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Medisina at Politika by Dr. Rey Pagtakhan  

Vaccinations a vital step to end pandemic

by Dr. Rey Pagtakhan

Could Canada vaccinate all Canadians against COVID-19 by the end of this year? By December 31, 2021 New Year’s Eve?

It has been a little over a year since the World Health Organization (WHO) declared COVID-19 a “public health emergency of international concern.”

Starting in December 2019 as a cluster of undiagnosed pneumonia in Wuhan, China and promptly spreading throughout the country and beyond its national borders the following month, the pandemic has since sickened over 108 million and claimed the lives of nearly two-and-a-half million citizens worldwide.

Cumulative COVID-19 cases and deaths

Location
[Population]

Total Cases
(Per 100k)

Cases
Daily Average

Total Deaths
(Per 100k)

Deaths
Daily Average

 World
 [7,794,798,739]

 108,043,938
 (1,386/100K)

 425,399

 2,377,988
 (31/100K)

 12,882

 Canada
 [37,894,839]

 823,851
 (2,174/100K)

 3,348

 21,142
 (56/100K)

 93

 USA
 [331,002,651]

 27,457,968
 (8,295/100K)

 105,338

 479,842
 (145/100K)

 3,346

 Philippines
 [109,581,078]

 545,300
 (498/100K)

 1,639

 11,495
 (11/100K)

 62

Source: Johns Hopkins University Coronavirus Tracker, February 1-12, 2021

The USA has remained the epicenter of the pandemic but appears headed for control under the new presidential leadership. They still have nearly 27.5 million cases and deaths trending to half a million. President Joe Biden has made control of this public health misery top of his agenda since his inauguration. He has appointed Dr. Anthony Fauci, the world’s acknowledged pandemic expert, his chief medical adviser and delegate to the WHO, which U.S. has re-joined. The latter move also augurs well for the global aspect of COVID-19 vaccination.

Adverse events from immunization reports

As we collectively champion the need for vaccination, let me share a brief summary of the reports from the Canadian Adverse Events Following Immunization Surveillance System of Public Health Agency of Canada and the Canada Vigilance Program of Health Canada:

Pfizer-BioNTech and Moderna have distributed a total of 928,200 and 517,700 doses, respectively with a total of 651 people reporting adverse events up to February 5, 2021.

  • Total adverse events: 1,568;
  • Majority are mild to moderate;
  • Serious adverse event reports: 99;
  • 9.5 reports per 100,000 doses administered;
  • Occurrence of anaphylaxis was rare;
  • No deaths due to vaccination were seen;
  • No vaccine safety issue has been identified.

Global vaccination campaign

The U.N. World Health Organization said recently, “In the COVID-19 vaccine race, we either win together or lose together.”

Indeed, global vaccination against COVID-19 is the universal public health goal, although we acknowledge manufacturing, accessing, delivering and injecting billions of vaccine shots into the arms of billions of people on planet Earth will be a herculean logistical challenge.

The Bloomberg COVID-19 Vaccine Tracker Project reported recently on the following:

  1. As of February 10th, Israel and the United Arab Emirates have vaccinated 68.5 doses injected for every 100 Israeli citizens) and 47 per cent of their populations, respectively.
  2. While the United Kingdom has vaccinated 20 per cent of their residents and U.S. 15 per cent, other countries are much lower, under four per cent on average, with Canada at 2.52 per cent.
  3. Globally as of February 12, over 168 million COVID-19 vaccine shots had been given across 77 countries, which have limited access to seven vaccine brands. Nine more most promising vaccines in development are being followed closely.
  4. The latest global vaccination rate is 5,902,851 doses daily on average. At this rate, it will take about 5.3 years to vaccinate 75 per cent of the population with a two-dose vaccine.
  5. Nearly a third of the global vaccines administered – 50.1 million doses – were in the U.S.A.
  6. With the U.S. population at 331 million, it means about 15.2 vaccine doses have been administered for every 100 Americans and nearly three-fourths (73 per cent) of the shots delivered had been injected into the arms.

