Sep 17, 2021 Letters
Vaccine mandates are being implemented globally and regardless of what people think about this matter there’s a very important fact that remains – remember that the dangerous Delta variant emerged because of high levels of unvaccinated people. A recent research article (https://www.medrxiv.org/content/10.1101/2021.08.08.21261768v2) from scientists at the University of Maryland, using global genomic surveillance data accumulated for SARS-CoV-2 variants, showed that virus mutation frequency is inversely proportional to vaccine coverage. So lower vaccine coverage means the virus mutates (forming variants) faster. This article is in the process of being peer reviewed but one can still look at the numbers, as they are real and collected from 20 countries. The numbers show what is already known from the basic science of how viruses operate and what scientists have been reiterating to the general public from the start of the pandemic – vaccination suppresses viral mutations, we need to get vaccinated as fast as we can to decrease the number of hosts (people) available for the virus to spread, thrive and mutate into worse forms. In the paper in question, it is shown that the mutation frequency of the virus in India (highest of all countries studied), which at the time had less than eight percent of its population fully vaccinated, was significantly higher than that of countries which had more than 40 percent of their population fully vaccinated. Remember that the Delta variant emerged in India when less than four percent of its population had received one vaccine dose. Crisis followed where millions were infected, oxygen was in short supply and hospitals were overwhelmed. Crisis is what public health officials (globally) are trying to avoid with the implementation of vaccine mandates since to get out of the pandemic we need very high levels of immunity in our communities and at the population level and, only vaccines are going to get us, safely, to such high immunity levels.
A lot is being said on the best way to deal with current infection surges due to the Delta variant and it includes a combination of control measures in addition to vaccination. While all measures are important to help break chains of transmission (the virus spreading), we must not lose sight of what needs to be achieved to get out of the pandemic (globally). To do so and fully suppress the virus, we need population level immunity. Without a doubt, control measures help to significantly reduce the spread and prevent hospital systems from becoming overwhelmed but it remains very important that everyone (who can) needs to get vaccinated or we may end up with a worse form than the Delta variant.
There is also a lot of commentary on ‘breakthrough infections’ – the vaccinated getting infected, citing Israel as an example. Israel has attributed this to waning immunity from vaccination with the Pfizer vaccine– basically a reduction in protective antibody levels is seen with time (antibodies being those defense molecules, which neutralise the virus). Consequently, they are administering booster shots, which increased antibody levels again. This should emphasise the importance of getting protection from vaccination since we know there is protection from measurable levels of antibodies generated post vaccination. Further, if you look at the huge amount of data coming out of US and Canada, with tens of millions vaccinated, there is overwhelming evidence to show that places with very low vaccine coverage have resulted with a surge in hospitalisation and death. Some amount of breakthrough infections is expected because vaccines aren’t perfect but we can’t say breakthrough infections mean the vaccines aren’t working. They are actually working very well at preventing a severe form of the disease. They are now less effective at preventing mild infections since we are dealing with a much more aggressive form of the virus than the original Wuhan strain; all vaccines currently in use were developed against the original strain. Many companies have altered vaccines to target the Delta variant and others but these modified vaccines must go through testing in clinical trials again. Nevertheless, current vaccines protect against severe illness, hospitalisation and death and are therefore very much effective. The bigger problem would be if something worse emerges but we can help prevent that, with most getting vaccinated.
At the beginning of the pandemic, the worry was whether we would have a vaccine before the virus changes into something worse. Then vaccines came but worse forms of the virus still emerged due to low global vaccination coverage of which a major contribution factor is vaccine inequity which arose because of vaccine nationalism and equity initiatives such as COVAX still having a supply shortage and being underfunded. To date, of the 5.82 billion doses of vaccines administered only 1.9 percent of people in low-income countries have received at least one dose. Less than six percent of the population of Africa has received one dose while this is 61 percent and 55 percent for North America and Europe respectively. The WHO Director General, Dr. Tedros Ghebreyesus, in a September 14 statement said, “More than 5.7 billion doses have been administered globally, but only 2% of those have been administered in Africa. This doesn’t only hurt the people of Africa, it hurts all of us. The longer vaccine inequity persists, the more the virus will keep circulating and changing, the longer the social and economic disruption will continue, and the higher the chances that more variants will emerge that render vaccines less effective.” This message, in various forms, has been repeated numerous times by many professionals and leaders globally since the start of the pandemic – it takes a collective approach to suppress variants and get out of the pandemic. I think vaccine inequity is a bigger threat to a pandemic end than anything else because high levels of unvaccinated areas mean high likelihood of more variants of concern. Vaccine inequity indicates that having access to vaccines is a privilege. So, I urge everyone to make full use of this privilege and get vaccinated and, help to prevent something worse than the Delta variant from arising. Instead of contributing to vaccine, hesitancy be an advocate for vaccine equity.
Jacquelyn Jhingree, Ph.D.
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