Vaccines have been in the ‘sensational news’ segment for the last couple of months. News headlines like :
40 doctors testing positive despite taking two doses of the vaccine.
Vaccine recipients in European Union (EU) dying due to blood clots.
246 fully vaccinated citizens of Michigan tested positive and 3 died (only the 2 mRNA vaccines were used).
A Vaccine Centre closed abruptly after recipients suffer side effects immediately after taking their first dose of the Jansson’s (new name of Johnson and Johnson) vaccine in the US.
– VARIOUS NATIONAL AND INTERNATIONAL NEWSPAPERS
Hence the need for this article. Last August and September I had written two articles on vaccines, hence will not dwell upon the basics of vaccines. Here, I will attempt to clear the air on the myths, mysteries, and misunderstandings as much as possible, with the facts available to date. Of course, this is not a scientific treatise.
SAFETY – Vaccine safety is confirmed during the trial stage of vaccine development and it may last 5 to 10 years. Since the present pandemic was causing a large number of deaths, the Emergency Usage clause was invoked by the regulating authorities worldwide. The Phase III trial was hastened and Phase IV trials were circumvented. And now after commencing mass production, certain extremely rare side effects such as the ‘blood clots’ due to AstraZeneca’s Oxford vaccine (called Covishield) have come to light. This vaccine was given to over 28 million people in the UK, of which, 79 developed blood clots and 17 died. The deaths due to vaccine-related blood clots are actually just about 1 in a million. In a normal population, 2 to 5 persons per million will die due to blood clot-related issues every year. Blood clots usually contribute to Deep vein thrombosis, Pulmonary embolism, and rarely Cerebral venous sinus thrombosis. This is because of the development of low platelet count, occurring in a few people. This sensational news made the country regulators, especially in the EU, respond in many different ways. Some banned it, others restricted the use in children while some restricted the use in persons below 60 or even 65 years. The ban was lifted later as deaths continued unabated. Interestingly, UK continued one of the fastest Vaccination campaigns, without banning this vaccine, reducing deaths almost to a trickle. Intriguing isn’t it!
EFFECTIVENESS – Effectiveness, and Efficacy are two terms that define how well a vaccine works. ‘Efficacy’ is the degree to which a vaccine prevents disease, and possibly also transmission under ideal and controlled circumstances on healthy groups of people. ‘Effectiveness’ meanwhile refers to how well the vaccine performs in the real world. Factors such as other illnesses in people, parallel medication, rare health conditions, age, and also the conditions in which the vaccine is stored and administered can reduce how effective the vaccine is at preventing disease.
As compared to a high ‘Efficacy’ percentage, the ‘Effectiveness’ of the same vaccines in the masses is usually much less. Most of the existing vaccines reduced serious diseases and deaths to negligible numbers. But, they may not have fully prevented the spread of the disease and a minimal number of people still contract the disease albeit in a mild form or be asymptomatic or become carriers to the disease spreading it to others. Those who took that vaccine without fully understanding its limitations may have felt cheated. Others, who do understand the Effectiveness of the vaccine may continue to harbor ‘Vaccine Hesitancy’.
RISK – BENEFIT ANALYSIS – This jargon is used in almost all fields, especially management, yet, subconsciously each one of us since birth has been practicing it. Infants take the risk of falling down when they try to stand. But, the benefit of walking appears far more than the pain of falling. A housewife takes the risk of making a new dish. Every one of us takes a risk of walking on the road – after all, 62 pedestrians die every day in India. The same is the case of opening a new business which may fail or it may give tremendous benefits. Taking antibiotics for fever may give relief but there may be side effects, some extremely rare. Now, if 17 people died in the UK due to clots, the vaccine also prevented over 10,000 deaths. Was the risk of Vaccine worth taking in 2.5 million people in the UK? In India, we have seen many people admitted in COVID19 wards, dying of burns due to short circuits. Others dying for lack of oxygen or ventilators or drugs like Remdesivir. Should they have got admitted or allowed to die at home?
BLOOD CLOTS – A blood clot is a gelatinous blob of blood in a vein that can block blood flow. It is commonly formed at injury sites. It can also form in certain genetic disorders, Cancers, due to certain drugs or even due to sitting in one place for long periods of time as in long-distance air travel. Scientists in the EU have found that a few recipients of the Covishield vaccine produced a kind of antibodies that encouraged their platelets to clump together forming clots. Younger recipients were more at risk of developing such antibodies and could develop clots. Incidentally, such people are also at a higher risk of getting a severe form of Corona disease. Young people who receive this vaccine should look for swelling in the legs, persistent abdominal pain, severe and persistent headaches, and blurred vision. Once again, it is emphasized that such cases are extremely rare and risk-benefit analysis shows that vaccination is much better than getting the disease.
MYSTERIES – Some mysteries will continue from day to day in this disease, in its treatment, and in its vaccines. This is because the disease is new and the virus is mutating as it spreads from country to country. New races of people with different genomes will react differently and the virus will adapt accordingly. Brazil is presently the worst affected. With a population of 22 crores, it is seeing over 4000 deaths a day. The present P1 strain is highly infectious. The Chinese Sinovac vaccine in use is only 50% effective against it. Over 60 poor countries are still waiting to get vaccines from the COVAX initiative of WHO. Treatment with some drugs found effective in one region of the world may not be effective in another region. We see countries like South Africa and Canada refusing the Covishield vaccine in favor of Janssen’s vaccine which appears more effective against the South African strain of the virus. India has given the nod for trial of this single-dose Janssen’s vaccine. The Sputnik-V vaccine is also awaiting approval for mass production and usage in our country. All options need to be kept ready for the ‘double mutant virus’ and its unpredictable behavior. The country needs the prevention of severe disease and death due to this scourge. On the positive side, UK and Israel have rapidly carried out vaccination of a large percentage of their population and the disease/ deaths in their countries is declining rapidly. A new Treatment schedule with just one spray in the nose has shown to be 100% effective, but when it will come to our medical stores is still to be seen.
Maj Gen Krishan Chauhan is a second-generation army officer. He studied in Sainik School Kapurthala, graduated from IG Medical College, Shimla and did his MD from AFMC/Pune University. He has served in the Army Medical Corps for 36 years and retired as the Addl DGMS army. He is an avid marathon runner and a writer. He first wrote articles for children in The Young Chronicles. Later, he started writing his own blog as Genkris, on WordPress where over 25 articles on various subjects can be accessed.
