstraZeneca if the latter was not available, Reuters reported.

A clinical trial led by the University of Oxford in the UK is ongoing to investigate mixing the regimen of AstraZeneca and Pfizer vaccines. The trial was recently expanded to include the Moderna and Novavax vaccines, according to the same news agency.

Dr.Renu Madanlal GARG, Acting WHO Representative to Thailand, said of the mixing and matching of the vaccines that WHO has no opposing views against the Thai government’s policy. It depends on the situation and the data in hand.

The agency would just recommend concerned agencies to base their decisions on scientific data and systematic studies, and individuals should not decide to mix and match Covid-19 vaccines themselves, he said.

 So far, some academic institutes including the Center of Excellence in Clinical Virology at the Faculty of Medicine, Chulalongkorn University, have been conducting studies on the mix and match use of Covid-19 vaccines here.

Head of the center, Prof, Dr. Yong Poovorawan, revealed some clinical study results on over 40 Covid-19 vaccine recipients at the press conference yesterday that the mix and match use of China’s Sinovac and AstraZeneca as the first and second dose consecutively with a time interval of six weeks could help boost immunity to nearly 800 u/ml. Compared with the use of two China’s Sinovac, the immunity could be raised only around 100 u/ml, while using double AstraZeneca would yield a higher level of immunity, around 900 u/ml, but that would take nearly double the time interval, or 12 weeks.

So, he recommended the use of mixed vaccines against the virus, especially the Delta variant, which is 1.4 times faster than the UK’s Alpha, as the double Sinovac jabs nor one dose of AstraZeneca are unlikely to help prevent the virus.

“We are facing the severe situation of the spread of the variant, while our vaccines are limited. So, the mixing of the vaccines could be an option,” said the respected virologist, while stressing the need for other public health measures including disciplined social distancing measures among individuals.

For safety concerns, he said, over 1,200 vaccine recipients of such the mixed vaccine jabs on the state record of Mor Prom application so far have shown no signs of side effects developing against them. His clinical trial would also soon be released to confirm the result, which he said, is safety in the real world data, or real lives.

According to the Medical Sciences Department’s monitoring on the spread of the virus, the Delta variant this week has taken over the Alpha variant in the city, with 57.1% per 42.9% infection rate. Nationwide, the variant’s infection rate has inclined from 32.2% last week to 46.1% per 51.8% of Alpha.

The department has also detected the so-called co-infection of the variants of Delta and Alpha in seven construction workers out of 228 samples taken from one construction camp in Bangkok for the first time, prompting concerns over possible re-combination of the variants or hybrid variants if such an infection is allowed to continue.