Dr Nicole Ram­lachan

The world cel­e­brat­ed World Im­mu­niza­tion Week (April 24-30), for which the theme this year is #Vac­cinesWork­forAll fo­cus­ing on how vac­cines–and the peo­ple who de­vel­op, de­liv­er and re­ceive them–are he­roes by work­ing to pro­tect the health of every­one, every­where.

It is no time­li­er than right now, as these same he­roes are de­vel­op­ing and ad­min­is­ter­ing vac­cines against COVID-19. His­tor­i­cal­ly, vac­cines have saved us in the past, ever since the very first known com­mer­cial vac­cine. As they say, we should know where we have come from to know where we have to go.

Amidst the small­pox pan­dem­ic, in 1796 Dr Ed­ward Jen­ner no­ticed milk­maids nev­er got the fa­tal dis­ease but had lit­tle scar­ring from a rel­a­tive­ly mild form called cow­pox. The small­pox virus was rav­aging the world, with the rise in glob­al trade, there were 33 per cent of in­fect­ed adults and 80 per cent of chil­dren dy­ing, and Na­tive Amer­i­can pop­u­la­tions dec­i­mat­ed due to no known im­mu­ni­ty.

Dr Jen­ner, trained in Lon­don, wit­nessed the hor­rors of small­pox first-hand. He con­vinced the par­ents of an eight-year-old boy to al­low him to scratch his skin with pus from the le­sions ob­tained from the hands of a young milk­maid. The boy was then in­oc­u­lat­ed with mat­ter from a small­pox blis­ter and ful­ly re­cov­ered with­out get­ting small­pox. Jen­ner wrote his pa­per with ac­com­pa­ny­ing ex­per­i­ments on his son and oth­ers, in the in­quiry. Two hun­dred years lat­er in 1980, small­pox was erad­i­cat­ed and Jen­ner is con­sid­ered to be the fa­ther of mod­ern vac­ci­na­tion. Mod­ern vac­cines, like those for COVID-19, are de­rived from much more eth­i­cal and less ques­tion­able ex­per­i­ments due to the reg­u­la­to­ry, le­gal and “watch­dog” health agen­cies. All avail­able vac­cines un­der­go strin­gent test­ing in lab­o­ra­to­ry/clin­i­cal tri­als and eval­u­at­ed/con­tin­ued/paused as need­ed.

We are in the midst of an­oth­er pan­dem­ic, COVID-19, caused by the SARS CoV-2 coro­n­avirus. We have been through pan­demics be­fore. Po­lio rav­aged the world caus­ing paral­y­sis and death (1949-1955), was elim­i­nat­ed by Salk’s at­ten­u­at­ed then Sabin’s oral vac­cine which saved mil­lions, and are still be­ing giv­en to chil­dren world­wide. When pan­demics oc­cur and vac­cines are un­avail­able, death comes quick­ly to many. The Span­ish Flu (1918-1919) left 50 mil­lion dead and the Black Plague killed 50 per cent of the world’s pop­u­la­tion, nei­ther of which had an avail­able vac­cine. To­day, we have lost over three mil­lion peo­ple in 12 months with cas­es ris­ing ex­po­nen­tial­ly once again. Vac­ci­na­tion is the on­ly way out of this pan­dem­ic.

Dis­trust of sci­ence, lack of po­lit­i­cal lead­er­ship, lim­it­ed re­sources, en­vi­ron­men­tal de­struc­tion, and re­fusal to fol­low pub­lic health guide­lines have great­ly con­tributed to the spread of pan­dem­ic virus­es. COVID-19 is the first pan­dem­ic re­vealed on so­cial me­dia plat­forms. Con­spir­a­cy the­o­rists reign supreme, with mis­in­for­ma­tion usu­al­ly the first to spread like wild­fire, with lit­tle truth to ex­tin­guish­ing its fer­vent blaze, its flames be­ing fanned con­tin­u­ous­ly by scep­ti­cal grad­u­ates of the Uni­ver­si­ty of the In­ter­net, taught by Dr Google.

Who am I?

I am a mol­e­c­u­lar ge­neti­cist, a moth­er, a daugh­ter, a teacher and a con­cerned sci­en­tist, with no mon­e­tary in­ter­est in any vac­cine or treat­ment avail­able or be­ing de­vel­oped against COVID-19. I still, how­ev­er, feel a strong sense of moral oblig­a­tion to share my knowl­edge with the pub­lic to al­le­vi­ate fears, counter un­truths, en­cour­age hes­i­taters and help the com­mu­ni­ty un­der­stand what is at stake.

Who is like­ly to get COVID-19?

In ear­ly in­fec­tions, old­er, (>50) peo­ple with co-mor­bidi­ties in Asia, then Eu­rope seemed more at risk. As the COVID-19 pan­dem­ic was de­clared in March 2020 by the WHO, it was re­alised that all de­mo­graph­ics were at risk for in­fec­tion. Chil­dren un­der 18 seemed to gen­er­al­ly present as asymp­to­matic or had a dif­fer­ent form of the dis­ease called MISC. The new­er vari­ants are more in­fec­tious, seem­ing­ly to in­fect chil­dren to a greater ex­tent than old­er peo­ple. Of great con­cern are the vari­ants re­cent­ly iden­ti­fied in T&T, which seem more like­ly to cause se­vere dis­ease and death. We are cur­rent­ly ex­pe­ri­enc­ing a surge in cas­es, with an in­crease of over 300 in less than three days. We must con­tin­ue to take pre­cau­tions, re­duce ex­po­sure and be vig­i­lant to re­duce these surges un­til herd im­mu­ni­ty can be achieved.

