We think about vaccination logically, not as a magical solution!
10/28/2021 4:15:18 PM
We think about vaccination logically, not as a magical solution!
Introduction
Among the many communicable diseases which threaten human life, only a few have effective vaccines. This could be a reminder that we should consider other alternative approaches in managing communicable diseases, specifically COVID-19 in parallel.
Although vaccines showed some positive effects at first, their effectiveness has been fading over the past few months (1). Now many countries which have vaccinated a considerable percentage of their population face a high number of COVID-19 cases, such as the USA (57%), UK (67%), Canada (74%), Germany (66%), etc. (2, 3).
On the other side, some countries successfully controlled the pandemic within their own borders, even before the emergence of COVID-19 vaccines, such as New Zealand, Taiwan, Singapore, South Korea, etc. (2).
Body
Evidence has emerged that the efficacy of vaccines is too short, and after around six months, booster doses are needed; thus, a huge amount of money has been spent for mass vaccination, just for six months effectiveness. This seems somewhat unreasonable. The virus quickly drifted and shifted, shrinking vaccines' effect just in a few months. Up till now, we have seen some different variants of the virus, such as Alpha, Beta, Delta, etc. (4). All these variants have made new surges across the globe, leaving the vaccines in the dust. As vaccine manufacturers produce a new version of vaccines, a new variant will emerge, and this cycle continues to spine. Relying on the vaccine means repeating the booster dose every six months via updated vaccines. How long can we keep up with such a vicious cycle?
Now many countries in the OECD region and North America face a considerable surge in new cases and death rates after what they considered acceptable vaccination coverage.
Israel was the first country that vaccinated a high number of its population and showed a new surge after almost fully vaccinating 65% of the population (3). This happened after a few months with zero number of new cases (2).
Figure 1 – Trend of New Cases of Corona in Israel (2)
In Israel, even the number of deaths was considerable in the last surge, and health officials ran booster doses for healthcare staff, elderly people, and patients with preexisting conditions (5, 6).
Figure 2- Trend of New Deaths of Corona in Israel (2)
In the mean, while scientistss have developed the new technology of mRNA vaccines, which is being used on such a huge scale, even though we are still not sure about its possible long-term side effects, its actual effectiveness for COVID-19 eradication.
In the UK, post-vaccination and follow-up care has a well-established study reporting that 30,000 women developed abnormal uterine bleeding after receiving the vaccine (7). We are still clueless about whether it could have a negative side effectss on fertility or maternity in the future. If it has some long-term side effects, no one would be held responsible for compensation under the indemnity agreement with vaccine manufacturing companies.
Another critical concern is that the elderly are more vulnerable to SARS-CoV-2 and show higher death rates, but most published data for current vaccines show relatively lower vaccine efficacy for the elderly. Moderna mRNA vaccine showed a 95.6% Vaccine Efficacy for people younger than 65, but the vaccine efficacy dropped to 86.4% for people over 65 (8, 9). This rate for Johnson & Johnson is around 76.7% (10). Most vaccine effectiveness estimations have not been done on immunocompromised patients and therefore the results in real population may differ (11). And now, even lower effectiveness is being reported, in reducing hospitalization, preventing ICU admissions and death (12).
Numerous factors, including genetic defects, chronic diseases such as osteoarthritis and cancer, and the use of immunosuppressive drugs after organ transplants and unknown pot interactions, can cause defects in the immune response to vaccination. The immune system in these patients is not able to respond effectively as a result of receiving the vaccine and cannot protect them against COVID-19 disease; therefore, the vaccine can be ineffective for them; consequently, it is necessary to identify and screen these people in the process of vaccination and find alternative approaches. One of the alternatives is a monoclonal antibody. This type of antibody mimics the body's natural antibody response and binds to the virus's crown protein, and may neutralize the virus and protect individuals. AstraZeneca, Regeneron, and Eli Lilly are currently testing the effectiveness of monoclonal antibodies in immunizing people against the new Covid-19 virus (13).
Why do we focus on vaccines much more than they are worth it? Why neglect other alternatives for managing this disease. We have some excellent examples of countries that successfully managed the pandemic in their own boundaries, such as Singapore, South Korea, Taiwan, New Zealand, etc. (2).
In the picture below, you see Taiwan had excellent performance in controlling COVID-19. Just one considerable surge has happened, and majority of the the time, there is barely any new cases or significant numbers. The only surge that has occurred is just after of introduction of vaccines.
Figure 3 - Trend of New Cases of Corona in Taiwan (2)
Compare the situation of Taiwan with UK or Netherland. In the UK, the most continuous surge has just happened after mass vaccination of the population and is still continuing (2)!
