[Q&A] "All vaccines meet WHO standards... Herd immunity depends more on participation rate than vaccine efficacy"

Announcement of COVID-19 Vaccination Implementation Plan
Vaccine Choice Not Available
Aim to Achieve Herd Immunity with Over 70% Vaccination This Year

Vaccination Also for Overseas Koreans and Foreigners
Current Vaccines Effective Against Variants

Jung Eun-kyung, Director of the Korea Disease Control and Prevention Agency (KDCA) and Head of the Central Disease Control Headquarters, who is in charge of the COVID-19 Vaccination Response Task Force (left), along with attendees from the Ministry of National Defense, National Police Agency, and Ministry of the Interior and Safety, announced the "Comprehensive COVID-19 Vaccination Plan" at the regular briefing on COVID-19 response held on the afternoon of the 28th at the Disease Control Headquarters in Cheongju, Chungbuk.
[Image source=Yonhap News]

[Asia Economy Reporter Chunhee Lee] "Unlike other chronic diseases, infectious diseases are not just a personal issue but can be transmitted to others. Foreigners will also be vaccinated in the same order as nationals." (Jung Eun-kyung, Director of the Korea Disease Control and Prevention Agency)

"(All the vaccines to be introduced) are all judged to have preventive effects exceeding the standards set by the World Health Organization (WHO). Herd immunity depends more on vaccination participation rates than on the efficacy of individual vaccines." (Sung Baek-rin, Director of the Vaccine Commercialization Project Group)

The government will begin COVID-19 vaccinations next month targeting 50,000 workers at COVID-19 treatment hospitals.

After administering the first vaccinations to medical staff, the plan is to vaccinate nursing home residents and workers in the first quarter, seniors aged 65 and older in the second quarter, and adults aged 19 to 64 in the third quarter, completing the first dose by September and the second dose for 70% of the population by November. Individuals cannot choose their vaccine, and those who refuse vaccination will be moved to the end of the vaccination queue.

Jung Eun-kyung, head of the COVID-19 Vaccination Response Task Force, announced the 'COVID-19 Vaccination Implementation Plan' during a vaccine briefing on the 28th, stating, "We plan to sequentially implement COVID-19 vaccinations starting in February, aiming to establish herd immunity by November to minimize deaths and block community transmission."

The following is a Q&A with Director Jung Eun-kyung of KDCA, Kim Sang-bong, Director of the Biologics and Pharmaceuticals Bureau at the Ministry of Food and Drug Safety, Sung Baek-rin, Director of the Vaccine Commercialization Project Group, and Baek Kyung-ran, President of the Korean Society of Infectious Diseases.

- What criteria were used to review the COVID-19 vaccination order?

▲ (Baek Kyung-ran) Since vaccine administration and introduction take time and initial supply is expected to be limited, we had no choice but to prioritize and decide the vaccination order. We based this on the risk of severe disease, maintenance of the medical system and social infrastructure, transmission from vulnerable groups, exposure risk to COVID-19 patients, and applicability. The expert advisory committee discussed this several times before deciding. Subsequently, depending on the timing and quantity of vaccine introduction and the COVID-19 epidemic situation, the order may be somewhat variable, and decisions will be made through discussions each time.

- There have been reports of adverse reactions in countries that started vaccinations earlier. How safe is the COVID-19 vaccine?

▲ (Sung Baek-rin) Although adverse reaction cases have occasionally been reported overseas after vaccination, no direct causal relationship has yet been proven. It can be said that no major side effects have appeared so far, but continuous monitoring of overseas vaccination trends is necessary. Domestically, it is essential to ensure compliance with safety protocols during vaccination, promptly prepare measures for possible adverse reactions, and thoroughly prepare for emergencies through information sharing.

- Are overseas Koreans eligible for vaccination upon entering the country, and is there a separate vaccination plan for them?

▲ (Jung Eun-kyung) Vaccinations will also be administered to overseas Koreans in Korea. The vaccination order for them will follow the same sequence applied to nationals, and vaccinations will be conducted according to scheduled appointments.

- Is there a vaccination plan for foreigners residing in Korea?

▲ (Jung Eun-kyung) Foreigners with long-term residency and foreign registration cards will be vaccinated in the same order as nationals. For undocumented foreigners, vaccinations will be provided if deemed necessary considering COVID-19 transmission and impact on high-risk groups. The same risk-based criteria and vaccination order will be applied to determine their vaccination sequence.

