Dr Amir Khan
The COVID-19 pandemic has already introduced new words and phrases that were rarely before used in our common vernacular: “furlough”, “social distancing”, “flattening the curve”. Now there is a new phrase in use among experts: “vaccine nationalism”.
Vaccine nationalism occurs when governments sign agreements with pharmaceutical manufacturers to supply their own populations with vaccines ahead of them becoming available for other countries.
Even before many of the now-approved COVID-19 vaccinations had completed their clinical trials, wealthy countries such as Britain, the US, Japan and the European bloc had procured several million doses of the ones that seemed the most promising. As we have seen in the United Kingdom, it was a prudent move. After a devastating death toll, millions of vulnerable people and front-line workers have been offered their first dose of either the Pfizer or Oxford-AstraZeneca vaccines. Despite the political bickering, Europe will soon follow suit and with a new president in place, the United States is prioritising its own vaccine programme.
According to a new report, published in the British Medical Journal (BMJ), the US has secured 800 million doses of at least six vaccines in development, with an option to buy about one billion more. The UK has purchased 340 million shots: approximately five doses for each citizen. Although, on the surface, it may seem these countries have ordered more doses than they need, the truth is many of these orders were put in during trial phases of the vaccines when they did not know for sure which vaccines would be successful. Essentially, countries like the UK have put their eggs in several baskets, which has now proven to be a good idea.
The World Health Organisation (WHO) has expressed its concerns about this and there are fears that such unilateral deals with wealthy countries will make the vaccines inaccessible to those in some of the poorest parts of the world. “We need to prevent vaccine nationalism,” Tedros Adhanom Ghebreyesus, the director of WHO, wrote to member states on August 18, last year. “Whilst there is a wish amongst leaders to protect their own people first, the response to this pandemic has to be collective.”
The concern over less wealthy countries not having access to a vaccine is a serious one, and it is everyone’s problem. The pandemic is a global issue; we have already seen how quickly it can spread around the world, bringing some of the most powerful economies to their knees.
If we were to vaccinate only those countries that bought up the majority of the supplies of the vaccine, it would mean the virus would continue to rage in other non-vaccinated countries. And we have already seen just how quickly and efficiently this virus can mutate when allowed to ravage unchecked through populations anywhere.
The more people it infects, the more likely it is that further mutations will occur and it is inevitable that an “escape” mutation will eventually surface. This is a mutation that allows the virus to evade the immune response set out by vaccinations, which could mean they become less effective in preventing serious illness. The new mutation is then likely to become the dominant strain and will find its way back to our shores, setting off a whole new set of infections in those vaccinated against only the old variants.
The pharmaceutical companies have said they can “tweak” their vaccines to combat any new variants that may occur, but that may take time – something experience has taught us is vital when it comes to containing a pandemic. We also do not yet know if the vaccines stop transmission of the virus – what we do know is that they allow for a quicker immune response by those vaccinated, meaning less time for the virus to potentially mutate inside of its host. For this reason, we need a more global response to this pandemic.
Vaccine nationalism, therefore, is incredibly shortsighted. The alternative is a global vaccine programme and this is what the WHO aims to do through COVAX, a global facility set up in April last year to speed up the development of medicines to treat COVID-19 and make them available everywhere.
Set up alongside the Vaccine Alliance and Coalition for Epidemic Preparedness Innovations (CEPI), the COVAX agenda is to provide innovative and equitable access to COVID-19 diagnostics, treatments and vaccines. So far, more than 170 countries have signed up to COVAX, including the UK and China. Its aim is ambitious, but by working together, all countries that are part of COVAX are supposed to follow a plan for fairly distributing the vaccine in order to prevent self-interested hoarding at a national level. This will help ensure that even the poorest countries have access to vaccines while the wealthiest remain protected.
Is the South African variant less susceptible to vaccines?
There has been increasing concern over the so-called South African variant as it has been linked to an increasing number of cases in other countries. So far, the variant has been identified in more than 30 countries including the UK, the UAE, Belgium and Austria.
Although experts have insisted that there is currently no evidence that the South African variant – known as 501 V2 – will cause a more severe illness, they have expressed their concerns about it being less susceptible to immune responses triggered by our currently approved vaccines.
The South African variant includes the N501Y mutation identified in the UK variant, which makes the virus more infectious. But it also includes another mutation, known as E484K.
