Covid-19 vaccine: Booster dose for low immunity patients on the cards, say officials

KARACHI: On the recommendations of transplant surgeons and infectious diseases experts, health authorities in Pakistan are considering to ‘allow a booster dose of Covid-19 vaccines’ for immune-comprised people including those who had an organ transplant, HIV and cancer patients, and people taking high-doses of steroids or other immunosuppressive drugs, officials said on Saturday.

They said even the persons below 18 upto 12 years of age could be allowed to get Covid-19 vaccine jabs, who were immunosuppressed and had ‘special needs’, adding that there were thousands of children suffering from genetic blood disorders, HIV and other diseases who needed to be vaccinated to prevent them from Covid-19 .

“Being considered”, was the response of Special Assistant to Prime Minister on Health Dr. Faisal Sultan when asked if Pakistan could allow a booster dose of Covid-19 vaccines for such people including those who had organ transplants.

Dr. Faisal Sultan did not elaborate when a final decision would be announced by the National Command and Operation Center (NCOC). However the decision would be easier for the health authorities as the US Food and Drug Administration (FDA) and the Centers for Disease Control and Prevention (CDC) have both recommended a third dose of the Pfizer-BioNTech or Moderna vaccine for certain immunocompromised people.

When asked if there was any plan to vaccinate people below 18 years of age upto 12 years, SAPM Sultan said ‘not yet’, but their would likely be allowed in the near future. “They (12 years and above) would be vaccinated, probably with Pfizer-BioNTech and other vaccines too,” Sultan added. Another officer at National Health Services, Regulation and Coordination (NHS,R&C) said Drug Regulatory Authority of Pakistan (DRAP) has allowed Pfizer vaccine for youngsters of 12 years and above and initially, ‘immune-suppressed people and children with special needs’ could be allowed inoculation.

Commenting on the need for a booster dose of Covid-19 vaccine for transplant patients, liver transplant surgeon Dr. Faisal Saud Dar said it was expected that transplant recipients would develop an adequate immune response to the vaccine but early results showed a weak or even negligible immune response to standard two doses of vaccine (18-20%in transplant recipients vs. 80-96% in normal population).

“Few small case studies of the third dose of Covid-19 vaccines have suggested that an additional dose may produce an adequate or even robust response in most transplant recipients.

A recently published article in New England Journal of Medicine has provided a convincing evidence of enhanced vaccine efficacy in transplant recipients with a third (booster) dose of mRNA-1273 vaccine”, Dr. Faisal Dar, who is the Dean of Pakistan Kidney and Liver Institute (PKLI) Lahore said. He maintained that third vaccine was ‘very well tolerated with only mild side effects’ by the transplant patients and did not cause acute organ rejections, which is an important finding.

Another renowned transplant surgeon Prof. Saeed Akhtar said immune-compromised patients are at much higher risk for fatal Covid-19 disease and should be vaccinated with the booster dose, adding that the effect of third dose in transplant patient has seen "objective increase in neutralizing antibody titres" and should be given to all the transplant patients.

“The risk of serious life-threatening diseases and death also decreases significantly in them. Data with Chinese vaccines in transplanted patients is not very clear and where possible Moderna or Pfizer vaccines should be used. People who have received Chinese vaccines can also be boosted with the same vaccine or Moderna or Pfizer booster,” Prof. Saeed Akhtar suggested.