The Kashmir Monitor
By Aamir Ahmad Amin –
Look around. How many cases of polio can you identify in your locality?
None, presumably.
Turn the epidemiologic clock back to little over half a century ago, however, and the communicable disease profile of your country will present a remarkable contrast, with a sizeable proportion of an entire demographic appearing visibly marred after sporadic outbreaks of acute flaccid paralysis (AFP) left unsuspecting children limping and longing for a normal life.
I distinctly remember when I was vaccinated at the erstwhile Regional Research Laboratory (RRL) in Sanatnagar; how two glistening drops of the bitter-tasting Oral Polio Vaccine (OPV) trickled down my throat as I scowled at my relatives for taking me there. Nevertheless, it is not lost on me that years of successful campaigning worldwide has rendered infections with the causative virus all but harmless, such that polio is well on its way to joining smallpox as the only second disease in the history of mankind to be completely eradicated from the surface of the planet.
This year, around two decades following the H5N1 Influenza pandemic, and a century after the Spanish Flu rampaged its way through the early 1900s, we are once again at crossroads with a menacing virus that has left its indelible mark on the world; with over 200 countries affected, more than a 100 million confirmed cases and a death toll crossing 2 million people – SARS CoV-2 stands tall among its recent forerunners in the microcosm of RNA viruses.
Thankfully, the global race for a vaccine has also ended with several alternatives demonstrating comparable safety and efficacy profiles. Dozens of countries including the US, UK, Russia, India, Bangladesh, Mexico and Chile have commenced nationwide immunization campaigns, prioritizing high risk groups such as the elderly and front liners. According to the Bloomberg Vaccine Tracker, about 170 million doses have already been administered worldwide. Mid-last year, Russia was accused of jumping the gun and met with harsh criticism from the international scientific community for doling out its highly publicized Sputnik-V vaccine months before completion of its clinical trials. As highlighted in a previous article in this newspaper dated August 13, 2020 – for a process that usually takes years, one may consider it plausible that accelerated clinical evaluations are necessary during pandemics that cripple established systems and transform life as we know it. But how far exactly can we push the limits before things go wayward?
There is genuine concern, as such, regarding a most fundamental pre-requisite in the level of safety accorded by these vaccines and thus, public opinion is guarded. While as getting a shot will not turn people into crocodiles (disappointingly so) or make women grow beards as claimed by the Brazilian President – between December 14 to 23, the US witnessed a total of 21 cases of anaphylaxis following the first dose of the Pfizer-BioNTech vaccine, and as of January 10, there were about 10 detected cases of anaphylaxis after the administration of about 4 million first doses of the Moderna vaccine, according to data from the Vaccine Adverse Event Reporting System (VAERS). All this ultimately boils down to a singular proposition that, unlike the many other demonstrably successful vaccines in recent history, the ones against COVID-19 have not passed the test of time. There is little to no reliable information which can pinpoint the exact duration of immunity or confidently dismiss any potential long-term side effects. While as this article is not contesting the validity and outstanding contribution of vaccines to the improvement in human health, its primary aim is finding a rational path that balances these concerns with the ever-growing necessity of vaccinations in the present scenario.
A sensible approach to this dilemma would have us analyse key facts from both the Pfizer and Moderna trials to gain valuable insight into the process which has led to their Emergency Use Authorization (EUA). First and foremost, both the trials are double-blind, randomized and placebo controlled – which is the gold standard of epidemiologic studies and confers the highest-level scientific exactitude. It is noteworthy that, although a combined total of over 70,000 people participated in both the Phase-3 trials, the efficacy profile to date is around 95% for the Pfizer vaccine based on 170 patients and about 94.5% for the Moderna vaccine based on 95 patients. Reporting in VAERS shows that for every one million doses of the Pfizer vaccine administered, only 5 cases of anaphylaxis occurred and for every one million doses of the Moderna vaccine administered, 2.8 cases of anaphylaxis took place.
