Giving Third Vaccine Dose as ‘Complement’

BPMI SEKRETARIAT PRESIDEN

President Joko Widodo observes the implementation of mass vaccination at the 762/Vira Yudha Sakti Infantry Battalion Headquarters, Sorong City, West Papua, Monday (4/10/2021).

Equitable distribution of the first and second doses should be prioritized in the country’s Covid-19 vaccination drive. Later, a third dose can be given to vulnerable groups.

JAKARTA, KOMPAS — Experts have recommended giving a third vaccine dose for those with immune disorders to protect them against Covid-19. In addition, elderly people who have received the Sinovac or Sinopharm vaccines are advised to get another dose as a booster. But it is recommended that Indonesia prioritize the equitable administration of the first and second vaccine doses.

The recommendations regarding the third vaccine dose were presented at a meeting of the Strategic Advisory Group of Experts (SAGE), the principal advisory group to the World Health Organization (WHO) for vaccines and immunization, held on 4-7 Oct. 2021.

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Responding to the matter, the Health Ministry’s vaccination spokesperson, Siti Nadia Tarmizi, said on Wednesday (13/10/2021) in Jakarta: “We remain focused on completing the first and second vaccine doses. This is also in the SAGE recommendation.”

The set of recommendations published by SAGE advises offering an extra dose of WHO-approved vaccines to people with moderate and severe immune disorders as an “extended primary series”.

A third dose was necessary to augment the first two doses, because people who were immunocompromised generally did not respond well to the first or second vaccine dose, which left them at risk of developing severe symptoms if they contracted Covid-19.

Administering a heterologous vaccine as a third dose could also be considered, depending on vaccine supply and access.

An additional dose of a homologous vaccine should also be offered to people aged 60 and above as an extension to the primary vaccination course program, especially recipients of inactivated Covid-19 vaccines such as Sinovac and Sinopharm. Administering a heterologous vaccine as a third dose could also be considered, depending on vaccine supply and access.

KOMPAS/VINA OKTAVIA

Seorang pelajar mendapat penyuntikan vaksin Covid-19 oleh petugas vaksinator di Bandar Lampung, Senin (11/10/2021)

Nonetheless, the recommendations stress that countries should achieve maximum two-dose coverage. Only after this should administration of the third dose commence, starting with the elderly.

According to Health Ministry data, Indonesia has so far reached first dose coverage of 48 percent of the targeted population, while it has achieved 27.59 percent of the targeted population in second dose coverage. Elderly recipients are among the groups with the lowest coverage, with first dose coverage only reaching 33.6 percent and second dose coverage 21.7 percent.

Regarding the many people experiencing difficulties in getting a second dose of the same Covid-19 vaccine they received for their first dose, particularly the AstraZeneca vaccine, Nadia asked that they wait for supplies to arrive. She made no suggestion that they receive a different vaccine for their second dose.

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Indonesian vaccine and molecular biology researcher Ines Atmosukarto, at Australia National University’s John Curtin School of Medical Research, explained that vaccines that used inactivated viruses, such as Sinovac and Sinopharm, generally had lower immunogenic capacity compared to those that used other vaccine platforms.

“Therefore, the recommendation for getting a third dose, which applies to recipients who have received two doses of an inactivated vaccine (Sinovac or Sinopharm) are called a complement, rather than a booster,” she said.

Three doses

According to Ines, inactivated vaccines generated a better immune response if three doses were administered instead of two. She pointed out that two doses of the Sinovac vaccine had an efficacy of 50-65 percent.

“Evidence for a decline in antibodies is as yet unclear, but it’s clear that the titer of antibodies (triggered by the Sinovac vaccine) is not as high compared with mRNA or viral vector vaccines. What’s more, administering a third dose significantly increases the titer of antibodies,” she added.

This was why the SAGE recommendation referred to administering a third dose as a complement to the first and second doses of the Sinovac or Sinopharm vaccines, rather than administering a booster for the mRNA vaccines.

Although a third dose was necessary for recipients of the Sinovac vaccine, Indonesia finds it more urgent to provide basic immunization, or the first and second doses, for the majority of individuals.

Kompas/Heru Sri Kumoro

Vice President Ma'ruf Amin accompanied by Minister of Health Budi Gunadi Sadikin while reviewing the Covid-19 vaccination at Bentara Budaya Jakarta, Jakarta, Thursday (23/9/2021). This activity is the second dose of vaccination for media workers.

Indonesian epidemiologist Dicky Budiman at Griffith University suggested that a third vaccine dose should be given after reaching minimum second dose coverage.

“Regions that still have not achieved second dose coverage of 50 percent of their population and 70 percent of vulnerable groups should strive to achieve [minimum] vaccination coverage before administering the third dose,” he said. (AIK)

(This article was translated by Aris Prawira).