Vaccine horizon

This tormented year 2020 is ending with some hope that with a COVID-19 vaccine rolled out in the United Kingdom (the first jab administered by a Filipino nurse) and the United States, we might be seeing the end of COVID-19.

Now people throughout the world are asking when the vaccines (there are seven now approved or near approval) will arrive in their country. For the Philippines, President Duterte says that Sinovac’s vaccine will be available by March.

But before we celebrate, let’s take a reality check for these vaccines.

First, and most importantly, these first-generation vaccines will not prevent transmission of COVID-19. What they have been proven to do is to prevent COVID-19 symptoms in those who are vaccinated. By preventing symptoms, the chances of the person becoming seriously ill or dying are greatly reduced. Also, without symptoms like cough, a vaccinated person who is infected will not be as likely to transmit COVID-19. Remember, though, transmission can still occur through talking and singing.

Put briefly, masks, physical distancing, and other precautions will continue to be important even after vaccinations are rolled out.

Yes, that’s such a downer, but the researchers have compressed what usually takes 10 years or so to less than a year to roll out vaccines, so we can hope that eventually, we will have vaccines that do prevent transmission. This first generation will still make a difference.

Second, we do not know how well the vaccines will protect certain populations. The clinical trials show efficacy only for adults, and the trials also do not have enough numbers to tell us how well it will work with children, older people, with people who have health problems like obesity.

Third, in our reality check, the COVID-19 vaccine is still too new for us to know how long protection will be. How will we ever know then? People who get vaccinated will be asked to report if they do develop symptoms. Simple, but somewhat distressing.

A related issue is that of people who have natural immunity, that is, who recovered from COVID-19. In the same way that we do not know how long vaccines will protect people, we do not know either how long “natural immunity” will last, which is why they will still be advised to get vaccinated.

Fourth, still related to vaccine effectiveness will be the logistics around cold chains, meaning the vaccines have to be kept in very cold temperatures from production to administration. The Pfizer/BioNTech vaccine is the most demanding, requiring a temperature of -75 degrees Celsius—note the negative sign. The Moderna vaccine requires storage temperatures of -20 degrees Celsius, more like other vaccines, but even that has been problematic in the Philippines, with frequent electricity outages and, I have seen this for myself, refrigerators in health centers being used for other purposes, including storing merienda.

Fifth point will be cost. The Philippine government’s 2021 budget allocates P70 billion for vaccines. The costs for the vaccines supplied by Sen. Sonny Angara as part of his proposal to have government allocate money for vaccines range from P610 to P4,504.

Finally, there’s the threat of vaccine hesitancy or skepticism, with significant numbers of people likely to refuse to get vaccinated. A survey of 19 countries published in the journal Nature Medicine found the highest willingness of more than 80 percent in China, South Korea, and Singapore. The lowest acceptance rates were in the US (67 percent), Germany (67 percent), France (59 percent), and Russia (54 percent). A Social Weather Stations survey conducted in September found 66 percent of Filipinos saying they would definitely or probably get the vaccine, putting us in the league of low acceptors.

This is problematic, because the estimate is that for an entire population to be protected, 70 percent of the people will have to be vaccinated. This is called herd or community immunity. If the rate is lower, then we actually run the risk of infections still occurring in significant enough numbers to cause an outbreak or epidemic within that community.

Vaccine hesitancy in the Philippines will likely be fueled by the “Dengvaxia hangover,” memories of adverse reactions and deaths following the use of Sanofi dengue vaccines in 2017. The government had to suspend the vaccination and never fully explained what happened. Vaccination for other childhood diseases, notably measles, dropped as well after that Dengvaxia mess. The promises of vaccines and their effectivity loom like a horizon, so near and yet so distant.

For a sobering medical summary of where we are, see:

https://www.thelancet.com/journals/lanmic/article/PIIS2666-5247(20)30226-3/fulltext

Enjoy your holidays and the best for 2021. It can only get better!

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