In India, Covishield (the local name for the Astra-Zeneca vaccine manufactured by the Serum Institute) and Covaxin (Bharat Biotech) were both approved for use this January. Whereas efficacy data for the latter is yet to be provided, among nearly 9,000 volunteers in the UK and Brazil who received two full doses of the former AstraZeneca vaccine, data from the trial suggests an efficacy of over 60%. However, about 2,700 other participants in the trial were reportedly administered a half dose followed by a full dose. It is interesting that, for the smaller group, the effectiveness of the vaccine shot to about 90%. The two results were subsequently averaged by the company and the efficacy was placed at a promising 70% for the vaccine. This has been rather confusing to analysts who have expressed doubts and alleged inconsistency in the data. Moreover, among 2,000 participants infected with the South African B.1.351 strain, the efficacy dropped to a dismal 22% calling for a temporary suspension on the vaccine in the country.
For a significant herd protection threshold to be reached against COVID-19, what the public needs to understand is that, as with most infectious diseases, there are essentially two methods by which people can be immunized. First off, we can all throw caution to the wind and risk getting infected with the virus, survive the ordeal and make sure we develop the baseline titer of antibodies required to fight off future infections – notwithstanding the vast array of complications and the sheer unreliability in the disease course and prognosis about which so little is known.
The only scientific alternative to this path is – you guessed it – vaccination. As a matter of fact, the idea of herd immunity without vaccines is so outrageous from the very outset that, there is no infectious disease for which herd immunity has been achieved sans vaccination. Measles, for example, requires an estimated herd immunity of approximately 90% which is impossible through natural transmission of the measles virus alone. Poliomyelitis, as mentioned earlier, is an ancient disease that is known to have affected many civilizations of the past, destroying lives and crippling youngsters right until the first vaccines were developed in the early 1950s. In all fairness, it is not every day that one comes across vaccines which have an efficacy of over 90%, as is the case with the two forerunners against COVID-19. Take, for example, the BCG (Bacillus Calmette Guerin) live, attenuated vaccine against tuberculosis which is nearly 70% effective, or the Flu vaccine which is around 40-60% effective and yet, both are mindfully incorporated into the immunization programs within endemic zones from across the world.
Unchecked travel, particularly during the initial stages, has been incriminated as the single most important factor in the global transmission of COVID-19. What matters today, however, is containing the local spread of the virus, if putting an end to its destruction is truly a priority for any government. Vaccination provides a safe and effective route by which people can be immunized and the spread of this virus effectively blocked. However, in event of any carelessness or lapse on part of the national or international health setups to take the necessary preventive measures, it is likely that travellers who become infected will harbour the disease back to their home countries or abroad and further heighten its worldwide dissemination. With several new mutants of the SARS CoV-2 virus, such as the N501Y, D614G and K417N making rounds in the United Kingdom, South Africa, and Brazil respectively, the need for safe and effective vaccination is now more than ever. Certain countries, including Spain, have gone to the extent of documenting people who refuse to be vaccinated against coronavirus – details that will be shared with other European Union nations.
Choosing to vaccinate or not are both acceptable and should not be met with derision or hostility, but only after one has made an informed decision by going through the scientific literature and come to a conclusion based on the evidence in favour of getting a shot – or a lack thereof.
Do not be a ‘covidiot’. Take some time to read the data behind the vaccines and equip yourself with the relevant information that can help you formulate an unbiased opinion, and to take the decision which is best for you – instead of submitting yourself to one from the beginning. Blind acceptance and blind disapproval are both alien to the scientific thought process. We must all confront our apprehensions by exposing our minds to the data in its entirety, rather than formulating an opinion in the negative or positive, and then cherry-picking information in support of it.
Based on the diverse and compelling evidence across scientific literature in favour of vaccination against COVID-19, I have decided to get my jab as soon as possible and strongly urge others to do the same. Vaccination saves lives and its consequences are far reaching. Though largely an individual decision, even the harshest critic will find it difficult to ignore the fact that COVID-19 has joined the list of vaccine preventable diseases.
The writer is a Final Year medical student at Khwaja Yunus Ali Medical College (KYAMC) with honours in Microbiology and Pathology, among other subjects.
