Current Medical Issues

EDITORIAL
Year
: 2021  |  Volume : 19  |  Issue : 2  |  Page : 67--69

COVID-19 vaccines: Hope on the horizon with doubts


Kundavaram Paul Prabhakar Abhilash 
 Department of Emergency Medicine, Christian Medical College, Vellore, Tamil Nadu, India

Correspondence Address:
Dr. Kundavaram Paul Prabhakar Abhilash
Department of Emergency Medicine, Christian Medical College, Vellore - 632 004, Tamil Nadu
India




How to cite this article:
Abhilash KP. COVID-19 vaccines: Hope on the horizon with doubts.Curr Med Issues 2021;19:67-69


How to cite this URL:
Abhilash KP. COVID-19 vaccines: Hope on the horizon with doubts. Curr Med Issues [serial online] 2021 [cited 2021 May 13 ];19:67-69
Available from: https://www.cmijournal.org/text.asp?2021/19/2/67/313810


Full Text



The COVID-19 pandemic is not the first pandemic in the history of humanity, nor will it be the last. Previously, pandemics caused immeasurable suffering and deaths, destabilized economies, and wiped out civilizations. Notable past pandemics that left in their wake, gargantuan devastation, include Middle East respiratory syndrome coronavirus in 2012, the severe acute respiratory syndrome coronavirus (SARS-CoV) in 2003, Spanish flu (H1N1 influenza: 1918–1920), black death (bubonic plague: 1346–1353 AD), plague of Justinian (bubonic plague: 541–750 AD), Antonine plague (measles/small pox: 165–180 AD), and the plague of Athens (typhoid: 430–426 BC).[1] We no longer live in the dark ages and are now better armed than ever with modern medicine, which is an incredible force for good. Scientific advancement has given us the technical knowhow to challenge these great scourges.

The current pandemic that threw normal lives out of gear has forced scientific community to find answers in terms of therapeutics and vaccines at a record pace.[2],[3] The unrelenting contagion forced widespread restrictions on life and large-scale changes in day-to-day practices. Highly specialized surgeons and preclinical specialists, after a crash course in medical management and ventilatory support, found themselves managing COVID-19 patients of varying severity. Last year was abuzz with many conspiracy theories such as “artificial virus,” “biological warfare,” “plandemic,” and “leakage from a laboratory in Wuhan.” This year, after a detailed investigation, the World Health Organization seems to have closed the lid on those. COVID-19 has primarily become a disease among adults, with children being spared from severe infection.[4],[5] There seems to be a not yet fully understood potential cross-reactive immunity to SARS-CoV-2 from prior vaccinations and other common infections.[6]

Vaccines save millions of lives every year. If taken by a large proportion of people, herd immunity may be achieved and could alter the course of the COVID-19 pandemic, like never before in the history of pandemics. There are currently more than 140 different vaccines in varying phases of clinical trials. As of April 2021, 11 vaccines have been authorized by at least one national regulatory authority for public use. The four main types of COVID-19 vaccines currently in use across the World are presented in [Table 1]. In addition, four other vaccines made in India are in early phases of trials and are likely to seek approval soon. These are ZyCoV-D DNA vaccine (Zydus Cadila healthcare), HGC019 mRNA vaccine (Gennova pharmaceuticals), Mynvax peptide vaccine, and the Biological E vaccine. The reported efficacy of most of these vaccines ranges from 50% to 95% at preventing mild and severe disease.[7],[8] Current data show this efficacy to be applicable across age groups, racial, ethnic groups, and sexes.[7],[8] Is it naïve to think that the current vaccines are the solution to this dreadful pandemic? Are these the weapons we need to win the war against the infinitesimal contagion? Which one of these will prove to be the miracle vaccine? Only time will tell.{Table 1}

The world collectively took giant strides toward the development and testing of vaccines at a rapid pace. For the first time in human history, every country is targeting mass immunization of its entire adult population. India kick-started one of the world's largest vaccination programs, with priority to healthcare workers and other frontline warriors on January 16, 2020, and vaccinated more than 10 million in 30 days, at a rate exceeded only by the United States. In the second phase, people over 45 years of age have been offered the vaccine. Hopefully, the vaccination program will help the millions of people who lost their livelihoods to pick up the pieces and get back to living their lives. The success story of Israel's vaccination program with more than 90% of the vulnerable population being vaccinated is evidence of the potential of mass immunization.

