Registration for the coronavirus vaccine will open up for those 30 and above from Sunday (May 16). Pakistan has so far approved five Covid vaccines: Sinopharm, Cansino, Sinovac, Sputnik and AstraZeneca.

As the government's vaccine drive picks up pace, Dawn.com reached out to Dr Bushra Jamil, the president of the Medical Microbiology and Infectious Diseases Society of Pakistan and a professor at Aga Khan University Hospital on queries related to getting the Covid jab.

Dr Jamil is a pro bono adviser to the National Command and Operation Centre (NCOC) on the Covid-19 pandemic and has devised vaccine-related guidelines currently employed by the health ministry.

FAQs

Q: Do Covid-19 vaccines reduce the ability to make antibodies or affect the immune system?

A: No, vaccines do not reduce the ability to make antibodies and do not suppress the immune system.

Q: Is the vaccine safe for patients with diabetes, high blood pressure and arthritis?

A: Vaccines are recommended for people with diabetes, hypertension, heart diseases etc. These are high-risk groups that must get vaccinated.

Q: Should people getting dialysis, taking insulin, or those with pacemakers and transplants get vaccinated?

A: People on insulin, dialysis and transplant recipients must get vaccinated. Dialysis patients and transplant recipients have a weaker immune system and as more information becomes available, vaccination schedule may be modified for these groups. For now, follow the current guidelines.

Q: Should people with hepatitis, tuberculosis and HIV get vaccinated?

A: People with tuberculosis, HIV and chronic hepatitis must get vaccinated. Discuss your condition with your doctor in detail.

Q: I am a married man/woman and plan on starting a family soon. Will the Covid vaccine affect my fertility?

A: Coronavirus vaccine, like all other vaccines, have no effect on fertility. None of the vaccines developed and in use for preventing childhood and adult infections have any effect on male or femalereproduction.

Vaccines induce immunity against bacteria and viruses and not against human cells and tissues. Scientifically, it is impossible to induce infertility through the administration of a vaccine.

Q: Is it safe for pregnant or lactating women to get the jab?

A: All vaccines are safe for lactating mothers. Almost all vaccines are safe in pregnancy. However, for some vaccines, recommendations on risk versus benefit will be updated as more information becomes available.

Q: Is there any category that should not be vaccinated?

A: Vaccination should be deferred in acutely ill, hospitalised patients and those with acute Covid-19 infections.

In addition, those with a history of severe allergic reactions to vaccine preservatives/stabilisers in the past. It is important to check vaccine guidelines.

Q: Why are children not being vaccinated?

A: There is currently not enough safety data available. Generally, children are the last group to be subjected to clinical trials.

However, some preliminary data is available which suggests that Covid-19 vaccines may be safe and effective in children. We need to wait for more information and recommendations regarding this.

Q: Why is Covid vaccine being given to people over the age of 60? Wouldn’t it be too strong for their immune system?

A: The age group most at risk for severe disease is 60 and above. Therefore, this is the priority group that must get vaccinated.

Q: I and my wife are getting vaccinated while my parents, both above 60 and with Type2 diabetes, are refusing to vaccinate. I have young children at home. What’s the way out?

A: Explain the risks of disease transmission and the increased chance of serious disease and death if Covid-19 infection is acquired by someone who is over 60. Convince parents and the elderly to get vaccinated.

Q: I got the Sputnik/Pfizer shots. Should I also go for the Chinese vaccines for added protection?

A: If a complete course of one vaccine has been administered, it is not recommended to go for another type of vaccine.

Q: Should a person over 50, who has recovered from Covid, get vaccinated?

A: It is recommended that people who have recovered from Covid- 19 should get vaccinated. Immunity after recovery from infection needs to be boosted with the vaccine.

Q: How long after recovering from the virus should one get vaccinated?

A: Soon after complete recovery from infection.

Q: How long does it take for antibodies to develop and how long does vaccine protection last? Do I need a booster dose in the future?

A: Antibodies may take three weeks to develop after the second dose. However, immunity is a complex phenomenon and there are other mechanisms in the body which provide protection.

Therefore, monitoring antibodies post-vaccination is not recommended. Immunity may decline in 6-7 months. Booster doses may be required but there are no formal recommendations available regarding this as yet.

Q: Why is AstraZeneca's Covid-19 vaccine allowed in Pakistan?