Infectious diseases, unlike other chronic diseases, are not just personal issues but can spread to others. Since nationals are at risk of exposure, from the perspective of the health of the entire population, it is considered a principle to maintain the same vaccination order and set standards accordingly.

- Disability organizations have requested priority vaccination for disabled persons not living in facilities. Why were they excluded?

▲ (Jung Eun-kyung) Priority vaccination currently considers the probability of severe disease and risk of death upon COVID-19 exposure as the top priority. Therefore, those living in group settings are included in the priority vaccination group and will be vaccinated accordingly. Additionally, disabled persons with diseases or chronic illnesses may have priority based on those conditions. More detailed criteria will be reviewed and continuously revised by experts.

- What is the scope of adult chronic disease patients eligible for priority vaccination? Also, there are opinions that vaccination might be risky for patients undergoing chemotherapy or with terminal illnesses. What is your view?

▲ (Baek Kyung-ran) Adult chronic disease patients discussed include those with diabetes, chronic heart disease, chronic lung disease, and other conditions with a high risk of severe COVID-19. If vaccine introduction accelerates, rather than identifying chronic disease patients, age may be considered a key factor related to severe disease, so vaccination by age group is also being discussed. The specific scope of chronic disease patients has not yet been finalized.

For patients undergoing chemotherapy, since the COVID-19 vaccine does not contain live virus, there is no risk of infection from the vaccine itself. Therefore, vaccination is possible; however, immunosuppression due to chemotherapy may reduce vaccine efficacy. Also, early in chemotherapy, patients' conditions may be poor, so it is better to avoid vaccination during that period.

The COVID-19 vaccine and syringe placed in front of the AstraZeneca logo.
[Image source=Reuters Yonhap News]

- Which vaccines will be administered to medical staff and nursing home residents/workers receiving the first vaccinations in February? Has the type of vaccines to be supplied by the COVAX Facility in early February been finalized?

▲ (Jung Eun-kyung) The vaccines scheduled for introduction in the first quarter include the AstraZeneca vaccine contracted individually with the pharmaceutical company, expected to arrive at the end of February. Additionally, AstraZeneca and Pfizer vaccines are scheduled to be supplied through COVAX. However, the quantity and timing of supply from COVAX are being coordinated based on feedback from countries worldwide and will be notified soon. We need to assess this information before making decisions.

Regarding COVAX vaccines, when contracting with COVAX, we had the option to select vaccine types. COVAX inquired about which vaccines we intended to purchase, and we expressed interest in Pfizer and AstraZeneca vaccines. Therefore, the vaccines we have proposed to purchase are Pfizer and AstraZeneca.

For AstraZeneca vaccines, vaccination targets will be selected considering the Ministry of Food and Drug Safety's approval scope, and decisions will be made after review by the Vaccination Review Committee, reflecting COVAX supply plans and approval details. For Pfizer vaccines, domestic approval has been applied for, but if supplies arrive before approval is finalized, we are considering importing under special approval based on WHO emergency use authorization.

- Since vaccine efficacy may vary by type, shouldn't vaccines with higher efficacy be used to achieve herd immunity?

▲ (Sung Baek-rin) It is very difficult to uniformly compare and evaluate vaccine efficacy. Production platforms differ, and clinical trial subjects and conditions vary. Therefore, slight differences in efficacy may exist. However, all vaccines introduced are judged to have preventive effects exceeding WHO standards.

Regarding herd immunity, vaccination participation rates are more important than individual vaccine efficacy. Just as wearing masks protects not only oneself but also neighbors, vaccination prevents not only oneself but also neighbors and society as a whole, which is expressed as herd immunity. We hope discussions will encourage as many people as possible to participate in vaccination to contribute to social stability and immunity.

- How many minutes does it take for one doctor to complete vaccination for one person? What is the realistic maximum vaccination speed per center, institution, or personnel?

▲ (Jung Eun-kyung) Vaccination includes a pre-screening to check for contraindications and assess the individual's health status on the day. The pre-screening simulation suggests that if there are no special symptoms, it takes about 1-2 minutes; if symptoms require consultation or examination, more time is needed. Since delegated medical institutions provide both medical care and vaccination, the daily vaccination capacity differs from vaccination centers, and discussions with experts are ongoing. Adjustments will be made through simulations at standard centers.

- Can the first and second vaccination locations be chosen differently?

