Evaluation Comparison of the Effectiveness of Full Dose Pfizer

Vaccine with Pfizer Booster Society in Indonesia

Marthius Putra Yehezkie and Diana Laila Ramatillah

Faculty Pharmacy, Universitas 17 Agustus 1945 Jakarta, Indonesia

Keywords: Vaccine Effectiveness, the Complete Dose of Pfizer, Pfizer Booster, and Society in Indonesia.

Abstract: Efforts to socialize vaccination programs to achieve herd immunity worldwide are increasingly being

carried out. The vaccination program is aimed at all people in the world, especially in Indonesia. In addition

to full-dose vaccination, now booster vaccination is also shown to all people in the world, especially in

Indonesia. The Indonesian government provides several types of full-dose vaccines as well as boosters, one

of which is Pfizer. This study was conducted to evaluate the effectiveness comparison between the complete

dose of Pfizer vaccine and Pfizer Booster in the community in Indonesia. This type of research is

observational with a prospective invitational method. This study involved 600 respondents, of which 300

respondents were Pfizer boosters and 300 respondents were Pfizer complete doses. In this study, there were

372 males and 228 females. A significant correlation was found between the type of vaccine with side

effects, age with side effects, and BMI with side effects. The effectiveness of each vaccine was 99.3% for

the Pfizer booster and 99.1% Pfizer full dose vaccine. From this study, it can be concluded Pfizer booster

more effective compare to full dose Pfizer vaccine.

1 INTRODUCTION

In late 2019, the coronavirus 2019 (COVID-19)

outbreak became a public health threat to people

worldwide. The lower respiratory tract is the main

target for severe respiratory disease (SARS-CoV-2)

infections (Lee et al., 2020) It was recorded on the

official Covid- 19 website regarding the

Development of Covid-19 Cases in Indonesia in the

March 2022 update, and there were 5,630,096

confirmed positive patients and 4,944,237 recovered

patients, and 149,036 deaths. Caused by

Coronavirus Disease 2019 (COVID19) Severe Acute

Respiratory Syndrome Coronavirus 2 (SARSCoV2)

has been declared a new pandemic by the World

Health Organization (WHO) ‘(Anka et al., 2021).

Vaccines are a way to control outbreaks of infectious

diseases and reduce the risk of pandemics and

epidemics. The sooner the vaccine is distributed, the

sooner the outbreak can be brought under control

‘(Excler et al., 2021). The Ministry of Health of the

Republic of Indonesia provides six types of

clinically passed Covid-19 vaccines for people in

Indonesia that can be used by people in Indonesia,

namely Sinovac, Astrazeneca, Moderna, Pfizer,

Sinopharm, Janssen.

The first Covid 19 vaccine approved by the

world's

regulatory agencies to prevent respiratory

syndrome

coronavirus 2 (SARSCov2) is a comirnaty

vaccine developed by Pfizer and BioNTech

‘(Nittner-Marszalska et al., 2021). The Pfizer-

Biotech Covid-19 vaccine is an mRNA vaccine in

which lipid nanoparticles are modified utilizing

nucleosides. Encoding the spike glycoprotein of

SARS-CoV-2, the cause of the coronavirus disease

(COVID19) (Sutardi and Ramatillah, 2022)

The Pfizer-BioNTech (BNT162b2) vaccine is an

mRNA- vaccine containing modified lipid

nanoparticles made using a nucleoside, which

encodes the SARS-CoV-2 spike glycoprotein and is a

coronavirus disease (coronavirus disease) (Sutardi

and Ramatillah, 2022). According to research by The

New England journal of medicine on Safety and

Efficacy of the BNT162b2 mRNA Covid-19

Vaccine. The efficacy of the Pfizer Vaccine against

COVID-19 is 95% (Polack et al., 2020).

