Health, 13.01.2021

Will we be able to choose the vaccine?

People In Berlin will be able to choose between the individual Corona vaccines. Opinions on the subject are divided in Switzerland.

The statement before Christmas was clear. Christoph Berger, President of the Federal Commission on Vaccination, said: "People will not be able to choose which vaccine they receive. There will be no request programme."

The issue is relevant because the novel mRNA vaccines have many sceptics. The Pfizer/Biontech vaccine has already been approved, and Moderna's corona vaccine is also expected to receive the green light in Switzerland soon. The vaccine from Astrazeneca, which is based on an older operating principle, is not expected to be approved before the end of January.

The city of Berlin is now pushing ahead. "Citizens should have the freedom to decide which vaccine to use," said Berlin health senator Dilek Kalayci at the weekend. The city wants to offer only one vaccine at a time for each vaccination centre. When registering for an appointment, people from Berliner can thereby determine which of the approved vaccines they would receive, said Kalayci to the broadcaster RBB.

The first person have been vaccinated in the Baar vaccine centre. They couldn't choose which vaccine they received

 

The vaccine overview

 

Pfizer/BionTech
(BNT 162)

Moderna
(mRNA 1273)

AstraZeneca
(AZD 1222)

Cost

12 Euro/dose (estimated)

 

18 US Dollars/Dose (estimated)
15-25 US Dollars /dose (other sources)

4 US Dollar/dose (US, multiple sources)
1.78 Euro/dose (estimated)

Ordered / reserved vaccines for Switzerland

3 million
(230,000 + 125,000) doses available in January

7.5 million
200,000 doses immediately; whole promised by mid-June

5.3 million
The companies promise 300 million doses for Europe

Efficacy according to Phase III test (manufacturer's specifications)

95% (14 days after the second dose)

94.1% (7 days after the second dose)

62.1% at 2 standard doses 90% at 1 low + 1 standard dose

Approval

Switzerland

EU (Switzerland expected)

Great Britain (EU/Switzerland expected)

Type of vaccine

The mRNA vaccines are a novel process, but are classified as very safe. They can be manufactured and produced quickly. Once the genome of the pathogen (also a mutant) is known, the vaccine can be produced in the laboratory. No cell cultures are necessary, so there is no risk of contamination.

The building instructions for a viral protein are injected, which is then synthesised by the cells. It serves as an antigen for the immune system. It stimulates the production of antibodies against the virus protein. The building regulations (the mRNA) are dismantled very quickly. It is not possible for it to get into the cell DNA.

The gene material for the construction of antibodies is injected into the cell by a carrier virus (here an adenovirus). If the body has triggered an immune defence against the carrier virus, this could reduce effectiveness. The production is relatively complex, because the carrier viruses are bred and the gene material for the antigen has to be incorporated.

 

mRNA

mRNA

Vector

Logistics

 

Must be stored at -70 degrees Celsius to remain effective

 

Must be stored at -20 degrees Celsius to remain effective

Can be stored in the refrigerator

 

In Switzerland, it’s mainly conservative politicians who like the idea. "I’m in favour of the possibility that those who want to vaccinate can choose among the various Corona vaccines," says Martin Bäumle, National Councillor of the Green Liberals. Although I personally prefer mRNA vaccines, I can understand the scepticism about the new forms of vaccine. "If people have the freedom of choice, we can bring more vaccine sceptics on board," says Bäumle.

 

There is currently a lack of sufficient vaccines
There is, of course, a question of feasibility, especially in the area of logistics. In addition, it is not yet clear when which vaccine will be available in Switzerland, and in what quantities. The logistics should not be a hurdle, these are solvable problems, says SVP National Councillor Thomas de Courten. The aim must be to achieve the highest possible vaccination rate. This can be promoted with freedom of choice, says the politician from Basel Land.

BDP National Councillor Lorenz Hess is sceptical: "Until the general security of supply of vaccines is guaranteed, we shouldn't rush ahead with the issue of freedom of choice." If one wanted to set this up seriously, however, it would be administratively and logistically demanding. In addition, Hess wonders how well those who want to be vaccinated are actually able to judge which vaccine is the right one for each person..

SP National Councillor Flavia Wasserfallen from Bern shares his concerns. "Given the small quantities of vaccines, we are not in a position to be able to choose." At present, there are more people willing to be vaccinated than doses available, so the question does not arise at all, she says. Like de Courten and Hess, she is a member of the Health Commission of the National Council.

Huge logistical effort for freedom of choice
If it turns out that one of the available vaccines is preferred by the population, this question could arise again later. For state councillor (Ständerätin) Maya Graf (Greens), speed is a priority. The priority now is to vaccinate the elderly and members of the risk groups as a matter of urgency. Freedom of choice would entail a huge logistical effort, which could slow down the vaccination campaign.

Meanwhile, Christoph Berger, President of the Vaccination Commission, no longer sounds quite so absolute. "At the moment, we are still in a situation where there are many more people willing to be vaccinated than there are doses available." The Commission does not assume that it should be possible to choose in Switzerland. Only one vaccine is available in the vaccination centres and hospitals, not several.

Unlike the product from Pfizer/Biontech, the Moderna vaccine can be administered by family doctors, as the Moderna vaccine does not need to be stored at such a low temperature. "If resourceful people chose to go to their GP or to a vaccination centre or a hospital, then that's the way it is," says Berger. If the Moderna vaccine is approved this week, two vaccines will be available. As the two are equivalent, the question of freedom of choice doesn’t arise in any case.

Which vaccine is administered is decided by the immunising specialist
At this stage, it is not possible to choose between vaccines, says a spokeswoman for the Federal Office of Public Health. Depending on the characteristics of the vaccines, they will be recommended for different target groups, such as particularly vulnerable individuals. Which target group can be vaccinated and when is set out in the vaccination recommendations, which have been prepared by the Federal Office working together with the Vaccination Commission (Impfkommission).

The immunising specialist will decide which vaccine is appropriate in terms of efficacy and tolerability, and the appropriate vaccine will be selected for each person, said the FOPH spokeswoman.

There is currently no freedom of choice in other countries either. This depends on the state In the USA, although, as far as can be seen, those who wish to be vaccinated cannot choose which vaccine they receive. There is also no freedom of choice in the UK, as a spokesman for the Department of Health and Social Affairs replied on request. This is also not possible in Israel, which has so far vaccinated the most people.