Should you mix Covid-19 vaccines?

Vaccination against Covid-19 has received mixed reactions with some Ugandans aged 18 and above embracing the campaign, while some are uncertain. However, the most prevailing issue even among those pro-vaccination is whether it is possible to mix vaccines. Currently, some types are out of stock yet it is recommended that one takes two doses. 

Ruth Namuli, a teacher at St Joseph Primary School, Nantabulilirwa in Mukono District, falls in the latter bracket having received Sinovac in August for her first dose and was to return in September for the second dose but found it was out of stock. Namuli wonders if she should restart the whole process or take another vaccine type for the second jab.

Fortunately, Ministry of Health’s Emmanuel Ainebyoona says the ministry has received about 700,000 doses of Sinovac vaccine which were undergoing standard procedures at National Medical Stores and would be distributed to districts starting November 8.
Godwin Ahabwe, a resident of Mukono District also faced the same dilemma when he returned for his second dose of Pfizer but found out it was unavailable. 
“I had my card indicating the vaccine I was to receive. After standing in line and crowding at the health facility, I was told that the vaccine had been used up and I would have to return another day,” he says.

Standard
Regarding mixing vaccines, the Ministry of Health has discouraged this practice and a recent tweet reads: “When you start on one Covid-19 vaccine type for the first dose, you must stick to that type even for the second dose.” 
Additionally, Ainebyoona assures Ugandans that delay to receive a follow-up dose does not weaken the effectiveness of the first dose. “I encourage all persons who received their first dose of Sinovac to check at the district vaccination centres and continue with their second dose of the same.”

Globally, the World Health Organisation has not come up with scientifically proven reports to encourage mixing vaccines, and Soumya Swaminathan, their chief scientist says: “Individuals should not decide for themselves. Public health agencies can, based on data which is awaited regarding the immunogenicity and safety of the mix and match.”
However, some countries have already gone down that road. According to Aljazera.com, this practice was quietly authorised by Public Health England when vaccine supplies were limited. Other countries include Canada, Italy, Thailand, and South Korea.
 
Efficacy
The University of Oxford’s Com-Cov trial, involving more than 800 volunteers, investigated the efficacy of either two doses of AstraZeneca, Pfizer, or one of them followed by the other. Results revealed that mixed schedules involving the Pfizer vaccine and AstraZeneca shot generated a strong immune response against the virus. Nonetheless, it is important to note that the order of the vaccines matters, with AstraZeneca followed by Pfizer inducing higher antibodies and T-cell responses than Pfizer followed by AstraZeneca.
That said, data from the same study also showed that 30 to 40 per cent of those who received mixed doses reported fevers after a second dose, compared with 10 to 20 per cent of those who did not mix the vaccines.
 
Dr Betty Tewo, a community health worker and influencer at a vaccination centre in Kisugu, Namuwongo, advises individuals going for the second jab to ensure they know the vaccine to be administered and search around different vaccination points for their intended second dose and its availability. She adds that there are about eight vaccines in the country and it is the duty of health leaders within the community to sensitise people prior to vaccination as well as tell them the vaccine to be administered. 
In regards to whether vaccines are free or come at a fee, in a tweet, Ainebyoona says: “Do not pay for a Covid-19 vaccines anywhere. It is free of charge at all designated vaccination centres.”

The process
One of the requirements of receiving a vaccine is possession of a National Identity card which is followed by signing a consent form. “Consenting to the exercise is crucial and we usually issue out consent forms as people register and in case one needs additional help, health workers or Red Cross volunteers at the vaccination centres will give guidance. However, for one that is unable to read, you can seek help from the Village Health Teams (VHTs), Dr Tewo explains. 

For a smooth vaccination procedure, she urges individuals getting a second dose to carry the cards received from the first visit as that saves the vaccinator’s time and mitigates challenges that may rise from mixing vaccines. 
“The health card holds a serial number which is registered with the MoH, with details that prove one is fully vaccinated together with the vaccine type and vaccine batch number,” she adds.

The Myths
Brian Mugabe 22, a student at Makerere University was very reluctant to receive his first jab because he was told that it would quicken his death.
“I never believed in Covid vaccination mostly because it seemed like trial and error. Not much research had been done on the effectiveness of the drugs,” he shares. 
Dr Tewo disregards a number of myths related to the vaccine and says the vaccine helps one reduce the risk of being hospitalised or getting severely ill. 

Mugabe later gave in to his mother’s pleas to get vaccinated and after the first dose, his complaint was pain on his upper left arm. “I got my first dose of Pfizer and went home with a painful arm and reddening on the vaccinated area.” 

Dr Tewo advises individuals to avoid exerting pressure on the vaccination site and softly massaging the area with a bottle; the traditional way. 
Mugabe also registered general body weakness and headaches together with dizziness which Dr Tewo says can be mitigated by taking panadol. “This is the only painkiller one should use. Additionally, ensure you drink lots of fluids to avoid severe headaches,” she adds.

Vulnerable groups
Information on whether one is pregnant or breastfeeding, or has recently received Hepatitis B vaccine is some of the input gathered from the consent form and Dr Adrian Mwota, a general practitioner says such persons much be checked and examined by their attending physicians to ensure they are fit to receive the jab. “The practice is aimed at ensuring any occurring adverse effects owing to the vaccine such as clots are avoided. It also helps to control any side effects should any arise after receiving the vaccine,” he says.

Gilbert Wanyama a patient suffering with diabetes says he takes his injection daily to regulate his sugar levels, and has suffered no side effects after the two AstraZeneca doses save pains around the arm.