Taiwan’s first-dose coverage for COVID-19 vaccination has already reached 70 percent, but rollout of subsequent doses has only reached 30 percent coverage and enthusiasm is waning.
To address this, the Central Epidemic Command Center is pushing for people to get their second AstraZeneca shot and reduce the time between shots of the Pfizer-BioNTech vaccine to four weeks, the smallest gap advised.
This is misguided, because the coverage rate does not necessarily equate with optimal protection.
Large-scale trials conducted in Sweden recently showed that a mix of the AstraZeneca and Moderna shots offers 79 percent protection against the Delta variant of SARS-CoV-2 compared with protection of 30 percent from two AstraZeneca shots, while an AstraZeneca-Pfizer-BioNTech combination provided 67 percent protection.
More than 7 million Taiwanese, about one-third of the population, have had a first jab of the AstraZeneca vaccine. If the study’s data hold true, a second AstraZeneca shot would boost the coverage by more than 30 percent, but the protection rate would only be half of that.
However, if those 7 million were to be given Moderna for dose No. 2, the protection rate would be much greater.
By the same principle, if Taiwan is seeking to fully vaccinate 60 percent of the population, but more than 7 million people are given two AstraZeneca jabs, the protection rate would be at best 45 percent.
In the absence of community prevention measures, the Delta variant has a basic reproduction number (R) — the expected number of cases directly generated by one case in a population in which everyone is susceptible to infection — of 6. If the government is relying solely on herd immunity, it needs to achieve 83 percent immunity. Such a figure is only possible in a population completely inoculated with an mRNA vaccination, with the exception of children, who still cannot be vaccinated.
However, if the AstraZeneca vaccine was used exclusively, even with a 100 percent vaccination rate, the nation would be nowhere near herd immunity.
Many people mistakenly believe that as the AstraZeneca and mRNA vaccines prevent serious symptoms from developing in 90 percent of cases, they are virtually the same.
However, the point of the next phase of pandemic prevention measures is to reduce the incidence of less severe symptoms.
Singapore, which has deployed exclusively mRNA vaccines, has reduced incidents of severe infections, but as it opens its borders to visitors from some countries and eases other restrictions, those who are yet to be vaccinated, especially elderly people, face trouble.
If there are breakthrough infections, the death rate among elderly people might be as high as 2 percent, far above the rate of influenza deaths.
Regarding the wait period, why was the previous advice that there should be a 10-week wait between Moderna jabs, but now a second BioNTech jab can be received after four weeks?
The recommended wait period for the BioNTech vaccine is three weeks, but studies in Europe showed that protection levels improved with a 10-week wait, so many people delayed their second shot.
A US study in July showed that protection from two BioNTech shots fell to only 40 percent after five months, with one of the reasons possibly that the time between jabs was too short.
If Taiwan wants to open its borders, it must ensure that it has the best possible protection from its vaccination program. This means allowing those who have gotten an AstraZeneca jab to receive a different brand for their second shot, while those who have had the first shot of an mRNA vaccine to should wait 10 weeks before getting their second.
Taiwanese should not be fooled into thinking that they are adequately protected simply because they have had two shots.
Shen Chen-nan is a physician.
Translated by Paul Cooper
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