The dark Covid-19 narrative has turned a lot more positive by the development of several vaccine options. This is a development that has to be celebrated, said Prof Jimmy Volmink, Dean of Stellenbosch University's Faculty of Medicine and Health Sciences (FMHS), during a recent webinar that highlighted the urgent need for vaccination to curb the pandemic.
Several FHMS experts took part in this alumni event, chaired by Dr Therese Fish, FMHS Vice-dean: Clinical Services and Social Impact.
“Second to safe water, vaccines have proven to be the most effective public health intervention available to us. They have saved millions of lives," emphasised Dr Jantjie Taljaard, Head of the Division of Infectious Diseases.
He outlined the important current use of vaccines, including childhood vaccinations; the prevention of infections after injuries, such as rabies and tetanus; preventing infection of diseases such as yellow fever and hepatitis A when travelling; and to control outbreaks of deadly diseases such as Ebola and meningitis.
Taljaard emphasised that the only safe route back to any kind of normality, to restoring access to hospitals and clinics and to freedom of movement and economic engagement, is through Covid-19 vaccines.
Although unprecedented acceleration of Covid-19 vaccine development, registration and production took place, cutting usual time in stages of development from more than ten years to less than one, safety criteria remained unchanged, Taljaard said. The data regarding the majority of available vaccines can be trusted because these have been rigorously tested in terms of safety and efficacy. The duration of testing has been shortened, but not in terms of the quality of testing. This has been made possible by pouring significant amounts of money into the testing programmes and by scientists and technicians working together across the globe.
He highlighted the pros and cons of the available vaccines using various criteria, such as storage requirements (especially important for rural areas), approximate cost, dosing schedule and efficacy against the normal virus versus the South African variant. The J&J, Pfizer and Novavax vaccines tick most of the boxes.
According to Prof Gerard Walzl, Head of the Division of Molecular Biology and Human Genetics, the fast-tracking of vaccines has been a remarkable achievement for science, but also has inherent risks. “However, we should see it as relative risks, like the risk-benefit ratio that has to be taken into consideration with any vaccine or drug. Here the risk of not vaccinating is a deadly pandemic that can continue; millions that are ill or dead; healthcare services that are completely overstretched; a world economy that is in tatters; and the real potential for long-term social economic instability.
“If this had been a vaccine against the common cold, the process would have been unacceptable and the risks far too high, but it is against Covid-19 that has ravaged the planet. The risk-benefit ratio is clearly tilted heavily in favour of accepting the relatively small risk of the roll-out of fast-tracked vaccines."
According to Walzl the risk of long-term effects does exist, but it is very small and extremely rare. Overall, the vaccines have proven to be safe with transient effects including pain at injection site, fever, muscle pains, headaches and allergic reactions. These effects have been mild to moderate at most.
Regarding variants and possible more lethal mutations, Prof Wolfgang Preiser, Head of the Division of Medical Virology, said the way that the SA variant seemed to emerge from nowhere in December “really threw a spanner in our wheels, but South Africa should be proud of having one of the few networks in place globally to characterise it and to blow the whistle.
“The genomic surveillance unit that was established in April 2020 brings together various institutions, universities and the National Health Laboratory. It was through this consortium that we were able to recognise that a variant had emerged in the Eastern Cape and was spreading along the coast. It is really something to be proud of, since other countries have scrambled to come to the same level of surveillance that we have in place.
“The virus just did what viruses are known to do – it mutated, thereby adapting to the circumstances. Evolution will continue to happen, but we can reduce its likelihood to come up with more bad surprises by limiting its circulation. It will not mutate if it doesn't get a chance to replicate. That really brings home the need to roll out immunisation programmes as quickly and largely as possible."
According to Prof Hassan Mahomed, public health medicine specialist at the Western Cape Department of Health, who is also attached to the FMHS' Division of Health Systems and Public Health, equity of access to vaccines at a global, national and local level is an ideal that has to be actively pursued.
Regarding the current roll out of the vaccine among health workers, he said the Western Cape has a scoring system looking at exposure in terms of where they work and individual vulnerability in terms of age and co-morbidities. Willingness to be vaccinated has increased to more than 80% from the initial 50%. New strategies are required to address misinformation regarding vaccination.