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Monday 26 July 2021

BioNTech Vaccine Is Growing Less Effective, Says CEO

BioNTech CEO Says Vaccine Is Growing Less Effective, but Still Prevents Severe Disease

BioNTech CEO Ugur Sahin.

The protection provided by Pfizer and BioNTech’s Covid-19 vaccine is dropping due to the Delta variant, BioNTech’s CEO told The Wall Street Journal in an interview published Sunday, but most recipients are still protected against severe disease caused by the virus.

“The vaccine protection against the new variant is considerably lower,” BioNTech (ticker: BNTX) CEO Dr. Ugur Sahin told the Journal.

He said, however, that even though the protection against all symptomatic disease is dropping, protection against severe disease remains high, and most people may not yet need a third dose.

Sahin declined to take a position in the Journal interview on whether governments should authorize a booster dose of its vaccine. BioNTech’s partner Pfizer (PFE) has said it plans to ask the U.S. government to authorize a booster dose.

“This debate must proceed without us: We will only supply data and governments will need to tell us what they want,” Sahin told the Journal.

Read moreWith Cases Rising, Travel’s Rebound Faces a Big Test

BioNTech shares were up 1.5% on Monday, and the stock is up 251% so far this year. Pfizer was up 0.3% and is up 13.6% this year. The S&P 500 was up 0.2%.

In recent weeks, as new cases of Covid-19 have climbed around the world, Pfizer has begun to push for authorization of a third dose of the vaccine. Health officials in Israel, meanwhile, have reported that the efficacy of the Pfizer and BioNTech vaccine at protecting against all symptomatic Covid-19 has dropped to 40.5% as Delta has become dominant in the country, though protection against hospitalization remains high, at 88%.

Federal health officials in the U.S. pushed back in mid-July against Pfizer’s assertion that it would submit a booster dose of its vaccine for emergency authorization. But late last week, a key advisory committee to the Centers for Disease Control and Prevention signaled early support for recommending a booster dose for immunocompromised people.

The World Health Organization’s director general, meanwhile, said last week that the world had squandered Covid-19 vaccines by failing to distribute them more equally around the world, and called the notion of administering booster shots a “moral outrage.”

Read More: The Market for Booster Vaccines Just Keeps Getting Bigger

“Some of the richest countries are now talking about third booster shots for their populations, while health-workers, older people, and other vulnerable groups in the rest of the world continue to go without,” said Dr. Tedros Adhanom last Wednesday. “This is not just a moral outrage; it’s also epidemiologically and economically self-defeating. The longer this discrepancy persists, the longer the pandemic will drag on.”

In a note out Monday, Citi analyst Andrew Baum argued that Covid-19 vaccine booster shots will be authorized in Western markets for people aged 50 and older around the end of this year. “We have increased our concern that waning antibodies, especially in the elderly and immunosuppressed, creates public health risks that will likely necessitate at least one booster as well as continued episodic public health measures,” Baum wrote.

Moderna (MRNA), for its part, has been quiet in recent weeks on the possibility of boosters, though the company’s CEO has said that boosters will be needed. “More than ever, we believe that coronavirus vaccines won’t provide lifelong immunity,” Moderna CEO Stéphane Bancel told Barron’s in June.

Read more: Rising Covid Cases Put Economic Recovery at Risk

BioNTech’s Sahin has also warned that boosters could be necessary. He told Barron’s in April that patients may need to receive another dose of the vaccine six to nine months after their second dose, and then every 12 to 18 months after that. And at Barron’s Investing in Tech conference in June, Sahin said that antibody responses in people who had received the vaccine were stable for four or five months after the second dose, and at six months the antibody levels begin to drop. Redosing boosts those levels again.

“At the end of the day it’s also a decision of the governments when to introduce the booster shot for the population,” Sahin said in June.

In his comments to the Journal, BioNTech’s Sahin also said that he was staying out of the debate over whether countries should authorize booster doses. 

“When the vaccine becomes available on the free market everyone will be able to make this decision for themselves,” he said.

https://www.marketwatch.com/articles/biontech-covid-19-vaccine-efficacy-delta-booster-51627302003?mod=mw_latestnews

The top 3 drugs used to treat COVID-19

 To ensure supply of the top 3 drugs used to treat COVID-19, it’s time to boost domestic medicine manufacturing

July 26, 2021 3.07pm AEST




We now know enough about how COVID works for health authorities to have issued clear guidance on which drugs doctors should use on hospitalised patients. The recommended drugs are dexamethasone, remdesivir, and tocilizumab.

