Opinion: Easing lockdown poses threat to those living with compromised immunity

Thailand is among the very few countries in the world that have not been looking at immunosuppressive patients, a group of patients who are among the most vulnerable among the population to Covid-19, for booster shots.

Immunosuppressive patients are patients who are taking immune suppressing medication, and these could be due to various factors ranging from transplant of an organ to leukemia and other autoimmune diseases. (read more here)

These patients, who have low immunity due to their daily intake of immune suppressing medications have weakened immunity and are prone to most common bacterial and viral infections, let alone SAR-COV2. 

Thus, the population is at risk of developing severe or life-threatening conditions if they contract COVID-19.

The number of patients in Thailand that have organ transplants in the last ten years number at 7,865 patients, according to official statistics. Out of these 7,042 patients are patients who have had their kidney transplant while 221 have had their heart transplant. The number of people who have have liver transplants number at 602 patients as of end of 2020, although liver transplant data has only been collected for the past 5-years. 

The Organ Transplant Association of Thailand has only been collecting data since 2008.

Research has suggested that many patients on immunosuppressive therapy may not confer a high level of protective antibodies after receiving a full-dose of COVID-19 vaccination.

The UK is undertaking a study called the OCTAVE Trial. This study is still ongoing to evaluate the immune responses following COVID-19 vaccination in these patients.

In some countries, this group are among the first group to receive booster shots with first generation vaccines.

The US National Institute of Allergy and Infectious Diseases (NIAID) is undertaking a pilot study called the COVID Protection After Transplant (CPAT) Trial. This study is aimed at evaluating the antibody responses to a third dose of an authorized COVID-19 mRNA vaccine in kidney transplant recipients who did not respond to two doses vaccine regimens of the Moderna or Pfizer-BioNTech COVID-19 vaccine.  The outcome of the study will shed light on the benefit of additional vaccine doses for kidney transplant and potentially other impaired immune patients.

Despite awaiting results, the FDA in United States and other countries have all recommended the 3rd dose to these patients due to their vulnerability and their lack of immune.

The UK Joint Committee on Vaccination and Immunization also viewed that the COVID-19 booster vaccine could improve protection for these vulnerable patients.

Patients in Thailand can Wait

In Thailand, due to the shortages of vaccines, those with compromised immunities have to wait for their third dose.

The priority is for the country to administer the second dose of the vaccine and fully vaccinate the population rather than focus on the 8,000 or so people who may need a life-saving third dose.

The CCSA did not respond to queries about how many people there were taking immunosuppressive drugs or with compromised immune systems. Spokesman Taweesin Visanuyothin said that the government was working on administering and providing third doses for all Thais that needed including those with compromised immunity as well as those who were given two doses of Sinovac vaccine.

The CCSA did not specify, however, how patients who have received two doses could tackle the lengthy administration needed to apply for a third dose.

Taweesin said that ‘the government places heavy emphasis on taking care of Thais with compromised immune systems’ but more transparency and clearer administration must take place.

A medical worker wearing PPE (personal protective equipment) takes a swab sample from a woman during a mass testing event at a sport complex in Bangkok on April 17, 2021, after the recent outbreak of Covid-19 coronavirus cases in Thailand. (Photo by Mladen ANTONOV / AFP)

Avoidable administration.

What is clear is that had Thailand’s vaccine roll-out not excluded them from the high risk, priority group for the first phase vaccination, their ordeal would not be so perilous.

The current booster plan or the 3rd dose of using the AstraZeneca and the Pfizer-BioNTech vaccine apparently is granted for medical professionals and wider population who get two Sinovac shots – a tack for the Centre for Covid-19 Situation Administration (CCSA) to get away with vaccine mismanagement muddle, rather than justifying based on medical risks. 

We would argue that the booster programme for immunosuppressed patients is equally urgent.

This situation is worrying amid easing COVID-19 restrictions. The CCSA’s decision last week to gradually reopen the country starting in October 1 could jeopardize these immunosuppressive patients.

While these easing restrictions are the light at the end of the tunnel for many Thais, for the 8,000 or so people with compromised immunity, the darkness is still pervasive.

Dr Ukrit Angkawinitwong is a healthcare professional based in London, United Kingdom (UK). He is a former medical researcher in drug development at University College London, UK.


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