The AstraZeneca vaccine is safe for Basotho: Govt, WHO

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LAST week, Health Minister, Semano Sekatle, announced that the government had ordered Covid-19 vaccines from three different leading pharmaceutical companies ahead of rolling out a mass vaccination programme which will begin next week.

He said the government has ordered the Pfizer, Johnson & Johnson as well as the AstraZeneca vaccines.

The three vaccines are seen as the best way of fighting Covid-19. A study of 1, 2 million people in Israel, which has vaccinated most of its population with the Pfizer vaccine over the last two months, found that it was 94 percent effective across all age groups.

Some studies have shown that the Johnson & Johnson vaccine can be 85 percent effective in treating Covid-19 and preventing infections.

While the AstraZeneca has been used in other jurisdictions it has been proved to be ineffective against the South African variant of Covid-19 (also known as B.1.351 or 501.V2.).

South Africa took delivery of a million doses of the AstraZeneca vaccine before the country realised it was ineffective against its variant of the virus. It has since halted the further procurement of the vaccine. South African Health Minister Zweli Mkhize has even said his country would sell AstraZeneca vaccines to the African Union (AU) for distribution to countries “who have already expressed interest in acquiring the stock”.

Unsurprisingly, the Lesotho government’s decision to procure AstraZeneca vaccines at a time when neighbouring South Africa is trying to offload its stockpile has raised eyebrows. Many are asking whether the vaccine will protect Basotho whose close proximity to South Africa could mean that the South African variant could also be widespread in the country.

This week, the Lesotho Times (LT) editor, Herbert Moyo, sat down with Mr Sekatle who was assisted by some health experts to unpack the issues surrounding the AstraZeneca vaccine. With Mr Sekatle was Richard Banda, the World Health Organisation representative in Lesotho; Nthatisi Mothisi, the manager of the Expanded Programme on Immunisation (EPI) in the Health ministry; and Tholoana Masupha, the senior programme manager at the Clinton Health Access Initiative in Lesotho.

Below are excerpts of the interview:

LT: Please tell us about the government plans to deal with the Covid-19 pandemic 

Minister Sekatle: We are rolling out a vaccination programme for the nation. We have seen that the vaccines have been very effective in other countries that have already rolled them out because the number of sick people from Covid-19 as well as deaths have decreased.

Although our expectation is that everyone aged 16 and above should be vaccinated, I must emphasise that this is voluntary and no one will be forced. But as we have said before as government, it is in the best interests of everyone to be vaccinated and contribute to the country’s efforts to reduce the positivity rate.

LT: You have mentioned that government will procure three types of vaccines including the AstraZeneca vaccine. In South Africa, the main reason why AstraZeneca was suspended was because it was found to be ineffective against the South African variant of Covid-19. The variant is said to be more virulent and highly infectious than the original strain of the virus. Why then is Lesotho taking up the vaccine? Did Lesotho even conduct its own studies to ascertain if the country does not have the same South African variant of Covid-19 which would render AstraZeneca ineffective as per the findings in South Africa?

 Dr Banda: The specimens collected in Lesotho have been sent to National Institute for Communicable Diseases (NICD) laboratory in South Africa to see whether we have the South African variant circulating in Lesotho and if so to what extent it is circulating. More specimens will be sent this week.

The results are not yet back. But whether there is the South African variant circulating in Lesotho or not, we still recommend the use of AstraZeneca because all that South Africa did in its study was to assess its effectiveness in preventing the mild symptoms. But other studies have shown that AstraZeneca is highly effective in reducing severe symptoms.

LT: But the South African study concluded that AstraZeneca was only 22 percent effective. Are you not putting Basotho at risk by using it here?

 Dr Banda: Severe symptoms are what we are worried about here in Lesotho. Let me take you through the issues regarding the South African experience. The South African study on AstraZeneca had a lot of limitations. They found out that the vaccine was 22 percent effective in protecting against mild symptoms. What was not assessed was how well the vaccine would protect against very severe symptoms.