Remdesivir, also known as Veklury, is not manufactured in Australia and the Therapeutic Goods Administration (TGA) has recently issued an alert warning of a shortage of tocilizumab in Australia. And the large dexamethasone manufacturers are based overseas. The website Pharmaoffer, which shows suppliers of active pharmaceutical ingredients, lists the countries that produce the active ingredient in dexamethasone; Australia is not one of them.

More broadly, Australia lacks medicines manufacturing capability and this puts us at significant risk should supplies from overseas continue to be interrupted.

One report released last year described the Australian market for pharmaceuticals as “possibly one of the most vulnerable in the OECD”.

It’s time for Australia to re-invest in domestic medicine manufacturing.

Drugs used to treat COVID-19

Many people diagnosed with COVID-19 experience only mild, or no symptoms at all, and can be managed and monitored at home. Rest is the main treatment, and medicines such as paracetamol and/or ibuprofen can provide symptomatic relief of any mild fevers.

People with moderate to severe COVID-19 are treated in hospital. The medicines doctors will prescribe in hospital depend on a patient’s clinical circumstances, such as whether or not they are receiving oxygen therapy.

The pharmaceutical treatment options include:

  • dexamethasone, a corticosteriod

  • remdesivir, an antiviral and

  • tocilizumab, a monoclonal antibody and immunosuppressive agent (monoclonal antibodies are lab-made proteins that mimic the immune system’s virus-fighting abilities).

Dexamethasone is already used for a wide range of conditions, such as certain forms of cancer and arthritis, and various other disorders. Now, it is used in treatment of COVID-19 to suppress inflammation and immune responses.

Remdesivir works by stopping the replication of viral RNA.

And tocilizumab is sometimes used when COVID-19 patients have signs of systemic inflammation.

Dexamethasone is already used for a wide range of conditions. Nati Harnik/AP

Where are they made?

Australia is heavily reliant on supply agreements for medicines that come from overseas (and a manufacturing network might include a lot of countries). It’s been reported some of the large dexamethasone manufacturers are in Brazil and India.

To meet growing demand for remdesivir, its company (Gilead) has approved new deals for manufacturing in Egypt, India, and Pakistan. But while the remdesivir manufacturing network now includes more than 40 companies in North America, Europe, and Asia, the medicine is not manufactured in Australia.

Tocilizumab was developed in Japan and is now also licensed for manufacturing by the California-based company Genentech.

Need for Australian manufacturing base

There is an urgent need for Australia to increase local manufacturing of many types of medicines, not just COVID treatments, to secure current and future needs.

In general, Australia does have some medicine manufacturing sites in Australia but several have either closed or are slated for closure.

The Australian government has acknowledged the importance of boosting local production of medicines but it’s unclear what progress has been made.

In March this year, an interim report by the Productivity Commission on vulnerable supply chains again indicated medicines as an area of concern, noting that

the pharmaceutical industry is highly regulated, making entering the market or modifying existing facilities to respond to a crisis a slow and costly process.

The final report from this committee is currently with the government.

Manufacturing of medicines in Australia is regulated by the TGA. According to its website, it can take up to 12 months for an Australian manufacturer to get approval to bring a new manufacturing site online. This means it would take us a long time to act if a supply shortage pops up.

Significant backing from the federal government for local medicine manufacturing would reduce the risk of key medicine shortages in Australia, while also creating many highly skilled jobs.

https://theconversation.com/to-ensure-supply-of-the-top-3-drugs-used-to-treat-covid-19-its-time-to-boost-domestic-medicine-manufacturing-164948

3 drugs for treating Covid-19

 Remdesivir, dexamethasone and baricitinib represent the best therapeutic approaches for Covid-19 and have helped reduce viral loads, decrease inflammation and ease symptoms in hospitalised patients.

By Tharanya Arumugam - July 26, 2021 @ 9:40am

New Straits Times

Medical frontliners arriving at the Covid-19 Assessment Centre at Malawati Stadium in Shah Alam on Saturday. -NSTP/ASYRAF HAMZAH


KUALA LUMPUR: Remdesivir, dexamethasone and baricitinib represent the best therapeutic approaches for Covid-19 and have helped reduce viral loads, decrease inflammation and ease symptoms in hospitalised patients.

