Prioritize Vaccines for Vulnerable Groups

AFP/AZWAR IIPANK

This handout photo taken and released on August 11, 2020 by Presidential palace shows President Joko Widodo (C) visiting the Bio Farma Pharmacy that produce vaccines for COVID-19 coronavirus in Bandung, West Java. - Indonesia on August 11, 2020 launched human trials of a Chinese-made coronavirus vaccine with some 1,600 volunteers slated to take part in the six-month study.

In the midst of the third phase of clinical trials for the COVID-19 vaccine, data collection on potential vaccine recipients needs to be done immediately. Groups vulnerable to infection must be prioritized.

JAKARTA, KOMPAS — The COVID-19 vaccine will be effective in breaking the chain of the spread of SARS-CoV-2 virus if it has wide coverage. For the first stage, the vaccine must be prioritized for vulnerable groups, namely the elderly and those with comorbidities.

Also read: One More Step to Take for Vaccine

"While waiting for the research and clinical trials of the vaccine until it is ready for production, we must prepare data on the vulnerable groups who will get it," said Deputy Head of the Eijkman Institute for Molecular Biology David Muljono Handojo in Jakarta, Wednesday (12/8/2020).

The vaccine will be effective in breaking the chain of transmission if it is given to at least 70 percent of Indonesia\'s population or 175 million people. "The Sinovac vaccine, if the clinical trial is successful, will be distributed in addition to China to other countries participating in clinical trials. Therefore, it is important we have a vaccine made in the country," said David.

Another thing that needs to be taken into account, David added, is the social problem in the form of a lack of awareness and knowledge of citizens regarding the vaccine.

Also read: Vaccine Development and Fund Disbursement Need to be Accelerated

Data from the COVID-19 Mitigating Task Force yesterday showed that there were 1,942 additional COVID-19 cases in Indonesia from the previous day. The number of cases examined was 13,698 people or a positivity rate of 14.2 percent. Thus, there are now a total of 130,718 COVID-19 cases in Indonesia, with 85,794 patients recovering and 5,903 people dead.

KOMPAS/TATANG MULYANA SINAGA

Situation in the vaccine packaging room at Building 43 of PT Bio Farma, Bandung City, West Java, Wednesday (12/8/2020). If the clinical trials are successful, a Covid-19 vaccine will be produced in this building.

The largest number of patients who died due to COVID-19 in Indonesia are from the age group of 46-59 years, namely 39.5 percent, followed by the age group over 60 years (38.6 percent). The majority of sufferers are 31-45 years old (31.4 percent), 46-59 years old (24.6 percent), 19-30 years old (23.5 percent), and over 60 years old (11.4 percent).

Of the comorbidities, 13.2 percent have hypertension, followed by diabetes mellitus (11.7 percent), heart disease (7.6 percent), kidney failure (3.1 percent), chronic lung disease (2.4 percent), and other breathing disorders at around 1.7 percent.

Collaboration

Previously, the third phase of the clinical trial of the potential COVID-19 vaccine made by Sinovac Biotech, China, began in Bandung, Tuesday (11/8), involving 1,620 volunteers. The clinical trial has been conducted in collaboration with PT Bio Farma and Padjadjaran University, Bandung.

AFP PHOTO/INDONESIAN MINISTRY OF STATE-OWNED ENTERPRISES

This handout photo taken on August 4, 2020 and received on August 5 from Indonesia\'s Ministry of State-Owned Enterprises (SOE) shows SOE Minister Erick Thohir (C) visiting the Bio Farma Pharmacy that will produce vaccines for COVID-19 coronavirus in Bandung, West Java.

The candidate vaccine, called CoronaVac, is made from an inactive virus so that it no longer causes disease. On the other hand, the vaccine triggers antibody production. Last June, Sinovac completed the combination of the first and second phase of clinical trials on 743 volunteers. According to Sinovac, there are no ill effects and the vaccine produces an immune response.

Last month, Sinovac launched the third phase of clinical trials in Brazil on 9,000 volunteers with Instituto Butantan, a Brazilian producer of vaccines and immunobiological products. Meanwhile, Bio Farma\'s production capacity is 100 million doses per year, with Bio Farma ready to increase the capacity by another 150 million doses.

Apart from Sinovac, currently four other companies are conducting clinical trials in the third phase, namely Sinopharm (China), which tests in the United Arab Emirates, Moderna in the United States, Oxford University (UK) in collaboration with AstraZeneca, and BioNTech (Germany) in collaboration with Pfizer (US).

In addition to working with foreign countries, according to President Joko Widodo, the government is developing a vaccine from the COVID-19 samples in Indonesia, targeted for completion in 2021. The candidate vaccine is being developed by a research consortium consisting of the Eijkman Institute for Molecular Biology and the Indonesian Institute of Sciences (Kompas.id, 11 August 2020).

Clinical trial procedure

As quoted from the websites of The New York Times and Vaccine Today, there are several stages of vaccine development from laboratories to clinical facilities. In preclinical testing, researchers test the candidate vaccine in vitro (isolated cell or organ culture), before being tested on experimental animals such as mice. It aims to see if a vaccine triggers an immune response and doesn\'t trigger adverse effects.

ZHANG YUWEI/XINHUA VIA AP

In this April 11, 2020, photo released by Xinhua News Agency, a staff member tests samples of a potential COVID-19 vaccine at a production plant of SinoPharm in Beijing. In the global race to make a coronavirus vaccine, the state-owned Chinese company is boasting that it gave its employees, including top executives, experimental shots even before the government OK\'d testing in people.

If judged effective, the phase one of the clinical trials is conducted in humans, usually dozens of people. Furthermore, the second phase of the clinical trials is carried out on hundreds of people to ensure its effectiveness and safety.

The next stage is the third phase of clinical trials, in which the vaccine is tested on thousands of people in a number of countries (multicenter). It aims to determine the ability of the vaccine to trigger an immune response compared to those given a placebo. This test ensures the vaccine can protect against the new coronavirus and its safety or whether there are side effects that are not seen during previous clinical trials.

Then there is the clinical trial after the vaccine has been marketed, namely the phase 4 to evaluate the safety of the vaccine in people of all ages and races.

Once proven effective, the authorities in each country evaluate the results of clinical trials and decide whether or not to approve vaccine distribution. Last June, the US Food and Drug Administration (FDA) said a vaccine is effective if it protects at least 50 percent of the people vaccinated. Then there is the clinical trial after the vaccine has been marketed, namely the phase 4 to evaluate the safety of the vaccine in people of all ages and races.

Even though clinical trials of the vaccine have entered the third phase, control of COVID-19 must not be relaxed. According to epidemiologist from the School of Public Health, University of Indonesia, Pandu Riono, zoning in determining the risk of COVID-19 transmission is not precise because there is still a lack of tracking and case examination. (AIK/ TAN/ATK)