A: The decision is based on available data, compiled and vetted by experts. The guiding principle to halt the pandemic is to weigh risk (adverse effects) versus benefit (preventing death and disability). Astrazeneca vaccine is authorised in the EU and many countries of the world to prevent Covid-19. The benefits of this vaccine far outweigh its risks in adults of all age groups. It is effective at preventing hospitalisations, intensive care unit (ICU) admissions and deaths due to Covid-19.

The benefits of vaccination increase with increasing age and when infection rates are high. The most common side effects are usually mild and get better within a few days. The most serious side effects are very rare cases of unusual blood clots with low blood platelets, which are estimated to occur in 1 in 100,000 to 250,000 vaccinated people.

In view of limited vaccine supplies worldwide, Pakistan is offering Astrazeneca vaccine to all adults over 40 years of age. This decision is based on WHO's recommendation of considering local epidemiology (including incidence and mortality from Covid-19 disease), age groups targeted for vaccination, data on vaccine adverse effects and the availability of alternative vaccines.

Guidelines for use of this vaccine will continue to be updated as new information becomes available. Overall, the currently available Covid-19 vaccines in Pakistan are very safe and effective at preventing infection. It is imperative that all adult citizens get their first available shot as soon as possible given the ongoing third wave of the virus in Pakistan and the real risk of spread of infection from neighbouring countries.

Q: How do I register for the vaccine?

A: Citizens between 30-39 years of age can register by texting their CNIC number to 1166 or by visiting the National Immunisation Management System (NIMS) website. The vaccination centre, PIN code and date will be communicated via SMS.

The procedure is the same for citizens above 40 years of age. Once you visit the NIMS website or send your CNIC number, a four-digit PIN code will be messaged to you within 24 hours. Once you receive the code, you can visit your nearest vaccination centre.

For registered healthcare workers, the centre and date will be communicated via SMS. They should visit covid.gov.pk/vaccine to register.

Q: How much do I need to pay for vaccine?

A: The government of Pakistan is providing the CanSino, Sinopharm, SinoVac and AstraZeneca vaccines free of cost.

The Sputnik vaccine is being administered by the private sector, the price of which can be check with hospitals offering the facility.

Q: What is the fee for the Covid-19 vaccination certificate? Where can I get the certificate from?

A: The fee for the vaccination certificate is Rs100. You can obtain the certificate by visiting the NIMS website or the nearest National Database and Registration Authority centre.

Q: Should I change my vaccination centre?

A: If you are opting for the free Covid-19 vaccination facility being offered by the government, it is best to visit the centre that you have been assigned.

If you opt to change it, you are likely to get bumped down the list and may have to wait a few days before another appointment can be scheduled.

All government vaccination centres have done a remarkable job at handling the vaccination process. Citizens have also shared their pleasant experiences on social media.

Q: Anything specific I should keep in mind when I go to the vaccination centre?

A: Here is a list of things you should keep in mind:

• Make sure you are registered by sending an SMS to 1166 or via the NIMS website.
• Do not forget your four-digit confirmation code message. Do save the message on your phone and write it down on a piece of paper.
• Do take your original CNIC to the vaccination centre.
• Do not bring children, especially infants, to the vaccination centre. If you can't leave your children at home, please make sure you have a family member or a friend who can watch over them outside the vaccination centre.
• Make sure to wear a loose shirt, or one with short sleeves, as the jab will be administered in your non-dominant arm. Please make sure your clothes are clean and ensure good hygiene.
• Wear a face mask and make sure you carry hand sanitiser and a water bottle.
• Patiently wait for your turn.
• Do greet the staff at the vaccination centre and be polite.
• When it is your turn, expose the injection site (non-dominant upper arm). Please do not expect the staff to assist you in lifting your shirt/sleeve. They have to keep their hands clean and avoid contamination. Wear appropriate clothing. Best to wear a loose sleeved shirt or a T-shirt.
• You will be asked to wait at the centre as you might experience some side effects. Please cooperate with the staff as they monitor you for adverse effects.
• Do thank the vaccinator on your way out. A little appreciation goes a long way, especially during the pandemic.
• A day after the vaccination, you will receive an auto-generated message to inquire about any side effects 24 to 48 hours post-vaccination. You can reply up to seven days later, in which case you will be directed to a health facility.
• The NIMS online portal will be open to citizens for registering complains, adverse effects post-vaccine.
• If you have been administered the first shot of a two-dose vaccine, you will receive a message for the second as per availability of inventory 24-48 hours before the due date.