▲ (Jung Eun-kyung) We are preparing a system that allows changing the region when making the second appointment for convenience. However, this vaccination is more complex than other influenza vaccinations because different vaccine types are used, and the same vaccine must be administered for the second dose with the appropriate interval. The system will allow reservations within these constraints.

- Is vaccination possible for those diagnosed with COVID-19? What are the policies if someone is diagnosed between the first and second doses?

▲ (Baek Kyung-ran) It is considered safe for COVID-19 infected individuals to receive the vaccine. However, vaccination is recommended after recovery and when the condition improves. The first dose alone may not provide sufficient protection, and it takes more than two weeks for immunity to develop. Therefore, even after vaccination, COVID-19 prevention measures must be followed. Also, even after completing the second dose, protection is not 100%, so basic preventive measures should continue.

Jung Eun-kyung, Director of the Korea Disease Control and Prevention Agency (KDCA) and Head of the Central Disease Control Headquarters, who is in charge of the COVID-19 vaccination response task force, is announcing the "Comprehensive Plan for COVID-19 Vaccination" at a regular briefing on the response to the novel coronavirus infection (COVID-19) held at the Disease Control Headquarters in Cheongju, Chungbuk, on the afternoon of the 28th.
[Image source=Yonhap News]

- Pfizer vaccines are indicated to be delivered by the manufacturer directly to vaccination sites. Is SK Bioscience only responsible for distribution management of AstraZeneca, Moderna, and Janssen vaccines? If distribution is split, will there be difficulties in cold chain management? Will Pfizer manage temperature control independently?

▲ (Jung Eun-kyung) Currently, SK Bioscience is contracted to handle specialized distribution, and several distribution companies are involved in preparations. Vaccines managed through SK Bioscience include AstraZeneca, Janssen, and Pfizer vaccines. A separate company is being considered for Moderna vaccine distribution.

Pfizer vaccines are scheduled to be delivered to designated sites. We are planning detailed delivery plans considering two options: allocation to central ultra-low temperature freezers for redistribution and direct delivery to some confirmed vaccination sites. Therefore, SK Bioscience will also handle some aspects of Pfizer vaccine distribution.

Even when Pfizer delivers directly, the Korea Disease Control and Prevention Agency will secure temperature records and continue supervising cold chain maintenance.

- Some countries temporarily halted vaccinations due to vaccine shortages. Will this affect our vaccine supply?

▲ (Jung Eun-kyung) Globally, including Korea, there is uncertainty and shortage in vaccine supply timing. Our biggest challenge is to secure stable vaccine supply and prevent vaccination interruptions. Unlike other vaccinations where vaccines are secured before administration, COVID-19 vaccines require multiple types and face global supply instability. To minimize uncertainty and manage stable supply, a dedicated vaccine procurement team has been formed through inter-ministerial efforts including the Ministry of Foreign Affairs, and we will do our best.

- Certificates in Korean and English will be issued after vaccination. How will these certificates be used? Will they simplify immigration procedures or exempt quarantine?

▲ (Jung Eun-kyung) Under the Infectious Disease Control and Prevention Act, vaccination certificates can be issued upon request for all vaccinations, including COVID-19. How these certificates will be used, especially for entry and exit, and to what extent they will be recognized by other countries or international organizations like WHO, has not yet been established. Since this is still in the early stages, we will develop scientific policies considering changes and prepare guidelines for quarantine or testing exemptions for those entering with vaccination certificates.

- Vaccination personnel training is scheduled for early February. Is this timeline tight given that vaccinations start in February?

▲ (Jung Eun-kyung) Due to the COVID-19 epidemic, in-person training is difficult, so we are preparing non-face-to-face training. Medical staff must complete mandatory training to be designated as delegated medical institutions, and we are preparing various methods including issuing training completion certificates. It will be difficult to complete all training simultaneously in February. We will start with nursing homes, home visit vaccination personnel, and some central and regional vaccination centers, expanding training step-by-step as vaccinations begin.

- With the emergence of variant viruses, are the current vaccines effective?

▲ (Sung Baek-rin) Although variant viruses have appeared, fortunately, there are no reports that they evade the efficacy of vaccines currently under development worldwide. Among various variants, the concerning one spreads about three times faster than the original virus. Current vaccines are effective against this variant as well. Therefore, there is no need for concern at this time.

However, we must anticipate that COVID-19 may become endemic like influenza over the next 5 to 10 years. Influenza vaccines are administered annually, and COVID-19 might become similar. Expert opinions vary on this. Fortunately, experts agree that current vaccines cover existing variants.