With the emergency use authorization by several developed countries, the covid 19 vaccination process is on fast pace, vaccinating their high risk citizens first, with gradual roll out to full coverage. The situation here is a bit different. According to the advisor to Prime Minister on health, Pakistan is in talks with vaccine manufacturers but uptill now confirmed orders have not been placed yet but hopefully will be placed in a matter of days and the first batch might be available in first quarter of year 2021.
Why has Pakistan not placed any order?
There are 2 most probable reasons Cost & lack of real world vaccine efficacy data.
Cost: The vaccine cost varies among different manufacturers with the Uk & Russian candidates being the cheapest followed by the ones from china. Several factors affect the final cost of a vaccine e.g the number of doses required (mostly 2 with a one month gap between each dose), temperature requirement for storage and transport ( the mRNA based vaccines by Pfizer & moderna requiring ultracold storage facilities – which Pakistan currently lacks). The total population covered also escalates the cost.
Efficacy: What is the efficacy of a vaccine, right now it is a little bit too early to answer, vaccine manufacturers have carried out trials and released preliminary data, for emergency use authorization, but only time and followup surveillance will tell how much a vaccine is efficacious in real world setting.
So which vaccine will be available in Pakistan & when?
Right now there are 4 candidates most likely to be chosen from. All these vaccines can be stored at normal fridge temperature.
•Sinopharm (China) (type: Inactivated)
2 doses required ~ $30 – efficacy 79-80%
•Cansino biologics (China) (type: vector)
1 dose required ~ $20-30 – efficacy: under trial
•Sputnik V (Russia) (type: vector)
2 doses required – $10 – efficacy 92%
•Oxford-Astra zeneca (UK) (type: vector)
2 doses required – $4 – efficacy 70-90%
•Others: Moderna, Pfizer-bioNtech (these require ultra-cold chain for transport and storage)
DRAP the drug regulator authority of Pakistan has already received licensing request by the above 4 vaccine manufacturers. A pre-requisite for registration is the provision of clinical trial data, which are almost complete, clinical trial of one vaccine is also under process in Pakistan i.e Cansino biologics others have completed clinical trials in other countries. Followed by clinical trial, a mandatory safety trial will have to be taken in Pakistan for each of the vaccine, before approval for emergency use is given by drap.
Update: DRAP, as of 16/01/21 has approved the Oxford-Astra Zeneca vaccine for emergency use in Pakistan.
 DRAP has also approved the 2nd covid vaccine by Sinopharm for emergency use on 18/01/2021
The health authorities are currently analyzing the trial data before deciding to procure vaccine that is both cheap and clinically efficacious as per independent observers, also the only vaccine to undergo local trial at 5 different hospitals in Pakistan is nearing its trial completion in a few days, the data will also help choose the vaccine for local population.
Hopefully by February or early march 2021 the first batch of vaccines will arrive in Pakistan.
How to register for Covid-19 vaccine in Pakistan
The govt intends to inoculate almost 70% of the population to prevent the disease spread. Initially 1.1 million doses are planned to be procured, followed by other orders later on, for mass vaccination govt. will wait for WHO to provide free vaccines to cover almost 20% of the population.
The vaccination process is divided into 3 phases, the first phase includes front line health care worker and people above age 65.
The second phase includes all health workers and people aged 60-65.
The third phase will include the rest of population. The govt will provide free vaccines to all but private sector will also be allowed to sell vaccines to those affording it.
Regarding Covid19 vaccination of health workers in Pakistan, NCOC has defined who comes under the definition of frontline health care worker, and how to register for vaccination in the first phase.
All staff of COVID-19 hospitals (public and private sector) and isolation centers. All staff includes clerical, administrative and support staff (sanitary workers, guards) in addition to doctors, nurses, paramedics etc.
b. Public health staff involved with test, track and quarantine. These are staff visiting patients at home, collecting data and samples from home.
c. Health Care Workers deputed to inject Covid-19 vaccine and essential staff at Adult Vaccine Counters (AVCs) involved in handling of individuals being vaccinated.
d. All laboratory staff for both public and private sector who are collecting and processing specimens of COVID-19.
e. Staff carrying out screening / triage of suspected COVID patients in Fever / Screening Clinics (at Non COVID Hospitals, PHC facilities, emergency departments and Points of Entries) in public or private sector (taking into consideration high risk areas).
f. EPI vaccinators for outreach / fixed sites.
g. Staff of ambulance services public & private (e.g. Edhi, Chippa etc) dealing with Covid-19
h. General Practitioners registered with their respective health care commissions. In federating units without a formal regulator, the department or ministry of health will have to certify the bona fides.
Registration process covid 19 vaccine
Health care workers in Punjab, Sindh and KP (Public/ Private Hospitals) will be registered in provincial health system by the relevant health facility. HCWs to contact their hospital administration to confirm all required details (including Name, CNIC, Mobile No, Designation) have been communicated to concerned district/ provincial health department for registration.
● HCWs in Islamabad, Balochistan GB and AJK will be directly registered in Resource Management System (RMS) by the concerned health facility/ district health department. HCWs to contact health facility administration to confirm all required details have been entered in the system by health
facility focal person for RMS or by district health department.
● All HCWs in other relevant health facilities
to contact local health authorities for information related to registration