So, the (South African) study did not come out with findings on how well this vaccine can prevent deaths and other severe symptoms. Also, it should be noted that when you are vaccinated, there are two types of reactions that the body develops.

There is an antibody reaction and then there’s cellular immunity. Now what they tested in the South African study was the antibody reaction but they did not test to ascertain whether the vaccine would generate cellular immunity in people.

Even South Africa now wants to do further studies because what they found was just preliminary. We cannot suspend a vaccine because of preliminary findings which are yet to be confirmed by a larger study.

Ms Mothisi: If I may add to that, the South African study was not conclusive as it had been conducted on just 2000 people around the same age group.

Therefore, it would be difficult to extrapolate the preliminary findings and use them as a basis for concluding that the vaccine was ineffective in the general population of South Africa.

LT: What percentage of the population will have to be vaccinated to achieve herd immunity to halt infections?

 Dr Banda: Some studies have suggested a figure of 60 percent of the population and others even higher. But we don’t know for sure. Herd immunity varies from disease to disease and vaccine to vaccine. So, for now it’s very difficult to estimate the exact proportion of the population that has to be vaccinated in order to achieve herd immunity.

For some diseases, you find that herd immunity is around 95 percent. This Covid-19 virus is still new. We haven’t dealt with this virus before. There are a number of things that we don’t know about these newly developed vaccines.

For example, they are giving protection but for how long will that protection last in your body? That is not yet known? The other thing is that when you get this vaccine, you are not necessarily being protected from getting infected, you’re being protected from the severe symptoms. You might still get infected even though you have been vaccinated.

So, there are a number of unknowns on this vaccine. So, for now, we do not know for sure how many people need to be vaccinated for us to achieve herd immunity. The studies are ongoing to ascertain what figures will be required to achieve herd immunity.

LT: When all is said and done, what message would you send to Basotho concerning the AstraZeneca vaccine?

 Dr Banda: My message to Basotho is that they should understand that the decisions that the leadership of this country is making right now are very important.

I urge them to listen to their leaders and be vaccinated. This vaccination programme can only be successful if people participate in large numbers. We ask them to accept these vaccines because these vaccines will help all of us to reduce the number of Covid-19 deaths and hospitalisations.

Not only will these vaccines save lives, they will also help the economy of this country to recover because many people have been affected by the lockdowns. Once people have been vaccinated economic activities will resume and many people will be able to get back to their productive capacities and contribute to national development.

Ms Mothisi: What I can say is that from the programme side, the country is ready to roll out the vaccine. We have developed a curriculum because the vaccinators have to know exactly how to manage the vaccinations. So, we are planning to start vaccinating soon, probably next week.

“We are expecting an initial 36 000 doses of vaccines. Each person will get two doses. Phase one of the immunisation programme will target health workers.

It is important to prioritise health workers because once they’re protected this will prevent the health system from collapsing. They will be able to care for the patients. They also interact with people including patients suffering from other diseases. It is therefore important to keep them healthy so that they don’t pass on Covid-19 to patients.

Phase two will target essential workers, the elderly, those with chronic illnesses and the last phase will target the rest of the population.

In terms of our strategy, it is also important for us to look at the burden of the disease. We have to ask ourselves, where do we have the most positive cases?

We could then roll out the programme starting with the district with the highest burden of the disease. We have seen that Maseru has the highest number of positive cases, then Leribe. So, we might have to start in those districts.

LT: You have spoken about vaccinating everybody except those who are below the age of 16. Why are they being excluded? 

Dr Banda: The trials for the vaccines were conducted in population groups from the ages of 18 and above. So, you want to use the vaccine in a population group where its safety is assured because it has been tested on people of that age.

But even as we speak, studies are being conducted to determine whether the vaccine will still be safe and effective in the younger age groups. Only when the results show that it will be safe will the vaccines be used on younger people.

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