The novelty of Coronavirus has perplexed both doctors and the common man. This has raised several questions, not only related to the virus, but also for its treatment and vaccines. With several options available, people are waiting to get their choice of jab. But, doctors tell MUSBA HASHMI it’s a big no-no
Picking and choosing things is a human trait. Be it your favourite pair of shoes, or shirts or even COVID vaccines. Yes, you read that right. With more and more options available in the market, choosing a vaccine has become a task for many.
There were some people who preferred Covishield over Covaxin, while others were waiting for Sputnik V. To add to the list of choices, Serum Institute of India is all set to bring Novavax, which apparently offers more than 90 per cent efficacy, in the country by September, reportedly.
And given the current situation, when a US university, reportedly, had asked the students who got vaccinated with Covaxin and Sputnik V to revaccinate themselves, choosing the best of the lot may seem as the right option to many.
“For the more obvious reasons that these vaccines are not giving prevention from the disease rather making the disease pattern less severe, we have to choose one with a little better studies. Following the advisories are mandatory for people traveling to foreign countries, hence they may select their shot accordingly, but for people staying in India Covaxin is equally good or even slightly better than Covishield in all the studies conducted so far,” Dr Rachit Srivastava, Consultant, General Medicine, Apollo TeleHealth, says.
The situation is particularly challenging for students from India. It is becoming increasingly hard to secure an appointment for a vaccine that will be accepted by American campuses. Covaxin is not yet approved by the WHO. Students who got Covaxin are concerned about the uncertainty of its approval.
“The safety and effectiveness of receiving two different COVID-19 vaccines have not been proved yet, but some researchers feel that it may work. The American universities are about to start their autumn semester and Covishield is the only WHO approved vaccine available in India at this time. The Government has done right in reducing the interval for this category of population to 28 days. Rolling out the WHO approved vaccines like Novavax, Pfizer and Moderna in India can make the situation easy for students travelling abroad but this could take time,” Dr Namita Jaggi, Chairperson — Lab services and Infection control & Chief — Education & Research, Artemis Hospitals, Gurugram, tells you.
However, if you are not among the people who are travelling abroad, doctors say being fussy about vaccines is not a wise thing to do.
“Not taking the vaccine—whichever one may be available in India—is not a smart move. Almost all existing vaccines drastically reduce the odds of hospitalisation or death due to COVID-19. Take whichever vaccine you can when it’s your turn. This is currently the World Health Organisation’s guideline, too, which urges people to take whichever vaccine is available in their countries. Globally, doctors believe that barring some side effects, a vaccine is better than no vaccine,” Jaggi opines.
Don’t compare 95 per cent efficacy of one vaccine with 67 per cent of another. This only means the percentage of people who may not get COVID. All vaccines are 100 per cent effective in preventing COVID hospitalisations and death. With that being said, there is no doubt that vaccines with higher efficacy like the m-RNA vaccines and Novavax will however be better.
Dr Sharwari Dabhade Dua, Consultant Internal Medicine, Madhukar Rainbow Hospital, Malviya Nagar, agrees with Jaggi and says that both Covishield and Covaxin have studies and trials favouring its effectiveness in multiple variants of COVID-19. “The recently launched Sputnik vaccine has evident studies supporting its efficacy too. On the other hand, phase 3 UK clinical trials showed strong efficacy especially against UK and South African variants with Novavax. In my opinion, all the vaccines that are readily available in India today can be taken, because we saw a few cases who got infected with only mild symptoms, after the vaccination, and waiting further for newer vaccines can slow our process of mass vaccination and thus achieve herd immunity,” Dua says.
Srivastava emphasise on the fact that in the current scenario waiting for a preferred vaccine is never an option , use the vaccines that we have and reduce the chances of having severe infection. “We all should understand these vaccines are not the last doses that we are going to take. It’s just the beginning of it, we have to keep taking these vaccines for a long period. Obviously, at a later stage, we will get all other privileged vaccines in India and probably then we can choose the better one,” he says.
Adding to the woes
As if multiple vaccines with different efficacy rates, but with a single purpose —that of reducing the severity of the disease — wasn’t enough to perplex people, the first confirmed death of a 68-year-old man following vaccination in the country is adding to the woes.
This has raised several concerns among people, especially in the minds of those who are still already apprehensive about getting vaccinated. This might give them a reason to not go for nothing less than the best. But this incident, doctors say, shouldn’t give rise to fear.
