Choosing additional COVID shots for Ukrainians treated with Covishield or CoronaVac

A member of a family of Ukrainian refugees get Covid-19 vaccine shots at the Acea Hub in Rome, Italy, 09 March 2022. [EPA-EFE/RICCARDO ANTIMIANI]

To prevent the spread of COVID-19, countries receiving Ukrainian refugees are encouraged to ensure that vaccines are available. Of the six vaccines authorised in Ukraine, two are not authorised by the EU drugs agency, and the World Health Organisation says mix and match technology needs to be used in these cases. 

Since Russia’s invasion of Ukraine on 24 February, 3,6 million refugees have left Ukraine. While the COVID-19 pandemic is still present and cases are rising worldwide, international and European health organisations want to ensure vaccinations are available for those fleeing war. 

“Those that are in particularly vulnerable circumstances, conflict settings, humanitarian emergencies, these are the highest priority groups to be fully vaccinated,” Kate O’Brien, immunisation, vaccines and biologicals director at the WHO, told a press briefing on Wednesday (23 March).

She added that it is important that people have “protection, especially against severe disease, and hospitalisation”.

35% of Ukrainians are fully vaccinated and around 2% have received a booster dose, based on WHO data from 27 February. 

At a press briefing on Wednesday, European Commission Vice-President Margaritis Schinas said that “unfortunately, Ukraine is a low vaccination country and this will be a challenge when it comes to vaccinations.”

He added that the EU has “enough COVID vaccine stocks to cover the needs of all those arriving.”

“We are pursuing efforts to use EU tools like the joint Procurement Agreement to support member states in rolling vaccines out.”

There are six vaccines authorised in Ukraine. Four of them are well known to Europeans, developed by BioNTech and Pfizer, Moderna, AstraZeneca, and Janssen Pharmaceutica NV.

The remaining two vaccines are listed by the WHO as vaccines for emergency use: the Indian Serum Institute’s vaccine Covishield and Beijing-based pharmaceutical company Sinovac’s vaccine CoronaVac, but these are not authorised by the European Medicines Agency (EMA).

The process is clear for those who need a primary vaccination or who got their first jab of a vaccine authorised in the EU but less so for those who were vaccinated with Covishield or CoronaVac and now need a second shot or a booster.

WHO calls to ensure health of both Ukrainian refugees and host population in Moldova

The urgent need to strengthen the national public health system for Ukrainian refugees and Moldovans has been stressed by Hans Kluge, WHO Regional Director for Europe, during a trip to the latter.

WHO says – go for “mix and match”

“The recommendations from WHO are allowing for and recommending, in fact, mix and match schedules as a perfectly acceptable means to assure full vaccination,” said O’Brien.

A WHO spokesperson told EURACTIV that a heterologous approach, where different vaccines are given, might even give more protection against the virus.

Increasing evidence shows that effectiveness and immunogenicity of heterologous schedules were similar to or greater than that of homologous schedules. This indicates that it is both safe and at least as effective to take a different vaccine as the second and/or a booster dose as it is to take all doses of the same product,” the spokesperson said.

“Those who cannot access the same vaccine product should take the product that is licensed and available to them where they are,” the spokesperson concluded.

Asked by EURACTIV which vaccine platforms should be chosen for mixing and matching with Covishield and CoronaVac, O’Brien did not specify them but said that “the availability of products across a number of different platforms allows broad access for people to complete their vaccination schedules if they’ve already started”.

‘Mix and match’ approach to COVID-19 vaccines could help boost effectiveness

‘Mix and match’ or heterologous vaccination strategy split the scientists over the usage of different vaccines against covid. While some argue that this would boost the protection others say that more evidence is needed. 

No ECDC recommendations

On 18 March, the European Centre for Disease Prevention and Control (ECDC) released “guidance for the prevention and control of COVID-19 in temporary reception centres in the context of the large numbers of people fleeing Ukraine”. 

The main focus was put on vaccinating and testing displaced people in the reception centres, “where there is a higher risk of communicable disease outbreaks,” the ECDC said in a press release.

It stressed that “many of the people fleeing Ukraine are expected to not be fully vaccinated against COVID-19” and in case of the “absence of documented evidence of prior vaccination, eligible children and adults from Ukraine should be offered a primary vaccination course against COVID-19 as well as a booster dose”.

But there was nothing about vaccinating people who got their first shot or primary vaccination with Covishield and CoronaVac. 

An ECDC spokesperson told EURACTIV that mixing vaccines was demonstrated to be “safe and elicit satisfactory immunogenicity, most evidence involves vaccine products authorised in the EU and there is very limited evidence from the literature on heterologous vaccinations in individuals primed with Covishield or Coronavac”.

At the moment there is “no information available at ECDC on national policies on heterologous vaccinations after primary vaccination with a COVID-19 vaccine that is not approved in the EU,” the ECDC’s spokesperson said.

EU healthcare systems adjusting to arrival of 2.5m Ukrainian refugees

The EU’s healthcare systems, already stretched from the COVID-19 pandemic, are adjusting to deal with the huge influx of new arrivals from Ukraine – numbered over 2.5 million, as of Friday (11 March).

[Edited by Zoran Radosavljevic]

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