Public health medicine specialist Associate Professor Dr Rafdzah Ahmad Zaki of University Malaya Medical Centre said remdesivir (an anti-viral agent that scientists initially designed to treat Ebola) and dexamethasone (an anti-inflammatory medication) were considered the best available treatment options for Covid-19 pneumonia.

"Remdesivir is likely to be most effective in the early stage of pneumonia, whereas dexamethasone is likely to be most effective later in the disease's course.

"Baricitinib hopes to fill the gap or unmet need of providing efficacious therapies for the grey zone between remdesivir and dexamethasone," she told the New Straits Times.

Health director-general Tan Sri Dr Noor Hisham Abdullah had on July 23 said health facilities would start administering baricitinib to Covid-19 patients, especially those in categories four and five (patients with lung infections and require oxygen or ventilators).

Category one patients are asymptomatic, while those in Category two display mild symptoms. Category three patients suffer from pneumonia and lung infection.

Dr Noor Hisham had said baricitinib, also a drug approved for use in patients with moderate to severe arthritis who have had an inadequate response to other treatments, had been proven to be more effective in treating infected patients, along with dexamethasone.

Dr Rafdzah, who is head of the Centre for Epidemiology and Evidence-Based Practice, Department of Social and Preventive Medicine, Faculty of Medicine,  said two main processes were thought to drive Covid-19's pathogenesis.

She said that early in the clinical course, the disease was primarily driven by the replication of the SARS-CoV-2 virus, while later in the clinical course, it appeared to be driven by a dysregulated immune/inflammatory response to the virus that led to tissue damage.

"Based on this understanding, it is anticipated that therapies that directly target SARS-CoV-2 would have the greatest effect early in the course of the disease, while immune-suppressive/anti-inflammatory therapies are likely to be more beneficial in the later stages of Covid-19.

"Baricitinib is a drug that reduces the activity of the immune system. As an anti-inflammatory, it may block the signalling activity that can contribute to the hyper-inflammatory state caused by a severe Covid-19 infection."

Dr Rafdzah said besides Malaysia, the United States' National Institutes of Health and Singapore's National Centre for Infectious Diseases had recently included baricitinib in their treatment guidelines for Covid-19.

Japan had approved the use of the rheumatoid drug for treating Covid-19 patients.

"The use of baricitinib together with remdesivir have been found to be superior to remdesivir alone in reducing recovery time and accelerating improvement in clinical status among Covid-19 patients, especially among those receiving high-flow oxygen or non-invasive ventilation.

"The combination of baricitinib and remdesivir is associated with fewer serious adverse events."

On calls for ivermectin to be included as part of the country's list of treatments for Covid-19, Dr Rafdzah said the evidence on the use of the drug to treat Covid-19 patients was inconclusive.

Most studies looking at ivermectin and Covid-19 had incomplete information and significant methodological limitations and bias, she said.

"Some of the limitations include the sample size of most of the trials, which was small, and some of the randomised controlled trials were open-label studies, where neither the participants nor the investigators were blinded to the treatment arms.

"Besides, patients received various concomitant medications (for example, doxycycline, hydroxychloroquine, and corticosteroids) in addition to ivermectin or the comparator drug. This confounded the assessment of the efficacy or safety of ivermectin.

"The severity of Covid-19 among the study participants was not always well described, and the study outcome measures were not always clearly defined. Therefore, until more data is available, the drug is only approved to be used within clinical trials."

She added that the US Food and Drug Administration had not approved ivermectin for use in treating or preventing Covid-19 in humans.

"Ivermectin tablets are approved at very specific doses for some parasitic worms, and there are also topical (on the skin) formulations for head lice and skin.

"Ivermectin is not an anti-viral (a drug for treating viruses). Taking large doses of this drug is dangerous."

Epidemiologist and biostatistician Professor Dr Jamalludin Ab Rahman from International Islamic University Malaysia said doctors should not rush to administer ivermectin, but instead wait until the clinical trials conducted by the Health Ministry were completed.

"Most countries are not using ivermectin. This pandemic is testing many so-called scientists and experts.

"We should be patient and go back to the fundamentals of evidence-based medicine.

"This practice is confusing the public because even experts can't agree on certain standards and are still citing conspiracies.

"I praise the ministry for sharing the data on Covid-19 recently, which is an important progress in battling the pandemic.

"Now, many epidemiologists, statisticians and data scientists, locally or abroad, are looking for trends and any information that can assist the government."

