COVID-19 and the vaccine dilemma

The classic spike proteins on SARS-CoV-2 visualised under an electron microscope.

It has been four hundred and thirty one days since the not-so-novel coronavirus called SARS-CoV-2 reached the shores of the Indian Subcontinent. A lot has changed since then — firstly, we know a lot more about the disease than we did, even just a year ago. We know fairly well how the virus spreads, what kind of symptoms it can cause, how to test yourself if required, how and when to isolate yourself, and how to wear a mask properly. Well, I might be exaggerating a little on that last one, but hey, more power to them, right?

Enough and more has been written about the disease itself, so let’s skip straight to the key takeaways that I have had, over the past several months of voracious, daily, relentless reading about the what’s what in the COVID vaccine world.

A vial of a COVID vaccine — these vaccines were developed in record time, and are the most practical way of ending this pandemic.
  1. Take whatever vaccine you can get your hands on sooner. Period.

The earlier you are vaccinated, the sooner you can be rest assured that you shall not suffer from serious illness or die from COVID. Ever heard of the phrase ‘vaccines save lives’? — this is the point of vaccination. Not to eradicate COVID from this planet, not even to ensure that you never get infected with the virus again, and certainly not just for the ‘Gram, although it’s great to spread the word. Vaccinations are the safest, most reliable, and the surest way to end this pandemic.

2. Efficacy rates of the vaccines are vastly overrated.

This is especially true in the context of daily conversation, especially if it results in a stance like “I’m waiting for a better vaccine to come out”. Efficacy rates are measured in monitored clinical trials, and the way this works is that the participants are split into two groups — one group gets the actual vaccine, and the other gets a placebo. You then ask all the participants to go about their daily lives, and then check how many of them test positive for SARS-CoV-2. Let’s say 20 people do; if more of them are from the placebo group, then that’s superb news. If more of them are from the vaccine group, then that docks the vaccine’s efficacy rate.

However, efficacy rates just look at the chances of infection. On that note, anything above 50% is awesome according to the WHO, because it essentially means that your chances of getting infected with the virus is cut in half.
What is more important, is how good these vaccines are at preventing COVID from turning into the nightmare that it has, for millions of individuals around the world. On that count, every single one of them stand at 100%.

3. Now let’s take a look at the vaccines broadly available around the world:

a) The mRNA vaccines: it’s all in the genes

Both Pfizer/BioNTech and Moderna have developed some of the coolest and most effective vaccines for COVID-19, yet. They basically took a portion of your genes (what fancy people call the mRNA), modified it in a small way to make sure alarm bells go off if the virus ever enters your body, and enclosed the whole thing in a ball of fat, to make sure that whatever is inside stays stable after it has been injected into you. mRNA is basically just a bunch of genetic code, so to even conceive an idea like this is really exciting.

b) Adenovirus vectors: some really cool engineering

AstraZeneca (branded Covishield in India), Sputnik V and Johnson&Johnson all decided to do something very fascinating. Instead of trying to use inactivated coronavirus itself, AZ for instance took stool samples from a friendly ape that happened to fall ill with a cold. From the sick stools, they isolated the DNA of the virus that infected our ape, and dressed up that DNA to make it look more like a coronavirus. That’s a fancy-dress winner if I ever saw one.

c) Protein subunits: smaller portions, please

Companies like Novavax decided to take a piece of SARS-CoV-2, chop off its arms and legs till it can barely be recognised, and turned it into something that is essentially a ‘subunit’ of the virus, but is still plenty enough for our body to recognise and sound the alarm.

d) Inactivated whole virus: why go small when you can go all the way

Covaxin and Sinopharm decided to go for what is probably the hardest type of vaccines to make, where you essentially take the entire virus molecule, inactivate it to a point where it’s more than just dead, and convert it into a vaccine that can provide really wholesome immunity. This is the oldest form of making vaccines, so as the saying goes, when in doubt, always opt for the ‘tried and tested’.

4. “When should I get my second dose of Covishield?”