The vaccines — a snapshot

Following is brief information about the five vaccines approved by the Ministry of Health in Pakistan:

Sinopharm:

The Sinopharm vaccine has been developed by the Beijing Institute of Biological Products (BBIBP), a subsidiary of China National Biotec Group (CNBG). The BBIBP-CorV vaccine — popularly known as Sinopharm — is a chemically-inactivated whole virus vaccine for Covid-19. Sinopharm announced that the vaccine has an efficacy of 79.34 per cent.

Phase III trials with over 60,000 participants were carried out in Argentina, Bahrain, Egypt, Morocco, Pakistan, Peru, and the United Arab Emirates (UAE) in late December 2020. BBIBP-CorV shares similar technology with CoronaVac (Sinovac) and BBV152 (developed by Bharat Biotech) and uses inactivated virus vaccines for Covid-19.

On May 7, 2021, WHO listed the Sinopharm Covid-19 vaccine for emergency use, giving the green light for this vaccine to be rolled out globally. “The addition of this vaccine has the potential to rapidly accelerate Covid-19 vaccine access for countries seeking to protect health workers and populations at risk,” said Dr Mariângela Simão, WHO Assistant-Director General for Access to Health Products. “We urge the manufacturer to participate in the Covax facility and contribute to the goal of more equitable vaccine distribution.” In the case of the Sinopharm vaccine, the WHO assessment included on-site inspections of the production facility, a report on the WHO website said.

Sinovac:

Developed by the Chinese company Sinovac Biotech, CoronaVac, popularly known as Sinovac in Pakistan, is an inactivated virus Covid-19 vaccine. Phase III clinical trials have been conducted in Brazil, Chile, Indonesia, the Philippines, and Turkey. It relies on traditional technology similar to Sinopharm, BBV152, and other inactivated-virus Covid-19 vaccines.

Data from a real-world study in Chile showed that the Sinovac vaccine was 67pc effective in preventing symptomatic infection. "The CoronaVac vaccine was 85pc effective in preventing hospitalisations and 80pc effective in preventing deaths," the Chilean government said, according to a media report.

“The Covid-19 vaccine produced by China’s Sinovac Biotech is efficacious in preventing Covid-19 in adults under 60 but some quality data on the risk of serious adverse effects is lacking, World Health Organisation experts have found. The independent experts on the WHO’s Strategic Advisory Group of Experts (SAGE) reviewed Sinovac’s CoronaVac jab from Phase III clinical trials in China, Brazil, Indonesia, Turkey and Chile,” a Reuters report, published on May 6, 2021, said.

Sputnik V:

Developed by Russia’s Gamaleya Research Institute of Epidemiology and Microbiology, Sputnik V is an adenovirus viral vector vaccine for Covid-19. The vaccine uses a modified viral vector to deliver genetic material coding for a desired antigen into the recipient's host cells. Published in The Lancet, an interim report from the trial indicated 91.6pc efficacy without unusual side effects. In December 2020, countries including Russia, Argentina, Belarus, Hungary, Serbia and the UAE allowed emergency use of the vaccine.

According to the manufacturer, Sputnik V is one of the three vaccines in the world with efficacy of over 90pc. “The Vaccine’s efficacy is confirmed at 91.6pc based on the analysis of data on 19,866 volunteers, who received both the first and second doses of the Sputnik V vaccine or placebo at the final control point of 78 confirmed Covid-19 cases,” it adds.

WHO technical experts were due to start the next round of their review of Russia's Sputnik V vaccine against Covid-19 jointly with the European Medicines Agency on May 10.

CanSino (AD5-nCOV):

Developed by the Chinese military and Tianjin-based CanSino Biologics, AD5-nCOV, trade-named Convidecia, is a single-dose viral vector Covid-19 vaccine. Trials data, shared in February 2021, showed that the vaccine had a 65.7pc efficacy in preventing moderate symptoms of Covid-19, and 91pc efficacy in preventing severe disease.

Phase III trials have been conducted in Argentina, Chile, Mexico, Pakistan, Russia, and Saudi Arabia with 40,000 participants since late 2020.

