25 October 2020
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Nancy Lane/Boston Herald via AP

How will a vaccine for COVID-19 work?

Dr Ross Walker
3 October 2020

It is my opinion, not shared by an ignorant, ill-informed few, that vaccination was the greatest advance in medicine of the last century. With the introduction of vaccines, we saw the end to a variety of conditions that would either prematurely kill or disable a significant proportion of the population. For some bizarre reason, not based on any scientific fact whatsoever, a small but very vocal group of the population have become known as anti-vaxxers, spreading ridiculous, and unscientific nonsense, typically on social media.

2020 has been dominated by COVID-19 and to this point we have seen around the globe over 32 million cases and around 1 million deaths. The USA has been the most prominent, with more than 7 million cases and over 200,000 deaths, to date, with India, Brazil and Russia following close behind. In Australia, to this point, we have seen over 27,000 cases and just below 900 deaths. Fortunately, in our country, the caseload is diminishing rapidly, even in Victoria. 

Although there are increasing effective treatments for COVID-19, once a person has contracted the disease both at a mild level and even for the most severe cases, the pandemic doesn't appear to be going away. Unlike its more lethal cousins SARS and MERS, it doesn't appear to be fizzling out any time soon. The great hope for the side is, of course, a safe and effective vaccine. There are a variety of vaccines being tested around the globe and, to this point, the Oxford vaccine has been used in most people with what appears to be good effectiveness. When the vaccine was given to rhesus monkeys, which have a similar immune system to humans, the immune response at both a T-cell and Ab level was highly effective, with a similar response being simulated in human beings given a similar vaccine. When these monkeys were exposed to the coronavirus, none of them developed the clinical illness.

A phase 3 trial has begun in humans and to this point around 20,000 people have been included in the trial. Recently, one person who was given the active vaccine did develop a spinal-cord syndrome known as transverse myelitis after the second dose of vaccine but does appear to be recovering. The trial has been recommenced, once this case was investigated. The reality with any infectious disease and the subsequent responses of various human beings to treatment will really depend on that person’s own innate immune system. This clearly varies between each individual and may certainly be important when it comes to how a person responds to the coronavirus and equally how they respond to vaccination.

What we do know is the 80:10:10 rule, which basically looks at the people who have been diagnosed with COVID-19 to date. It has been estimated that around 80% of people develop a mild flu like illness or remain asymptomatic. Those who do get the milder illness recover within a week or two without any sequelae. Of the 20% left, half become quite ill and recover fully, whereas the other half are the ones who develop significant problems. A third of this 10% appear to die and the other 2/3 are left with what is known as long COVID. Long COVID is ongoing symptoms characterised by extreme fatigue and at times fever lasting for weeks to months. They experience varying degrees of shortness of breath, cough, palpitations, exercise intolerance, mental and physical exhaustion. Anxiety, depression, inability to concentrate and brain fog are also common, as is inflammation of the heart known as myocarditis. Although serious, COVID-19 is more common in males, it appears that long COVID is twice as common in females.

This brings me to the major part of this discussion, which is the effectiveness of a COVID-19 vaccination. Many health experts estimate that it is likely we will have a safe and effective vaccine possibly through the first half of next year. There are many questions around this. Who should receive it first? Will a vaccine, such as the Oxford vaccine, work in the sickest of the sick, such as the vulnerable, elderly population with comorbid conditions or people with other diseases of the immune system or other chronic illnesses? Most people would not argue that frontline health workers should also be amongst the first to receive the vaccine.

This brings us to the uncomfortable topic of the anti-vaxxers. Clearly, they will refuse to have the vaccine and it is my opinion that no doctor or health authority has the right to mandate any treatment. In a free society, we all have a right to treat our body how we choose. But the question here is: should people who refuse the vaccine have some limitation on aspects of their life? Should proof of vaccination be a condition of travel? Should a condition of the work environment be related to proof of vaccination? Should you be able to visit restaurants and other public places only if you are vaccinated? Of course the anti-vaxxers would say this is rubbish and if they choose to not have the vaccine and become ill because of COVID-19, that is their choice and this should be respected.

But, we do know that until 70% of the population is exposed to this particular coronavirus or is vaccinated, then the virus will continue to grumble on in society and again affect the most vulnerable and elderly, often, in spite of vaccination in this group because of their inability to mount a decent immune response to either the virus or a vaccine. Also, for those of us who believe in and support the obvious science around vaccinations, why should society pay for the health consequences of allowing the virus to remain because people refuse proven medical therapies? It is a vexed question and some would say a ‘vaxxed’ question, but certainly not straightforward or easy to answer. It is best that we have the debate now and decide how society is going to respond once the vaccine is freely available and has been shown to be safe and effective.

Having spoken to a handful of anti-vaxxers over the years, it is clear to me that their thinking is distorted and illogical and they are certainly not responsive to any scientific argument or respect the views of any experts in the area of infectious diseases. 2020 has been a difficult year for everyone and hopefully through the brilliant work of many scientists around the world we will conquer SARS-CoV2 at some stage in the near future. Wouldn't it be good if as a society we could all work together to ensure this victory is as smooth and as rapid as possible?

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