Vax or Not to Vax?

 Covid 19 has swept across the world over the past year with over 249 million reported infections and over 5 million deaths. There is little doubt that the virus remains a major concern. The economic, social and personal costs of this deadly virus remain incalculable and to this day we experience lockdowns and travel bans. While masks and social distancing are considered a broad based tool to contain the spread of the virus, the development of vaccines implies that vaccinations remain the main defence against COVID 19. Yet when it comes to vaccinations the response from people is varied and very emotional. In some countries governmental regulations have driven the vaccination policies, while elsewhere, to vax (vaccination) or not to vax remains a contentious issue.

Before one explores the pros and cons of vaccinations it is important to highlight some of the characteristics of the Covid 19 virus. 

• Covid 19 virus contains a spike protein which, like most viruses, mutates over time. This results in new variants such as alpha, beta, delta and gamma variants and the more recent Omricon strains of the virus. While more research is needed to determine why and how mutations take place, there is a general consensus that mutations are influenced by climate, and conditions typical to a geographic region.
• It is generally believed that most viruses mutate to the point that their potency for harm is minimal or non-existent as it happened with SARS. 
• COVID 19 variants indicate a propensity to be more spreadable even though so far the indication is that each of the subsequent variants have been less lethal than the original virus.
• Unlike other viruses the COVID 19 virus can and is carried by people who show no symptoms of the virus thus making it difficult to contain. In the case of viruses like SARS and Ebola, only patients with full blown symptoms can transmit the virus thus making immediate isolation as the most effective means of containing the virus. This is not the case with COVID-19.

Containing COVID 19 has been a combination of broad measures of protection and with the development of the vaccines the adherence to clinical means to contain its spread. There is not doubt that most of the vaccines were developed rapidly and anti-vaxxers claim this speed of approvals implies not all side effects have been taken into consideration. Indeed, vaccines take years of research and then clinical and human testing before they are approved for mass usage. 

However, in the case of COVID 19 vaccine development some important factors have to be considered.

A. The rampant spread of the virus required extraordinary measures and one of the main catalysts to speed research is financial resources. In this respect governments and private sector poured in phenomenal amounts of cash to fund the research and development of the vaccine. This cut down the R&D times from years to mere months.

B. R&D basic data was shared by many of the developers of the vaccine. Indeed, the Chinese shared the genome structure of the virus soon after it spread in Wuhan, thereby giving researchers a head start to develop a vaccine.

C. It is a valid comment that human testing and pretrials before certification were not as complete as would be normal, (usually a couple of years of testing). There was, however, elaborate clinical modelling done to determine the possible side effects of the vaccine and there was reasonable assurance that side effects could be managed. 

D. The efficacy of the vaccines used in the past year have shown its effectiveness to be as high as 96% in the first eight weeks to 84% six months after the second dose. A second dose does push the efficacy back to 90% and it is determined that this efficacy works against all the variants that have emerged so far. 

The vaccine and anti vaccine camps are equally vocal in their positions and considerable effort is being made by each camp. Let us see their views.

Arguments of the anti vaxxers and a response:

A. The vaccine was 'rushed' and its long term effects are still to be determined. 

Response: What was rushed was the administrative process while all the clinical steps were all followed. Given the financial support it was easier to fund these clinical steps through all its stages rather than wait for piecemeal funding.

B. Testing in human trials have been lower than is typical of vaccines.

Response: This is an incorrect statement as testing is not simply a matter of time but the number of subjects who are available for testing. For example for years bio tech companies have been close to a vaccine for Ebola but given the number of people available for testing is very small in population the minimum threshold of 30,000 subjects has not been achieved. In the case of COVID 19 there was no shortage of subjects and in some countries like say UAE there were over 30,000 volunteers for the testing period. 

