COVID 19 Vaccines – Types, Dose, Efficacy, Side effects

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covid 19 vaccines in pakistan types dose efficacy cost

This topic was presented in our online class presentation by Dr. Tayyaba Noor (Postgraduate Resident, Pakistan Institute Of Medical Sciences, Islamabad).

A Brief Introduction about COVID-19 Timeline and Vaccines:

  • December 31, 2019:
    • China alerts WHO to several unknown cases of pneumonia in WUHAN, the disease goes on to be named COVID-19.
  • January 11, 2020:
    • China reported its first known death from COVID.
  • March 11, 2020:
    • WHO declares COVID 19 as a pandemic,118,319 cases globally
  • April 2nd, 2020:
    • Confirmed COVID-19 cases top 1 million worldwide.

In Pakistan:

  • Feb 26th, 2020:
    • The first case of COVID 19 identified in Karachi
  • Mar 18th, 2020:
    • First COVID death reported in Pakistan.
  • Jun 7th, 2020:
    • COVID-19 cases reach up to 100,000.

How COVID 19 Vaccines Work?

COVID-19 vaccines help our bodies develop immunity against the disease. Different types of vaccines work in different ways to offer protection, but with all types of vaccines, the body is left with a supply of “memory” T-lymphocytes as well as B-lymphocytes that will remember how to fight that virus in the future.

It typically takes a few weeks for the body to produce T-lymphocytes and B-lymphocytes after vaccination. Therefore, it is possible that a person could be infected with the virus that causes COVID-19 just before or just after vaccination and then gets sick because the vaccine did not have enough time to provide protection.

Sometimes after vaccination, the process of building immunity can cause symptoms, such as fever. These symptoms are normal and are a sign that the body is building immunity.

The Different Types of COVID 19 Vaccines:

Currently, there are three main types of COVID-19 vaccines that are or soon will be undergoing large-scale (Phase 3) clinical trials.

  1. mRNA vaccines:
    • These vaccines contain mRNA sequences to make a harmless protein that is unique to the virus. After our cells make copies of the protein, they destroy the genetic material from the vaccine. T-lymphocytes and B-lymphocytes remember how to fight the virus that causes COVID-19 if we are infected in the future.
  2. Protein subunit vaccines:
    • These vaccines include harmless pieces (proteins) of the virus instead of the entire germ. Once vaccinated, the immune system recognizes those proteins and begins making T-lymphocytes and antibodies. If we are ever infected in the future, memory cells will recognize and fight the virus.
  3. Vector vaccines:
    • These vaccines contain a weakened version of a live virus – a different virus than the one that causes COVID-19 – that has genetic material from the virus that causes COVID-19 inserted in it (this is called a viral vector). Once the viral vector is inside our cells, the immune response is the same as explained earlier.

covid 19 vaccines in pakistan side effects

COVID 19 Vaccines – Types, Dose, Efficacy, Cost, and Side effects:

BioNTech andPfizer BNT162B2:

The Pfizer-BioNTech COVID-19 vaccine was sent to the FDA for possible Emergency Use Authorization (EUA) in November 2020 and authorized in Dec. It is an mRNA vaccine that codes for the virus’s spike protein and is encapsulated in a lipid nanoparticle.

In Phase III trials, it demonstrated 95% efficacy. The Pfizer-BioNTech vaccine requires storage at about -94 degrees F, which requires specialized freezers.

Side effects of BNT162b2 (BioNTechand Pfizer):

  • Local and systemic side effects can occur.
  • Side effects are dose-dependent and relatively common after the second dose
  • Fever may occur in 16%
  • Moderate to severe fatigue has been reported in 38%.
  • Headache has been reported in 28%
  • Chills occur in 18%
  • Rates of side effects among older participants were slightly lower.
  • Anaphylactoid reactions noted in some patients.

Type, Dose, Price, Efficacy:

  • Type: mRNA
  • Doses: 2 doses administered intramuscularly 21 Days Apart (0.3ml each)
  • Price: $19.50 per dose
  • Efficacy: About 95%
  • Variants: Lab data suggest “quite effective” against the UK variant as well as the South African and Latin American variants.

Moderna MRNA 1273 Vaccine:

On November 16, Moderna issued a preliminary data readout out of its COVID-19 vaccine, suggesting an efficacy rate of 94.5%. It was authorized by the FDA on December 19 for EUA. Like the Pfizer-BioNTech vaccine, it is an mRNA vaccine.

Unlike that vaccine, however, the Moderna vaccine is stable at 36 to 46 degrees F, about the temperature of a standard home or medical refrigerator, for up to 30 days and can be stored for up to six months at -4 degrees F.

