A double dose of reality
Mixing vaccine brands and getting an mRNA booster after 2 Sinovac jabs has led to a scramble
The threat of a prolonged Covid-19 outbreak, triggered by the Delta variant, has prompted people to scramble for alternative vaccines, including Moderna, that are not provided the state mass inoculation scheme.
A mix of different types of vaccines to boost immunity against variants has increasingly become part of the decision to receive jabs amid ongoing concern about a vaccine shortage.
People queue to receive Covid-19 vaccines at Bang Sue Grand Station. Nutthawat Wicheanbut
Asst Prof Kamthorn Malatham, MD, deputy director of Ramathibodi Hospital, said few medical researchers in Thailand and many experts globally are conducting clinical trials of cross-vaccination, trying to find a mix-and-match method and interval for each shot that can provide the most effective result for Covid-19 prevention.
"It should not take longer than 2-3 months before we have clearer knowledge on cross-vaccination. But as we wait for those results, each hospital follows its own principles based on what they have studied," he said.
"For the public, the most important action is to receive any available vaccine as soon as possible because the virus spread in the country is worsening."
Even though information about the effectiveness of cross-vaccination remains unclear, that did not prevent people from flooding alternative vaccine booking systems that hospitals opened for deposits last week.
Many hospitals had to close registration in less than 10 minutes as demand reached the quota.
Ramathibodi Hospital, the only public hospital to join the Moderna procurement, opened the registration system to the public last Monday and those slots were fully booked in three minutes.
Dr Kamthorn, also president of the Infectious Disease Association of Thailand, said the spike in daily infections stirred demand for mRNA vaccines, including Moderna, which are proven to be more effective against the Delta variant than Sinovac, the primary vaccine the Prayut government chose for the country.
The distribution of mRNA vaccines among medical personnel should help the public health system deal with rising caseloads, which already exceed the system's capacity, he said.
"All vaccines can work well against the virus, but to different degrees. None of them prevent the virus 100%," said Dr Kamthorn.
"The disease will eventually become endemic in Thailand, similar to influenza which requires annual vaccinations. Until that day, we should strive for herd immunity and have most people receive their first shot as soon as possible."
Pongpat Patanavanich, vice-chairman and managing director of TPP Healthcare International Co, the owner of MedPark Hospital, said MedPark and Mahachai Hospital Group together recorded 100,000 Moderna doses booked a few hours after opening for registration.
Mr Pongpat insisted hospitals are ready for Moderna payment to the Government Pharmaceutical Organization (GPO), which was assigned to be the official dealer on behalf of private hospitals.
"We admit the situation in Thailand has reached critical status. The public and private hospitals combined don't have enough ICU beds for Covid-19 patients," he said.
"The non-stop growth of new infections is a daily reminder that we don't have enough doctors for the population in the country."
The most important action the government can take is to deliver reliable vaccines that can cover a wide range of the population as fast as possible, said Mr Pongpat.
"Our three hospitals in Mahachai [Samut Sakhon], which was the epicentre of the second outbreak, are dealing with a new outbreak, as today over 700 Covid-19 patients have been admitted," he said.
Vaccinating medical personnel and their families with effective boosters can strengthen the public health capability of the country, said Mr Pongpat.
Krittavith Lertutsahakul, chief executive of Vimut Hospital, a subsidiary of developer Pruksa Holding Plc, said the hospital started to reserve Moderna vaccines in mid-May this year.
"In the first round of reservations, we did not collect deposits for bookings as the price and number of doses we could purchase had not been determined by the GPO," he said.
This uncertainty caused a problem for private hospitals wanting to offer alternative vaccines.
In its first round of reservations without payment, Vimut Hospital received 300,000 reservations in three days, said Dr Krittavith.
Demand fell to around 100,000 once the hospital asked for deposits, he said.
"The process does not end with a sale," said Dr Krittavith.
"We cannot offer too many shots because we may not be able to accelerate inoculations. The more we sell, the quicker we need to administer the jabs as the vaccines have a limited shelf life."
He said the shelf life of vaccines in general is no longer than six months, with logistics from manufacturers to hospitals account for most of that period.
Recommended usage is within three months, said Dr Krittavith.