Figure 4 - Trend of New Cases of Corona in the UK (2)
The same trend happened for Netherland and other European countries, which relied on vaccines much more than it was worth.
Figure 5 - Trend of New Cases of Corona in the Netherlands (2)
Figure 6 - https://ourworldindata.org/covid-cases
As another alternative, giant pharmaceutical companies such as Merck suspended their R&D platform for COVID-19 vaccines and decided to focus on COVID-19 treatments, and it seems that they got some valuable achievements in the field. Merck and Ridgeback developed a highly effective pill, "Molnupiravir," against COVID-19, and it's not far away from getting emergency use authorization. If authorized, Molnupiravir could be the first oral antiviral medicine for COVID-19 (14). Other scientists around the globe are also working together to provide solutions for managing COVID-19. Since the beginning of the pandemic our knowledge about controlling the disease has evolved significantly, such as developing better ventilation systems, new and more powerful disinfectants, providing accessible and affordable face masks, better treatment protocols, etc.
Please take into account this critical point that we are not totally against vaccination. No, we think relying on just one strategy and over-focusing on it can have negative results. In so many countries, after considerable vaccination coverage, people and the government neglected health precautions for preventing COVID-19. Because they think the vaccination against COVID-19 would guarantee against further infections. But reality showed us something different!
Vaccines could be useful to some degree. But not as a magical intervention for eradication of COVID-19. People still need to care about health precautions. Vaccination only alongside other interventions may help to reduce the number of cases.
Conclusion
So far, we don't know how long this condition of living alongside COVID-19 will continue. We should adopt wiser strategies altogether. Vaccination may be effective somehow, but it couldn't be considered the only hope to overcome the crisis today. We should strengthen other strategies for overseeing this pandemic, particularly continuing health precautions such as wearing face masks, social distancing, developing other effective treatments and drugs, improving hospital care, etc.
By: Masoomeh Gholami, Ghazaleh Ghaffaripour, Shaghayegh Naderi and supervised by Dr. Alipasha Meysamie
References:
- Levin EG, Lustig Y, Cohen C, Fluss R, Indenbaum V, Amit S, et al. Waning immune humoral response to BNT162b2 covid-19 vaccine over 6 months. New England Journal of Medicine. 2021.
- https://www.worldometers.info/coronavirus/.
- https://ourworldindata.org/covid-vaccinations.
- https://www.cdc.gov/coronavirus/2019-ncov/variants/variant-info.html.
- Mahase E. Covid-19 booster vaccines: What we know and who’s doing what. British Medical Journal Publishing Group; 2021.
- Mahase E. Covid-19: Booster dose reduces infections and severe illness in over 60s, Israeli study reports. British Medical Journal Publishing Group; 2021.
- Male V. Menstrual changes after covid-19 vaccination. British Medical Journal Publishing Group; 2021.
- Baden LR, El Sahly HM, Essink B, Kotloff K, Frey S, Novak R, et al. Efficacy and safety of the mRNA-1273 SARS-CoV-2 vaccine. New England Journal of Medicine. 2021;384(5):403-16.
- Voysey M, Clemens SAC, Madhi SA, Weckx LY, Folegatti PM, Aley PK, et al. Safety and efficacy of the ChAdOx1 nCoV-19 vaccine (AZD1222) against SARS-CoV-2: an interim analysis of four randomised controlled trials in Brazil, South Africa, and the UK. The Lancet. 2021;397(10269):99-111.
- Corchado-Garcia J, Hughes T, Cristea-Platon T, Lenehan P, Pawlowski C, Bade S, et al. Real-world effectiveness of Ad26. COV2. S adenoviral vector vaccine for COVID-19. 2021.
- Kow CS, Hasan SS. Real-world effectiveness of BNT162b2 mRNA vaccine: a meta-analysis of large observational studies. Inflammopharmacology. 2021;29(4):1075-90.
- Jara A, Undurraga EA, González C, Paredes F, Fontecilla T, Jara G, et al. Effectiveness of an inactivated SARS-CoV-2 vaccine in Chile. New England Journal of Medicine. 2021;385(10):875-84.
- Jahanshahlu L, Rezaei N. Monoclonal antibody as a potential anti-COVID-19. Biomedicine & Pharmacotherapy. 2020;129:110337.
- https://www.merck.com/news/merck-and-ridgebacks-investigational-oral-antiviral-molnupiravir-reduced-the-risk-of-hospitalization-or-death-by-approximately-50-percent-compared-to-placebo-for-patients-with-mild-or-moderat/.