Side effects of Moderna Vaccine:

The most common side effects are:

  • In the arm where you got the shot:
    • Pain
    • Swelling
    • Redness
  • Throughout the rest of your body:
    • Chills
    • Tiredness
    • Headache, nausea, vomiting
    • Myalgias, arthralgias

Type, Dose, Price, Efficacy:

  • Type: mRNA
  • Doses: 2 doses, 28 Days Apart (0.5 ml each)
  • EUA Date: December 18, 2020
  • Price: $25-$37 per dose
  • Efficacy: About 94.1%
  • Variants: Lab data suggest “quite effective” against the UK variant as well as the South African and Latin American variants.

Oxford, AstraZeneca, Serum Institute of India CHADOX1 NCOV-19/AZD1222 Vaccine:

On November 23, AstraZeneca and the University of Oxford announced high-level results from an interim analysis of their COVID-19 vaccine, AZD1222. The analysis was from the trials in the UK and Brazil and demonstrated the efficacy of up to 90%. The vaccine was effective at preventing COVID-19, with no hospitalizations or severe cases in people receiving it.

Approved for use by DRAP in Pakistan.

Side effects of the vaccine:

  • fatigue, headache, and fever – 8% in earlier phases.
  • In the phase III trial, 2 cases of transverse myelitis. One was thought to be possibly related to vaccination. The other was thought to be possibly related to a previously unrecognized multiple sclerosis.

Type, Dose, Efficacy, Cost:

  • Type: Adenovirus-based
  • Doses: 2, 28 Days Apart
  • EUA Date: Authorized in UK, Argentina, India, and Mexico on January 12, 2021
  • Price: $25-$37 per dose
  • Efficacy: Currently about 70% overall
  • Variants: At least one study finds it has little effect against the South African variant but appears effective against the UK and Brazilian variants.

Novavax NVX-COV2373 Vaccine:

On January 28, 2021, Novavax announced that its COVID-19 vaccine, NVX-CoV2373, hit the primary endpoint with a vaccine efficacy of 89.3% in its Phase III trial in the UK. The vaccine is a protein-based COVID-19 vaccine candidate containing a full-length spike protein.

Side effects:

  • 6% experienced systemic effects (mainly fatigue, headache, myalgias, and/or malaise) following the second dose.

Types, Cost, Efficacy:

  • Type: Protein-based vaccine
  • Doses: 2, 21 days apart
  • Likely EUA Date: Possibly in March or February 2021 in the UK; possibly later in the U.S.
  • Price: $16 in the US
  • Efficacy: 89.3%
  • Variants: Effective against UK and South African

Sinopharm BBIBP-CORV Vaccine:

An inactivated vaccine based on a SARS-CoV-2 isolate from a patient in China.

Side effects:

  • Local Side effects: Swelling, itching, erythema, and flushing
  • Systemic Side effects: Headache, fever, chills, flu, fatigue, nausea, diarrhea,  body aches, and cough.

Types, Dose, Efficacy, Cost:

  • Type: Inactivated Vaccine (Aluminum hydroxide adjuvant)
  • Dose: IM, 2 doses 28 days apart.
  • Efficacy: 79% (86% IN UAE)
  • Storage: 2 – 8 C
  • Licensed in UAE based on interim data from a phase III efficacy data from the trial in that country. Approved in China, Bahrain, Egypt, and Jordan.

Currently Being given in Pakistan to health care workers in the initial phase.


Jansen AD26.COV2.S COVID Vaccine:

Johnson & Johnson announced on November 15 that it initiated a second global Phase III trial of its Janssen COVID -19 vaccine.

Whereas all of the other three vaccine candidates require two doses about 28 days apart, the J&J vaccine only requires a single dose.

Interim results from its Phase I/IIa trial demonstrated a single dose of the vaccine-induced a robust immune response and was generally well-tolerated. The ENSEMBLE 2 study evaluated a two-dose regimen as well.

The Phase III ENSEMBLE trial demonstrated the single-shot vaccine is 66% effective overall in preventing moderate-to-severe COVID-19, 28 days after vaccination. However, it demonstrated 100% efficacy ad preventing severe disease after day 49.

Type, Dose, efficacy, Cost:

  • Type: Adenovirus-based
  • Doses: 1 and 2 dose schemes are being tested
  • Likely EUA Date: Possibly March or April 2021
  • Price: $10 per dose
  • Efficacy: Unknown yet
  • Variants: Based on clinical studies in Africa, UK, and Latin America, there is evidence the vaccine is effective against the variants, although less so against the South African and Latin American strains.