C. There have been cases, albeit a few, of fully vaccinated people contracting COVID 19 and succumbing from the virus.

Response: Correlating the vaccination rates with hospitalisations and deaths show that in the case of COVID 19 vaccines the more people have been vaccinated the less hospitalisations and deaths have occurred. In UK alone as more people have been jabbed the less hospitalisations have taken place and death rates have come down. Yes in recent weeks the effects of the Omricon and Delta variants has shown a huge spike in positive tests but we notice hospitalisations have not matched this huge spike. This spike is largely explained by the 'over relaxation' of the safety protocols in terms of social events and mass events (football matches, and music events). 

In addition even with a 90% efficacy there will be the odd case of vaccinated people testing positive and in a few rare cases (a handful) resulting in death. When and if we achieve a 100% vaccination rate then we can determine if these odd cases are a failure of the vaccine or anomalies in the immunology response system of the concerned patient.

D. Vaccinations should be a personal choice and not a government mandated requirement.

Response: The argument of personal rights versus civic duty will always be a never ending saga of arguments. Suffice to mention we as a society follow many laws, regulations and directives that fall under the gambit of social and civic good. These range from seatbelt rules, obeying traffic laws and the list is never ending. Without a doubt the civic duty to protect ourselves and those we come into contact with does dictate that personal choice in the case of a pandemic like this needs to be set aside for the good of society.

E. The mRNA vaccine, which is what all COVID 19 vaccines are, can alter the DNA of the recipient and are considered relatively new methodology for vaccine development. 

Response: This is entirely untrue. mRNA vaccines have been under development for decades and are not at all something that was discovered in response to COVID19. Essentially these are messenger vaccines that create a protein spike on the outside of your DNA cell. This spike protein replicates the characteristics of the COVID 19 virus which then 'messages' your immune system to create the anti bodies to fight the virus. After the second dose it is expected that the body 'learns' to create the anti bodies for the COVID 19 vaccine automatically. The mRNA vaccine does not penetrate into the DNA cell and therefore cannot alter it.

F. Even if you are vaccinated you can transmit the virus.

Response: No vaccine is 100% effective and to that extent this statement is generally true. In general it has been seen close to an average of 80% protection is achieved upto 8 months after the second done. However, vaccinations across society ensure that over 80% of transmission can be blocked by the vaccine. Thus if only say 30% of a society are vaccinated as compared to say 90% in another country then in the first country vaccinated people may be able to transmit the virus. Thus the more a country is vaccinated the better the protection is going to be. 

G. Messenger RNA vaccines alter the genetic code.

Response: Since the mRNA vaccine does not go into the cell it cannot affect the genetic structure or genetic code of the DNA cell. This is all the more true since the COVID 19 virus is not a retrovirus like say AIDS where the DNA cell is compromised and vaccines and medicines used to combat retroviruses do interact with the cell itself.

H. The Long term affects of the vaccine are not known.

Response: Indeed this is true as it is equally true of any other vaccine that is developed. However, with artificial intelligence and clinical modelling with computers vaccine behaviour over longer period of time can be predicted. Suffice to mention the current probability is that most of the possible outcomes have been considered. On balance the uncertainty of long term effects have to weighed against the possible outcome of a virus infection.

I. Some of the anti vaxxers are against chemicals being put into the body.

Response: This is a generic view that anti vaxxers have and is misplaced insofar as the vaccine is concerned, The mMRNA is not a chemical vaccine,(in the Pfizer vaccine) and its active ingredient is ribonucleic acid, which is also produced naturally in our body. The other major ingredient is lipids which again are commonly ingest by us in things like olive oil etc. It the arrangement of these ingredients through bio processing that creates the spike protein that is essential in creating the anti bodies in our system. In the Johnson and Johnson vaccine the active spike is the adenovirus spike (like the common cold virus) which then teaches the body to create antibodies.

J. People can die of the side effects of the vaccine.

Response: Theoretically this is true to COVID 19 vaccines as it is true to any medication. Thus if there was a young person who has a history of hospitalisation from myocarditis (a heart condition) then there is a one in a million chance that such a person could have a seizure and die from the vaccine. This was equally true of the small pox vaccination where there was a risk that people with cavernous sinus thrombosis could die from the vaccine. Again these risks weighed against the millions of vaccinations creates a very low probability of such an outcome.

