Confusion regarding the optimum gap between doses keeps health care workers away from follow up dose of Covishield and Covaxin

It has been over a week since the second round of doses began for Covid vaccines, and Delhi has till February 24 seen just 25,110 come through. This is in fact just over half of what should have been administered if we look at January 28 which till that date saw 48,008 vaccinated in Delhi.

We take January 28 into consideration as it would mean completion of four weeks by February 24, which both the Covaxin by Bharat Biotech and Covishield – an Oxford-AstraZeneca’s formula manufactured by Serum Institute of India – prescribe for dosage.

The process of vaccination began on January 16 with health care workers across the country, followed by front line workers from February 2.

Interestingly, till January 23, Delhi saw just 6,111 beneficiaries vaccinated and by the next day there was a huge jump. The Union Ministry of Health and Family Welfare press release shows, Delhi saw that a total of 25,811 received one of the two vaccines by January 24.

Till February 24, now, adding the frontline workers and the health care workers Delhi has seen 3,37,080 of dose 1 being given. Beneficiaries availing round 2 of the vaccines are moving slower than required. And this could be due to some confusion with just how many weeks one must wait for their second dose.

Even Serum Insititute’s fact sheet makes a confusing read. It says that the Covishield vaccination course consists of two separate doses of 0.5 ml each. The second dose should be administered between four to six weeks after the first dose. “However, there is data available for administration of the second dose up to 12 weeks after the first dose from the overseas studies”.  And a majority of the hospitals and or centres are administering Covishield in Delhi.

An expert panel of the UN health agency has suggested an 8–12-week interval between two doses of the Covid-19 vaccine. While Covaxin is still in stage 3 trial, there is discussion on what works best for Covishield. An expert panel of the National Technical Advisory Group on Immunisation (NTAGI) was also to meet on February 19 to discuss the dosage interval for the vaccine, but at the moment no change in administering of dosage has been announced.

We spoke with a few persons who had taken the second dose of the vaccine, and a nodal officer for vaccination. The majority cited that the colleagues who did not return on the prescribed gap of four weeks was due to the different material which says prolonging the gap could prove to have more efficacy in combating the virus.

At Safdarjung Hospital only 40 people had turned up to get their second dose on the weekend, while 72 health care workers got vaccinated only on the very first day, when the vaccine was launched. Delhi’s Apollo hospital refused to comment while AIIMS is yet to share their data on the same.

Dr Kalra, the nodal officer at GB Pant hospital pointed to two reasons why they were seeing fewer people return for their second dose of the vaccine. One was the confusion over the waiting period between the shots and second was rumours of adverse reactions being spread and keeping people away.

“However, the government has been trying to create awareness and urge more healthcare workers to take the dose. The numbers have increased over the week,” he shared.

A nurse at GB Pant, Ramachandani took his second dose on the first day itself. He said that although he turned up for his follow up, many of his colleagues abstained. “Very few of my colleagues turned up because of the confusion regarding the duration one should wait before getting the second shot. People are waiting for antibodies to grow and are waiting for the six-week cut off thanks to messages being circulated on WhatsApp,” he said.

He also added that a lot of the healthcare workers were not aware of the dates for follow up on vaccination as they had not received any message from the vaccine portal.

Another nurse, BL Sharma who works at Kasturba hospital said he plans to take his second dose scheduled for February 27. “Almost all of my colleagues have taken the vaccine. Those who have not taken, have real reasons to abstain, like lactating mothers.” But those who have in fact decided to delay their second dose, he points to “new research which says taking the second dose after eight weeks is better”. His hospital is administering the Covaxin vaccine. 

But the confusions on the dosage make it clear on how important it is for a concrete time frame and the correct gap for the administration of the vaccine. This, especially as the country will start vaccination of those who are above 60 years of age from March 1. The government has also decided to extend the rollout of vaccines to people above 45 years of age who have comorbidities.

But not all point to dosage confusions, but the lack of time. A report had also cited administration officials in the city attributing the low turnout in Delhi to the weekend, and the fact that hospitals were open only for half the day.

Dr Hema Gupta, associate professor at the Department of paediatrics at ABVIMS and RML hospital got her second dose of vaccination on schedule. She believes those who abstained from the second dose did so, due to personal availability issues. “Some days people may not be available that’s all…Health workers are not put off by the second vaccine dose. Anyway, mild fever and headache are common side-effects to vaccines and are nothing major.”

She said any other scare tactic being spread should not be taken seriously, “I had no adverse symptoms. Some of my colleagues who did, had very minor symptoms. I was in fact back to work in half an hour after the vaccine. In my opinion India is doing well in the vaccine drive and there is no apprehension for getting the vaccine.”

According to data shared by the North Delhi Municipal Corporation, its four hospitals have seen a total of 4,959 workers avail the vaccine till February 23. In Kasturba Hospital a total of 1,156 have been vaccinated, at Hindu Rao hospital a total of 1,838, at Girdhari Lal Maternity hospital 974 staff members have been vaccinated and 991 at Balak Ram Hospital till February 23.

While vaccinations are on the next stage in the country, India reported 16,738 new cases, and 138 fresh fatalities in the country on February 24. The daily rise in Coronavirus infections in India was recorded above 15,000 after nearly a month taking the country’s total tally of Covid-19 cases to 1,10,46,914, according to the Union Health Ministry data.

In the past one week, 12 states have reported more than 100 average daily new cases. These are Maharashtra, Kerala, Tamil Nadu, Karnataka, Punjab, Gujarat, Madhya Pradesh, Chhattisgarh, West Bengal, Telangana, Delhi and Haryana.

According to Delhi government’s health bulletin the Capital city witnessed 200 new positive cases on February 24, taking the total active cases to 1137. The city also recorded 2 deaths on the same day.

While numbers are much lower than what they were during the peak, there is danger of a second wave which speedy vaccination can hope to thwart. But with different opinions on what makes the vaccine work at its best and people’s anxieties on the next step remain.

With inputs from Proma Chakraborty