WHO’s call to global leaders

In a joint statement from UNICEF Executive Director Henrietta Fore and WHO Director General Dr. Tedros Ghebreyesus, the following message was issued on February 10.

1. UNICEF and WHO call on leaders to look beyond their borders and employ a vaccine strategy that can actually end the pandemic and limit variants.
2. Of the 128 million vaccine doses administered so far, more than three quarters of those vaccinations are in just 10 countries that account for 60 per cent of global Gross Domestic Product.
3. Almost 130 countries, with 2.5 billion people, are yet to administer a single dose.
4. This self-defeating strategy will cost lives and livelihoods, give the virus further opportunity to mutate and evade vaccines, and will undermine a global economic recovery.
5. To ensure that vaccine rollouts begin in all countries in the first 100 days of 2021, it is imperative that:

a. Vaccine manufacturers allocate the limited vaccine supply equitably; step up and maximize production; and transfer technology to other manufacturers who can help scale the global supply.
b. Governments that have vaccinated their own health workers and populations at highest risk of severe disease share vaccines through COVAX so other countries can do the same.

Indeed, global leadership is needed to increase vaccine production and attain equitable access to vaccines. Unfortunately, two global powers – China and Russia and, until recently, the U.S. – have apparently declined to support the global effort. Many poor countries around the world stand to suffer. Through COVAX (COVID-19 Vaccines Global Access) poverty-stricken countries would have a better chance of access to vaccines and their deployment and administration.

What are some of the adverse implications when developed countries fail to heed the need for vaccines in underdeveloped nations? – not only illness and deaths and ongoing financial hardships from lockdowns, but also increased chances for the emergence of more lethal and transmissible virus variants that are vaccine resistant. Their circulation around the world would just lead to vicious pandemic cycles and their complications.

The collateral harms to children – lost schooling, more child labourers, more child brides, increased gender inequality, greater hunger, shorter lives – cannot be excused.

We know that even Canada had its recent struggle with earlier promised supply from foreign firms. The decision to build one or more vaccine manufacturing plants is overdue.

Overdue as well is the strategy and commitment on the part of well developed countries to help vaccine producers output more for other countries to share. This includes “openly sharing vaccine manufacturing technology, intellectual property, and know-how through the WHO COVID-19 Technology Access Pool, temporarily waiving intellectual property barriers, and expanding voluntary contracting between manufacturers and helping build additional manufacturing bases – especially in Africa, Asia, and Latin America – which will be essential to meet ongoing demand for COVID-19 booster shots and future vaccines.

Where is Canada in its mass vaccination drive?

Can Canada vaccinate all her residents against COVID-19 by December 31, 2021?