Acquired Herd Immunity is formed at the

individual level by natural infection by pathogens or

by vaccines. Several current clinical trials are

underway to evaluate new vaccine candidates and

drug replacement strategies for preventing and

treating SARS-CoV-2 disease. However, it is

206

Yehezkiel, M. and Ramatillah, D.

Evaluation Comparison of the Effectiveness of Full Dose Pﬁzer Vaccine with Pﬁzer Booster Society in Indonesia.

DOI: 10.5220/0011978800003582

In Proceedings of the 3rd International Seminar and Call for Paper (ISCP) UTA â

Z45 Jakarta (ISCP UTA’45 Jakarta 2022), pages 206-212

ISBN: 978-989-758-654-5; ISSN: 2828-853X

 2023 by SCITEPRESS – Science and Technology Publications, Lda. Under CC license (CC BY-NC-ND 4.0)

unclear whether these studies will result in effective

interventions, and although the optimistic estimate

of each vaccine study is at least 12-18, these studies

are considered effective ‘(Randolph and Barreiro,

2020).

1.1 Covid-19

Coronavirus (CoV) is part of the Coronaviridae

family. Coronavirus (COVID19) began to spread in

December 2019 and was detected in early January

2020. The virus began to spread in China from mid-

January to late January. The virus spreads in the host

and clinically shows several symptoms, such as the

common cold to respiratory infections ‘(Randolph

and Barreiro, 2020). Covid-19 is an RNA infection

in the form of a royal attribute, having a diameter of

approximately 60- 140 nm. It is transmitted through

inhalation, namely coughing and sneezing. The

Covid-19 virus enters the human nasal system by

inhalation and begins to replicate. The main receptor

for the Covid-19 virus is ACE2. Then the virus starts

to spread with a limited immune response and can be

detected with a feeling of discomfort in the nose.

The COVID-19 virus then spreads and reaches the

human respiratory tract, and the virus faces a more

robust innate immune response. Most Covid-19

patients are elderly/elderly patients, such as lung

disease, hypertension, malignant tumors, coronary

heart disease, and chronic kidney disease

(Ramatillah and Isnaini, 2021).

The Covid-19 virus belongs to the category of

betacoronavirus viruses, such as MERS-CoV and

SARS-CoV-1. The virus comes from animals,

namely bats. The patients in the United States were

similar to those obtained in China, suggesting the

possible emergence of this new virus from animal

reservoirs. There were reports that several pets had

previously tested positive for SARS-CoV-2 in

several countries such as Hong Kong, Belgium, and

New York City zoos (López, de Casas Moreno and

Mera, 2021)

The Covid-19 virus attacks the immunity of

humans. Immunity in humans is the best fortress.

The individual's immune system is divided into three

categories, namely native immunity (quickly),

adaptive immunity (long term), and passive

immunity. The human immune system can detect

and support antibodies, defending against viruses or

invading germs. However, when it first attacks the

body, the immune system cannot work correctly, and

we become sick. Precisely what happened like

Covid-19 (Ramatillah and Isnaini, 2021)

1.2 Symptom

Symptoms in patients with COVID-19 are similar to

Middle East Respiratory Syndrome (MERS),

starting from 2-14 days of exposure to SARS-CoV-2.

Causes such as high body temperature, fatigue, and

phlegm. In a sick person found, there are symptoms

such as weakness, flu, inflammation, and excretion.

These causes are usually easy and start slowly. Some

patients contracted SARS- CoV-2 infection but did

not show any reason and did not feel unwell(López,

de Casas Moreno and Mera, 2021)

A retrospective analysis was performed on

patients in Jinan and Rizhao, Shandong Province,

from January 23 to February 15. There were 53 cases,

including 67 cases with an average age of 41.47 years

(range 21-65 years), and 26 cases (49.1%) were men.

