On December 25, Prime Minister Narendra Modi announced that healthcare, frontline workers and those who are above 60 years and have comorbidities will be eligible for a ‘precaution dose’ from January 21. The use of ‘precaution’ doses had arisen as the question is to why Centre had not termed it ‘booster’ doses as is the global norm.
What are India’s ‘precautionary doses’?
- As per Ministry of Health and Family Welfare (MoHFW)'s guidelines, beneficiaries above 18 years who have received two doses, are eligible to receive another dose of COVID-19 vaccine.
- The prioritisation and sequencing of this precaution dose would be based on the completion of 9 months, or 39 weeks, from the date of administration of the second dose.
- Co-WIN system will send SMS to such beneficiaries for availing the precaution dose when the dose becomes due.
- The details of administration of the precaution dose will be suitably reflected in the vaccination certificates.
- Private vaccination centres can charge up to a maximum of Rs 150 as service charge for vaccination, over and above the cost of the vaccine.
- Precaution dose will be of same vaccine which has been used for administration of first and second dose.
ICMR on ‘booster doses’
Technically, the ‘precaution dose’ is effectively a ‘booster dose’, differing only in nomenclature. As late as December 12, 2021, the Indian Council of Medical Research (ICMR) maintained that the “need for a booster or additional COVID-19 vaccine dose” was being examined.
Dr. Samiran Panda of ICMR added that there was no immediate recommendation to introduce booster or additional dose. He said from a public health point of view also more coverage is what India is looking at.
Twenty-three days later, PM Narendra Modi announced the launch of 'precautionary' doses for frontline workers and eligible population over 60 years.
How is it different from a ‘booster’ dose?
The main difference between 'precautionary' and 'booster' doses is that mixing of vaccines is not allowed in India's 'precaution' doses.
After Mr. Modi's announcement of 'precaution' doses, Dr V.K. Paul, Member-Health, NITI Aayog said that the 'precaution dose' of COVID-19 vaccine will be of the same vaccine which was administered previously. That is, beneficiaries who have gotten two Covishield doses, will be given a 'precaution dose' of Covishield only.
However, an ICMR study titled ‘Serendipitous COVID-19 Vaccine-Mix in Uttar Pradesh’ found that mixing of Covishield and Covaxin was safe and showed better results. The study was based on a group of Covishield recipients in Uttar Pradesh who had inadvertently received Covaxin as their second dose.
On a comparative study of this group to two groups of 40 people who had received two doses of Covishield and Covaxin respectively, ICMR found that those who received a mix of vaccines (an adenovirus vector platform-based vaccine followed by an inactivated whole virus vaccine) elicited better immunogenicity than two doses of using the same vaccines.
‘Booster’ doses across the world
In US, which is currently administering booster doses, the government allows its eligible population above 18 years to get either Pfizer-BioNTech or Moderna vaccine as booster doses, five months after getting the primary doses.
For those who got two doses of Johnson & Johnson’s Janssen vaccine, the Centre for Disease Control (CDC) recommends getting either Pfizer-BioNTech or Moderna as a booster. Similarly in UK, either Pfizer-BioNTech or Moderna are offered as booster inspite of Oxford-AstraZeneca vaccine (i.e Covishield) being the main vaccine to be administered.
WHO on ‘booster doses’
In September, The World Health Organisation (WHO) had called for a moratorium on booster vaccination for healthy adults until the end of 2021 to counter the persisting and profound inequity in global vaccine access.
The WHO prioritises Global COVID-19 Vaccination by mid-2022 and has stated “Vaccine effectiveness data for a booster dose are being published from an increasing number of countries, but remain limited in follow-up time. All studies demonstrate an improvement in protection against infection; milder disease; as well as severe disease and death”.