AstraZeneca:

The Oxford–AstraZeneca Covid-19 vaccine, brand names Vaxzervia and Covishield (codenamed AZD1222), is for people aged 18 years and older. The AstraZeneca vaccine has a modified adenovirus containing the gene for making a protein from SARS-CoV-2. The vaccine, which does not contain the virus itself, cannot cause Covid-19.

AstraZeneca Covid-19 vaccine showed effectiveness of about 62pc in preventing symptomatic Covid-19 disease beginning two weeks after the second dose.

The vaccine has been associated with an increased risk of blood clots in combination with low levels of blood platelets. According to the European Medicines Agency, as of April 4, 2021, 222 cases of blood clots have been reported from the European Economic Area and the UK, where around 34 million people have received the vaccine.

However, the Ministry of National Health Services in its guideline has said that the vaccine must not be used for adults below 40 years of age (pending safety data), people with a history of severe allergic reaction to any component (e.g polysorbate) of the vaccine formulation, those having active GI bleeding disorder or seizures as well as those with history of heparin-induced thrombocytopenia and thrombosis (HITT or HIT type 2) amongst other conditions.

Guidelines for vaccines

AstraZeneca

Who should receive AstraZeneca

• All adults over the age of 40 years
• Eligible adults with diabetes, hypertension, heart disease and other stable chronic disorders
• Those with mild Covid-19 can receive the vaccine once the isolation period is complete
• Those with severe Covid-19 can receive the vaccine once they become stable
• Those chronically immunosuppressed may receive the vaccine, though efficacy may be lower

Who should NOT receive AstraZeneca

• Adults below 40 years of age (pending safety data)
• People with a history of severe allergic reaction to any component (e.g polysorbate) of thevaccine formulation
• The vaccine is not recommended for people younger than 18 years of age pending the resultsof further studies
• People who developed clotting disorder with the first dose of AstraZeneca vaccine
• Individuals running a fever at the time of coming for vaccination (can be rescheduled after theillness is settled)
• Individuals on short-term immunosuppressive medication should wait for 28 days after themedication ends
• Those with active GI bleeding disorder or seizures
• Those with a history of heparin-induced thrombocytopenia and thrombosis (HITT or HIT type 2)
• Those with a history of major blood clot occurring at the same time as having low levels ofplatelets after receiving any Covid-19 vaccine

Sinovac Vaccine (CoronaVac)

Who should receive CoronaVac

• Individuals who are above 18 years of age
• Vaccination is recommended for persons with comorbidities that have been identified as increasing the risk of severe Covid-19, including obesity, cardiovascular disease, respiratory disease and diabetes
• Pregnant women and those who are breastfeeding

Who should NOT receive CoronaVac

• Individuals who are below 18 years of age. The safety and efficacy of CoronaVac in children and adolescents below 18 have yet to be established
• People with history of allergic reaction to CoronaVac or other inactivated vaccine, or any component of CoronaVac (active or inactive ingredients, or any material used in the process)
• Previous severe allergic reactions to the vaccine (e.g. acute anaphylaxis, angioedema, dyspnea, etc.)
• People with severe neurological conditions (e.g. transverse myelitis, Guillain-Barré syndrome, demyelinating diseases, etc.)

Adverse Events Following Immunisation (AEFI)

According to the grading standard of adverse reaction incidence from the Council for International Organisations of Medical Sciences (CIOMS), i.e. very common (10%), common (1%-10%), uncommon (0.1%-1%), rare (0.01%-0.11%) and very rare (<0.01%). All adverse reactions are summarised and described as follows:

Local adverse reaction at injection site

• Very common: pain
• Common: swelling, pruritus, erythema, induration
• Uncommon: burn at injection site

Systemic adverse reactions

• Very common: headache, fatigue
• Common: myalgia, nausea, diarrhea, arthralgia, cough, chills, pruritus, loss of appetite, rhinorrhea, sore throat, nasal congestion, abdominal pain
• Uncommon: vomiting, hypersensitivity, fever, tremor, flushing, edema, dizziness, drowsiness
• Rare: muscle spasms, eyelid edema, nose bleeds/epistaxis, abdominal distension, constipation, hyposmia, hot flashes, hiccup, conjunctival congestion

Severity of adverse reactions

• The severity of adverse reactions observed in these clinical trials is mainly Grade 1 (mild); the incidence rate of adverse reactions for Grade 3 and above was 1.31pc
• Grade 3 and above adverse reactions include pain at injection site, cough, fever, headache, sore throat, abdominal pain, dizziness and drowsiness.