Most cases were mild (8 cases, 15.1%) and

conventional (44 cases, 83%), with only one severe

case (1.9%). The most common symptoms at the

beginning of the illness were fever (60.4%), dry

cough (54.7%), phlegm (37.7%), pharyngitis

(35.8%), and fatigue (32.1%). Less common

symptoms were headache (20.8%), anorexia

(15.1%), myalgia (13.2%), chest pain, (11.3%),

nausea (5.7%), diarrhea (3 .8%), dizziness

(3.8%), and vomiting (1.9%) (Asaduzzaman et al.,

2020).

1.3 Vaccine

Vaccination against (SARS-CoV-2) remains the

main hope in controlling the pandemic (COVID-

19). (WHO) Approves COVID19 Vaccine

Emergency Use List (EUL) contains (mRNA) Pfizer

BNT162b2. BioNTech (Pfizer, Inc; Philadelphia,

PA, USA) and Moderna mRNA vaccine 1273

(MODER) naTX, Inc.; Cambridge, Mass. USA);

Viral vector vaccines (AstraZeneca, Cambridge,

UK) and Janssen Ad26.COV2.S (Janssen Biotech,

Inc; a pharmaceutical company owned by Janssen,

Johnson & Johnson; New Brunswick, NJ, USA);

and

Sinopharm, Inactivated Virus Vaccine (China

National Pharmaceutical Group) and Sinovac

(Sinovac Biotech Ltd.; ‘(Al-Awwal et al., 2022)

AntiCoV2 vaccine was developed in a much shorter

time than previous vaccinations. Previous

vaccinations took 8 to 10 years for human use, while

the antiSARSCoV2 vaccine took 8 to 10 months

(Han et al., 2020)

Most Covid-19 vaccines need to be given in two

doses at intervals of 3-12 weeks to provide sufficient

immunity for recipients of the Janssen vaccine,

currently used as a single dose. The SARSCoV2

Evaluation Comparison of the Effectiveness of Full Dose Pﬁzer Vaccine with Pﬁzer Booster Society in Indonesia

207

spike protein mRNA vaccine was retrieved and

transcribed after being injected into host cells. It

produces spike proteins, is presented to B and T cells

on the cell surface, and induces an immune

response. The vaccines used are already weakened

germs, so they do not cause illness but create

immunity (Al-Awwal et al., 2022)

There are four types of vaccines, namely mRNA

vaccines developed by PfizerBioNTech and

Moderna. RNA and DNA vaccines are closer to

using RNA or DNA made as if it were safe to build

immune capabilities—vector vaccine virus

(adenovirus) developed by AstraZeneca, Johnson &

Johnson, Litera, Sputnik. Viral vector vaccines do

not cause disease but use genetically modified

viruses that detect viral germs to capture immunity

better. Inactivated viral immunization was

developed by Sinovac (Han et al., 2020.)

2 MATERIALS AND METHODS

2.1 Design

This study used a prospective cross-sectional study to

evaluate the comparative effectiveness of the Pfizer

full-dose and Pfizer booster vaccines in the

Indonesian population. A validated questionnaire

was used to collect the data. For the sampling

technique using convenience, the sampling follows

the inclusion criteria. Inclusion criteria are people in

Indonesia over 17 years who have received a total

dose of Pfizer vaccine or Pfizer Booster and are

willing to participate in the study. The exclusion

criteria were all Indonesians over 18 years of age

suffering from cancer, autoimmune diseases,

HIV/AIDS patients, pregnant women, and

Indonesians who only followed the 1st dose of the

Pfizer vaccine.

2.2 Participant

Participants in this study were all people in

Indonesia aged over 17 years who had been

vaccinated with a total dose of Pfizer or Pfizer

booster with a total of 600 respondents.

2.3 Data Analysis

The results obtained were analyzed using the SPSS

version 25 application. Fisher, Chi-square, Mann-

Whitney, and Kruskal-Walis tests were used to find

the relationship between risk factors (gender, age,

BMI, vaccine type) and side effects. A p-value of

0.05 was considered significant.

