By: Dr. Taimoor Janjua & Dr. Fizza Zulfiqar
The current global initiative for bringing COVID-19 pandemic in control via equitable access to effective vaccine availability worldwide has trillions of dollars already invested for its procurement. It can be conspicuously witnessed that the contest among countries and pharmaceutical giants to introduce vaccine prior to their competitors has now entered an exciting final stage. Lately, around the world, managerial attentions have shifted from lockdown imposition, stimulus packages, and addressing exponential COVID cases rise and deaths towards the finalization of deals for reaping the benefits of novel vaccine as early as possible. This race among the multinational corporations and giant pharmaceuticals could potentially provide immense global influence and economic benefits to their respective countries.
The top current contenders with their efficacy rates are household names now which include USA’s Moderna (94.5%) and Pfizer (95%), Russia’s Sputnik V (95%), United Kingdom’s AstraZeneca/Oxford vaccine(60-90%). Some others are yet to publish final results.
The purpose of this article is to underscore the greatest vaccine procurement race and drive since the last few decades the world will soon witness, moderate risks involved with early vaccination and weighing their benefit against risks in unusual/urgent circumstances for countries like Pakistan. Furthermore, to reiterate educating under-privileged masses about necessary vaccinations for diseases like SARS-Cov 2 and Poliomyelitis.
Vaccines go through vigorous testing for safety and effectiveness before they are approved ensuring human subject protection in place and preventing unreasonable risks or harm. Normally an FDA approval for a drug or vaccine requires completion of at least 3 Phase trials which includes: Phase 1-Is the drug safe and devoid of serious side effects in the general population? Phase 2-Does it work? i.e. producing sufficient antibodies in this case, Phase 3-Is it better or showing improvement compared to similar drugs and placebos? Phase 4-Does it have any long-term adverse effects etc.?
However a pandemic emergency certainly allows emergency approvals from regulatory bodies like the FDA.
This is an evident race where the well-connected countries shall receive vaccines first and the best vaccine maker might even fetch the Nobel Prize. However, outside this competition, acceptance of vaccine by people around the world is a major concern but cutting the corners and skipping large scale human trials to roll out a vaccine quickly will put a huge number of people at risk. Masses of population would potentially hesitate to get vaccinated; the distrust of people would inevitably grow if vaccine is rushed with incomplete safety data. Also, the matter of how quickly and effectively the third world is vaccinated and vaccine allocations are done, echoes serious concern for GAVI( the Global Alliance for Vaccines and Immunization) i.e. the World Health Organization’s (WHO) key body for justly ensuring safe and timely vaccine provision for poor communities.
Challenges for Pakistan
Amid all this, Pakistan’s case deserves special mention and discussion. Pakistan has remarkably managed to flatten the curve presumably through innovative Smart lockdown strategies which remained to be validated in the face of unknown and unproven external factors including but not limited to younger population and cross immunity to past Corona infections. A recent peer reviewed publication by an eminent doctor from the National Institute of Blood Diseases(NIBD) Pakistan underscores increased infectivity induced immunity for our reduced critical cases and deaths and hence according slim chances for a second destructive COVID wave. Regardless a grand effort by Pakistan’s National Command and Operation Control center (NCOC) using test, trace and quarantine (TTQ) strategies utilizing digital and logistic input from local top health experts deserves credit for efforts to understand and contain the COVID spread and as per the WHO Director General’s recent remarks, also employing the infrastructure used to combat Polio recently. Pakistan recently also became the first nation to officially acknowledge the WHO recommended typhoid vaccine.
However, accepting the vaccination concept gradually let alone urgently, as a cure for disease has been challenging for countries like Pakistan, Afghanistan and Nigeria. On behalf of the Word Economic Forum, IPSOS survey was recently done to gauge percentages of population willing to get vaccinated including 20,000 adults from 27 countries; 74% agreeing for vaccination and 26% speaking against it citing reasons of worrisome side effects and doubtful vaccine effectiveness. This survey included developed countries like USA, Canada, Malaysia, China, Japan, Italy and others. Therefore in Pakistan where people doubted existence of corona virus and refused wearing masks, reluctance would certainly be great against COVID vaccination if they lack clarity regarding virus lethality and vaccine’s potential curing properties.
Pakistan’s history regarding vaccination campaigns does not offer a pleasant read.
A universal vaccine development for Poliomyelitis; a vaccine preventable disease was a novel scientific breakthrough because it has saved many lives since the 1950s. Pakistan’s official campaign started in 1974 although it did not pick pace until 1994. Polio has been globally eradicated successfully, yet Pakistan and Afghanistan hold the disgraceful distinction of being the last two Polio infected countries left. Polio vaccination has not been locally accepted despite decades of irrefutable scientific evidence, due to ethical controversies, religious and ideological beliefs of people not supporting vaccination. Apart from public resistance Pakistan’s shameful vaccination record will reveal fatal shootings of vaccine administering volunteers .
The Lancet has published reports of over-vaccination among children in KP province possibly contributing to unwanted symptoms in children drawing whiplash from their parents.
Furthermore after digesting the ‘polio vaccine induced infertility’ conspiracy theory we must acknowledge the current estimated risk for Vaccine associated Paralytic Polio (VAPP) i.e. 1 case per 2.4 million live viral doses. A very low digit yet questionable for many.
Regarding the novel COVID vaccine’s introduction in near time and before inaugurating inoculations, health and religious experts must seriously consult and reach consensus before such decision-making owing to past events and more importantly many demographic factors like age, comorbidity, gender, pregnancy status of women and variable ethnicity which can influence responses to a novel vaccine.
The root problem after all lies not with the technical and manual implementation of vaccination but its acceptance and educational aspects for the mass public. A nationwide survey addressing people’s intent and hesitation regarding vaccination could reveal remarkable responses.
Pakistanis are a very diverse people; a nation where even a minor misconception regarding vaccination could cause complete distrust among people’s willingness to get vaccinated, a single oddity or outlier could spark fearsome riots nationwide. Imagine then the havoc a newly available vaccine could wreak whose long-term side effects have not been properly ascertained. Hence, premature campaigns could be disastrous. While the world might be willing to overlook the risks for single-shot and co-administered different Vaccine serotypes i.e. live, attenuated, inactivated or killed, Pakistan’s past is not favorable for initiating such steps. The inactivated ‘CoronaVac‘ vaccine is no different. It is also worth mentioning that annual ‘Flu shots’ occasionally offer zero protection to some patients; few still develop the flu.
A very robust public health education campaign must be developed at the earliest so effective strategies are timely implemented to educate people’s understanding about vaccine importance be it Corona or Polio vaccines. The campaign should address their concerns, enlighten them about vaccine mechanism of action, plausible risks and simultaneously promote its benefits to prevent further emergence of false beliefs. Education before vaccination is necessary for Pakistan. It will require few months to properly negate conspiracies of infertility and ‘the west inserting microchips’ through COVID vaccination and putting to task notorious local religious clerics falsely accusing hospitals with killing patients purposely.
The ‘vaccine induced infertility’ polemic must be addressed and resolved once and for all since Pakistan will soon face its grandest vaccination challenge. It could serve as a much needed impetus for not just eradicating polio but also imprinting a lasting education among its underprivileged uneducated masses. Fewer deaths per million must not compromise a nations resolve while caring for the underprivileged. Empathy and patience must precede forcefulness for the underprivileged.
If Pakistan; the world’s fifth most populous nation with a minimal 35% illiteracy rate yet rapidly emerging economy can temporarily beat COVID without a vaccine, can it not beat Polio with a vaccine.
The writers are medical graduate doctors