The Indian government has recently put out new guidelines on the dosing interval of the Covishield vaccine, where it has been increased from 4 weeks, to 6–8 weeks. I find the science behind this to be slightly problematic, as it is largely based off a Lancet analysis that explored an existing clinical trial, which was not designed to look into this data. Moreover, the analysis showed an increase in efficacy largely at 12 weeks interval, while the efficacy at 6 weeks showed no significant change.
Things to remember here are:
a) The Astra-Zeneca vaccine is one of the most comprehensively researched vaccines out in the market right now. Almost all of the scientific data we have from the vaccine is through the standard 4-week dosing interval.
b) The first dose of the vaccine (called the prime) works really well, and maintains sufficient antibody levels from 22–90 days. This means that you are sufficiently protected for upto 12 weeks, with just a single dose.
c) Clearly, if one dose confers enough protection for so long, it made perfect sense from a policy standpoint to defer the second dose (called the booster) until 12 weeks, as it would lead to better resource management.
Let me explain — if you had only 100 vaccine doses with you, it would make more sense to administer 100 people with the first dose, rather than just 50 people, who would return in 4 weeks’ time for their booster jab.
d) Antibody levels do fall over time after the prime dose, which is why the booster is necessary for long-term protection. Logically speaking, it only makes sense to take it as soon as permissible, to ensure that this doesn’t happen too quickly, leaving you potentially vulnerable.

5. Covishield can give you blood clots apparently. Also it is a UK vaccine, why we are still under the shackles of colonialism?”

While it is true that there are scattered reports of increased blood clotting incidents resembling what is called heparin-induced thrombocytopenia (HIT) after taking the AZ vaccine, the proportion of such incidents is astronomically low when compared to the total doses of the vaccine administered. It is worth discussing with your doctor if you really are concerned, but the risk of not vaccinating, especially with the rising number of cases, is far greater.

6. “I shall only take Covishield, only Bhakts will opt for Covaxin.”

I think as a matter of public service, people who propagate the above sentiment need to be publicly flogged.
Keeping point number 1 in mind, let us briefly pause to understand a few things about Covaxin -
a) The vaccine has been demonstrably safe to inject on all counts. The polio shot you got as a kid was probably manufactured by these guys, they know what they are doing.
b) Estimated efficacy from Phase III trials is 80.6%. This is amazing, and on some notes better than what we have seen from Covishield.
c) Dosing interval is 4 weeks. Not 6 weeks, not can be as long as 8, not maybe 12, but a clear, consistent four.
d) Initial studies show good amount of effectiveness against the different strains of the virus such as the UK variant. This is also very promising.

The math here is really simple — in light of the rising number of cases in almost every neighbourhood in the country, would you rather leave yourself vulnerable because of your ideological perspective that goes against all available scientific evidence?
It is okay to not want to bang your utensils at home, light a lamp, or clap your hands, as this will not alter the course of the pandemic. Taking a vaccine, can.

7. “Forget Covishield/Covaxin/Pfizer and all. Why get vaccinated only? Isn’t it suspicious that they came up with all of these vaccines so quickly? Definitely microchips are being implanted, they are going to track my every move.”

I do not have words, only tears.

8. Phased vaccinations, and what can be done better.

An ideal way to go about vaccinations is to ensure that the most vulnerable people in your family are protected, as quickly as possible.
This strategy was globally adopted by several countries for their populations, and it also had the added benefit of preventing a single country from monopolising vaccinations. It also makes perfect sense for a massive population like India, as a non-phased, free-for-all deployment of vaccines will almost certainly result in faster shortage of vaccines, bigger headaches at managing the vaccination sites, and a more complicated path towards achieving ‘herd immunity’.

The current system followed in the country does have its fair share of problems, the biggest one being the initial vaccine hesitancy displayed by even some of the healthcare professionals. This, I suspect did lead to a longer delay in progressing through the subsequent phases, but thankfully, things have picked up. Ironically enough, I have also noticed some rising criticism against people who managed to get vaccinated despite not being in the bracketed age group. I find this anger to be extremely misplaced, as I would definitely prefer people bending a few rules to protect themselves and their loved ones (if they can), over those who go out of their way to do the opposite. Claims of ‘shorting vaccine supply’ and ‘taking the place of someone who really needs it’ have not really been substantiated by the available data, and therefore not something I consider relevant.

9. “What next?”

This pandemic will end. SARS-CoV-2 will likely not go away, but the pandemic it has caused will come to an end.
Regarding vaccines, I strongly feel that multiple vaccines are the way forward. I can see modified vaccines coming into trial very soon (against variants), and maybe an RNA-based vaccine booster that will be required down the line. The most important thing is that we have several options already available, and that number is only going to go up.

For once, that is not a bad thing.

Aspiring to write about the several rabbit holes I find myself burrowing down the internet.