Despite the optimism surrounding the vaccines, “vaccine hesitancy,” which is influenced by factors such as complacency, confidence, and convenience, is a major hurdle to overcome. Fear of side effects, suspicions over the expedited approvals, and doubts about efficacy have largely been fueled by social media mis-information. Today, anecdotes often win over facts, while sensationalist emotional stories, conspiracy theories, and fake news on social media have undermined public trust in established authorities. When it comes to immunization, “consumer choice” of the brand of vaccine is an alien concept. No one asks the brand name or the manufacturing company of the regular tetanus, polio, or hepatitis B vaccines. However, the rapid pace of approval for the COVID-19 vaccines has created brand awareness among the common public who, during the boredom of the protracted lockdown, had a “crash course” in epidemiology, immunology, and virology through social media. The big dilemma now among the medical and nonmedical personnel alike is – which brand is the safest: Covishield, Covaxin, Pfizer, or Moderna?

What still needs to be done to reach the target of pan global herd immunity are the following: large-scale manufacturing of billions of doses, distribution across continents while maintaining the cold chain, allaying public concerns regarding this vaccine and more research on long-term efficacy against the emerging variant strains. Despite the wealth of knowledge available through extensive, fast-track research, some mysteries still remain: How long would immunity to COVID-19 last? Will a combination of different doses of vaccines or different vaccines improve efficacy and provide better and lasting immunity? With new variants emerging across the world, would annual quadrivalent or multivalent COVID-19 vaccines be recommended like the seasonal flu vaccine? Although doubts exist and vaccine hesitancy looms large, the prospect of an early return of life to normality is still a tantalizing possibility.

References

1Huremović D. Brief History of Pandemics (Pandemics Throughout History). Psychiatry of Pandemics 2019:7-35. doi: 10.1007/978-3-030-15346-5_2. PMCID: PMC7123574.
2Kaur SP, Gupta V. COVID-19 Vaccine: A comprehensive status report. Virus Res 2020;288:198114. doi: 10.1016/j.virusres.2020.198114. Epub 2020 Aug 13. PMID: 32800805; PMCID: PMC7423510.
3Dong Y, Dai T, Wei Y, Zhang L, Zheng M, Zhou F. A systematic review of SARS-CoV-2 vaccine candidates. Signal Transduct Target Ther 2020;5:237.
4Patel NA. Pediatric COVID-19: Systematic review of the literature. Am J Otolaryngol. 2020;41:102573. doi: 10.1016/j.amjoto.2020.102573. Epub 2020 Jun 6. PMID: 32531620; PMCID: PMC7833675.
5Rabinowicz S, Leshem E, Pessach IM. COVID-19 in the pediatric population-review and current evidence. Curr Infect Dis Rep 2020;22:29.
6Reche PA. Potential Cross-Reactive Immunity to SARS-CoV-2 From Common Human Pathogens and Vaccines. Front Immunol. 2020 Oct 16;11:586984. doi: 10.3389/fimmu.2020.586984. PMID: 33178220; PMCID: PMC7596387.
7Lin DY, Zeng D, Mehrotra DV, Corey L, Gilbert PB. Evaluating the Efficacy of COVID-19 Vaccines. Clin Infect Dis. 2020 Dec 19:ciaa1863. doi: 10.1093/cid/ciaa1863. Epub ahead of print. PMID: 33340397; PMCID: PMC7799296.
8Mahase E. COVID-19: Pfizer vaccine efficacy was 52% after first dose and 95% after second dose, paper shows. BMJ 2020;371:m4826.