Are the risks of the vac­cines more harm­ful than the risk of the COVID-19?

The nor­mal re­ac­tions post-vac­ci­na­tion re­sem­ble any those of any vac­cine you or your three-month old child may re­ceive. Pain at site of in­jec­tion, lo­calised swelling, fever, chills, aches/pains, headaches etc, are com­mon. Less com­mon are ana­phy­lac­tic re­spons­es, throm­bolyt­ic clots and throm­bo­cy­tope­nia. The gen­er­al pop­u­la­tion’s risk of cere­bral ve­nous si­nus throm­bo­sis (CVST)–one of the blood clot types ob­served in As­traZeneca/Ox­ford Vaxzevria re­cip­i­ents, is around five in a mil­lion. You are at a much greater risk af­ter COVID-19 in­fec­tion for blood clot­ting and as­so­ci­at­ed death. Af­ter vac­ci­na­tion, the risk of clot­ting is not any greater than nor­mal, un­less you are in a high-risk cat­e­go­ry which can be eval­u­at­ed ge­net­i­cal­ly or bio­chem­i­cal­ly. Dai­ly, peo­ple ac­cept > 30 times more risk of clot­ting tak­ing vi­a­gra or birth con­trol pills than they would be tak­ing any vac­cine, in­clud­ing the COVID-19 vac­cines.

Why should you be vac­ci­nat­ed?

Pan­demics in his­to­ry have on­ly end­ed with­out great loss in the pop­u­la­tion, through vac­ci­na­tion. With­out vac­ci­nat­ing 80 per cent of the el­i­gi­ble pop­u­la­tion, we will not achieve the herd im­mu­ni­ty we need to end this pan­dem­ic, stop new vari­ants and save our el­der­ly, vul­ner­a­ble and now chil­dren and youth from COVID-19. As of this week, more than 225 mil­lion dos­es of vac­cines were ad­min­is­tered world­wide, with less than 200 as­so­ci­at­ed deaths (which is less than those seen with the MMR vac­cines ad­min­is­tered to chil­dren). Any of the COVID-19 vac­cines avail­able are just as safe as and in most cas­es more ef­fec­tive than the in­fluen­za or any child­hood vac­cines we ad­min­is­ter to our el­der­ly and chil­dren every day.

Which vac­cine is best to take?

The EU, UK, USA, Cana­da, Chi­na, Russ­ian and In­di­an have all pro­duced very ef­fec­tive vac­cines based on dif­fer­ent tech­nolo­gies with one sin­gle goal: to pro­tect against COVID-19 se­vere dis­ease and death. Any avail­able COVID-19 vac­cine will help pro­tect you by cre­at­ing an an­ti­body (im­mune sys­tem) re­sponse with­out hav­ing to ex­pe­ri­ence se­vere sick­ness or risk of death from nat­ur­al in­fec­tion. Enough vac­cines need to be pro­vid­ed to achieve the 80 per cent herd im­mu­ni­ty (nat­ur­al im­mu­ni­ty com­bined with ac­quired im­mu­ni­ty) re­quired to end the pan­dem­ic, re­duce the risk of new vari­ants ap­pear­ing and stop­ping the spread of the SARS CoV-2 virus to the most vul­ner­a­ble, un­vac­ci­nat­ed im­mune-com­pro­mised el­der­ly or in more re­cent cas­es, our youth. The US has just ap­proved pre­vi­ous­ly banned ship­ments of raw ma­te­r­i­al for the Co­v­ishield vac­cine, the In­di­an man­u­fac­tured ver­sion of the Ox­ford/As­tra-Zeneca to be sent to com­bat In­dia’s surge in coro­n­avirus cas­es. John­son & John­son-Janssen and As­tra-Zeneca-Ox­ford vac­cines are be­ing utilised for vac­ci­na­tions in many coun­tries. Sinopharm, Sino­vac, Sput­nik, Mod­er­na, Pfiz­er/ BioN­Tech, and Ox­ford/As­tra-Zeneca have ac­count­ed for the ma­jor­i­ty of the 225 mil­lion dos­es giv­en. More vac­cines are be­ing de­vel­oped world­wide, will be avail­able lo­cal­ly and are good op­tions.

How will this pan­dem­ic end?

With­out enough buy-in by our pop­u­lace or pro­vi­sions made by the GOTT to achieve high enough rates of im­mu­niza­tion against COVID-19, we will be left be­hind, with our bor­ders ar­ti­fi­cial­ly shut to “re­duce risk” while not on­ly our peo­ple, but our econ­o­my and small busi­ness­es, die. The rest of the world are charg­ing to­wards achiev­ing herd im­mu­ni­ty with Is­rael, the UK and the US al­ready over 65 per cent vac­ci­nat­ed and even coun­tries in our re­gion like Do­mini­ca and Bar­ba­dos al­ready over 25 per cent, while we are crawl­ing for­ward with just one per cent. The case­load in T&T stands at over 9,600 cas­es by RT-PCR with a sev­en-day in­crease of ten per cent con­firmed by the MOH. The COVID-19 in­fec­tion will con­tin­ue to rise, our pop­u­la­tion will even­tu­al­ly be com­plete­ly locked out and locked in, with lit­tle re­course, if the pop­u­la­tion does not re­spond in time or the health au­thor­i­ties do not pro­vide im­me­di­ate ac­tion to vac­ci­nate and achieve the herd im­mu­ni­ty need­ed.

For more in­for­ma­tion please fol­low Dr Ram­lachan on the UTT COVID-19 Se­ries, Hype or Hope? In­ves­ti­gat­ing the COVID-19 Vac­cines. To join the con­ver­sa­tion, please use the link be­low: https://u.tt/re­search/covid-19