"Knowing the precise amount, the date we can procure vaccines and the shelf life could help us better manage distribution," he said.
"However, there's still concern about variants of the virus and which vaccines are effective against those variants."
Dr Krittavith suggested a third shot of an mRNA vaccine as a booster following the two Sinovac jabs provided by the government.
A health worker prepares a dose of the Covid-19 vaccine at Bang Sue Grand Station. Nutthawat Wicheanbut
TAKE YOUR TIME
Despite being aware of high demand for Moderna vaccines, Bumrungrad International Hospital (BH) offered vaccine booking later than other hospitals because it wanted to plan an effective vaccination programme.
The hospital also wanted to wait until it was "confident" it would receive the vaccines, said BH chief executive and pharmacist Artirat Charukitpipat.
The hospital allowed targeted customers, such as regular BH patients, to book Moderna vaccines last Friday.
Hospital personnel can provide inoculation for only 300 people a day, said Ms Artirat.
"We received a lower amount of vaccines than we asked for on our purchase orders," she said.
A health worker prepares a dose of the Covid-19 vaccine at Bang Sue Grand Station. Varuth Hirunyatheb
DIVIDING MODERNA SHOTS
Thonburi Healthcare Group Plc (THG), which imported Moderna vaccines, expects 5 million doses to be delivered to Thailand in the fourth quarter this year, but this amount is short of demand and needs to be divided among hospitals.
"Each hospital will receive a different share," said Boon Vanasin, chairman of THG.
Some 1 million doses are allocated to the Thai Red Cross Society, while 4 million are for private and state hospitals.
Private hospitals under the THG and Kasemrad Hospital network are allocated 800,000 doses each, while the remaining 2.4 million doses are for other hospitals in Bangkok and upcountry, including Ramathibodi Hospital.
The Private Hospital Association placed an order to import 9.5 million doses of Moderna vaccines via the GPO, but the manufacturer can sell only 5 million doses due to limited supply to serve global demand, Dr Boon said.
THG received 3 million bookings for one dose from the public, so many of them must wait for the next lot of vaccines, he said.
The GPO set the price of the Moderna vaccine at 1,100 baht a dose, but after injection fees are included, the Private Hospital Association settled on 1,650 baht a dose.
Dr Boon insisted the main motivation for hospitals in the vaccination drive is to help people.
"I think some people may have a negative perception about private hospitals. They are not unfairly making a profit from imported vaccines," he said.
"Doctors have medical ethics."
Earlier THG asked for permission to buy Pfizer vaccines, but its request was rejected because the law does not allow private hospitals to import the same vaccines as those procured by the government, said Dr Boon.
The first batch of Sinovac Biotech's vaccines are displayed on arrival in Thailand on Feb 24. Wichan Charoenkiatpakul
SPEED IS CRUCIAL
Sanan Angubolkul, chairman of the Thai Chamber of Commerce, said the government needs to speed up vaccine purchase contracts and alternative vaccine supplies for people who are willing to pay for their vaccinations as fast as possible.
Mr Sanan brushed aside concerns about a glut of vaccines, saying there is currently a shortage and the Sinovac jabs administered by the government look to require an mRNA booster to be effective against the Delta variant.
"The private sector is growing concerned about the delay in the distribution of the vaccines amid rising infection rates," he said.
"The infection rates are serious, especially in Bangkok and surrounding areas, with inoculations desperately needed. The government's mass vaccination scheme needs to be accelerated as fast as possible, particularly in high-risk areas to contain the spread."
ALL VACCINES NEEDED
The point of talking about "alternative vaccines" is pointless -- Thailand needs any and all vaccines it can find, said Supant Mongkolsuthree, chairman of the Federation of Thai Industries (FTI).
Earlier the organisation announced it would buy Sinopharm vaccines through the Chulabhorn Royal Academy to vaccinate workers of companies that are FTI members.
"We are worried Covid-19 will spread to more factories where workers have yet to receive vaccines, especially those located in Bangkok suburbs," said Mr Supant.
He wants the government to speed up distributing vaccines to factories to keep their production on schedule, especially as the export market is the only segment keeping the Thai economy afloat.