‘New puzzle’ due to supply problems vaccine, is key to second prick?

A big setback for the European Union, but also for the Netherlands. Last night it was announced that the Netherlands receives fewer vaccines from the pharmaceutical company AstraZeneca: not the 2.3 million vaccines planned, but 920,000 vaccines. The pharmaceutical has reduced deliveries to the EU by 60% due to production problems. โ€œWhatever you‘re going to arrange this, you have to reinstall the vaccination puzzle,โ€ says Ben van der Zeijst, emeritus professor of vaccines, former director of the Netherlands Vaccine Institute and former head of Vaccines at RIVM.

According to the plan, more than half of the vaccinations would be delivered by AstraZeneca in the first quarter, says Van der Zeijst. โ€œThe idea was that a lot of people would be vaccinated with this vaccine.โ€

The Netherlands expected millions of vaccines from AstraZeneca (via the EU) – so there will be fewer:

The failure of deliveries is likely to lead to postponement for some groups. Especially the vaccinations of the 60-year-olds living at home, people aged between 18 and 60 with medical indications, community care and WMO staff. And later possibly also the rest of the people between 18 and 60 years old.

Postponement second prick?

A possible solution to the delay is to postpone the second vaccination, says Van der Zeijst. This way more people can get the first shot. The postponement of the second prick does not seem to be a problem with the Astrazeneca vaccine, says Van der Zeijst. โ€œIt turns out that the longer you postpone the second prick at AstraZeneca, the better it works. That is probably what the European Medicines Agency (EMA) will say when the vaccine is approved on Friday.โ€

Van der Zeijst explains: by the first prick, antibodies are created that can cause temporary immunity to the second prick. As a result, that prick can become less effective. So a long (re) period between the two pricks is needed.

This was the vaccination strategy before the news about AstraZeneca became known. The blue color is the Astrazeneca vaccine:

According to Van der Zeijst, the effectiveness of the Astrazeneca vaccine is most likely 73 percent. The second shot does not add much effectiveness to this, he says in response to a research report by the British pharmaceutical company MHRA. โ€œAround 10 percent, something like that.โ€ Now the plan is that there are 12 weeks between prick 1 and prick 2. โ€œThat’s how they did it in Britain. But that can easily be 24 weeks, for example.โ€

According to the emeritus professor, the question at all is whether the second prick is necessary for the Astrazeneca vaccine. According to him, research is already being carried out in the United Kingdom. Pharmaceutical Janssen has also been researching a vaccination course with only one shot, he says. If only one vaccination is chosen, another jigsaw puzzle is needed, but a shorter one.

Professor of Immunology Marjolein van Egmond, who has not yet seen the Astrazeneca data, has doubts about Van der Zeijst‘s proposal. According to her, a second prick is usually really necessary to get a good immune response, especially since the protection against the virus becomes better and stronger. โ€œOf course, we don’t have that data for the coronavaccins yet, but it is very likely that you will be protected for longer with two pricks.โ€

Many virologists are also opposed to postponing or abolishing the second prick, says Van Egmond. โ€œVirologists fear that with one shot people are only partially protected and the virus is not properly combated. This could create new variants of the virus that become resistant to the vaccine.โ€

Production process

In any case, a solution is needed to address the delay that is now occurring at AstraZeneca, for which the production process is the reason for. AstraZeneca has chosen to have production facilities all over the world. In one place they tested the production of the vaccine, and now it turns out that the production is different from the factory in Belgium which is to supply the production for the European Union.

โ€œ Not all pharmaceutical factories are the same. Think of it as making wine: the fact that the grape is the same with different winegrowers does not mean that the wine tastes the same. Other processes affect the outcome. For example, the tank in which the vaccine is produced is not the same everywhere, and therefore the yield may be disappointing,โ€ says Van der Zeijst.

That is why the EU is not happy with:

The Ministry of Health, Welfare and Sport (VWS) will discuss the vaccine deliveries in the first quarter with AstraZeneca next week. โ€œWe (the EU, red.) are still talking to them about this.โ€ The Ministry can say that vaccination planning may need to be adjusted due to the delay in the delivery of the vaccine.