During the first two months of this year, I worked as one of many doctors, vaccinating people in the UK thus helping deliver COVID-19 protection to the elderly and the vulnerable. I returned to Nepal this month and wondered how reactions to the vaccine differed in the two countries. People in both often express concerns about the safety of a vaccine which has been produced so quickly but pharmaceutical companies have been working overtime to address this issue. Usually vaccines take years to develop and yet a vaccine for COVID was launched within a year of the identification of the COVID virus: surely safety was compromised? Is this the case and have how vaccines been made so speedily?
 
Generally, any new vaccine or medicine is developed, it goes through a sequential series of trials of efficacy and of safety. If at any stage it is found to be ineffective or dangerous, development ceases and no more money is spent on it. In the case of COVID-19 vaccines, pharmaceutical companies ran many of these trials in parallel. The correct normal procedures were still followed with no short-cuts and without compromising safety. The reasons that pharmaceutical companies don’t usually do things this way is because of financial risk. In the case of COVID-19, various national governments financially supported a range of pharmaceutical companies allowing them to produce the vaccines speedily but safely and thus mitigate this financial risk. Numerous different vaccines were in development in many countries at the same time, and inevitably not all were successful. The vaccine that was being researched in France by Pasteur, for example, proved ineffective and production ceased. Pasteur could not recoup any of their costs through vaccine sales, but the company was cushioned by government support.
 
There has been a lot of discussion about which vaccine is ‘best’; efficacies have been quoted as highest for the Russian Sputnik vaccine and also the Pfizer and Moderna products at over 90%. The Astra Zeneca or ‘Oxford’ vaccine, which is the type that is being rolled out in Nepal, appears to have slightly lower efficacy. This has led to claims that this vaccine is being dumped in the third world. However, this is the vaccine that is being given to most people (>70%) in Britain and it seems to have an excellent safety profile.
 
It is important to remember that few vaccines give 100% protection against any specific disease. Even those that do so in theory, may fail if the cold chain is broken or there are other problems in delivery. Many vaccines have relatively low efficacies. For example, influenza vaccine is 40 – 60% effective, BCG probably around only 50% efficacious while typhoid is about 65% with zero protection against paratyphoid. It is difficult to say what the efficacy of the Astra Zeneca vaccine is as it is so new:  it is at least 70% with one study suggesting it was 81% after a single dose. While studies in Scotland showed that administration of just one Astra Zeneca dose reduced hospital admissions by 94% compared to a reduction ‘up to 85%’ for Pfizer. The immune response to the vaccine depends on which strain of the virus is circulating, whether an absolute protection is quoted against even mild disease as well as serious and deadly cases, the amount of vaccine given, the dosing interval and probably also the age of the person being vaccinated.
 
Pfizer and Modern vaccines are reported to have good efficacies (above 90%) but need to be kept frozen at very low temperatures (-70°C and -20°C respectively) making the risk of vaccine spoilage a real risk, especially in a region where there are frequent power cuts and difficult transport in rural areas. The Astra Zeneca vaccine is more robust and just needs to be kept in an ordinary fridge.
 
China’s Sinovac is being rolled out in Brazil, Turkey, Indonesia, Singapore and other countries and, whilst its efficacy is reported to be the least good of all the vaccines, it is still above the 50% required for regulatory approval and although it does seem to have a relatively low efficacy against preventing all symptoms, importantly it appears to be powerful in preventing severe disease and death. Despite having an efficacy that may be lower than other vaccines, this will still help protect us all when large numbers of people are vaccinated. It is sad that there is so much discussion about which vaccine is ‘best’ and that this has become a political issue or a matter of national pride: French President Macron was inappropriately critical of the successful British Astra Zeneca vaccine perhaps partly in reaction to the failure of the French vaccine. It is important that simply as many of us are vaccinated as possible. Politics should keep clear of this, except perhaps to curb profits. Pfizer are reportedly making 80% on each ampoule of vaccine they sell while Astra Zeneca are distributing at cost. Let’s accept whatever vaccine is being offered and listen to WHO Director General Tedros Adhanom Gebreyesus who repeatedly says that “none of us is safe until we are all safe.” By this he means it is a global priority for as many people to be vaccinated is possible, and let us not worry about theoretical efficacy comparisons.
 
Safety, of course, is a different matter. The very high death rates in the UK has stimulated a good response from the government and more than a third of the British adult population has been vaccinated to date, that’s more than 22 million people. In Nepal, some elderly people and those with medical problems worry that the vaccine may harm them since perhaps they think that their bodies are weak but the UK programme started with such elderly people (including the 94-year-old Queen and 99-year-old Prince Philip) and people with multiple medical problems because they are at greatest risk of dying from COVID-19. The people of Nepal can be reassured that UK citizens have done an excellent and reassuring safety trial!
 
As a routine, vaccinators (both in Nepal and the UK) ask people about allergies and other medical details although there are few reasons not to have the vaccine. There is no problem for people with multiple medical conditions including diabetes, high blood pressure, cardiac or kidney patients taking the vaccine. It is probably best avoided in pregnancy and anyone with multiple severe allergies (particularly those causing collapse and needing an admission to hospital) should probably take the vaccine at a health post or hospital.
 
In the UK patients went straight home after receiving the Astra Zeneca vaccine but were asked not to drive or cycle for 15 minutes. Short-term side-effects after the vaccine are to be expected and are reported in more than one in ten people. Side-effects seem to be commoner in younger rather than older people (over the age of 65) and in women more than men. Most people have a slightly painful arm at the site of the injection. People who take blood-thinners might expect a little bruising at the site of the injection, although the needle is very fine and although I take blood thinners, I did not experience this problem. Some people experience body aches and fever but only for a day or so and paracetamol helps those who are feeling uneasy. A few feel quite unwell for nearly a week after receiving the vaccine, but this is a small cost for protection against a potentially fatal disease. Finally, there have been reports of people experiencing blood clots soon after COVID vaccination. Clots are common in the elderly, especially in people over the age of 80 and it appears that the blood clot rate in vaccinated people is actually LESS than in unvaccinated people.
 
Let us all keep each other safe by accepting the vaccine when it is offered and continuing mask-wearing, lots of hand-washing and maintaining social distancing until we are all vaccinated. The government have briefed the people but increased dissemination of accessible information by it and major stakeholders would reassure the public and improve trust.

This text is pretty much identical to the article that was published in Setopati newspaper on 24th March 2021.
See it here: Best Vaccine
 

Foot-operated hand-washing station at the Kaniyabas gaun palika office last week