ANTI-VIRAL AND ANTI-INFLAMMATORY AGENTS


https://www.nst.com.my/news/nation/2021/07/711677/3-drugs-treating-covid-19

Repurposed drugs to treat COVID-19 symptoms

 Large clinical trial to study repurposed drugs to treat COVID-19 symptoms


Using an ACTIV master protocol, the trial will focus on potential interventions for mild-to-moderate illness.


National Institutes of Health

Monday, April 19, 2021

The National Institutes of Health will fund a large, randomized, placebo‑controlled Phase 3 clinical trial to test several existing prescription and over-the-counter medications for people to self-administer to treat symptoms of COVID-19. Part of the Accelerating COVID‑19 Therapeutic Interventions and Vaccines (ACTIV) public–private partnership, the ACTIV-6 trial aims to provide evidence-based treatment options for the majority of adult patients with COVID-19 who have mild-to-moderate symptoms and are not sick enough to be hospitalized. NIH will provide an initial investment of $155 million in funding for the trial.

“While we’re doing a good job with treating hospitalized patients with severe disease, we don’t currently have an approved medication that can be self-administered to ease symptoms of people suffering from mild disease at home, and reduce the chance of their needing hospitalization,” said NIH Director Francis S. Collins, M.D., Ph.D. “ACTIV-6 will evaluate whether certain drugs showing promise in small trials can pass the rigor of a larger trial.”

Several drugs currently are recommended for the treatment of hospitalized patients with moderate to severe COVID-19, including the antiviral drug remdesivir, the anti-inflammatory baricitinib, and corticosteroids. Additionally, the U.S. Food and Drug Administration authorized emergency use of intravenous monoclonal antibodies in non-hospitalized patients with mild to moderate COVID-19 who are at high risk for severe disease. However, medications that can be self-administered at home to reduce COVID-19 symptoms are critically needed.

The ACTIV-6 protocol will explore a pool of up to seven drugs approved by FDA for other conditions – an approach called drug repurposing – and test their safety and effectiveness in treating mild to moderate COVID-19. Because the drugs under consideration already have been tested in humans, repurposing could deliver COVID-19 treatment options sooner. Drugs will be administered orally or by inhaler and will be easy for participants to take at home. Participants will be assigned randomly to receive either a placebo or one of the treatments, which will be sent to them by mail.

Enrollment is expected to open in a few weeks to up to 13,500 participants who are at least 30 years old, have tested positive for SARS-CoV-2 infection and have experienced two or more mild-to-moderate symptoms of COVID-19 for no more than seven days. Researchers plan to assess changes in patients’ symptoms over a 14-day period, as well as hospitalizations and deaths over a 28-day period. They also will assess long-term COVID-19-related symptoms at 90 days after treatment begins. The list of drugs that will be added to the study arms is still being finalized. All the drugs will have established safety records and early indications from smaller or less controlled studies of effectiveness against COVID-19.

The trial will focus on enrollment of people within minority, rural and other communities that are significantly affected by COVID-19 but lack access to major academic medical centers, where large clinical trials usually take place.

With funding provided by the American Rescue Plan Act, NIH’s National Center for Advancing Translational Sciences (NCATS) will oversee the trial. The Duke Clinical Research Institute, Durham, North Carolina, an NCATS-funded Clinical and Translational Science Awards (CTSA) Program hub, will serve as the clinical coordinating center, and the Vanderbilt Institute for Clinical and Translational Research CTSA Program hub at Vanderbilt University Medical Center, Nashville, Tennessee, will serve as the trial’s data coordinating center.

To expedite enrollment in ACTIV-6, NCATS and its Duke-Vanderbilt Trial Innovation Center will partner with the Patient-Centered Outcomes Research Institute (PCORI), an independent nonprofit research funding organization. PCORnet, the National Patient-Centered Clinical Research Network, which is funded by PCORI, will support the ACTIV-6 governance and operations. In addition, PCORnet sites will enroll participants from a broad range of communities.

“Getting approval for a new drug to come to market usually takes years,” said Joni Rutter, Ph.D., NCATS acting director. “By leveraging drug repurposing and existing national clinical trial networks, ACTIV-6 aims to speed the delivery of definitive answers about available drugs that could help people manage COVID-19 symptoms at home.”

