I may need to revaccinate for legal reasons. Where can I get advice?
July 1, 2021 2:31 AM   Subscribe

I was vaccinated with one shot J&J in the US, but it doesn't appear the Indonesian government will easily accept that as proof for travel. I need to travel domestically for work. Who on earth can I ask about which vaccine available here is safest if I can't figure out another solution?

Dr. Google is not supplying much in the way of answer. My doctor here is obviously not a virologist and had no advice for me. I can't be the only person in the world with this issue, right? So who can I ask?

Obviously, I will first try to get the government here to accept it, but the flimsy little CDC card is not much good outside of the US so I see the Indonesian point given that we are desperately fighting off Delta.
posted by frumiousb to Health & Fitness (11 answers total) 2 users marked this as a favorite
Who on earth can I ask about which vaccine available here is safest if I can't figure out another solution?

To be clear, by "here" you mean Indonesia, right?
posted by trig at 3:20 AM on July 1, 2021

Response by poster: Sorry-- I think nobody in Indonesia will be able to answer the question, so I'll gladly take advice from other countries. I have no idea who to call with this kind of question.
posted by frumiousb at 3:36 AM on July 1, 2021 [1 favorite]

I don't think there's much data yet about vaccine mixing, especially with the J&J vaccine. The NIH has only now started a trial where 50 of the subjects are people who had the J&J vaccine and will receive a Moderna booster 12-20 weeks afterwards. Initial results are due in "late summer" of this year, but subjects will be tracked for a whole year.

There are some articles about a few experts gambling on mRNA (Moderna, Pfizer) boosters for themselves after having gotten the J&J vaccine (non-mRNA), and there are studies underway about mixing mRNA and other non-mRNA vaccines besides J&J. There may also be studies on mixing different non-mRNA vaccines, but I haven't checked.

I don't think there's anyone you can call who can give a real definitive answer yet because not enough research has been done. At the same time, early results have been promising and it looks like this is an approach that's attracting a lot of interest, partly because of availability and partly to strengthen immunity to the Delta variant. That BBC article notes that some countries are already offering people the ability to get mixed doses.

Which vaccines are available to you?
posted by trig at 4:16 AM on July 1, 2021 [2 favorites]

Also, there's this current (conservative) guidance from the CDC about mixing J&J (but in the opposite order than what you'd be doing):
The safety and efficacy of Janssen COVID-19 vaccine administered after an mRNA COVID-19 vaccine has not been established. However, in limited, exceptional situations where a patient received the first dose of an mRNA COVID-19 vaccine but is unable to complete the series with either the same or different mRNA COVID-19 vaccine (e.g., due to contraindication), a single dose of Janssen COVID-19 vaccine may be considered at a minimum interval of 28 days from the mRNA COVID-19 vaccine dose. See Contraindications and Precautions section for additional information on use of Janssen COVID-19 vaccine and additional precautions in people with a contraindication to mRNA COVID-19 vaccines. Patients who receive Janssen COVID-19 vaccine after a dose of an mRNA COVID-19 vaccine should be considered to have received a valid, single-dose Janssen vaccination—not a mixed vaccination series—and are considered fully vaccinated against COVID-19 ≥2 weeks after receipt of the single dose of the Janssen vaccine.
Here's a brief roundup of some of the current trials and guidelines in different countries.
posted by trig at 4:34 AM on July 1, 2021 [2 favorites]

Best answer: So it sounds like your options in Indonesia are Oxford/AstraZeneca, Sinovac CoronaVac, and Sinopharm BIBP - I don't know whether any one of these is more or less readily available than the others, which might influence your decision. It seems like mRNA vaccines aren't in the picture in Indonesia right now, so info about combining mRNA and other types of vaccines is of limited use to you.

It sounds like you're more concerned about safety than efficacy (given that you already expect to have an acceptable level of immunity from your J&J dose). So far I don't think any safety concerns have been raised about Sinovac/Sinopharm, which are both inactivated virus vaccines. You can read the WHO interim recommendations for Sinovac and Sinopharm - tl;dr is that they don't seem to be causing any unexpected adverse effects (i.e. a very small percentage of people have serious adverse effects or allergic reactions). Post-authorization surveillance for these vaccines has happened in China/Brazil/Indonesia rather than the US/UK/EU surveillance that the vaccines most MeFites are more familiar with have gotten - I don't know how pharmacovigilance standards differ from place to place, although I'm sure there are differences, but these vaccines have been administered tens of millions of times and no one's noticed anything like the AZ/J&J clotting disorders. Of course the Chinese vaccines haven't been extensively tested on people who have already had the J&J vaccine but I don't think there's any reason to suspect that that would be important from a safety perspective.