Conclusion.

While it is recognised that that will be a small percentage of people who will always resist vaccinations, there is a need for an objective discussion with the many others who have been influenced by the anti vaxxers. This entails and open and fair dialogue to ally the fears of people. Vaccinations are the most essential toll available to us for combating this deadly virus, which will continue to mutate to new variants till it becomes, hopefully, naturally extinct. Given the speed of the spread of this virus it is all the more essential that we, as a society, arm ourselves with the means to slow down and if possible arrest the spread of this virus. 

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United Kingdom and Migration.

 The daily news of channel crossings by people illegally trying to migrate to the United Kingdom is regular feature that continues to cause not only tensions between Britain and France but evokes intense debate within British society. Turmoil in Syria, Afghanistan, Iraq and elsewhere has fuelled the migration of people seeking to assert their refugee status to seek asylum in the UK. Before one deals with the current refugee crisis it is important to see the history of migration in the UK. 

Since Roman times, as an example, Londonium, as London was called, was a melting pot of many ethnic people. Like most modern countries before the advent of rigid borders it was common for people to move around. In the mid 1800's there were immigrants from Ireland, Germany, Russian Jews and even 1000 Africans who had sided with the British in the American War of Independence and been relocated to Britain. The table below shows the migration pattern from 1800-1945 and then from 1945 to 2010.

Migrant group	Migration 1800–1945 (145 years)	Migration 1945–2010 (65 years)
Africans	10,000	1,000,000
Americans	70,000	250,000
Arabs	10,000	290,000
Belgians	240,000	40,000
Chinese	20,000	320,000
Cypriots	2,000	80,000
French People	40,000	100,000
Germans	100,000	300,000
Hungarians	2,000	38,000
Irish	1,500,000	700,000
Italians	40,000	160,000
Jews	220,000	80,000
Poles	5,000	500,000
South Asians	20,000	1,000,000
West Indians	10,000	400,000
Others	50,000	1,000,000
Total migration	2,339,000	6,231,000
Average migration per year	16,131	95,862

It may be noted that the Alien Act of 1905 and then the Alien Restrictions Act of 1914 slowed down immigration in to Britain. In some cases these acts, especially that of 1914 caused a reduction of Germans and Jews, many of whom then immigrated to United States. 

While many immigrants were fleeing persecution and turmoil, there was also labor shortages in some major segments of British economy which created the impetus for bringing in foreigners. This was nothing new as we had seen through the British colonising years that labor movements were encouraged by British overlords to meet the demands of shortages. Needless to say some of largest owners of the slave trade were British merchants even though few if any slaves were brought into what is Britain today. Slaves were taken to what is today the West Indies and from then on into America, Cuba, Latin America and elsewhere. 

Around the mid 1700's there was a shortage of seaman for the ever growing merchant fleet of vessels that plied between the colonies and Britain. In order to meet this demand, for instance, the British East India Company employed Indian 'lascars' or seamen who were placed in port cities of Britain and were perhaps the first Indians to migrate to the Britain. It was common in those days for English captains of ships to employ Bengali and Goan cooks and then these captains retired and settled back in England it was quite normal to bring their cooks and even 'ayahs' (maids) with them. Records show that in the mid 1700's there were close to 40,000 Indians in Britain and they ranged from lascars, to cooks, students, and emerging Indian businessmen. Indeed one such cook, Sake Dean Mohammed, who was from Bengal went one to open and own in 1810, what is believed to be the first Indian restaurant in London with the name "Hindoostane Coffee House". 

From the mid 1950's Britain started to grant independence to many of its colonies and it was believed that this might slow down the immigration. However, this coincided with a rebuilding of UK's infrastructure, after the war, and a relocation of a large number of British colonial officers and personnel. This created shortages in the labor market and Britain to bring in workers for the transport and building sectors. The added benefit of workers from the Commonwealth countries (former British colonies). was that many of them were not averse to working longer hours and/or night shifts. Indian and Pakistani workers flocked to areas like Lancashire and Yorkshire to fill the jobs in the textile industry, and to London for the transport industry and Slough for the food industry. 

