SRI LANKA MEDICAL ASSOCIATION

6, Wijerama Mawatha, Colombo 7, Sri Lanka T’Phone: 2693324 Fax: 2688802

E-mail: office@slma.lk Website: www.slma.lk

8th September 2021

The SLMA Press Release

“3rd dose in primary series for Vaccination against COVID 19”
Sri Lanka, has relied on vaccination and movement restriction to control the Covid 19
epidemic. All vaccines approved so far by the NMRA have saved many lives and prevented
severe disease. Most people who have died from COVID are unvaccinated individuals. It is
therefore essential that all unvaccinated people, over the age of 18 years be immunized,
with any of the available vaccines at earliest possible.

Subject to above recommendation, the SLMA has formulated recommendations further based
on scientific principles with an objective of preventing severe disease and deaths. Preventing
severe disease will reduce congestion on hospitals and ICU, and will indirectly benefit people
with other diseases who also need ICU facilities.

With the roll out of the vaccines, certain characteristics that are specific for the type of the
vaccines have been identified. Specially with the Delta variant, while all vaccines reduce
death and hospitalization, fully vaccinated people can be infected and develop mild
symptoms, such as fever, cough etc. However, studies have revealed that a minority of fully
vaccinated people can get severe disease, and may even die. Studies from Bahrain has shown
that in those over 50 years, people given the Sinopharm vaccine, while preventing death and
severe disease compared to the unvaccinated, had a slightly increased death rate, and
hospitalization compared to the Pfizer, Moderna, Sputnik and Astra Zeneca vaccines. Studies
from the laboratory of the Department of Immunology and Molecular Medicine, Sri
Jayawardanapura University (SJPU) has shown that, while almost all people over 60 years
given the AZ vaccine develop antibodies, a very small proportion, 7%, given Sinopharm do
not do so. In addition, patients with some diseases or on certain drugs (organ and stem cell
(bone marrow) transplant recipients, patients with active cancer, those on immunosuppressive
therapies and on dialysis, advanced HIV have a weak immune system, and will not produce
antibodies, whatever the vaccine that was given.

1. For this reason, we propose that people over 60 who had been given 2 doses of
Sinopharm, and those with a weak immune system, be given a third dose, with AZ,
Pfizer or Moderna vaccines.

The study from Bahrain and data from SJPU indicate that people below 60 years produce a
robust immune response to Sinopharm, and are protected from death or severe disease.

2. We therefore recommend that all people (without the diseases mentioned above) are
given 2 doses of Sinopharm.
Children from 12 – 18 years generally do not get severe disease. However, children with
certain underlying diseases may get severe disease.

3. We therefore recommend 2 doses of Pfizer for this group.

Some people have been administered one dose of Sputnik; the second dose is different from
the first. If the second dose is not available.

4. We suggest that a single dose of AZ, Pfizer or Moderna be given instead.

Studies in the UK and US have shown, that, with AZ, Pfizer and Moderna, protection
(effectiveness) against severe disease and death is maintained for at least 6 months.

5. We therefore suggest that, as there may a waning of immunity with time, a booster
dose of the same or a different vaccine, be given to people over 60 years, who had
been given 2 doses of AZ, at least 6 months after the second dose. Studies have shown
that immunity is boosted, with this regime.

Dr. Padma Gunaratne

President
Sri Lanka Medical Association