The vaccines approved so far trigger an immune response that relies on recognising parts of the coronavirus spike protein which allows the virus to latch on and enter human cells. The E484K mutation, however, changes the shape of the spike protein in a way that makes it less recognisable to the body’s immune system. As a result, it may make it less susceptible to the vaccine.
Tests are being urgently carried out by scientists to see just how effective the current batch of vaccines are against this variant, but it is too early to draw any definitive conclusions.
Pfizer has published a study based on blood samples taken from people who had had its vaccine, showing that there only appears to be a small loss in effectiveness in the immune response triggered by their vaccine against an engineered virus that had similar mutations to the South African strain.
Moderna has conducted a laboratory-based study which suggest the immune response of its vaccine to the South African variant remains promising, though the response may not be as strong or last as long when compared with earlier variants.
Novovax has gone on the record to say its vaccine gives up to 60 percent protection against the South African variant in those with an otherwise healthy immune system. This is considered to be a good response rate.
We have seen how the South African variant has spread rapidly in South Africa itself, which is seeing a resurgence of cases.
It is now more important than ever that the countries where this variant has been identified double down on lockdown, border control and social distancing measures as well as carry our rapid testing and isolating to contain its spread until definitive results from vaccine trials are known. This also shows us why vaccine nationalism as a government policy will continue to endanger us all.
In the Doctor’s Surgery
How to put children at ease while wearing PPE
Going to the doctor can be scary for children at the best of times. They either associate visits to my surgery with childhood immunisations they have had in the past, or with feeling sick. Neither of these lend themselves particularly well to a harmonious relationship between a family doctor and their paediatric patients.
This issue has been compounded by the need for doctors to wear personal protective equipment (PPE) during all our consultations. Our doctor’s outfits now consist of gloves, a plastic apron, mask, goggles and a face visor. Although children are not required to wear masks during a consultation, their parents are and this can also alarm an unwell child.
Recently, I was due to see a child who was complaining of abdominal pain. He started crying the minute he set eyes on me. I imagine I looked frightening in all my PPE, and because my consultations are relatively short I had not had time to build a rapport with the boy. I needed to examine him, but the way things were going, that was looking impossible. Every time I took a step towards him, he howled. His mum looked at me apologetically. I needed to get this child on side so I could examine his abdomen.
I caught a glimpse of myself in the surgery mirror. With everything I was wearing, I realised I looked like an astronaut. The boy continued to wail. I took a step backwards; he got quieter. I took another step backwards; he stopped crying.
“Did you know we are on the moon right now?” I asked him. “That is why I have to wear this shield and goggles – it is my astronaut costume.” He looked interested.
“And I have to take big steps like this, because there is no gravity on the moon.” I took a large step towards him; he nodded. I took another step in his direction, lifting my feet as though I was on the moon. He smiled – I was onto something. I was now close enough to examine him.
“Only fit and healthy people are allowed on the moon,” I said. “Can I check to see if you pass the test?” He nodded, lifted his sweatshirt and allowed me to have a feel of his tummy. Nothing serious.
Before he left, I asked him if he wanted a pair of goggles for when he goes to the moon. He looked at his mum before giving me a quiet “yes”. I took out a fresh pair and handed them to him, smiling as they left.
Some Good News
Lateral-flow tests really can identify the most infectious
Researchers from Oxford University and Public Health England have found that rapid coronavirus testing kits – otherwise known as lateral-flow tests – are up to 90 percent accurate in detecting people who are most likely to be infectious and could play an integral part in relaxing lockdown measures when the time comes.
I am on medication which suppresses my immune system – can I still have the vaccine?
The short answer is yes.
We know that people with compromised immune systems are at increased risk of developing complications from a coronavirus infection. We also know the approved vaccines from Pfizer, AstraZeneca and Moderna are safe and, furthermore, recommended to be taken if you have a compromised immune system.
None of the approved vaccines are “live” vaccines. This means they do not contain weakened or active versions of the coronavirus. Therefore, you cannot contract coronavirus or any of its complications from these vaccines. You may get some short-lived and normal effects from the virus such as a temperature, headache or sore arm but this is just your immune system reacting and is not dangerous.
The British Society for Immunology says: “While COVID-19 vaccination might provide a lower level of protection in people who are immunosuppressed or immunocompromised compared with the rest of the population, it is still very important that you get vaccinated as it will offer you a certain amount of protection against catching COVID-19. It is important that you receive two doses of the vaccine to maximise the protection that vaccination offers you.”