Several epidemiologists have suggested administering a third dose of vaccine for health workers in the midst of the increasing number of deaths of their colleagues due to Covid-19 and the high increase in positive cases in Indonesia.
The administration of this third dose is said to be an incentive to increase or maintain the efficacy of the Sinovac vaccine and also protect health workers from attacks by new virus variants, such as Delta, which is reported to be more contagious.
This was revealed by an epidemiologist from the University of Indonesia Tri Yunis Miko and an Epidemiologist from Griffith University Australia, Dicky Budiman.
Health workers have received the Sinovac vaccine which has an efficacy of 65.3% based on BPOM data which began in January earlier this year.
However, an epidemiologist from Airlangga University, Surabaya, Windhu Purnomo, assessed that research needs to be done first to see the source of the virus that attacks health workers.
If it comes from a new variant, such as Delta, then there will be no point in having a third dose of vaccination.
Spokesperson for the Covid-19 Vaccination of the Ministry of Health, Siti Nadia Tarmizi, said that regarding the discourse of giving the third dose, there has been no scientific publication and recommendation from the World Health Organization WHO and the government is currently conducting a study on when the efficacy of the Sinovac vaccine will decrease.
Based on data compiled by the Mitigation Team of the Indonesian Doctors Association (IDI) it is known that 949 health workers died due to Covid-19.
Of these, there were 20 doctors and 10 nurses who died despite receiving the Sinovac vaccine – based on data from the IDI Mitigation Team and the Indonesian National Nurses Association (PPNI).
The push for a third dose of vaccination, why?
Epidemiologist from the University of Indonesia, Tri Yunis Miko, said that it was necessary to administer a third vaccine, one of which was because of the low efficacy of the Sinovac vaccine.
“The efficacy of Sinovac is small, 65.3% compared to other vaccines, which are above 70%. The efficacy will continue to decline and weaken over time, especially since it is now six months. [sejak pemberian vaksin pertama bagi nakes pada Januari],” Yunis said when contacted, Monday (28/06).
For that, Yunis added, health workers need to get immunizations again, namely giving the third dose.
Thus, encouraging antibodies in their bodies to remain strong or even increase.
“No problem [bagi kesehatan jika divaksin ketiga]In fact, the antibodies will increase and protect health workers more,” Yunis said.
Likewise, a third dose is needed, according to Griffith University Australia epidemiologist Dicky Budiman, due to the emergence of variants of the corona virus, namely Delta and even Delta Plus, which are more contagious and dangerous.
“Giving a third vaccine, booster This is very important for health workers, if possible the elderly are also comorbid because of this new variant problem, to increase protection,” said Dicky.
Dicky said this proposal arose, also because there were no adequate data on the effectiveness of existing vaccines against new variants.
“Booster this is indispensable for amplifying antibody responses to new variants, particularly Delta and possibly Delta plus. In addition to increasing immunity, it also increases its efficacy from the threat of new variants,” said Dicky.
Epidemiologist from Airlangga University, Windhu Purnomo, supports the administration of the third dose of vaccine, but there are two things that need attention.
“First, the problem of limited vaccine stock, because the target is to create herd immunity, so is it effective to vaccinate those who have been able to or give it to those who have not been vaccinated?” said Windhu.
Second, whether the Sinovac vaccine is effective in warding off new variants, it is necessary to do research first.
“For example in Bangkalan, Madura, there were five health workers who died, they already received two doses of vaccine. I suspect this is because of the new variant, an example might be the Delta variant from India which has high infectiousness and the ability to avoid antibodies,” said Windhu.
“Well, if the third, fourth dose is vaccinated, it’s useless if the variant is different from this vaccine vaksin [Sinovac] the Wuhan variant. So it needs to be researched first with the sequencing of the entire genome (whole genome sequencing), what variant exactly, “added Windhu.
Three chances of dying after getting vaccinated
A lung specialist from the Friendship Hospital, Jakarta, Faisal Yunus, said there were three possibilities why health workers who had received the vaccine still died from Covid-19.
The first possibility is that the health worker was exposed to the virus before or during the vaccination process so that the vaccine has not yet formed antibodies.
“The first vaccine doesn’t have antibody resistance yet. It’s just conditioning or preparing antibodies. The second vaccine just started producing antibodies and the maximum results were after one month,” said Faisal.
Second, is the effect of new variants where vaccines are made against old variants so there is a possibility that the vaccine will not work properly.
