Prof Brig (R) Waheed Uz Zaman Tariq
As the pandemic of the Covid-19 is with use, with new vigor, we have started talking about the vaccine. The Government of Pakistan has set aside a sizeable amount in foreign exchange to preserve the vaccine. The Prime Minister has approved an amount of US $100 million to make an advance payment for the purchase of the vaccine at the earliest. As per Dawn’s report of 18 November 2020, the priority for the administration of such vaccine will be given to high-risk groups of society, i.e. senior citizens, healthcare providers, and people afflicted with chronic diseases. Certain issues still remain to be discussed. So far, no candidate Covid-19 vaccine had been approved and licensed and no vendor has yet announced the price of the vaccine. What we know is that pharmaceutical giants like Pfizer and BioNTech have announced the results of their phase-III clinical trials. They claim that their vaccines have shown 90 percent efficacy in preventing the disease among those who have not contracted the virus. Much work still remains to be done. Obviously, the industry needs marketing and propaganda to sell its product. The markets have their own dynamics.
Meanwhile, at present, a Phase-3 trial vaccine is being conducted in Pakistan by the National Institute of Health (NIH), with the “formal approval” from the drug regulatory authority of Pakistan (DRAP). It was developed by the CanSinoBio and Beijing Institute of Biotechnology China (BIB) and is a Recombinant Novel Coronavirus Vaccine Adenovirus Type 5 vector (Ad5-nCoV). It is a part of a multi-country multi-center clinical trial being conducting in China, Russia, Chile, Argentina. The trials are necessary to ascertain efficacy, safety, affordability, and long-term protection by the vaccine. At a mass scale, the vaccine is given when it is approved and licensed by a competent authority. As the vaccine industry makes a lot of spending on research and development of the vaccine, it needs money and encourages the end-users to invest. Their prospective vaccine is claimed to be promising and different nations have pledged their resources to get a sizeable quota of the vaccine, when all work will be done. Pakistan too, in the background of her limited resources, has made its bid and is our nation waits for having a certain number of doses of the vaccine. Obviously, this quantity may not be sufficient for a mass-scale vaccination campaign. Too much hope, when too little is expected may be depressing. Therefore, the general public has to live with the virus and counter it with the measures suggested to the individuals, like immobility, keeping social distance, hand-washing, hand sanitization, and avoiding congregations of any type. Vaccination may be complementary to such efforts and not the only measure to be adopted. If the vaccination is developed, different firms may market them and if its stock is still left with the producers, it may make its way to the open market. at the moment, we are facing a big problem of unavailability of Influenza vaccine in Pakistan. The problem is a serious one in Pakistan. The affluent world has purchased its lots and we could not receive a sizeable supply. We were too late to order and price adjusted by our government was such that our suppliers could not make a deal. The same may happen if the Covid-19 vaccine is licensed and marketed. We do not know what will exactly be the price and whether it would be available. There are other questions, regarding its transportation under a strict cold-chain, vaccination at a proper body site, and follow up for its side-effects and efficacy. The whole matter does not look so simple.
When we talk of the vaccine in Pakistan, it is expected that the government will provide the vaccine to the masses and the prospective vaccinees may have a choice to get it or to make a campaign against the vaccination. If the vaccine is provided by an international agency or a philanthropic organization, our wizards may relate to a conspiracy of Judeo-Christian nexus. The history of such conspiracy theories may be traced in Punjab at least to 1888’s campaign of Small-Pox vaccine. There was one theory that the British Indian government was bleeding the young children to pick the boy whose veins would contain milk. According to them, he would be Imam Mahdi and the British would kill him immediately. There were many more theories spread by the Hindu Pundits, who wanted to maintain the populace of temples of Shitala Mata (the Hindu goddess of Smallpox) and centuries-old practice of variolation. The deliberate exposure to the material taken from the crusts of Smallpox with a needle was traditionally practiced in India and many pundits were involved in such a practice. The resistance to the vaccine created by the quasi-religious groups still haunts our society. In our countries, when social media is used to make propaganda for different tricks and feats to cope with Covid-19, the role of the vaccine may become dubious.
It will take a long time, to know about the long-term side effects of the vaccine. There is a worry about the vaccine-associated immune enhancement disease (VAED) in the vaccinated people, as was observed in the case of a vaccine against the Respiratory Syncytial Virus (RSV) and a type of old Measle vaccine, in the 1960s and such vaccines had to be withdrawn. In a recently published article “Prospects for a safe COVID-19 vaccine” by Barton F. Haynes and colleagues in “THE SCIENCE TRANSLATIONAL MEDICINE” on 4 November 2020, this issue was highlighted with grave concern. They have suggested lengthy Phase-3 trials to rule out this possibility. According to them the only way to address the theoretical risk of VAED is in phase 3 efficacy trials with sufficient numbers of endpoints to evaluate safety and efficacy and by post-licensure surveillance. So far, in animal studies, such a phenomenon has not been observed but the nature of human reaction may differ from that of human beings.
Unfortunately, in Pakistan, the issue of Covid-19 is being discussed by people who have no knowledge of virology and immunology and at times, their statements are misleading the innocent people, who have expressed undue reliance on the yet-to-come vaccine. Even, the vaccine trials are projected as vaccine-campaigns and a solution to all worries. The whole matter is too complicated and needs an elaborative discussion and left to the experts if at all they are found in Pakistan. One thing knows with surety that we as a nation have never thought of investing in the fields of medical virology and immunology. When a virus is unearthed, everyone starts speaking about it as he knows the most. I was a Medical Virologist know that one cannot be a jack of all trades unless he or she opts to be master of none.
Prof Brig (R) Waheed Uz Zaman Tariq BSc, MBBS, DpBact, PhD, MCPS, FCPS, FRCPath, FRCP
Head of Department of Virology, Chughtai Institute of Pathology