Sunday, July 26, 2020

Vaccines and Effective Means of Protection against Covid-19

Phial of Covid-19 Vaccine with a syringe and blue gloves
Now that it has been shown that herd or community immunity is not going to happen and that the Coronavirus will not just dissipate or disappear on its own, our only hope exists via two possible avenues: effective therapeutics and preventive vaccines.

Fortunately, science has been progressing at an incredibly rapid pace on both fronts as initial results of clinical trials look promising and hopeful; all of this is playing out against the ominous background of a potential upcoming second wave slated for some time during the fall season. 

But as Dr. Anthony Fauci has reminded us, we are still in the midst and thick of the first wave and must make sure to get through this one first, before we can focus on and worry about the next one.

As of this date, there are 197 vaccines in development, while 19 have reached the stage of clinical trials (note that these numbers could change and fluctuate very quickly). One thing that is certain and undeniable is that this development has been going at an unprecedented speed.

Part of this reason is that there was some previous information and knowledge about SARS that has helped researchers to determine different ways of tackling the disease through a vaccine. One of the things that has been promising with other Coronaviruses is that our body remembers its antigens at least for a couple of years.

A vaccine not only simulates a weaker version of the virus - one that cannot reproduce or do damage - but it can also teach the body how to effectively fight it. Although this is the most common and the most successful way of vaccinating people, it involves a slow and cumbersome process, which is a problem with SARS-Covid 2 as time is of the essence.

A more novel approach is to inject not the complete virus but merely an antigen, an essential component of the virus. This has been previously done with certain viruses, such as Hepatitis B and whooping cough, and it is currently one of the most popular methods of vaccine development.

The third and final type of vaccine is one that is also the most experimental. It does not use any parts of the virus, but only gives our bodies instructions on how to deal with the virus by providing key pieces of genetic code. They can be made very fast, but they have never been tried with humans.

There is a sense of urgency to act as fast as possible by trying to limit and mitigate the risks as much as possible. Since Covid-19 has devastated, crippled, and held hostage the global economy, researchers around the world have been working hard to find a solution to this serious and life-threatening problem.

There has been governmental support as well as substantial support from the private sector. Ideally, we want, to quote Dr. Fauci, “a marriage and a collaboration between government authorities and the private sector.”

Unfortunately, politics has been another factor at stake, which is often limiting and stifling progress in the fight against the virus as well as vaccine development. It would have been recommendable to unite and work together on a solution that will help and aid every citizen of the world.

Instead, it has turned into a Cold War of sorts in which many nations work on their own and shield their knowledge from others, while some nations engage in cyber espionage to find out the results and progress of other countries to be able to trump them.

It is sad and disheartening that such turmoil and suffering has failed to truly bring the world together, where spying and mistrust has led to a lack of coordination and cooperation, but the good news is that there are still many internationally led efforts and collaborations in progress.

Scientists, academia, and pharmaceutical companies are working together to find a viable vaccine against this virus. Yet the vaccines that are eventually developed need to satisfy the following criteria.

First, they need to be effective. So far clinical trials have been promising, and a few of these experimental vaccines seem to build or boost immunity.

The question remains for how long the immunity would last. Would booster shots be necessary? Will it be on an annual basis like the flu shot? The problem with the flu shot is that the virus often mutates and is hard to predict. To my knowledge, there has been some but not much mutation in the case of the Coronavirus. It remains to be seen how it will all play out.

Second, the vaccine needs to be safe. This is the main reason why clinical trials are so important. However, due to the urgency of the situation, sometimes two separate clinical stages are undertaken at the same time.

Once, the vaccine is deemed safe enough for a group of people, we would need to expand it to a larger sample and study the potential side effects. No vaccine will be a 100% effective (measles is the closest one with about 97% and smallpox with 95%) but, most likely, there will be secondary effects, which so far have been documented as headaches and low-grade fevers.

When it comes to safety, we would always need to counterbalance the harm with the benefits. Since vaccines are generally safe and have been extensively vetted, tested, and studied, they tend to be safe enough.

The current waves of people opposing all types of vaccines, generally referred to as anti-vaxxers, are a potential threat to building immunity, while their reasons do not constitute or bring about a veritable debate.

The staunch and blind opposition to science, this anti-scientific stance, is often tolerated and accepted in the United States under the guise of a liberty right’s issue, since it is allegedly part and parcel of constitutional rights enshrined in and guaranteed with the first and 14th amendments.

The issue is, however, not only of a “philosophical” or rather ideological matter, but it has serious consequences and repercussions for health and society. 

Liberties must always exist in relation to others, and with this comes social accountability and responsibility. For instance, freedom of speech is an essential aspect of one’s personal liberty, but it crosses a dangerous line when it becomes or borders on forms of hate speech aimed and targeted towards particular groups or segments of society.

In terms of anti-vaxxers, this is not about protecting one’s right to express oneself or to live in accordance with one’s beliefs, but it is an action that is unsafe, and it is of no benefit to neither the individuals themselves nor to their immediate surroundings. Since we are all in this together, the careless, irresponsible, and irrational actions of the few will have dangerous consequences for everyone.

The bottom line is that vaccines are lifesaving, and those who refuse to have them are not only putting themselves and their children at risk, but they put other people, particularly senior citizens, children, and those who are immunocompromised at risk as well.