By 1962-65 a flood of resentment swelled amongst 'white' British people who felt these immigrants were taking away their jobs. Subsequently on the back of Conservative Party pressure in this period various Acts were passed by Parliament to control immigration culminating in the 1968 Immigration Act which allowed immigration only to people who had 'a substantial connection; to the UK.  Anti immigrant sentiment remained high as evidenced by the right wing leader Enoch Powells 'Rivers of Blood' speech in 1968. 

With the Conservative Party's sweeping election victory in 1970 immigration was expected to slow down. However, political upheaval in Uganda, under Idi Amin, resulted in an influx of British subjects who had been granted special status under the 1948 Independence Act, were admitted into the UK. This was on the backdrop of the 1972 Immigration Act being debated and passed where by automatic entry for Commonwealth citizens was seriously revered and only skilled people already having been offered a job in UK and/or who could prove their parents or grandparents were British citizens were to be allowed in. All other entries were subject to the will of the British government. 

Contrary to the ultra conservative views of Powell and his supporters immigrants were filling job vacancies that 'white' British people were either not prepared to do, (cleaners, baggage handlers, unskilled labor) or were in sectors where there were chronic shortages, like the National Health Service. The NHS which has been created in 1948 really mushroomed its services in the late 1950's and was seriously short in doctors and nurses. In 1970 it was estimated that 33% of junior doctors positions and 44% of nursing positions were filled by immigrants. In sense this influx of people for the former colonies was like what famous author described as 'reverse colonisation' and has remained source of heated debate to this day.

In the late 1970's civil wars in the Horn of Africa and in Biafra created a new form of crisis where people displaced by conflict while not eligible for immigration felt they could arrive at a UK port and seek asylum. In 1951 the United Nations and passed a convention on Refugees and most countries were signatories to this convention and subsequent Protocol of 1967. Thus there is a clear distinction between people who seek to immigrate versus people who claim refugee status and/or seek asylum. The recent crisis in Iraq, Syria, and Afghanistan have created a influx into Europe and eventually Britain of asylum seekers and is the fraught with controversy.

The issue of refugees is emotionally charged and controversial and needs to be discussed even if some of the aspects of this debate are uncomfortable. Indeed there is the humanitarian aspect as enshrined in the 1951 UN Convention and the 1948 Declaration of Human Rights which gives every human the right to seek asylum from persecution and prevents recipient countries from returning asylum seekers to countries where the dangers they escaped from exist. These protocols establish the definition of a refugee and while the UNCHR was entrusted with a large body of the administrative and humanitarian protection of refugees, contracting states are obligated to protect and care for refugees. 

One of the essential responsibilities placed on a refugees was that he would seek refuge in the first country where he arrives and if this country has an absence of the conditions he/she are escaping from shall be considered his country of abode. This a key aspect of the dispute between UK and EU countries, particularly France because UK believes France is 'pushing' the refugees to cross the English Channel into UK. In the same view there is a common feeling that many of the refugees are 'asylum shopping' by not staying in the first safe country where they arrived and choosing preferred countries they would like to settle in. Whether this 'asylum shopping' is a personal choice or a choice made for them by the smugglers who profit from the asylum trade is not fully certain.

There is then the element of genuine refugees who face persecution and the danger of death and those who are essentially 'economic refugees'. Many of the refugees feel, as is the case of Afghan refugees, that since many of them worked for NATO, including British, forces now with the Taliban in control these countries 'owe' them the obligation of protection and settlement. Let us take the example of Afghan refugees as a test case to highlight the complexities of the refugee debate.

Since the Soviet invasion of Afghanistan back in 1980s both Iran and Pakistan have housed millions of refugees. Particularly in the case of Pakistan, which at the peak had close to 6 million refugees, the refugee camps became the recruiting ground from where the many militias who fought the Soviets emerged to eventually oust the invaders. The refugee situation did not ease as a bitter civil war followed and then the Taliban takeover, who themselves were ousted by the US and its allies in 2003. Through all these phases the refugee camps in Pakistan and Iran remained full and currently it i estimated that there are close to 3.5 million refugees in Pakistan and 2 million in Iran. 