The third factor is because the vaccine used is not effective against the corona virus, especially the new variant.
There is no WHO recommendation yet
When confirmed, Spokesperson for the Covid-19 Vaccination of the Ministry of Health, Siti Nadia Tarmizi, said that there was no scientific publication and recommendation from the World Health Organization (WHO).
“And, currently the research team from Unpad [Universitas Padjajaran] who are conducting a phase three clinical trial are monitoring antibody titers after the injection of two doses of Sinovac vaccine. Later this will certainly provide input for us whether it needs to be added again booster the third injection or it needs to be repeated from the beginning,” said Nadia.
Nadia added, related to the increasing transmission of Covid to health workers, it was caused by several factors.
Among them, the significant increase in Covid cases has made health workers work hard and cause fatigue so that they are vulnerable to infection.
“The fatigue factor, this large exposure factor is a transmission factor, but 90% of those infected have no symptoms and mild symptoms. Very few have severe symptoms and are generally caused by comorbidities,” said Nadia.
“We have seen many health workers who are infected, but with the vaccine, it provides protection so that the severe impact or death can be minimized,” he said.
The effectiveness of Sinovac was questioned after more than 300 health workers in Kudus, Central Java were infected with the corona virus.
Of these, data as of June 12, 2021, 277 health workers are in self-isolation treatment, and 193 others have been declared cured.
‘My antibodies are not increasing’
A lung specialist in Jakarta, who did not want to be named, said that the Sinovac vaccine he received last month had no effect on increasing antibodies in his body.
“I was vaccinated with Sinovac twice last month. My antibody was reactive with a result of 1.61 u/ml. It had no effect. This vaccine did not form antibodies in my body,” he told BBC News Indonesia.
He said the reactive results might be due to two things, one because it was formed by antibodies when he was exposed to Covid some time ago or the small effect of the vaccine.
“But it’s as if the antibody doesn’t exist because it’s very small. My friend’s results were 200 and mine was only 1.61,” he said.
He got these results after conducting a quantitative anti-SARS-CoV-2 immunoserological test in the laboratory some time ago. According to him, the concentration limit value for convalescent plasma is 132u/ml.
Until now, he still continues to practice and work serving Covid-19 patients and other lung diseases.
The number of health workers who died
Based on data from the IDI Mitigation Team — reports from medical professional organizations — there were 949 health workers who died from Covid-19 during the pandemic.
The details, from March 2020 to June 26, 2021, are 401 general practitioners and specialists, 43 dentists, 315 nurses, 150 midwives, 15 pharmacists, and 25 medical laboratory personnel.
Then, there are almost a thousand health workers who are undergoing self-isolation to intensive care.
For doctors themselves, after the vaccination program was carried out, there were 88 doctors who died.
In detail, 20 doctors have received the vaccine (10 people from February 2021-May 2021, and 10 people in June 2021), 35 doctors have not been vaccinated, and 33 doctors are still in confirmation.
Meanwhile, according to PPNI data, there were 28 nurses who died from Covid after the Idul Fitri holiday in May this year until June 26 last. Of these, 10 nurses had received the vaccine, 17 had not been vaccinated due to comorbidities, and one was still under confirmation.
The General Chairperson of the PPNI DPP, Harif Fadhillah, said the factors that caused many nurses to die from COVID-19 infection were because they worked in places that had a high risk of exposure, the disease itself, and comorbidities.
Meanwhile, regarding the proposal for a third dose of vaccine for health workers, Harif has not heard of it.
“But if the recommendations are from experts and experts, we strongly encourage it to be carried out. The bottom line is whatever it is that is important can provide a high level of safety for the officers,” said Harif.
Based on data up to (Monday 28/06), there were additional cases of more than 20 thousand so that up to now there have been more than 2.1 million positive confirmations in Indonesia with over 1.85 million recovered.
Meanwhile, the number of deaths increased by 423 to a total of 57,561 people.
What is the Sinovac vaccine?
The Sinovac vaccine, also known as CoronaVac, is a Covid-19 virus that has been inactivated which aims to trigger the immune system and produce antibodies against the corona virus so that infection does not occur.
This vaccine has received an emergency use permit from the Indonesian Food and Drug Supervisory Agency (BPOM).
This vaccine was developed by Sinovac Biotech Ltd, from China and has passed the third phase of clinical trials conducted in Brazil, Turkey and Indonesia with a protective effect or efficacy of 65.3%.