In fact, there is no debate to speak of, and this leaves little, if any, room for discussion on the matter; the evidence and science speak for themselves. Yet it is more than a matter of health, safety, and common sense; it is also an ultimate act of altruism, of acting for the benefit of one’s community and nation.

When it comes to the COVID vaccine, there will be elements of risk, but that is why it will not be available until it is deemed relatively safe. To remedy that, it is most useful and helpful to have more than one vaccine. When we have multiple and different vaccines available, they can be effective in complementary ways since there is no one-size-fits-all solution to this disease.

Dr. Stefano Bertuzzi, the CEO of AMS (American Society for Microbiology) stated in an interview with the US Chamber of Commerce that the different vaccine particles can be compared to making a pizza.

We could adjust the pizza according to necessity; we could provide different platforms, or in the case of our pizza analogy, gluten-free options with a variety of toppings, according to age, health, conditions, and other demographics.

The next factor to consider is whether the vaccine is affordable. That is another important issue that will be tied with patents. Will pharmaceutical companies try to make a quick buck by taking advantage of a global health crisis or will they do the right and ethical thing to make it as affordable as possible?

Will they become health heroes or saviors like Jonas Salk and forgo profit over doing the right and honorable thing? In the case of a pandemic, it affects everyone, and everyone, or at the very least 70% of the world population needs to be protected for the global community to be safe and immune against this virus.

We need to consider that there is substantial poverty in each nation. The poor and underprivileged also need to have protection, which leads us to the final point: The vaccine needs to be available for all and everyone.

Although the roll-out of the vaccines will start with those who are at highest risk, such as health care workers and those who are immunocompromised, we would need to find ways of reaching large swaths of the seven + billion citizens of this world and that includes actively seeking out and contacting underprivileged people in each and every community.

This will pose logistical problems as well. The vaccine needs to be able to be transported easily, and it needs to be administered in the furthest regions of the world, from the deserts to the mountain tops. We would need to have sufficient syringes, vials, and swabs for this enormous undertaking.

In terms of testing, there was an issue with the supply chain as the nasopharyngeal swabs were for the most part (about 80%) made in Italy. Since commercial planes were grounded at the time, the US decided to use military planes to transport them. And yet, even today, there is still not enough supply at hand. Hence, we need to find safe and quick manners of transporting the vaccine to places that are remote, and which may not have potable water, for instance.

Finally, there is also the issue of therapeutics. In terms of logistics, this is much easier to achieve as, unlike vaccines, it does not involve every citizen of the world but is limited to those who have contracted or developed this disease.

They can then be hopefully treated in an effective manner, and as such, we would reduce the number of deaths and fatalities due to Covid-19. Currently, there are experiments on repurposing antivirals for early stages of Covid-19, that is, they are using and experimenting with treatments for other diseases and conditions to find one that works best with this unpredictable and uncharted virus.

Before we have any viable vaccines or therapeutics in place, we need to be careful and vigilant. It would be best to follow the Core 4 strategies, that is, using masks and face coverings, especially when in crowded or enclosed spaces; by practicing social distancing by keeping at least two meters apart from others; by using hand hygiene, that is washing our hands as often as possible to kill the germs, most safely achieved through the simple use of soap and water; and finally, by staying home and avoiding contact with others when sick.

The latter point is a bit tricky and more complicated when it gets to the Coronavirus as it is oddly enough most contagious in its initial phases and this is compounded by the fact that many people may be asymptomatic, meaning they would display no visible symptoms whatsoever but will still be able to infect others with this highly contagious illness.

Children are also not spared of the disease. Although it seems that children younger than ten do not transmit the disease, it is quite a different story from the ages of ten and onwards. They could not only transmit the virus and infect others, but, in some unfortunate cases, children may themselves have serious repercussions and complications with what are known as multi-system inflammatory syndrome and Kawasaki Disease.

These conditions are caused by an overreaction of the immune system, and if untreated, they can become lethal. Although rare, they are serious enough conditions, but with early detection and proper medical care, children should recover.

In the meantime, we must engage in relevant cultural behavior change, according to Dr. Oxiris Barbot, the Acting Commissioner of the New York City Department of Health and Mental Hygiene. This is a necessary transition until we have a vaccine with most people having been vaccinated. This would not only include constantly engaging in the Core Four Strategies mentioned earlier but also to find alternative ways of transit and transportation to avoid crowds and gatherings. This could also mean using alternative forms of transit, such as biking and walking, whenever possible and feasible.

Finally, schools need to be opened in a safe manner where masks are not only encouraged but mandatory to protect each other. To encourage mask-wearing, Dr. Barbot suggested making face coverings together with the children by showing them the importance and the civic duty of protecting oneself as well as others.

As to businesses, the word of advice she gave was to go slow and not to cut any corners. Business owners need to ensure that their employees and their clients are as safe as possible and that the health recommendations are followed as closely as possible.

In the words of Dr. Fauci, it is essential that we have a healthy business community. This would be in the best interest of everyone until we can go back to at least a semblance of the normal that we used to know.

Finally, how can we ensure that most people will get the vaccine? Should it be mandatory? Should people have the right to become exempt as it has been the case with vaccinations and immunizations?

There may be legal repercussions involved, but the decision in these types of matter ought to be utilitarian, meaning they should serve the common good.

And it would be in the best interest of everyone to get vaccinated so that this COVID nightmare can finally become a thing of the past, a haunting memory of a time where we suffered and lost greatly but also when and where we realized that our only hope and faith lie in science and in our sense of community.


No comments: