Dying to get vaccinated

The unprecedented speed at which effective Covid-19 vaccines have been discovered is truly inspiring. The problem with acceptance and distribution of those vaccines, however, is another story.

Scientists can invent vaccines faster than ever, but political scientists cannot find answers to the problems of vaccine denial and inequity.

If this pandemic had happened 50 years ago and an effective and safe vaccine had ultimately been found, in all likelihood the administration of these vaccines would have happened more smoothly, probably with more equity and much less fuss.

To be sure, there was similar opposition to the smallpox vaccine when it was first developed, but eventually it was mandated by governments and the disease eradicated. And millions of lives are saved annually in low income countries by vaccines against preventable diseases.

But the speed with which medical science has come up with effective Covid-19 vaccines has been a game-changer. If this is followed by treatment protocols, it will be even more spectacular.

And the best example to showcase efficacious treatment has been the Oxford University-lead Recovery (Randomised Evaluation of Covid-19 Therapy) trial in which Nepal was the first actively participating site outside the UK.

In June 2020, the results of this trial showed that an inexpensive and widely-available drug, dexamethasone (a corticosteroid) substantially reduced deaths in hospitalised patients requiring oxygen. As a result, the drug has saved millions of lives.

For those of us in the health profession in Nepal, Covid-19 evoked a feeling of déjà vu. Common rampant infectious diseases like typhoid and tuberculosis are ideally controlled by contact tracing and treatment. Implementing these measures against another human-to-human infection like Covid-19 should therefore have been a no-brainer.

Unfortunately, in South Asia contact tracing even for biblical diseases like typhoid and tuberculosis is not done. We would have been able to more easily deal with Covid-19 if we already had contact tracing in place for these rampant, but overlooked, diseases mostly afflicting the impoverished.

The trajectory of the pandemic has led to revelations. Herd immunity acquired with previous infections seems to be an unreliable and less robust way to seek protection from the virus. This was dramatically illustrated with the spread of the Delta virus in India where many people, including doctors, thought they had enough antibody protection.

The BCG vaccine (against TB) was thought by many to protect them, and that has also turned out to be probably untrue. Protection afforded by prior exposure to other respiratory viruses including coronaviruses (non-Covid 19) also seems non-existent. The fallacious argument that we are hardy people from South Asia who are protected by our spicy diet also took a hammering.

The most dramatic observation during this pandemic has been in human behaviour and psychology. Literate people (many in high income countries) refusing to wear masks or be vaccinated despite overwhelming scientific evidence, is bewildering.

So, while vaccine stockpiles are nearing their expiry dates in the United States and parts of Europe, people in Africa and Asia are literally dying to be vaccinated.

Vedic philosophy calls this era the Kali Yug, a time when knowledge does not translate into wisdom. When individualism takes precedence over collective welfare, people are unkind and intolerant to each other.

Lack of humility and an excess of human hubris is also clearly in evidence during this pandemic. Leaders of countries who boasted that they were saviours of the world by promising vaccines were brought to their knees with the spread of the Delta variant. Those who extolled their superior public health status have had to eat their words.

Hypocrisy is also in full display. Early grandiose talk of vaccine equity in high income countries even before the discovery of the vaccine was soon forgotten as countries stockpiled up to four times what was needed to vaccinate their eligible populations with two doses.

Many countries did not put their money where their mouths were, espousing vaccine nationalism. The concept of vaccine distribution equity is now like talk of motherhood and apple pie.

The virus clearly showed us that the world needs not only universal health care and universal basic income but just as much universal behavioural therapy. Even in their enlightened self-interest, these countries should ensure universal vaccination because science has shown that the more people remain unvaccinated, the more the danger of variants mutating.

Here on, since 70% vaccine coverage will take time, Nepalis need to continue to mask up and wash hands. Those who are vaccinated must remember that it does not always protect them from infection, just severe symptoms, and they can be carriers to spread it to others. Vaccines only reduce mortality and morbidity and hospitalisations.

Same with masks. Wearing a mask and going into crowded places defeats the purpose. Those following proper guidelines have noted that they are less sick than usual with respiratory and gastrointestinal ailments. The use of masks and frequent hand washing in Nepal’s unsanitary conditions may lead to a decrease of other common infections besides Covid-19.

All presently available vaccines are effective in the prevention of Covid-19 infections, especially regarding hospitalisation. The important thing is not to miss the opportunity to get vaccinated with whatever doses are available whenever. All the available vaccines are safe and have very few, if any, contraindications even in pregnancy.

There is much less vaccine hesitancy and denial in Nepal now, especially after people saw how unvaccinated people in their families and neighborhood could easily succumb to the virus.

We have to psychologically prepare ourselves for the likelihood that the pandemic will continue for many more months unless the vast majority of us in the world are promptly vaccinated. Herd immunity from vaccination is much more reliable than herd immunity from natural infection.

Amazingly, no world leader has gone beyond rhetoric to actually start delivering vaccines to all corners of the world. As the pandemic plays out, the best-case scenario is that Covid-19 antibodies will be present even years after vaccination or post-infection, as was noted with SARS (a different but deadly coronavirus infection in 2002) and provide protection for years to come.

Or perhaps Covid-19 will peter out and become like the influenza virus requiring a jab every winter. Variants may continue to be a problem, but no one knows for sure as this is indeed a novel coronavirus, and we are still learning. In all likelihood, vaccines will continue to be effective even against variants.

One thing is for sure, all this shall also pass. But we have to learn lessons to be better prepared for the next pandemic.

Buddha Basnyat is a physician and clinical researcher at Patan Academy of Health Sciences and a frequent health columnist for Nepali Times.