AstraZeneca works the same way as the J&J vaccine you've already gotten and has a similar risk profile. A plus for AstraZeneca is that it is approved in more places in case you eventually want to travel somewhere else that doesn't recognize either J&J or the Chinese vaccines. The minus is that there are known serious adverse effects (although they are still very rare, depending on your demographic group).

With the AZ vaccine, the second dose has a much lower incidence of the serious adverse effect (VITT/clotting) than the first dose, and given that the J&J vaccine works the same way and has the same known adverse effect, it's not unreasonable to guess that a dose of AZ after a dose of J&J would also have a lower risk of adverse effect (but this is just an informed guess and the chances of us getting conclusive data about it are extremely low due to the rarity of the adverse effect and the unusual circumstance of getting AZ after J&J).

Anyway: I don't think there's any reason your previous vaccination would make another vaccine less safe or less effective, so you can probably just make your decision about which one to get as though you had never previously been vaccinated. The tricky bit is that you're taking on the (very small!) risk of vaccination mostly for convenience/ability to travel rather than for actual protection agains COVID-19 (although it's entirely possible a second vaccine will act as a booster and give you more immunity), which may influence the degree of risk you're willing to take on.
posted by mskyle at 5:56 AM on July 1, 2021 [3 favorites]

Best answer: mskyle's comment aligns with my current (not a medical professional) understanding. Canada, where I am, is one of the places doing trials of mixed vaccine courses (specifically, one shot of Astra Zeneca followed by an mRNA vaccines (Pfizer or Mederna), but the J&J vaccine was administered in remote Northern communities, so Health Canada might have some info on following J&J with a dose of another vaccine?). I haven't heard concerns that mixing vaccines changes their side effects safety - the current research seems to be focused instead on efficacy of mixed vaccine courses in preventing covid-19. But, as mskyle notes, the one-dose J&J vaccine that you've already taken has given you a substantial degree of protection against covid-19 already, so I don't think that's a detail that you need to worry about as much. Although, if I'm understanding the numbers correctly, if the Delta variant is rampant where you are, your risk of contracting a breakthrough case of covid-19 despite being vaccinated with J&J (which isn't as effective as the mRNA vaccines) is still higher than risk from side effects of Astra Zeneca, even though one of the mRNA vaccines would be a better option were they available? I don't know anything about the other vaccines available to you.

In your very general area of the world, I find that Dr. Siousxie Wiles (recent New Zealander of the year) gives very clear (to us non-experts) and accurate info about all matters pandemic. You could probably submit a question to her via The Spinoff, Twitter, or other contact methods, too, and she probably would know more about these other vaccines than someone with a more Western focus?
posted by eviemath at 6:12 AM on July 1, 2021 [1 favorite]

I suspect a Pfizer/Moderna booster is going to be recommended for those who obtained J&J in the US. There are already articles advocating for it and experts tweeting about doing it themselves. There's a robust discussion in our local vaccine hunters group about exactly how to do this - some folks are being up front with pharmacists and some have had luck getting a second type, but others are turned away. People are also going to no-ID community clinics and not disclosing their previous vaccination status.
posted by mcgsa at 7:36 AM on July 1, 2021 [1 favorite]

It looks like you'll just need a pre-flight Covid test if you're flying - proof of vaccination doesn't look like a requirement on the Garuda Indonesia or Air Asia sites.

This page has Garuda's "what you need for domestic flights" info - click the "domestic" tab to reveal various destinations' requirements. Here's Air Asia's page on Indonesia's domestic travel requirements.

You could also call or stop by one of the Garuda Indonesia offices scattered around Jakarta's malls to ask in person, if they're open. Here's a list of locations.
posted by mdonley at 8:35 AM on July 1, 2021

I also got J&J and want a second shot (partly because there's data showing that a single shot of AstraZeneca, which is similar, is not very effective at preventing infection with the Delta variant). Even though there isn't any guidance on this yet where I am, in the U.S., Canada's approval of vaccine mixing makes me feel more confident about it. But I don't think Indonesia would consider you officially vaccinated if you mix vaccines. I just think it might be a good idea for preventing infection.
posted by pinochiette at 9:29 AM on July 1, 2021

Response by poster: Hi mdonley, thanks. We’re going into stricter lockdown on 3 July and my information comes from the embassy. It’s Indonesia, and they could change their mind again, but you can assume since I live here and travel for work I have the possibilities straight.
posted by frumiousb at 5:26 PM on July 1, 2021 [2 favorites]

Response by poster: And to the others, thanks! My choices seem to be sinovac and Astra Zeneca. I also am concerned ethically with taking the shot out of the arm of someone who actually needs it.
posted by frumiousb at 5:28 PM on July 1, 2021 [2 favorites]

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