About the National Center for Advancing Translational Sciences (NCATS): NCATS conducts and supports research on the science and operation of translation — the process by which interventions to improve health are developed and implemented — to allow more treatments to get to more patients more quickly. For more information about how NCATS helps shorten the journey from scientific observation to clinical intervention, visit https://ncats.nih.gov.

About the National Institutes of Health (NIH): NIH, the nation's medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.gov.

NIH…Turning Discovery Into Health®

https://www.nih.gov/news-events/news-releases/large-clinical-trial-study-repurposed-drugs-treat-covid-19-symptoms


Monday 19 July 2021

Covid: Is China's vaccine success waning in Asia?

 Across Asia, Chinese vaccines have played a crucial role in immunising people against Covid-19, with millions receiving either a Sinovac or Sinopharm jab.

By Tessa Wong

BBC News

Published
An Indonesian student reacts as he receives his first dose of China's Sinovac Biotech vaccine for the coronavirus disease (COVID-19) at a high school, as the cases surge in Jakarta, Indonesia, 1 July 2021.IMAGE COPYRIGHTREUTERS
image captionIndonesia has been mainly using Sinovac's vaccine in its Covid immunisation programme

But in recent weeks, concerns have grown about their efficacy. Now, some Asian countries which made Chinese vaccines a key plank in their immunisation programmes have announced they will use other jabs.

The move has raised questions, not only about whether China's vaccines can be trusted, but also about its attempts at vaccine diplomacy in Asia.

What's happening in Thailand and Indonesia?

Last week, Thailand announced it was changing its vaccine policy - instead of receiving two Sinovac shots, residents will now get a mix of Sinovac and AstraZeneca.

Healthcare workers who are already fully vaccinated with Sinovac will also get a different jab as a booster shot.

Indonesia announced a similar move the previous week, saying it was giving Moderna booster shots to healthcare workers immunised with Sinovac.

The decisions followed reports that hundreds of fully vaccinated healthcare workers had caught Covid, with some of them - two in Thailand and 30 in Indonesia - dying.

Both countries, which have seen slow rollouts of their vaccination programmes, have been battling new outbreaks. Thailand is now reporting record high numbers of infections and deaths, while Indonesia - the new epicentre of Covid in Asia - has seen overcrowded hospitals and oxygen shortages.

Ketut Nomer, a 59-year-old patient suffering from coronavirus disease (COVID-19), rests as his 28-year-old son Gede Zico sits taking care of him, at a temporary tent outside the emergency ward of a government hospital in Bekasi, on the outskirts of Jakarta, Indonesia, 25 June 2021.IMAGE COPYRIGHTREUTERS
image captionIndonesia is currently in the throes of a new Covid outbreak

The two countries said they were making the switch to increase protection, and Thai officials cited local studies which showed mixing vaccines could boost immunity.

Indonesia's tourism minister Sandiaga Uno also recently told the BBC the Sinovac vaccine was "quite effective".

But by choosing to switch vaccines, the Thai and Indonesian governments were essentially "saying they are concerned about vaccine failure", said Dale Fisher, who heads the World Health Organization's Global Outbreak Alert and Response Network.

However, he also cautioned that there was not enough information about the healthcare workers' infections and deaths, and urged authorities to conduct a "thorough investigation".

Sinovac has yet to comment.

Since then, Malaysia announced it was switching to Pfizer's vaccine after it finished its Sinovac supplies.

But other countries like the Philippines and Cambodia are continuing to use Chinese vaccines.

Are the Chinese vaccines effective?

In clinical trials across the world, Sinovac and Sinopharm's inactivated virus vaccines have been shown to be 50% to 79% effective in preventing symptomatic Covid infection.

But they are still highly effective in preventing Covid hospitalisations or deaths - studies found Sinovac's jab was 100% effective in Brazil and 96 to 98% effective among Indonesian medical workers.

The fact that there are still numerous breakthrough infections in fully vaccinated people could be due to several factors, says epidemiologist Professor Benjamin Cowling, of Hong Kong University.

One is that the Chinese vaccines, like many other vaccines, may wane in efficacy over time. A Thai study released this week found that antibodies in those fully vaccinated with Sinovac decline by half every 40 days.

Another is that the clinical trials had smaller datasets compared to real-world infections, particularly in Indonesia which is seeing soaring daily infection numbers in the tens of thousands.

It could also be due to the more infectious Delta variant, which has been detected in 60% of recent cases in Indonesia and 26% of cases in Thailand's capital Bangkok.

