Covid-19 vaccination: Is it the proverbial ‘Silver Bullet’?

Dr B. J. C. Perera

MBBS(Cey), DCH(Cey), DCH(Eng), MD(Paed), MRCP(UK), FRCP(Edin), FRCP(Lon), FRCPCH(UK), FSLCPaed, FCCP, Hony FRCPCH(UK), Hony. FCGP(SL)

Specialist Consultant Paediatrician and Honorary Senior Fellow, Postgraduate Institute of Medicine, University of Colombo, Sri Lanka.

In this emerald isle, people take to any form of vaccination, like the legendary ducks take to water. Offer them a vaccine against anything and they will take it; at least most of them would do so. The vaccine antagonists and anti-vaxxers are extremely few and far between, so as to be almost a virtual non-entity. With a very high literacy rate, and a population that is prepared to take heed to the hilt, the axiom that dictates ‘prevention is better than cure’, it is the absolute dream of the experts in the public health scenario that there is unmitigated abiding interest on the part of our populace to get vaccinated against COVID-19. It has been said that vaccines do not save lives but vaccination most definitely does. Vaccines have to be given to people for them to produce the optimal effects. A receptive population to such a notion is indeed, a much-fancied reverie of all health service providers.

In such a background, it is most laudable that Sri Lanka is going pell-mell, even in an impetuous rush, to vaccinate her population against COVID-19, at what could best be described as at break-neck speed. Even given the spectacle of an insufficiency of adequate stocks of the coronavirus vaccines to freely vaccinate the population, the authorities are making the very best of the situation. We must, of course clearly appreciate the steps taken by the Government and the Ministry of Health in this initiative. The tri-forces, the Army in particular, have to be congratulated, in playing the lead role in organising a scheme of things to administer the vaccines in an orderly fashion. TAKE A BOW; ALL OF YOU, you are indeed giving the very best of yourselves in this endeavour.

Well, the goal is to somehow secure a high enough herd-immunity to defeat the virus; most definitely a commendable final goal. The currently prevalent mantra is to vaccinate, vaccinate, and vaccinate even more. Yet for all that there is much misinformation and an infodemic doing the rounds, especially on social media, about widespread speculations on loss of sexual prowess, impotence, subfertility and infertility, as undesirable effects of the COVID-19 vaccines. THERE IS ABSOLUTELY NO SCIENTIFIC BASIS FOR ANY OF THESE IMPLICATIONS. NONE OF THE CURRENTLY AVAILABLE COVID-19 VACCINES DO ANY OF THIS. It is just stupid covidiocy on the part of a few anti-vaxxers. It has induced a lot of young people to refuse the vaccine. This is a crime against humanity to spread such falsehoods. It is absolutely crucial to realise that the current vaccination drive is just a very important one of quite a few things we can do to try and keep the coronavirus at bay.

We have seen the fantastic results of immunisations against ‘child-killer diseases’ in paediatric healthcare. This author, as a young junior doctor, was witness to the ravages of the much-feared childhood diseases that killed or maimed scores of young children even in the second half of the last century. Those diseases such as tetanus, diphtheria, whooping cough, polio, measles, Japanese encephalitis; just to mention a few that took scores of young lives of yore, are a thing of the past now. Adequate vaccination has completely wiped them out. The last case of childhood polio in Sri Lanka was seen just around a quarter of a century ago. The young junior doctors of today and the current lot of medical students have not seen any of these dreaded diseases.

In the child healthcare scenario, vaccination has become the panacea for all ills in the above-mentioned diseases. In the same vein, it is quite reasonable to expect the coronavirus vaccines to provide a similar end-result. However, is it really so? It is a most lamentable fact that it is perhaps not quite so.

There is a well-recognised fundamental difference between all the vaccines that are used to prevent the much-feared childhood diseases of the past and the currently available vaccines against the coronavirus that is causing the current pandemic. The vaccines against all those childhood diseases COMPLETELY PREVENT children getting the disease!!!, period. Well, if the recipients are protected against getting the infection, it is the end of the story; a definitive conclusion of the matter in hand.