In 2021 total internally displaced people within Afghanistan was 3.5 million of which 677,000 are said of have left the country, mainly for Pakistan and Iran and Europe. UNHCR registration of Afghan refugees is not complete in many ways and stands at 2.2 million, thus causing much confusion on the actual numbers. UK, as apart of the withdrawal from Afghanistan took in 7,000 Afghan nationals and it is estimated another three to four thousand Afghan asylum seekers have crossed the Channel. Since the late 1990's total Afghan refugees settled in Europe, including UK are 570,000, of which about 40,000 arrived from Afghanistan after the withdrawal. 

At the peak US and NATO, and their non NATO allies, had 132,000 troops in Afghanistan, in 2011, while UK at not time had more than 10,000 troops. Of the total forces the US generally had close to 80% in Afghanistan with UK having around 8% of the total. One has to question whether the 570,000 'new' refugees escaping retribution from the Taliban are all political refugees who worked for foreign forces and thus feel their life is in danger. This does lead one to assume a large portion of the asylum seekers are really economic refugees who do not necessarily fall within the spirit and the letter of the law that the 1951 Convention and the Protocol of 1967!

The argument runs that because the Western powers left Kabul in a hurry there was no due process available for these persons, who are now asylum seekers, to legally seek immigration to the West. In fairness there is weight to this argument and one has to conclude that UK, US and their allies did little to think this process through.

The first place of safety for many of the refugees was and has been Pakistan and Iran. Why didn't the Western powers reinforce the administrative structure of these refugee camps and work with both Iran and Pakistan to deal with the refugees. They could then have set up processing centres in these camps to process the various possible cases for legitimate immigration. It would also have allowed them to create refugee camps with good facilities to house these refugees and reduce the incentive for them to fall prey to the smugglers? 

Secondly, Britain is right in its argument that France and some other EU countries should not 'push' the refugees on to cross the Channel. While the rules of first country are clear and all the refugees crossing the channel are violating the rules the problem is that in many cases the first safe country of entry for these refugees is Belarus. It is obvious that Belarus has adopted a policy of moving the refugees on to other European countries and is perhaps the base from which the people smugglers operate. 

Thirdly, the argument that former 'helpers' of foreign forces are still at risk in Afghanistan needs to be fully investigated. Indeed to say there is no one at threat would be flippant but it would also be silly to argue that all members of the former Afghan government and armed forces are targets. If indeed there are elements within the Taliban government who are targeting such people then an engagement should take place with the Taliban to correct the situation and countries like Pakistan can be asked to help in this process. 

Nothing in this suggests that asylum seekers should be sent back into the English Channel or other wise be abandoned. Humanitarian assistance but be accorded to all people who are at risk, this is beyond question. Looking ahead would it be impossible to build housing and services in say Pakistan and Iran and other neighbours of Afghanistan where the refugees can be housed and looked after. One would suspect it would cost less than trying to settle them in UK or Europe. This would also create the basis of repatriating those refugees who sought asylum and did not qualify to these new housing complexes within the neighbouring countries of Afghanistan. It would allow the very few genuine cases of asylum seekers to be processed and in time allow EU and UK to establish processing countries in the refugee camps and housing complexes adjacent to Afghanistan.

Addressing such a delicate issue is not easy but Europe and UK need to establish a new form of thinking and approach to dealing with asylum seekers. Sadly the 1951 Convention and the 1967 Protocol did not create and solution for mass asylum seekers who are either economic asylum seekers or people who would not qualify for entry. In sense all those conventions suggested was that those who do not qualify would continue to languish in refugee camps in the final country they arrived in! Those conventions were designed to deal with a limited form of refugee crisis that emerged in the aftermath of the Second World War. Today we face a different world with different challenges and while we would like to end strife and war the reality is it exists and displaces people. Having a comprehensive approach to deal with such displacement with compassion is very important.