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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