Tackling vaccine hesitancy

Amid concerns of side effects, doctors reassure patients suffering from chronic diseases and others they have nothing to fear

The fate of 4.3 million patients suffering from seven chronic diseases hangs in the balance as shortages loom over the nation's vaccine rollout scheme starting next Monday.

Last week, several hospitals postponed appointments for second doses of the AstraZeneca vaccine, fuelling speculation that supplies are running out.

In fact, vaccine bookings briefly hit a snag on the first day due to overwhelming demand. As of May 9, health authorities have insisted that patients suffering from seven chronic diseases and people over the age of 60 would receive the AstraZeneca vaccine made by Siam Bioscience. After many hospitals suspended inoculations, Public Health Minister Anutin Charnvirakul assured the general public that everything will go according to plan.

"We still have the Sinovac vaccine. I am confident that AstraZeneca will deliver its vaccine on schedule in June. The contract stipulates that if locally-manufactured vaccines are not available, the company must source them from abroad," he told reporters.

He assured that when the campaign begins on June 7, the country will offer all the vaccines at its disposal to those who registered on the Mor Prom mobile app. However, patients with chronic diseases have expressed concerns that it will affect their health. In light of this, doctors set the record straight about what some patients should watch out for.

Chronic kidney disease

Assoc Prof Dr Surasak Kantachuvesiri, president of the Nephrology Society of Thailand and lecturer in nephrology at Mahidol University's Faculty of Medicine, Ramathibodi Hospital, said patients with terminal kidney disease have a low level of immunity. If they contract the coronavirus, they will develop severe symptoms.

Thailand's mass vaccination programme against Covid-19 will begin next Monday. (Photo: Somchai Poomlard)

"The mortality rate for them is between 10-20%, which is higher than the average of 1-2%. Patients can experience kidney failure because coronavirus affects the lungs, kidneys and blood vessels," he told an online forum held by the nephrology and transplantation networks on May 21.

The total number of people living with kidney disease is 17 million. The majority of them are early-stage patients who receive treatment to slow kidney failure. Yet, patients in the fifth stage, or around 200,000-300,000 people, are on dialysis or have had kidney transplants -- 6,500 are living with new kidneys.

Dr Surasak encouraged patients to get vaccinated to reduce the severity of infection. They can use any type of vaccine -- inactivated, viral vector, mRNA or protein-based -- because they are not active and yield similar efficacy results.

"Vaccines are found to be over 90% effective in preventing death, regardless of brands. However, vaccinated people are still at risk of infection, so they should observe other health measures," he said.

Dr Surasak said mass vaccinations have not led to vaccine-related deaths, however, the daily death toll includes people suffering from kidney disease. Mild side effects -- fever, fatigue and muscle pain -- can occur in 5-10% of cases but disappear within three days. Adverse symptoms like numbness are rare and not related to stroke. Moreover, blood clots that were reported in the UK have not been found in Thailand.

"Patients should get vaccinated even though they will not achieve the same level of immunity as normal people. It won't reach 90% but it will be a satisfactory level," he said.

Assoc Prof Dr Cholatip Pongskul, president of the Thai Transplantation Society and lecturer in nephrology at Khon Kaen University's Faculty of Medicine, said organ recipients take immunosuppressants to prevent graft rejection. They must get vaccinated to reduce the severity of the disease.

"However, they will not achieve the same level of immunity as normal people. Among patients, those who have kidney transplants will respond [to the vaccine] less than those who are on haemodialysis, but it is better off being vaccinated," he said.

Heart disease and diabetes

Assoc Prof Dr Pattarapong Makarawate, lecturer in cardiology at Khon Kaen University's Faculty of Medicine, said the majority of patients suffer from coronary heart disease. Risk factors include diabetes, high cholesterol and deteriorating kidney function. If these patients contract the coronavirus, they will develop severe symptoms and be at risk of heart failure.

"Patients with all types of heart disease -- whether it be coronary heart disease, heart valve disease and arrhythmia -- must get vaccinated to reduce the severity of infection. Those who had surgery more than one month ago and are now in a stable condition can get jabs," he told an online forum held by Khon Kaen University's Faculty of Medicine on May 21.

Dr Pattarapong said patients who take antiplatelet drugs for coronary heart disease can get shots but those who take anticoagulants should follow the guidelines. Those who are taking warfarin can also get vaccinated if the international normalised ratio test, which measures the amount of time for the blood to clot, is lower than three over the past one to three months. Moreover, those who take novel oral anticoagulants should consult their doctor.

Meanwhile, Assoc Prof Dr Thongchai Pratipanawatr, lecturer in endocrine and metabolism at Khon Kaen University's Faculty of Medicine, asked 5 million patients with diabetes to get vaccinated because they are more vulnerable. It is common for elderly patients to contract the coronavirus from asymptomatic family members.

"Patients must get vaccinated. There is no restriction. In fact, it is more than necessary for those with complications like kidney and heart disease to get jabs as they face an increased risk of mortality," he said.

Vaccine conundrums

People have been asking why the Sinovac vaccine is being given to people over the age of 60. Assoc Prof Dr Piroon Mootsikapun, a lecturer in infectious diseases at Khon Kaen University's Faculty of Medicine, said the use of the vaccines for any age group depends on study results.

"In the past, Sinovac conducted studies on thousands of participants between the ages of 18-59 but there were only 252 people over the age of 60, accounting for 5%. It was not until a few weeks ago that a new study was released which noted that seniors responded [to the vaccine] relatively well," he said.

When asked about using two vaccine brands, Dr Piroon said a trial in the UK called the Com-Cov study is looking at a combination of jabs for first and second doses. However, current information shows it will lead to more side effects than using the same brand. Meanwhile, switching to another brand for a third dose will increase the level of immunity but it is not clear by how much.

A big question mark hangs over the Sinovac vaccine, especially after people suffered from partial paralysis in late April. Prof Dr Somsak Tiamkao, lecturer in neurology at Khon Kaen University's Faculty of Medicine, insisted that an investigation did not find any cases of paralysis after the first dose of the Sinovac jabs were administered. MRI scans also have not detected any irregularities. However, the Neurological Society of Thailand confirmed that although the Sinovac vaccine didn't cause stroke, it did lead to temporary neurological symptoms.

"People may feel numbness, which disappears in three days. Hypersensitivity is another common reaction for every vaccine [for all diseases]. It occurs three weeks after inoculation, such as Bell's palsy, Guillain-Barré syndrome and autoimmune disease, however, its incidence is one case per million doses. So far, we have found only one patient. Even without vaccination, we can find such a case in one out of 100,000 people," he said.