2.4 Ethical Approval

Ethical approval was obtained prior to conducting

the study. The ethical approval was sourced from the

health research ethics committee of the Universitas

17 Agustus 1945, Jakarta, with the approval letter

No.38/KEPK- UTA45JKT/EC/EXP/07/2022.

3 RESULTS AND DISCUSSION

3.1 Prevalence of Participants by

Domicile

The study this conducted in Indonesia with a

percentage domicile for each respondent 79% from

the island of Java, 18% from the island of Sumatra,

0.8% from the island of Kalimantan, 1.4%from the

island of Bali, 0.3% from the island of Sulawesi and

1.2% from the island of Ternate (figure 1). Domicile

is not one of the factors affecting vaccine

effectiveness and side effects.

Figure 1: Domicile.

3.2 Prevalence of Participants by

Comorbid

Figure 2 shows that from a total of 600 respondents,

each of the 300 respondents who received the total

dose of Pfizer vaccine and 300 respondents who

received the Pfizer booster, the percentage of

complications from the total was 0.3% diabetes,

0.3% hypertension, and 99.4%. Without

comorbidities.

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Figure 2 : Comorbidities

3.3 Relationship Between Types of

Vaccines and Side Effects

From the fisher test results, where the variable type

of vaccine as categorical data was analyzed with

side effects questions as other categorical data, the

results are as presented in table 1.

Significant results were obtained between the

type of vaccine and the side effects experienced by

vaccine participants after receiving the full dose of

Pfizer vaccine and Pfizer Booster. The results

showed that the Pfizer booster vaccine had more

side effects than the complete dose of the Pfizer

vaccine. It is known that from a total of 300

respondents who received the full dose of the

vaccine, 18% felt side effects such as fever, 32% felt

pain in the injection area, 8.6%.

Experienced diarrhea, 17% felt dizzy, 23% felt

drowsy after the vaccine, and 20.6% felt pain in the

upper arm. In contrast, in the other 300 respondents

who received the booster vaccine, 42.6% felt fever,

74% felt pain in the injection area, 4 .3% felt

diarrhea, 37.3% felt dizzy, and 45.6 felt drowsiness,

and 54% felt pain in the upper arm. In addition to

the type of vaccine, another variable that has a

significant correlation with the side effects that

appear is age.

3.4 Correlation Between BMI and

Vaccine Side Effects

Variables of age, side effects, and the efficacy of

each vaccine also have a significant correlation. In

this study, the range of respondents aged 17-66 years

with an average of 27 years. The details of the data

are presented in table 2.

From the results of the Man-Whitney test for

questions about side effects after the vaccine and test

results. Kruskal Wallis for questions regarding

monitoring side effects after 1-3 months after

receiving the vaccine.

3.5 Relationship Between Age and Side

Effects

The last variable that correlates with side effects and

efficacy is BMI. The average BMI obtained is 23.7,

shown in table 3.

Table 1: Relationship between types of vaccines and side effects.

Variable

Percentage %

p-value

Complete Dose (n=300)

Boosters

(n=300)

Fever after vaccine 54/18 128/42.6 0.000

Painful in area injection after vaccine 97/32.3 222/74 0.000

Diarrhea after vaccine

Dizzy after vaccine

Feel sleepiness after vaccine

Painful in arm bag. on after vaccine

26/8.6

51/17

69/23

62/20,6

13/4.3

112/37.3

137/45.6

162/54

0.020

0.000

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209

Table 2: Relationship between age and side effects.

