Medics disagree on Covid-19 vaccination plan

The new strategy contrasts sharply with the early pronouncement by Health minister Jane Ruth Aceng that giving people only one jab is more beneficial than spending the few doses at hand to give both the first and second round for only a few. 

“...with the first dose [of Covid-19 vaccine], there is 80 to 90 per cent efficiency against hospitalisation, hence protecting more people, which is more beneficial in terms of public health response,” Dr Aceng said on May 5. 

Following her remarks, many actions by the ministry, including mass vaccination in Kololo, Kampala, three weeks ago, and asking health workers not to keep vaccines for a second round, were driven to prioritise giving the first round of the vaccine so that a larger number of people get some form of protection from the deadly viral disease.

But the Health ministry made a U-turn when President Museveni last Friday directed them to prioritise the new batch of Covid-19 vaccines (175,200 doses) to give second round for those who already got the first jab.

“Yesterday (June 17), we received another 175,200 doses and we are expecting an additional 688,000 of AstraZeneca vaccine in early August. I have directed that these doses be prioritised to give a second dose to those who have already got their first dose,” the President said. 

The government is using a two-shot AstraZeneca vaccine, with the doses recommended to be given between eight and 12 weeks apart.

The government has so far received a total of 1,139,200 doses of AstraZeneca vaccine through donations, with the initial exercise launched in March in a long-term drive to vaccinate a population of 21.9 million Ugandans.

Prof Freddie Ssengooba, a health policy specialist at Makerere University School of Public Health, says bowing to the idea of prioritising the second round for those who are due will not be helpful in the fight against the coronavirus pandemic.

“The first dose provides protection, the more people you give the first dose, the more you cut down transmission of Covid-19, especially among those who are more vulnerable. But most importantly, it lowers the risk of complications and deaths due to Covid-19 [among vulnerable groups],” Prof Ssengooba says.

“If you give more first doses out, we have a chance of at least four and eight weeks to protect more people. But if we are giving a booster [second] dose, the few who are getting it will have better protection, but it will not help us as a country in fighting the epidemic,” he adds.

But Dr Henry Kajumbula,  the head of Infection Control in the Government Scientific Advisory Committee, who is in support of prioritising the second round, says the vaccine doses which are currently available are very few and they need to be prioritised.

“Optimum protection increases two weeks after the second dose, so it is more appropriate that people who already received the first dose are fully protected than spreading the first dose and none is well protected,” he said.

Dr Misaki Wayengera, the head of the Ministerial Scientific Advisory Committee on Covid-19, says the first dose of the vaccine is less effective. He argues that the first dose gives 60 per cent protection from the risk of severe illness and the second dose increases the protection to 92 per cent.

“It means in 100 people vaccinated against Covid-19 with AstraZeneca, only 62 will be protected by the first dose and up to 92 will be by the second dose. It implies that even at the second dose, some eight people might randomly get infected and possibly even get severe disease and die. The numbers protected are less with only one dose,” Dr Misaki says.

But Dr Ekwaro Obuku, a former president of Uganda Medical Association, disagrees. “I think the strategy should be to give more people a bit of protection than to give few people full protection, the more you give the better,” he argues.

However, Dr Alfred Driwale, the manager of Uganda National Expanded Programme on Immunisation (UNEPI), says the Health ministry had to undertake a delicate balancing act.

“We are also managing many things, that is one way of looking at it. Another way is the vaccine interval…some people have crossed three months and very anxious. You remember the people who came first are those who knew they were vulnerable so they are people at highest risk. We already started the protection and we need to complete it. We will come to younger groups later because their ability to fight back is higher. Enrolling more people on the first dose is what we may consider in subsequent doses,” he says.Dr Driwale says at least 841,629 people got first doses and 93,552 are fully vaccinated. 

He says the country needs to vaccinate five million people as quickly as possible but there are limiting factors slowing the process, which will make it difficult for the Health ministry to achieve the target.

“We will not manage the percentage, not that we have failed; it is just telling we are low [on coverage] as a result of global shortage of vaccines, inequitably allocation in distribution of the available global stock,” Dr Driwale says.
He adds the above factors explains why Africa has the least vaccination coverage.

What they say...

Dr Henry Kajumbula head, infection control, Government Scientific Advisory Committee: ''Optimum protection increases two weeks after the second dose, so it is more appropriate that people who already received the first dose are fully protected than spreading the first dose and none is well protected.”

Prof Freddie Ssengooba, health policy specialist: If you give more first doses out, you have a chance of at least four and eight weeks to protect more people. But if you are giving a second dose, the few getting it will have better protection, but it will not help the country in fighting the pandemic.”

Dr Alfred Driwale, manager, Uganda National Expanded Programme on Immunisation: ''The people who came first are those who knew they were vulnerable so they are at highest risk. We already started the protection and we need to complete it. We will come to younger groups later because their ability to fight back is higher. Enrolling more people on the first dose is what we may consider in subsequent doses.”

Dr Misaki Wayengera, head, Ministerial Scientific Advisory Committee on Covid-19: ''If 100 people are vaccinated with AstraZeneca, only 62 will be protected by the first dose and up to 92 will be by the second dose. This implies that even at the second dose, some eight people might randomly get infected and possibly even get severe disease and die. The numbers protected are less with only one dose.”