COVID-19: To vaccinate or not to vaccinate?

When scientists began searching for a vaccine for the SARS-CoV-2 coronavirus in early 2020

When scientists began searching for a vaccine for the SARS-CoV-2 coronavirus in early 2020, they were careful not to promise quick success. The fastest any vaccine had previously been developed, from viral sampling to approval, was four years, for mumps in the 1960s. Therefore, to hope for one in 2021 seemed highly unrealistic.

But here we are. Twenty-one days into the new year and we already have two vaccines developed by pharmaceutical giants- Pfizer-BioNTech and Moderna. Both have reported high levels of vaccine efficacy – around 95 per cent. They are also the first RNA vaccines ever to be approved for use against any disease. However, researchers have been using the technology for a while, and people have been given RNA vaccines in clinical trials for other diseases, like cancer.

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As expected, there are many questions, controversies and conspiracy theories that surround this vaccine. People are generally distrustful- How come a vaccine was developed so fast? What are the side effects? Is it true the vaccine is just a ruse to obtain our genetic composition? Is it a hoax by the west to wipe out the African population? When will it come to us in Nigeria? Why is it only available in high income countries? And my favourite one- Is the vaccine halal?

Before I proceed, permit me to bore you with a little medical jargon.

Firstly, all vaccines work by teaching our bodies to recognise and fight the pathogen in a safe way. They encourage our immune system to produce antibodies, T-cells or both, so that if we encounter the infection later our immune system knows how to defend against it. Vaccines can be made using many different technologies. The COVID-19 vaccines that are currently the most advanced are using four different approaches: viral vector, RNA, ‘whole’ virus and protein subunit.

So how come the vaccine was developed so fast?

The truth is, the research that helped to develop vaccines against the new coronavirus didn’t start in 2020. For years, researchers have been paying attention to related coronaviruses, which cause SARS (Severe Acute Respiratory Syndrome) and MERS (Middle East Respiratory Syndrome), and some had been working on new kinds of vaccine — an effort that has now paid off beautifully.

The slowest part of vaccine development isn’t finding candidate treatments, but testing them. This often takes years with companies running efficacy and safety tests on animals and then in humans. Human testing requires three phases that involves increasing numbers of people and proportionately escalating costs. The COVID-19 vaccines also went through the same trials, but the billions poured into the process made it possible for companies to take financial risks by running some tests at the same time. Additionally, vaccine researchers were fortunate with SARS-CoV-2 in many respects. The virus doesn’t mutate a lot or have effective strategies for foiling the human immune system, unlike HIV, herpes or even influenza. The influenza virus for example, because of its rapid mutation, requires a different vaccine formulation for every flu season.

In all honesty, the vaccine science would not have produced such fast results without massive funding. It didn’t happen with Ebola, which was devastating communities in Africa between 2014 to 2016. The Ebola vaccine took years to produce and is still not readily available in low- and middle-income countries, suggesting that the money only materialised this time because all countries, including wealthy ones, faced economic devastation. This means that the development of future vaccines, including for existing diseases such as malaria, unless it affects the superpowers, will not be as speedy. This proves the popular saying: “Cash is King’.

This brings us to another issue- the acceptability of the vaccine itself. A lot of people are sceptical and have no trust in the government to guard their interests. That is why, till date, there are numerous Nigerians who still do not take their babies for routine immunization against childhood diseases for fear that they may become infertile. And it is not only in Africa that we have such people- there is a teeming population of ‘Anti Vaxxers’ in the west who are opposed to vaccination because they want their children to remain in their ‘natural’ state, free of chemicals. In Oxford, England, a volunteer for a COVID-19 vaccine trial became the subject of a fake news story that purported she had died after a shot. The woman was forced to clarify the situation at a news conference that she was very much alive. Hence, it is important to get our facts right and put aside our doubts. Where ignorance thrives, conspiracy theories flourish.

The Lancet, an international medical journal, presented data collected in Australia in April, 2020, which suggested 86% of people surveyed (3741 of 4362) would be willing to vaccinate against COVID-19 if a vaccine became available. Between April and July, 2020, willingness to vaccinate has ranged from 58 per cent in the USA to 64 per cent in the UK and 74 per cent in New Zealand. The New Zealand data showed that the most commonly reported reasons to get vaccinated were to protect family and self, with safety being the chief concern about the vaccine.

These findings are important because they highlight some of the determinants of willingness to accept a COVID-19 vaccine if one becomes available. The vaccine development process must be transparent to increase public trust in safety and effectiveness, even for those who are already willing to vaccinate. Involving vaccine communication experts and the public in developing messaging and long-term vaccine strategy is crucial, and governments worldwide should begin preparing these strategies imminently.

However, the question in Nigeria is not if our people will get the vaccine or not. The million-dollar question is ‘IF’ we can afford the vaccine. There is a serious danger that low-income countries may be shut out of vaccine access, as they are less able to procure deals directly with pharmaceutical companies. Already, wealthy countries have signed deals to buy roughly 600 million doses of the Pfizer-BioNTech vaccine. This accounts for nearly half of Pfizer-BioNTech’s total production capacity up to the end of 2021. As usual, Nigerian politicians have already started travelling abroad, trying to secure a place on vaccine wait list. A video, which surfaced days ago, shows the wife of a Nigerian governor in the US receiving the COVID-19 vaccine while encouraging others to do so. Pray tell, who is her special assistant on PR? Did he or she not inform her that making that video would be an insensitive jab on Nigerians? To cut a long story short, we are on our own.

The COVID-19 experience will almost certainly change the future of vaccine science. It shows how fast vaccine development can proceed when there is a true global emergency and sufficient resources. In recent years, experts have attributed the rise in vaccine hesitation, ironically, to the fact that vaccines have been too successful. We rarely see what happens when we don’t vaccinate. The COVID-19 pandemic has given us a visceral reminder of what it’s like to live with a disease with no cure and no vaccine—and perhaps this, some suggest, could scare people into vaccination.

Or it might not. As for me, I will wait patiently for whenever our leaders deign it a priority to procure the vaccine for us, so that we may put this nightmare behind us.