Considering the COVID-19 vaccine

President Cyril Ramaphosa announced on Monday 11 January that South Africa would be getting its first batch of COVID-19 vaccines by the end of January 2021, with others to follow shortly after that. This announcement was met with mixed reactions. The conspiracy theories, which have been present throughout this pandemic, have brought uncertainty and fear about the vaccine into the minds of a lot of people.

Vaccinations have begun in a number of countries including Britain, the US, France, Canada, Germany, Israel the Netherlands and other countries. The aim is to protect the most vulnerable in these societies. Despite the good intentions, people are cautious about the vaccine and asking a lot of questions. In times of uncertainty I always find it best to begin with what we do know. Thereafter, one can consider legitimate questions and then weigh up the pros and cons of the unknown.

What do we know?

1. There are many vaccines being developed at the moment. Most of these are either mRNA vaccines (eg Pfizer and Moderna) or viral vector vaccines (eg AstraZeneca and Johnson & Johnson).
2. It is most likely that South Africa will receive the viral vector vaccines. These vaccines do not have to be stored at extremely low temperatures and are less expensive.
3. These vaccines were being developed long before the COVID-19 outbreak in 2020. Following the outbreak of other Corona viruses such as SARS in 2002 and MERS in 2017/2018, scientists began working on a vaccine. The vaccines being tested and administered are an extension of this research.
4. Each of the vaccines being used have passed through the various phases of testing. Phase 1 (safety/dosage), Phase 2 (human safety), Phase 3 (human efficacy).
5. The trials have shown that the vaccines have prevented COVID-19 in the communities where they have been administered.
6. None of the vaccines contain any of the live virus. These vaccines use very clever technology whereby your own body is instructed to produce a protein which triggers an immune response to the COVID-19 virus, thereby killing the virus.

Why can’t we wait for herd immunity?

To answer this question it is important that we understand what herd immunity means. Essentially “herd immunity” is a term used when enough people in a population have enough immunity to prevent further outbreaks. In terms of COVID-19 that would be the population of the whole world as it has affected people all over the globe.

Herd immunity to a specific illness depends on:

• How long immunity to that infection lasts
• How many people need to have immunity before the disease can be controlled. The number is usually around 70% of people. Scientists have stated that in the case of COVID-19 the number may need to be as high as 90%. This is due to the speed with which it is transmitted and mutates,

From the data that we currently have, natural immunity to COVID-19 only lasts for between three to nine months. This is why we are seeing evidence of people getting COVID-19 twice in a short space of time. For herd immunity to be achieved between 70 to 90% of the population would need to be ill every nine months. South Africa would need a minimum of 42 million COVID-19 positive people every nine months to achieve herd immunity. Our economy, health systems and population could not endure this. Imagine the population of the United States having to experience 230 million cases annually with around 2.3 million deaths each year.

To quote: “In other words, it’s impossible to achieve herd immunity to COVID-19 through widespread transmission”

Basically herd immunity is not an option. We need to have a vaccine which can achieve immunity without the devastating effects. We have seen the world literally rid itself of polio due to the vigorous vaccine programs. We have also seen measles contained and then cause huge devastation when the vaccine programs were interrupted. We want COVID-19 contained in a similar way.

Who can safely have the vaccine?

The answer to this question is not straight forward. As the vaccine is administered to more people we will learn more about it. For now however, we should consider what the Centres for Disease Control and Prevention are recommending:

• Children and teens – The vaccines were tested for people 16 years and older. There are new studies underway in the age group 12 to 15 years. Studies in children under the age of 11 years will take more time as there has not yet been work done to test the correct dose appropriate for this age group. So for now the vaccine would only be available to those over the age of 16 years in the priority group.
• Pregnant people – The vaccines developed for COVID-19 have not yet been tested on pregnant people. As one can imagine, drug and vaccine makers are always cautious of including pregnant people in initial trials for fear of injuring the foetus or threatening the pregnancy.
• Lactating people– To date the vaccine safety for lactating people has not been studied. Having said this, the mRNA vaccines are not thought to pose a threat so in instances where a lactating person is in a priority group then they may be vaccinated if they so choose.
• People with allergies-The CDC put out clinical guidelines for those who suffer from allergies. There are 3 main categories- don’t vaccinate, vaccinate with caution and proceed with vaccination. People who have had a severe reaction to any of the components of the vaccine should not be vaccinated. Those that have previously had a severe reaction to any vaccine or injectable therapy can be vaccinated, but with caution. In other words the decision would be made in conjunction with your healthcare provider. People who have minor reactions to food, insects, animals and latex and other common allergens can be vaccinated.

What about the side effects?

• Over 200 000 volunteers participated in the trial of the various vaccines and to date over 1.1 million people have been given a vaccine.
• Data thus far indicates that most people experience mild side effects like redness at the site of the vaccine, fever and a headache. The symptoms disappear after 2 days. These are side effects that many people experience with other vaccines.
• A few patients have had allergic reactions which is why it would be important to have the vaccination in a medical facility where a patient can be observed for 15 to 30 minutes.
• The Australian government cancelled an order for a vaccine which was being developed by an Australian firm, CSL and the University of Queensland. Candidates in their trials got false HIV positive results. The Australian vaccine has since been abandoned altogether.
• As greater numbers of the general public receive the vaccines, researchers will be provided with data of other or rare reactions to the vaccines. CNN reported that on 18.1.2021, 149 people per minute were being vaccinated in the UK. This is a huge number of people and it will certainly provide us with a lot of data.

Conclusion

Research has shown that we have not been able to rid our world of aggressive viruses without a vaccine program. This goes for illnesses such as measles, small pox and polio. COVID-19 is another aggressive, fast spreading virus. Healthy children will definitely be among the last group to be offered a vaccination, so parents will have time to process the facts.  Ultimately though, it is highly unlikely that we will be able to stop this illness without a significant vaccination program.