COVID-19 Vaccinations in Canada

Location

 Population

 Doses Delivered

Doses Injected

 1st Dose

 2nd Dose

 % Vaccinated

 British Columbia

 5,110,917

 156,250

 144,203

 15,684

 2.82

 Alberta

 4,413,146

 132,475

 93,413

 42,162

 2.12

 Saskatchewan*1

 1,181,666

 44,575

 35,895

 10,368

 3.04

 Manitoba

 1,377,517

 66,090

 34,410

 18,254

 2.50

 Ontario

 14,711,827

 437,975

 291,159

 151,282

 1.98

 Quebec*2

 8,537,674

 294,825

 280,612

 0

 3.29

 New Brunswick

 779,993

 22,650

 13,296

 5,347

 1.70

 Prince Edward Island

 158,158

 10,200

 5,352

 3,787

 3.38

 Nova Scotia

 977,457

 30,800

 14,845

 7,498

 1.52

 Newfoundland/Labrador

 521,365

 17,475

 9,822

 4,865

 1.88

 Northwest Territories*3

 44,904

 14,400

 12,833

 299

 28.58

 Yukon*3

 41,078

 14,400

 10,604

 830

 25.81

 Nunavut*3

 39,097

 12,000

 6,205      

 0  

 15.87

 Canada

 37,894,839

 1,253,140

 952,649

 260,376

 2.52

 U.S.A.*4

 331,000,000

 –

 50.1M

 15.14

Number of Canadians who received at least one dose of either the Pfizer/BioNTech or Moderna vaccine
*1 Saskatchewan found greater than 100% efficiency by drawing extra doses from the vials.
*2 Quebec decided to delay second doses for 90 days in order to vaccinate more initially.
*3 The territories lack the cold storage capability for Pfizer/BioNTech vaccine; they received the Moderna vaccine on December 28 and have since been administering them.
*4 Data from the Bloomberg COVID-19 Vaccine Tracker Project.Source: Public Health Agency of Canada and Johns Hopkins University, February 8-12, 2021

The Northwest Territories and Yukon have over a fourth of their citizens already vaccinated (28.58 per cent and 25.81 per cent, respectively), notwithstanding they started much later than the provinces. Nunavut came in third place at 15.87 per cent. The provinces range in their inoculation rates from 1.52 per cent in Nova Scotia to 3.38 per cent in Prince Edward Island.

Path to “herd” immunity

It is generally accepted that vaccinating 70 to 85 per cent of a country’s population would enable a return to normality. Dr. Anthony Fauci has reiterated often.

The concept is known as “herd,” community, or population immunity. As more people get vaccinated, they start to build a collective defence against the virus so that isolated occurrences of infection burn out instead of spreading unchecked into an outbreak. Herd immunity is achieved when enough people are protected that it begins to have a measurable effect on the speed of transmission. It could even begin well before 75 per cent of the population are fully vaccinated. Or, it is the point when outbreaks can no longer be sustained to ripple across the country and beyond national boundaries.

Today in the U.S. the latest vaccination rate averages 1,656,452 doses daily. At this rate, it will take about eight months to cover 75 per cent of their population with a two-dose vaccine.

In contrast, Canada has administered a total of 1,213,025 doses over a period of 68 days from December 14, 2020 when the first Canadian patient received her jab, effectively yielding an average of 17,838 doses daily during this interval period. Based on this initial experience, can Canada vaccinate all her residents against COVID-19 by December 31, 2021?

Let us do the arithmetic:

  1. We have vaccinated 2.52 per cent of the Canadian population of 37,894,939. That is 954,952 residents. (37,894,939 x 2.52 per cent)
  2. Thus, we need to vaccinate the remaining 36,939,987 Canadians.
  3. If we vaccinate at least 75 per cent of these non-vaccinated to attain herd immunity, we need to vaccinate at least 27,704,990 more. (36,939,987 x 75 per cent)
  4. Since two doses are required for full vaccine efficacy, we need to do 55,409,980 injections to reach herd immunity.
  5. We would need to do 181,078 injections daily for 306 days non-stop until December 31, 2021.
  6. If we continue with our current pace of 17,838 injection doses daily, we are looking at 8.5 years to reach our goal.

a. This might serve as a wake-up call to public health officials and political leaders;
b. With the temporary disruptions being solved soon and vaccine supply being resumed, we could expect a rebound and vaccination rates could be expected to climb.
c. And Canada has made more contracts to purchase more vaccines, not to mention establishing our own manufacturing capability.

The answer is obvious. We have to move now, plan and put the resources of the nation to act in unison with our public health officials and experts. We need uninterrupted supplies of vaccines, needles, alcohol swabs, personnel, budget, vaccination sites, volunteer health corps, the health care corps of the reserve and armed Forces, if need be, mobilized; and clear lines of command and action defined.

Lauren Pelley of CBC News listed the following points she had gathered from the community:

  1. build up community outreach,
  2. decentralize vaccination sites,
  3. combat vaccine hesitancy,
  4. address education, and
  5. provide information for our communities, especially new immigrants and refugees

I would add governments should continue to engage more community media outlets, both print and online.

Vaccination alone is not enough

Questions continue to be asked even as we pursue our mass vaccination drive. Here is a summary of what vaccine scientists and public health experts have taught us to help us better understand virus behaviour and the human host response

Q1. Why should I continue with the usual pandemic precautions after getting the COVID-19 vaccine?

