With input from Dr Monica Vasudev

1255:  HCFI Round Table Expert Zoom Meeting on “Time to unite to combat vaccine hesitancy”

19^th December, 2020, 11am-12pm

Participants- Dr KK Aggarwal, Dr JA Jayalal, Dr Jayakrishnan Alapet, Dr Suneela Garg, Dr DR Rai, Dr Anita Chakravarti, Dr Ashok Gupta, Dr Alex Thomas, Ms Upasana Arora, Dr Anil Kumar, Ms Ira Gupta, Dr S Sharma

Consensus Statement of HCFI Expert Round Table

• There has been a sudden spurt in cases in South-east England and South Africa. Two different variants of the new coronavirus have been identified in these countries; N501Y variant in England and 501.V2 in South Africa.
• The variant in England has been given the unique name of SARS-CoV-2 VUI 202012/01 (Variant Under Investigation, year 2020, month 12, variant 01).
• These variants are highly contagious and cause more infections but less mortality. There is a concern that these variants could cause re-infection.
• The CDC has published information about what clinicians need to know about the Pfizer-BioNTech COVID-19 vaccine (as below):

o   Pfizer-BioNTech COVID-19 vaccine is a lipid nanoparticle-formulated mRNA vaccine encoding the spike protein.

o   mRNA technology is new but not unknown; mRNA vaccines do not contain a live virus and the mRNA does not enter the nucleus of the cell; hence, there are no genetic changes.

o   ACIP has recommended that healthcare personnel and residents of long-term care facilities be offered vaccination in the initial phase of the COVID-19 vaccination program.

o   2 doses are given intramuscularly 3 weeks apart. It is necessary to take both the doses. There is a 4-day grace period for the 2nd dose. If >21 days since 1st dose, 2nd dose should be administered at earliest opportunity (but no doses need to be repeated).

o   This vaccine is not interchangeable with other COVID-19 vaccines.

o   There should be a gap of at least 14 days before or after administration with any other vaccine.

o   Persons with past infection (symptomatic or asymptomatic) should be given the vaccine.

o   Persons with active infection should defer vaccination until recovery from acute illness (if person had symptoms) and criteria have been met to discontinue isolation. They should wait for 90 days before taking the vaccine.

o   Persons with a known SARS-CoV-2 exposure in the community or outpatient setting should defer vaccination until quarantine period has ended to avoid exposing healthcare personnel (HCP) or other persons during vaccination visit.

o   Persons with underlying medical conditions who have no contraindications to vaccination may take the vaccine.

o   Immunocompromised persons may still receive COVID-19 vaccine unless otherwise contraindicated.

o   If a pregnant/lactating woman is part of a group (e.g., healthcare personnel) who is recommended to receive a COVID-19 vaccine and is pregnant, she may choose to be vaccinated. A discussion with her healthcare provider can help her make an informed decision.

o   Routine testing for pregnancy prior to receipt of a COVID-19 vaccine is not recommended.

o   Vaccine recipients should be counseled about expected local and systemic post-vaccination symptoms prior to vaccination. Unless a person develops a contraindication to vaccination, they should be encouraged to complete the series even if they develop post-vaccination symptoms in order to optimize protection against COVID-19.

o   Protection from vaccine will take 1 to 2 weeks following the second dose to be considered fully vaccinated. Hence, all persons who have taken the vaccine should adhere to protective measures (masking, physical distancing, hand washing, avoiding crowds).

o   Severe allergic reaction (e.g., anaphylaxis) to any component of the vaccine is a contraindication. 

o   Vaccine has to be given in a hospital with all precautions for managing anaphylaxis after informed consent. The patient has to be monitored for 15-30 minutes after the vaccine is administered for occurrence of immediate adverse reactions.

o   Prior receipt of the Pfizer-BioNTech COVID-19 vaccine will not affect the results of SARS-CoV-2 nucleic acid amplification or antigen tests.

• The DCGI should also come out with such similar information and post it to all doctors and also in their website.
• Doctors have a duty to convince the public and empower them to come forward and take the vaccine voluntarily.
• Preparedness is important and will clear up lot of misconceptions about the vaccine. Transparency is important.
• Doctors have to take the lead in taking the vaccine and talk positive about it to the public.
• India is almost on the verge of herd immunity. 20% vaccination is required for herd immunity.
• Inactivated vaccine has been tried in China after phase 2 trials in 10 million people in August. There is three months data, which says that it is safe.
• Inactivated vaccines are the best bridging vaccines in a pandemic situation.

Dr KK Aggarwal

President CMAAO, HCFI and Past National President IMA