Serious adverse event (SAE)

• No serious adverse event related to vaccination was identified

Sinopharm

Who should receive the vaccine

• Individuals who are 18 years of age and above
• Vaccination is recommended for persons with comorbidities that have been identified as increasing the risk of severe Covid-19, including obesity, cardiovascular disease, respiratory disease and diabetes
• Pregnant women and those who are breastfeeding

Who should NOT receive Sinopharm vaccine

• Individuals running a fever at the time of coming for vaccination (can be rescheduled after the illness is settled)
• Patients with active Covid-19
• Those with mild Covid-19 can receive the vaccine once the isolation period is complete
• Those with severe Covid-19 can receive the vaccine once they become stable
• Individuals on short-term immunosuppressive medication should wait for 28 days after the medication ends
• Those chronically immunosuppressed may receive the vaccine, though efficacy may be lower
• Those post-transplantation may receive the vaccine three months after transplantation
• Those post-chemotherapy may receive the vaccine 28 days after chemotherapy

CanSino Bio

Who should receive the vaccine

• Individuals who are above 18 years of age
• Vaccination is recommended for persons with comorbidities that have been identified as increasing the risk of severe Covid-19, including obesity, cardiovascular disease, respiratory disease and diabetes
• Pregnant women and those who are breastfeeding

Who should NOT receive the CanSino vaccine

• Individuals running a fever at the time of coming for vaccination (can be rescheduled after the illness is settled)
• Patients with active Covid-19
• Those with mild Covid-19 can receive the vaccine once the isolation period is complete
• Those with severe Covid-19 can receive the vaccine once they become stable
• Individuals on short-term immunosuppressive medication should wait for 28 days after the medication ends
• Those chronically immunosuppressed may receive the vaccine, though efficacy may be lower
• Those post-transplantation may receive the vaccine three months after transplantation
• Those post-chemotherapy may receive the vaccine 28 days after chemotherapy

Sputnik V

Who should receive the vaccine

• Individuals who are 18 years of age and over
• Vaccination is recommended for persons with comorbidities that have been identified as increasing the risk of severe Covid-19, including obesity, cardiovascular disease, respiratory disease and diabetes
• Pregnant women may receive the vaccine after consultation with their doctor. Women who are breastfeeding may take the vaccine

Who should NOT receive the Sputnik vaccine

• Individuals running a fever at the time of coming for vaccination (can be rescheduled after the illness is settled)
• Patients with active Covid-19
• Those with mild Covid-19 can receive the vaccine once the isolation period is complete
• Those with severe Covid-19 can receive the vaccine once they become stable
• Individuals who had severe post-vaccination complication with component I should not receive component II

Concurrent Illness

• As with other vaccines, administration of Sputnik V should be postponed in individuals suffering from an acute severe febrile illness. However, the presence of a minor infection, such as cold and/or low-grade fever should not delay vaccination.

Thrombocytopenia and coagulation disorders

• Sputnik V should be given with caution to individuals with thrombocytopenia, any coagulation disorder or to persons on anticoagulation therapy, because bleeding or bruising may occur following an intramuscular administration in these individuals.

Immuno-compromised individuals

• It is not known whether individuals with impaired immune responsiveness, including individuals receiving immunosuppressant therapy, will elicit the same response as immune-competent individuals to the vaccine regimen. Immuno-compromised individuals may have a relatively weaker immune response to the vaccine regimen.
• Individuals on short-term immune-suppressive medication should wait for 28 days after the medication ends
• Those chronically immune-suppressed may receive the vaccine, though efficacy may be uncertain
• Those post-transplantation may receive the vaccine three months after transplantation
• Those post-chemotherapy may receive the vaccine 28 days after chemotherapy

Duration and level of protection

• The duration of protection has not yet been established
• As with any vaccine, Sputnik V may not protect all vaccine recipients

The above recommendations are being regularly reviewed by the Ministry of National Health Services, Regulations & Coordination and will be updated based on international and national recommendations and best practices.