There is no public data yet on the Chinese vaccines' efficacy against any of the Covid variants. But preliminary studies have suggested that inactivated virus vaccines, like Sinopharm and Sinovac's, could offer 20% less protection against the Delta variant than against the original virus, according to Prof Cowling.

No vaccine is fully effective in preventing Covid infection, he said, and while the Chinese vaccines "are not 100% effective, they are still saving many lives". Experts stress that breakthrough infections do not mean vaccines are pointless, as immunisation helps to stop people from getting very sick with Covid-19.

A medical worker prepares a syringe with a dose of China's Sinovac coronavirus disease (COVID-19) vaccine at the Central Vaccination Center, inside the Bang Sue Grand Station, in Bangkok, Thailand, 24 May 2021.IMAGE COPYRIGHTREUTERS
image captionThere is no public data available on how effective the Chinese vaccines are against the Delta variant

There are also no reports yet of breakthrough infections in China, where more than 630 million have taken at least one shot of a Chinese vaccine. It is not known how many of them are fully vaccinated.

But the virus is thought to be controlled in China, which is reporting low daily infection rates and has moved swiftly to stamp out local outbreaks.

How does this affect China's vaccine diplomacy?

As the region that's received the most number of Chinese shots, Asia has been a key linchpin in China's vaccine diplomacy strategy.

More than 30 Asian countries have bought jabs or received donated shots. Indonesia is one of the biggest buyers of Sinovac vaccines in the world having ordered 125 million doses.

China's eagerness to sell or donate vaccines has been "an effort to change the narrative away from the fact that infections were first detected in Wuhan, and to show that it's a scientific powerhouse", said China expert Ian Chong, of the National University of Singapore.

With richer countries monopolising many of the early orders of other vaccines, many countries in Asia - particularly poorer ones - welcomed the Chinese jabs.

"The standard thinking was that 'some protection is better than no protection', even though at the time efficacy data wasn't great," said Dr Chong.

Thailand, for instance, had initially counted on a local firm owned by the king to produce the bulk of its vaccines, but the slow delivery timeframe forced the government to seek other sources after fresh Covid outbreaks this year.

Besides locally manufactured AstraZeneca vaccines, it has ended up relying mostly on Sinovac's jab for now, because the Chinese firm was one of the first to deliver.

A Thai health volunteer stands in front of a campaign banner for Chinese made Sinopharm vaccine during a mass vaccination drive for disabled and disadvantaged people in Bangkok, Thailand, 25 June 2021.IMAGE COPYRIGHTEPA
image captionThailand has also received some Sinopharm doses

Thailand and Indonesia's decisions to switch to other vaccines "could potentially puncture the image of success, bursting the bubble of effectiveness of Chinese vaccines, and in effect calls into question the technical prowess of China," said Dr Chong.

The Chinese government has yet to comment, but in the past has insisted that its vaccines are effective.

How is the public reacting?

Both Thailand and Indonesia's governments are facing mounting criticism over their slow vaccination rollouts and worsening Covid situations.

In Thailand, the outrage has been further fuelled by a leaked health ministry document quoting an official who opposed giving medical workers a Pfizer booster shot as it would be "an admission that Sinovac can't give protection".

"There is a lot of anger among the Thai public, they're saying 'why don't you care about healthcare workers', 'this should not be a factor'. Many people have deep concerns about the government's communications and reliance on Sinovac," said Dr Arm Tungnirun, director of the Chinese Studies Center at Chulalongkorn University.

"Right now there is an increasing number of people who reject Sinovac, who believe it's not effective. There's a big distrust in the Thai government, and the vaccine issue has become heavily politicised."

On Sunday, hundreds of protesters marched in Bangkok calling for the prime minister's resignation over his handling of the crisis, and also demanded that mRNA vaccines such as Pfizer or Moderna's be brought in .

There are fears that the latest reports of breakthrough infections will fuel overall scepticism in vaccines. In Indonesia, religious social media influencers and conspiracy theorists have already been spreading anti-vaccine messages laced with anti-Chinese sentiment.

Experts are urging tighter infection controls and greater efforts in combating misinformation online.

Says Prof Cowling: "It's great that we are using [the Chinese vaccines] but we can't expect too much of them.

"We have to recognise that there will be breakthrough infections and be ready to deal with them, because they can damage confidence in the vaccines."

media captionIndonesia is battling an oxygen shortage amid a Covid surge

More on this story

https://www.bbc.com/news/world-asia-57845644