Why you should not skip your second COVID-19 shot

In this report by SADE OGUNTOLA, experts say that individuals should ensure that they get both doses of the AstraZeneca vaccine to ensure that they have the strongest protection against Covid-19, especially with new variants circulating the globe.

Mrs. Tommy Adekola was hesitant to go for the second dose of the COVID-19 vaccine.  Her experience with the first dose was not palatable. She had a bout of pains, with severe headache and fever 12 hours after she took the COVID-19 vaccine. She declared that “These all started about 10 pm, and lying down to sleep was difficult because I was also experiencing muscular and joint pain, as well as stomach cramps. It lasted for about 12 hours. But afterwards, for another 12 hours, there was a slight headache.”

Mr Haruna Ezechi’s concern was where he would be going for the second dose. He is a trader and his neighbor appealed that the nurse at the village primary health care centre should oblige him the opportunity of getting vaccinated.

There has been reasonable concern among those who took the first dose in missing the second dose. Some from fear of potential side effects of the inoculation, to the belief that one dose is sufficient protection against the coronavirus, to logistical barriers beyond the individual’s control, such as cancelled appointments because there is a shortage of COVID-19 vaccine.

The second dose of AstraZeneca’s vaccine should ideally be given three weeks after the first. Moderna’s second dose is meant to be given four weeks after the first, while the Johnson & Johnson/Janssen shot is delivered in a single dose.

Research shows the immune response to the AstraZeneca vaccine was better after an interval of more than 12 weeks than it was at less than six weeks. The vaccine efficacy reached 82.4 per cent after a second dose for those who had a dosing interval of 12 weeks or more.

These second shots are commonly called “booster” shots by professionals, as they’re designed to “boost” your immunity, much like the series of shots used to protect you against mumps or measles, as an example.

But what happens when the second dose of the vaccine is missed beyond this extended period? Vice President for Research at the South African Medical Research Council (SAMRC) from South Africa, Professor Jeffrey Mphahlele, speaking at a virtual Vaccinate our World PAN-African press conference by AIDS HEALTH CARE FOUNDATION (AHF), stated that this depends on the type of vaccine that is given.

According to him, “Research reported 52 per cent efficacy from the first dose of the Pfizer vaccine and so clearly it reasons that there is a need for a second dose. It is licensed as a 2-dose regimen at 21 days intervals but the second dose can actually be delayed to two months and in some cases 3 months. But, if there is a delay, the individual can still go-ahead to take the second dose.”

What is more, Professor David Olaleye, a virologist, at the University of Ibadan said the consequence of missing out on the second dose is that an individual is not fully protected and on exposure to the infection, the person could get the infection, get the disease, and even get it severely.

Without the second dose, the antibody responses will wane relatively quickly. The second dose is very protective and brings the antibody levels higher, especially in old people. Also, the individual will be denied the protection the vaccine should provide due to the long interval between the shots.

Moreover, scientists have expressed concerns that a weak response to the virus in people who have received the first dose could accelerate the virus’ ability to develop vaccine-resistant mutations.

Dr Simon Agwale, chair, Africa COVID-19 vaccine manufacturing Initiative, stated that “the recommendation on AstraZeneca vaccine, the COVID-19 vaccine available in Nigeria is that the time interval can be less than 12 weeks because the initial trial was a one-month interval.”

Director of the U.S. National Institute of Allergy and Infectious Diseases, Dr Anthony Fauci, recently hinted that a single dose may not provide immunity as long as a full vaccine series could. “When you look at the level of protection after one dose, you can say it’s 80%, but it’s somewhat of a tenuous 80%, When you leave it at one dose, the question is, how long does [immunity] last? And because new variants of the SARS-CoV-2 virus are proving to be an issue even for fully vaccinated adults, a single shot may offer even less protection against new COVID-19 strains. You’re in a tenuous zone if you don’t have the full impact,” he added.

Agwale who is also the president, Innovative Biotech Nigeria, however, said getting at least 80 per cent vaccination coverage is what will get Nigeria and other African countries to pre-COVID-19 normalcy when the vaccines are available.

“Already we have issues with vaccine supply in Africa; the COVAX facility has a problem because of hoarding of the vaccine. The vaccine is supposed to come from India, which is having problems currently and might not be able to export vaccines for COVID-19 until the end of the year. The only way out is for African countries to start local production.”

India is also home to one of the biggest manufacturers of vaccines in the world: the Serum Institute of India (SII), which was making and exporting millions of vaccines to other countries as cases were coming down in India.

The SII and the Indian government have now reduced the volume of vaccine being exported from India, but this has come too late as they are also struggling to obtain the raw materials needed for vaccine manufacture from the United States, which is focused on getting its own population vaccinated.

According to him, already countries like Ghana, South Africa, Egypt and Morocco are working on local production of COVID-19 vaccine with the support of the European Commission. Thus Nigeria also needs to prioritise local production of COVID-19 vaccine.

Dr Agwale said the pandemic is an eye-opener that African countries also should put in place infrastructure for vaccine production rather than waiting for developed countries to give free vaccines

Director of African Center of Excellence for Genomics of Infectious Diseases (ACEGID), Professor Christian Happi, said African countries are highly vulnerable because they are dependent on the rest of the world for COVID-19 vaccines. “African countries can work towards developing a candidate vaccine that can be deployed on the continent to change the narratives. Candidate vaccines must be supported to undergo a clinical trial. In a way, that will curb this pandemic but also prepare us for a future pandemic. The reality is Africa should help itself first before going to the G-20 countries to seek for assistance,” he said.

However, Bureau Chief of AHF Africa from Uganda, Dr Penninah Lutung, stated that in ensuring Africa gets enough COVID-19 vaccines for its use, it must prioritse health by funding it even as the continent must ensure that it can access the vaccines.

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