A1. The answer is to protect yourself, the vaccine recipient, at least for a while. A vaccine’s effectiveness takes time to build up. That is, not to get sick with COVID-19 following vaccination. With the Pfizer-BioNTech vaccine, protection does not start until 12 days after the first shot and it reaches 52 per cent effectiveness a few weeks later. A week after the second vaccination, the effectiveness rate hits 95 per cent.

With the Moderna vaccine, protection rate is 51 per cent two weeks after the first dose and 94 per cent two weeks after the second dose.

That is not 100 per cent for either vaccine. This means one out of every 20 people who get either vaccine could still get a moderate to severe infection. Moreover, we are presently seeing new infections from new variants of the virus and scientists are closely monitoring the developments.

Q2. Can I spread the virus to others even if I am fully vaccinated with the two doses?

A2. Vaccine scientists do not have an answer yet. The data are just now being collected. The emergency authorizations that have allowed distribution of the two new vaccines cite only their ability to keep you from becoming severely sick with COVID-19. Public health experts advise the answer is “yes” until we get the needed scientific data and knowledge.

Q3. How can one spread a virus if he or she has been vaccinated?

A3. The COVID-19 vaccines rely on bits of genetic material or virus protein – not anything that could grow into an active virus. The concern is about whether one might still have an asymptomatic infection despite immunization but still be able to shed the virus. Imagine you have been vaccinated and you encounter SARS-CoV-2. You are much less likely to develop symptoms, but your immune system may not fight off the virus completely. Thus, some viruses may survive, reproduce in your body, and get expelled from your nose or mouth in a breath, cough, sneeze, shout or singing. No one can be sure yet if this actually happens or if it happens often enough that you would be emitting enough active virus to sicken someone else. This is our current state of knowledge.

Q4. Why did the government regulators not demand information on infectivity before authorizing the first two vaccines?

Q4. “In a word, time,” said Dr. Larry Corey, a virologist at the Fred Hutchinson Cancer Research Center at the University of Washington in Seattle. “We wanted to get an answer quickly,” Dr. Corey said, and to do so required as simple an experimental protocol as possible. He added: “Each of the 75,000 volunteers for the clinical trials of the Pfizer and Moderna vaccines had to come into a clinic; get a test for the coronavirus; get either a vaccine or a placebo shot, return for a second shot, and come back to the clinic for testing anytime in the interim if they showed any symptoms of having caught the virus. Adding in even more coronavirus tests along the way to see if the vaccinated volunteers had picked up or were transmitting the virus would have delayed the initial results considerably. And in the midst of the deadly pandemic, speed was of the essence.”

Q5. Now that I am vaccinated, can I take my mask off in a crowded room if everyone else has also been vaccinated?

A5. Not quite yet. Remember that the two vaccines are not 100 per cent effective, and many in the research community still advise caution. Once most people are protected and there is less virus circulating in the community, the advice and restrictions on this may ease up a bit.

Q6. What is the bottom line?

A6. With the magnitude of cases and deaths still around, and until the research on shedding has yielded some answers, health care workers who attend to COVID-19 patients really want you to continue to wear a mask, keep your distance and wash your hands, even if you’ve been vaccinated.

My advice is the same. Continue with the public health measures and especially wear a mask until vaccine scientists have the data. Especially now that new variants of the virus have been reported in all Canadian provinces. Vaccination is a vital step but not enough to end the pandemic; so take the public health precautions.

Rey D. Pagtakhan, P.C., O.M., LL.D., Sc.D., M.Sc., M.D. is a retired lung specialist and professor. He graduated from the University of the Philippines and did postgraduate studies/training at Washington University and the University of Manitob. He spent a sabbatical year as a visiting professor at the University of Arizona. He spoke on the “Global Threat of Infectious Diseases” at the G-8 Science Ministers and Advisors Carnegie Group Meeting held June 13-15, 2003 in Berlin, Germany.

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