The Secretary of Health (SOH) approved the HTAC recommendation on April 21 to finance a fourth dose of COVID-19 Vaccines AstraZeneca, CoronaVac, Moderna, Pfizer-BioNTech, and Sinopharm among the immunocompromised population (ICPs) ages 18 years old and above given at least 3 months after the third dose, and include these vaccines in the Philippine National Deployment and Vaccination Plan for COVID-19 (NDVP).
While the said vaccines are recommended for a fourth dose, the HTAC has preference for mRNA vaccines (Pfizer-BioNTech and Moderna) based on the available real world evidence on the immunogenicity and safety of a fourth dose among the ICPs who include the following:
- Individuals who have been receiving active cancer treatment for tumors or cancers of the blood
- Individuals who had received an organ transplant and are taking medicine to suppress the immune system
- Individuals who received a stem cell transplant within the last 2 years or are taking medicine to suppress the immune system
- Individuals with moderate or severe primary immunodeficiency (such as DiGeorge syndrome, Wiskott-Aldrich syndrome)
- Individuals with advanced or untreated HIV infection
- Individuals with active treatment with high-dose corticosteroids or other drugs that may suppress immune response
- Individuals on chronic dialysis
- People living with autoimmune disease, and treatment with specific immunosuppressive medications
- Individuals diagnosed with conditions that are considered to have an equivalent level of immunocompromise as advised by the physician (e.g., severe malnutrition)
The HTAC recommendation is based on evidence and guidelines from the World Health Organization (WHO), the US Food and Drug Administration (US FDA), the US Centers for Disease Control and Prevention (CDC), and the United Kingdom Joint Committee on Vaccination and Immunisation (UK JCVI) on the need for a fourth dose among ICPs as follows:
- Higher risk of severe COVID-19 and its complications among moderately to severely ICPs, regardless of age
- Insufficient and variable immune response among ICPs even after the extended primary series (3 doses)
- Evidence from immunological data suggesting relatively good levels of protection and acceptable risk-benefit profile based on short term follow up among ICPs after fourth dose
The HTAC reiterates the need to enhance the coverage of primary and first booster vaccination among our priority groups across the country.
For Janssen and Sputnik V COVID-19 vaccine, the HTAC has no authority to recommend DOH financing and inclusion in the NDVP among the immunocompromised population until the release of WHO recommendation, and the inclusion of the vaccine in the WHO Emergency Use Listing, respectively. HTAC shall continue to monitor the progress in the release of WHO recommendation on the said COVID-19 vaccines.
Please note that the review for the fourth dose for older persons and healthcare workers will be the topic of deliberation during the next HTAC Meeting pending the release of WHO recommendations for these populations. We emphasize that these recommendations are interim and HTAC is actively on the watch for evidence as it is rapidly evolving.
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