“This incident should not create fear in the minds of people and there should be no apprehension about the safety of the vaccines approved for Indian population. The number of deaths reported following COVID-19 vaccination in the country is only 0.0002 per cent of 23.5 crore doses administered which is within the expected death rates in a population. It is also important and pertinent to note that the mortality rates for those testing positive for COVID-19 disease is more than 1 per cent and vaccination can prevent these deaths. Therefore, the risk of dying following vaccination is negligible as compared to the known risk of dying due to COVID-19 disease. Those getting their vaccination need to wait for 30 minutes at the inoculation centre after vaccination as most of the anaphylactic reactions occur during this period and prompt treatment prevents deaths,” Jaggi says.
One more shot
“I have got my first shot of the vaccine. The second is due in a few weeks. If this was not all, I have been told that we may need a booster dose as well. How many doses do we have to take and why will we, if we will still get the infection anyway?,” a distressed man asks.
He is not an exception, there are many who have the same question. To answer their queries, experts say that it’s time we accept the reality and learn to live with it until herd immunity is achieved.
As for the boosters, Jaggi says, giving smaller doses in multiple shots (boosters) is often better than a large dose of vaccine in a single shot.
“This is because our immune system builds on our immunity like bricks in a wall; each level needs to be laid before the next layer is built. Memory to some pathogens as in Rubella, measles or mumps is life long and in some the immunity wanes over time as in whooping cough or tetanus where boosters may be required. It may also be required if the virus mutates and variants arise as in the influenza vaccine where we require an annual flu shot with the currently circulating strains,” she says.
Jaggi adds that for COVID, we are learning along the way. We are not very sure about whether our immunity will last for six months or a year and how impactful variants will be in the long run. “But for now, there is a growing consensus that boosters will be needed. But whether we will need it for the next year or not, will again depend on the way the pandemic behaves. Moreover, the current vaccines show reduced efficacy against the variants namely the Delta, and the South African variant. So, boosters against the newer variants may be needed. Some researchers are also looking to mix vaccines for a better immune response,” she explains.
Dua tells you that booster doses are needed to increase the amount of antibodies against the infection. In the case of COVID-19, we have studies suggesting declining antibodies and rare cases of reinfection too. “Yet, we need some extensive research on the development, the longevity and the efficiency of the antibodies produced by the vaccines to consider the use of booster dose,” she says.
On the other hand, Dr Deepak Verma, Internal Medicine, Columbia Asia Hospital, Ghaziabad, says that booster doses are needed in all COVID-19 vaccines that are available right now in India and it is nothing but simply a second dose.
“Even abroad, except for Johnson and Johnson, all the COVID-19 vaccines need a second dose, i.e. a booster dose. This is because COVID-19 is a novel virus and the booster dose increases its efficacy against the virus,” he explains.
Back to square one
Time and again, experts are emphasising that the virus is relatively new and it will take us some time to understand it completely. Such has been the case with COVID vaccines. There are people who wonder if they test positive after the first dose of vaccine, do they have to restart the vaccination process. The answer is no.
“No, there is no need to restart the vaccination process again. A COVID-19 infection helps the body mount certain protective antibodies naturally and it will boost protection and antibody count. People who recover from COVID-19 have been found to have all four of these components. Specificity about how long this natural immunity will last is not clear but various studies show for at least three months,” Jaggi tells you.
In a study published in The New England Journal of Medicine, researchers in Iceland studied 1,107 people who had recovered from COVID-19 and tested positive for the antibodies. Over a four-month period, they found that those COVID-19 antibodies did not decline. A study published in the journal Immunity found that people who recover from even mild cases of COVID-19 produce antibodies for at least five to seven months and could last much longer.
“Natural infection gives you strength for a longer time. Patients, in such a scenario, may need to revisit their dosage timeline but be sure not to miss it. This is because getting a vaccine jab will add to your immune strength, over and above the natural antibodies and serve additional purposes. So, wait for 90 days post infection and get your second jab that can act like a booster for immunity. It is not advisable to restart the vaccination process after natural infection in between the doses,” she suggests.
Verma, too, is of the opinion that if a person tests positive after the first dose of the vaccine, there is no way they can restart the vaccination process. The person must increase the gap between two doses and take the second dose of vaccine after three months, as stipulated by the Government of India.
