Writing this blog hit so close to home, as it will soon be the one year anniversary that our little town Hilton saw the first ever recorded case of COVID-19 and spun our world upside down. A momentous occasion indeed. Since then there has been an exponential explosion in research, updates, facts, misinformation, treatment and personal histories all interlinked with this pandemic. As pharmacists we feel like we have walked through each of these steps with you over the past year.
In today’s post I will be discussing the newest topic of attention, the COVID-19 Vaccine.
Researchers around the world have been working at record speed to develop vaccines to combat COVID-19. Less than a year after the start of the pandemic, that goal became a reality and is now hitting our shores in SA and about time, COVID-19 having killed more than 2.1 million people globally and devastated economies.
Vaccination has greatly reduced the burden of infectious diseases. Only clean water, also considered to be a basic human right, performs better in terms of public health. Paradoxically, a vociferous antivaccine lobby thrives today in spite of the undeniable success of vaccination programmes against formerly fearsome diseases that are now rare in developed countries. The arguments for the benefits of vaccination are transparent and positive in every sense.
How Does it Work?
The COVID-19 vaccines produce protection against the disease, as a result of developing an immune response to the SARS-Cov-2 virus. The coronavirus that causes COVID-19 has spikes of protein on each viral particle. These spikes help the viruses attach to cells and cause disease. Some of the coronavirus vaccines in development are designed to help the body “recognise” these spike proteins and fight the coronavirus that has them. Developing immunity through vaccination means there is a reduced risk of developing the illness and its consequences.
This immunity helps you fight the virus if exposed. Getting vaccinated may also protect people around you, because if you are protected from getting infected and from disease, you are less likely to infect someone else. This is particularly important to protect people at increased risk for severe illness from COVID-19, such as healthcare providers, older or elderly adults, and people with other medical conditions.
Are there different kinds?
Scientists around the world are developing many potential vaccines for COVID-19. These vaccines are all designed to teach the body’s immune system to safely recognise and block the virus that causes COVID-19.
Several different types of potential vaccines for COVID-19 are in development, including:
- Inactivated or weakened virus vaccines, which use a form of the virus that has been inactivated or weakened so it doesn’t cause disease, but still generates an immune response.
- Protein-based vaccines, which use harmless fragments of proteins or protein shells that mimic the COVID-19 virus to safely generate an immune response.
- Viral vector vaccines, which use a safe virus that cannot cause disease but serves as a platform to produce coronavirus proteins to generate an immune response.
- RNA and DNA vaccines, a cutting-edge approach that uses genetically engineered RNA or DNA to generate a protein that itself safely prompts an immune response.
What about Vaccine safety?
Understandably, vaccine safety gets more public attention than vaccination effectiveness, but independent experts and the WHO have shown that vaccines are far safer than therapeutic medicines. Before a vaccine is introduced into the population, it must go through rigorous testing and clinical trials, where it is administered and monitored in groups of volunteers. Once a vaccine is shown to be safe and effective, it is approved by national regulators, manufactured to exacting standards, and distributed.
What is herd protection?
Efficacious vaccines not only protect the immunised, but can also reduce disease among un-immunised individuals in the community through “indirect effects” or “herd protection”. Hib vaccine coverage of less than 70% in Gambia was sufficient to eliminate Hib disease, with similar findings seen in Navajo populations. Herd protection may also be conferred by vaccines against diarrhoeal diseases, as has been demonstrated for oral cholera vaccines.
“Herd protection” of the unvaccinated occurs when a sufficient proportion of the group is immune. The decline of disease incidence is greater than the proportion of individuals immunised because vaccination reduces the spread of an infectious agent by reducing the amount and/or duration of pathogen shedding by those vaccinated, reducing transmission.
The coverage rate necessary to stop transmission depends on the basic reproduction number, defined as the average number of transmissions expected from a single primary case introduced into a totally susceptible population. Diseases with high R0 (e.g. measles) require higher coverage to attain herd protection than a disease with a lower R0 (e.g. rubella, polio and Hib). Simply put, the more violent the disease the more targeted we have to be with our herd immunity approach.
What about the economics of all this?
Immunisation programmes require funding for infrastructure (e.g. cold-chain maintenance), purchase of vaccines and adequate staffing. However, the mortality and morbidity prevented translates into long-term cost savings and potential economic growth. Globally, the savings from vaccines were estimated by Ehreth in 2003 to be of the order of tens of billions of US dollars of direct savings. Malaria (for which there are currently several promising vaccines in development) costs sub-Saharan Africa US$ 100 billion worth of lost annual gross domestic product (GDP).
Savings are enhanced if several antigens are delivered in a single vaccine. Combination vaccines bring the added benefit of better compliance, coverage, and injection safety. Introduction of a new antigen is facilitated with combination vaccines, ensuring early high coverage by maintaining previous immunisation schedules, without compromising (and sometimes improving) immunogenicity and reactogenicity. We see this in our 4-strain flu vaccine we try to drive annually.
When taking into account indirect costs, savings are higher for common diseases with lower mortality and morbidity (such as varicella) than for more severe diseases (such as polio). Immunisation programmes, compared to other common public health interventions such as wearing seat-belts and chlorination of drinking water, are a good investment and more cost effective than, for example, advice on smoking cessation.
How will the COVID-19 Vaccine roll out in SA?
A national register for COVID-19 vaccinations will be established. The vaccination system will be based on a pre-vaccination registration and appointment system. All those vaccinated will be placed on a national register and provided with a vaccination card. A national rollout committee will oversee the vaccine implementation in both the public and private sectors.
How is Thrive getting involved?
We have partnered with the Department of Health and ICPA (Independent Community Pharmacy Association) because we want to be part of the solution! As soon as vaccines are being made available Thrive stores will be there for you. Keep an eye on our social media or subscribe to our newsletter for updates.
The benefits of vaccination extend beyond prevention of specific diseases in individuals. They enable a rich, multifaceted harvest for societies and nations. Vaccination makes good economic sense, and meets the need to care for the weakest members of societies. Facilitating universal access to safe vaccines of proven efficacy is a moral obligation for the international community as it is a human right for every individual to have the opportunity to live a healthier and fuller life!
BY: Kim Germiquet – Responsible Pharmacist & Thrive Hilton Manager