Gamaleya Institute, Russia SPUTNIK V Covid Vaccine:

Around November 11, Russia’s National Research Center for Epidemiology and Microbiology, which Russia authorized for use in August—ahead of even beginning a Phase III trial—claimed had an efficacy rate of 92% after the second dose.

It was based on a first interim analysis 21 days after the first injection during the ongoing Phase III study. On November 24, the organization claimed 95% efficacy based on new preliminary data.

The organization has indicated a dose of the vaccine will cost no more than $10, about half the cost of the Pfizer vaccine. At this time, aside from Russia, it will potentially be sold in India, Korea, Brazil, China, and Hungary.

On February 2, 2021, The Lancet published Phase III data demonstrating a 91.6% efficacy against the original strain of the virus. The vaccine has been approved by DRAP in Pakistan

Type, Dose, Efficacy, Cost:

  • Type: Adenovirus-based
  • Doses: 2
  • Likely EUA Date: Not applicable in the U.S.
  • Price: $10 per dose
  • Efficacy: 91.4%
  • Variants: Unknown. Clinical trial data was largely conducted in Russia prior to the emergence of major variants.

CanSino Biologics AD5-BASED COVID-19 Vaccine:

CanSino Biologics vaccine was co-developed with the Chinese military. It has an efficacy rate of 65.7% at preventing symptomatic cases. This is based on a multi-country analysis first posted by Pakistan,s health advisor on February 8, 2021.

The Phase III trial includes 30,000 participants and demonstrated 90.98% efficacy in preventing severe disease.

PAKISTAN is running one of the largest trials and has contracted for 20 million shots. It is also working with the WHO for approval of vaccine through the COVAX program.

Type, Dose, Cost, Efficacy:

  • Type: Viral vector, loading an antigen from the SARS-CoV-2 virus onto an adenovirus.
  • Doses: 1
  • Price: Unknown
  • Likely EUA Date: Not applicable in the U.S.
  • Efficacy: 65.7% at preventing symptomatic cases; 90.98% efficacy in preventing severe disease.

Sinovac, China CORONAVAC Vaccine:

On January 13, 2021, China-based Sinovac Biotech reported that its COVID-19 vaccine had a 50.38% efficacy in late-stage clinical trials in Brazil.

The company’s clinical trials are demonstrating dramatically varying efficacy rates. In Indonesia, a local trial demonstrated an efficacy rate of 65%, Turkey reported an efficacy rate of 91.25%. Another trial in Brazil reported last week a 78% efficacy rate in mild cases while 100% against severe and moderate infections.

Type, Dose, Cost, Efficacy:

  • Type: Inactivated SARS-CoV-2 virus
  • Doses: 2
  • Likely EUA Date: Not applicable in the U.S.
  • Price: $60 per dose in China
  • Efficacy: 50.38% to 91.25%, depending on the clinical trial
  • Variants: Unknown, although a study in Brazil demonstrated 50.4% efficacy at preventing symptomatic infections.

RBD DIMER, ANHUI ZHIFEI & CAS,CHINA ZF2001 Vaccine:

A coronavirus vaccine candidate developed by the Chinese Academy of Sciences (CAS) was found to be safe and triggered immune responses in early and mid-stage trials. ZF2001 is a protein subunit vaccine, which uses a harmless piece of the SARS-CoV-2 virus rather than the entire germ. Phase 3 trials are being conducted in many countries including Pakistan, Malaysia, and Uzbekistan.

Type, Dose, efficacy:

  • Type: protein subunit
  • Doses: 3 doses, one month apart.
  • Efficacy: not yet established.

COVID 19 Vaccination in Pakistan:

Pakistan has so far approved three vaccines for EUA:

  • Sinopharm
  • Astrazeneca by Oxford
  • Sputnik by Russia

While two candidate Vaccines are conducting phase 3 clinical trials:

  • CanSino ( NIH, UHS, AKUH, SIH)
  • RBD Dimer (UHS, AKUH) Both by China

The first covid vaccine shipment containing half a million SINOPHARM vaccines has arrived in Pakistan, further, we have also secured 17 million indicative doses of the ASTRAZENECA vaccine, out of which 35-40 percent or 6 to 6.8 million doses will be available within the first quarter of the current year.

A ray of hope but we still have a long way to go

covid 19 vaccines in pakistan types dose efficacy cost get vaccinated

Don’t Forget!

Wash Hands

Use Face Masks

Keep Distance

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