Variable

Percentage

p-value

Age (n=600 mean – average=27)

Effect side pain in the area

injection after vaccine

319/52.1 0.006

Infection Covid after 3

month vaccination

8/1.3 0.001

Monitoring change

cycle menstruation 1-3 month

after vaccine

29/4.7 0.011

Monitoring easy feel

tired 2-3 months after

vaccine

49/7.9 0.013

Monitoring painful in arm

2-3 month after vaccine

94/15.3 0.017

Monitoring easy

dehydration after 2-3 month

after vaccine

78/12.7 0.006

*Man-Whitney test, Kruskal Wallis test

Table 3 : Correlation between BMI and vaccine side effects

Variable

Percentage

p-value

BMI (n=600 mean=23,7)

Monitoring fatigue after 1-3 month vaccine

47/7.6 0.001

Monitoring pain in arm after 1-3 month vaccine

52/6.4 0.000

Monitoring easy ehydration after 1-3 month vaccine

49/7.9 0.000

*Kruskal Wallis Test

4 DISCUSSION

4.1 Efficacy and Side Effects

From the results of the study, it was found that

people in Indonesia aged 17 years and over who

received the complete dose of Pfizer and Pfizer

booster vaccines, recipients of Pfizer booster vaccine

were higher than the Pfizer complete dose vaccine

levels of 99.3% for the Pfizer booster and

99.1 % for the full Pfizer dose. The results

showed that the sponsoring group had the option of

concurrently building up the level of the counter-

acting agent seen after two doses, implying that the

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decline in resistance after the third part would be

slower even though a shortfall of time had passed to

decide if the problem was.

Preliminary studies also show that antibody

quality is higher after getting a booster. This

immune system continues to create antibodies at

specific sites and results in the experience of

infection or immunization and exhibits a broader and

stronger immune response after the third dose. The

body's defense system has a second line of

protection in T cells to fight off infected cells.

Therefore, if antibodies are insufficient to prevent

contamination, T cells can intervene to control the

disease that previously contributed to the

disease/disease (Andrews et al., 2022).

Table 1 shows that the Pfizer booster vaccine has

more side effects than the Pfizer whole dose vaccine.

This is supported by the p-value of the variable,

which shows the number <0.005. Some significant

side effects were obtained, such as fever, pain in the

injection site, diarrhea after the vaccine, dizziness,

feeling drowsy, and pain in the upper arm. This is

because the booster vaccine uses a larger dose.

4.2 Correlation Between Age and Side

Effects

As shown in Table 2, age impacts vaccine side

effects. The results of this study indicate that the

average age of the vaccine participants is 27 years,

and several side effects arise, namely pain in the

area of the injection site, changes in the menstrual

cycle in women, easy feeling tired, and easy

dehydration. According to research in Saudi Arabia,

differences in the immune system at age greatly

affect the side effects after the vaccine, where the

immune system of younger people is stronger and

more efficient than the immune system of older

people(Alamer et al., 2021)

4.3 Correlation Between BMI and Side

Effects

As shown in table 3, BMI impacts vaccine side

effects. The results showed several side effects such

as fatigue, arm pain, and dehydration. It is known

that people with a high BMI due to obesity are

overweight and easily feel tired to carry out their

activities. According to research in Saudi Arabia, the

vaccine's side effects can be exhausting because the

vaccine has worked and reacted on the immune

system (El-Shitany et al., 2021).

The next side effect is pain in the arm. From

writing in Iran various aspects can encourage pain

after injection such as the size of the needle and the

length of the injection needle used. It is known that

people with a high BMI have excess fat.

The following side effect is that you feel thirsty

after

the vaccine. It is known that people with a high

BMI require a lot of body fluids than people with a

normal BMI. According to another study, lymph

nodes and adenoids become active after a booster

vaccine, which causes thirst.

5 CONCLUSION

From the writing that has been done, it can be

observed that the effectiveness of the Pfizer booster

vaccine is higher than the Pfizer full dose vaccine,

which is 99.3% for the Pfizer booster vaccine and

99.1% for the Pfizer complete dose vaccine.

However, these two types of vaccines have a fairly

high level of efficacy for people in Indonesia. For

side effects, a significant correlation was found,

indicating that the Pfizer booster vaccine had higher

side effects than the Pfizer full dose vaccine. While

the side effects that

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