However, right up to just a few days ago, none of the currently available vaccines against COVID-19, were thought to be able to COMPLETELY PREVENT anyone getting the disease to any appreciable degree. How they work is by reducing the severity of the disease and by preventing the deaths. So…, the basic end-result characteristics of all the currently available COVID-19 vaccines were thought to be quite different to the standard vaccines against all other infective diseases. One could still get the disease in spite of being vaccinated against COVID-19 and would still be able to spread the illness to others.

Yet for all this, there seems to be a little bit of light at the end of the tunnel. In a most recent scientific publication in the New England Journal of Medicine, released as recently as 22^nd September 2021, an interim analysis of a large study conducted in 99 centres of the USA has shown significant protection against CONTRACTING THE DISEASE as well as AGAINST MORE SEVERE DISEASE AND DEATH by the mRNA-1273 (Moderna/Spikevax) vaccine, administered as two doses 28 days apart. Vaccine efficacy in preventing Covid-19 illness was 93.2%, the effectiveness in preventing severe disease was 98.2% and the efficacy in preventing asymptomatic infection, starting 14 days after the second injection, was 63.0%. Vaccine efficacy was consistent across ethnic and racial groups, age groups, and participants with coexisting conditions. No safety concerns were identified.

Be that as it may, added to all our problems, now there is the daunting spectacle of the various types of variants and mutants, ranging from Alpha through delta, even to Epsilon and most recently to a particularly nasty strain called ‘Mu’, of the coronavirus which could cause problems even in the fully vaccinated. We still do not understand completely the potential impact of these more virulent strains in vaccinated people.

However, a case in point in relationship to these facts is the presently dominant situation in Israel. That country, one of the fastest in vaccination and most-vaccinated nations in the world, in spite of almost the entire population being vaccinated, is having some problems at the present time. By mid-March 2021, Israelis were partying as lockdowns ended and by April, masks had more or less vanished, turning the tiny country into a tantalising glimpse of a post-pandemic future. However, the crafty blight of a coronavirus seems to have come back with a vengeance. From a few dozen daily cases in early June 2021, even zero on June 9, new daily COVID infections twice hovered near 6,000 very recently, the highest daily rate in six months. Having won early access to supplies of the BioNTech/Pfizer jab in exchange for sharing nationwide data on how mass vaccination drives affect the pandemic, Israel is a closely watched indicator of a country where well-inoculated developed economies are heading.

As new infections soared, so did the long tail of hospitalisations in Israel. Even though the unvaccinated were five to six times as likely to end up seriously ill, the vaccine’s protection was waning fastest for the oldest; the most vulnerable, who got their first jabs as early as December 2020. At this rate, health officials predicted at least 5,000 people would need hospital beds by early September, half of them with serious medical needs, twice as many as Israel is equipped to handle. The current Prime Minister of Israel was honest with Israelis when he announced a new measure just a couple of weeks ago, whereby the government was trying to cushion the blow. On August 1, it had started offering people, over 60, a third shot of the Pfizer vaccine, embarking on its own public health experiment as it tumbled into an unpredictable fourth wave. So far, 775,000 people have taken their third shot and doctors say they can see antibody counts rising measurably within days of the third jab.

For Israelis, the booster shots are a reminder that they are still on the frontier of Covid-19 vaccinations. They celebrated when they were the first to get jabbed, cheering Pfizer as lockdowns ended in March 2021. Now, they are the first to experience the limits of the vaccine and the first to accept a long-whispered inevitability: the need to give regular booster shots to stay protected.

All these facts tend to bring into sharp focus, again and AGAIN, the undoubted importance of time-tested manoeuvres of avoiding crowds, maintaining a social distance of at least one to two metres, wearing suitable and effective masks; even double-masking, and repeated washing of hands, as our own personal weapons against this dastardly blight. Vaccination against COVID-19 will probably not be the panacea for all ills in combating this pandemic, although it would be a very powerful tool in the hands of the authorities in their quest towards victory over this disease. It will certainly not be the ultimate ‘SILVER BULLET’ against the disease.

If there is a lesson to be learnt from Israel today, it is this: corona, in fact, is not over; perhaps not for quite a while. This summer was just an intermission. Next may come winter., sadly perhaps, a winter of discontent. We do hope to high heaven that it may not be so for this beautiful and much-treasured Motherland of ours.