The fax on vax

Just when you thought there was nothing else to say on Covid, I found a few things worth commenting on. Some relate to the past, some the present and some the future.

Why is there a vax shortage in Australia

To understand why you need to roll back to mid 2000. Governments were faced with a range of choices to pre-order vaccines. Broadly they fell into two forms of technology. One was similar to the traditional immunology approach using basically dead fragments of a virus to train the immune system. This is how we vaccinate against measles, chickenpox, smallpox, polio and even annual flu injections. The other was totally new delivery system for vaccination.

The first approach is called viral-vector vaccines. They train the immune system to recognise the Covid molecules by using a harmless virus, or adenovirus, as a delivery system to trigger the immune system to create antibodies to fight off an infection by SARS-CoV-2, which is the virus that causes COVID-19.  

The second was a new technology called mRNA. It was an experimental delivery system that had been around for some time, but not used for vaccination. As I understand it – and I am no scientist – it is messenger RNA that takes instructions to the body to produce antibodies. The DNA produces messenger molecules that instruct the body to produce proteins. By artificially creating the messenger RNA using gene splicing, the body can be trained to recognise the Covid spike protein and destroy it. The key point is that although the mRNA was being researched, it had never been used in a vaccine before.

To read a more technical article, click here.

This podcast is about half an hour but is an incredible story of how one researcher developed mRNA over decades. It was not until Covid hit there was an urgent need for mRNA technology.

Governments had to place their bets. The two key decisions were how wide to spread their bets and which of the 8 or so drugs under development to order. One seemed a no-brainer. The University of Queensland was developing a vaccine so it seemed like an obvious one to order. It could be produced locally and the government wanted to be seen to support the local product.

The one which seemed most hopeful at the time was the Astra Zenica development. It had good preliminary results and was traditional technology using viral-vector technology. Phizer was new tech mRNA, and Australia did not have the facilities to produce mRNA vaccines so it was our number three.

Of course, the UNQ vaccine never eventuated, the mRNA vaccines appeared more effective, and AZ had some bad press because of one in a million deaths from blood clots. Others like Moderna and Johnson and Johnson were not ordered initially. Not only that but the way the negotiations played out, our order was down the list rather than at the top.

So the problem was threefold. Firstly we did not spread the bets wide enough. Secondly, we picked vaccines that either failed or suffered from bad PR. Thirdly, we were not near the top of the delivery list.

Rather than admit the mistake and explain why, the government started saying it was not a race, and we didn’t need to get vaccinated immediately. because numbers were low. When that became a nonsense, they blamed States for a slow rollout and went on the attack of those criticising the Federal Government. Had Scott Morrison just said we thought we were making the right decision on the information available at the time, and we are now pulling out all stops to get mRNA vaccines, he might have gotten some measure of forgiveness. Unfortunately, it is just not in his nature to apologise. He only knows to obscure and attack.

It is a bit like the old story of the scorpion and the frog. The scorpion wanted to cross a river and asked the frog to swim across it while the scorpion sat on his back. The frog said, “No. you will sting me and I will die”. Finally, the scorpion convinced the frog that he would not sting him and they started across the river. Halfway across, the scorpion stung the frog. “Now we will both die.” said the frog. “Why did you do it?” The scorpion answered “It’s just in my nature.”

Does lockdown work?

It certainly did with the original variety of Covid as many countries proved. With Delta, the game has changed. Samuel Scarpino of the Rockefeller Foundation, who studies infectious-disease dynamics, said.

“The original SARS-CoV2 virus had a basic reproduction number or RO of 2 to 3, meaning that each infected person spreads it to two or three people. Those are average figures: In practice, the virus spread in uneven bursts, with relatively few people infecting large clusters in super-spreading events. But the CDC estimates that Delta’s R0 lies between 5 and 9, which is shockingly high,”

“At that level, its reliance on super-spreading events basically goes away,” Scarpino said.

Take that a step further. One person with Delta in an unprotected environment passes it on to between 5 and 9 people. The current lockdown in Sydney has a pass-on rate of just over 1.07 (and growing) for Delta. Although we are in lockdown, we are still seeing incremental increases in numbers. Lockdowns do work, but not currently to the extent of reducing numbers. They are just holding ground but that might change as the days go on.

Another factor is the tipping point. If there are ten infections a day, a team of contact tracers have a chance to do their work, contact people who may have been infected, and reduce future infections. At a hundred infections, it is ten times more difficult to carry out those traces. We are at almost 500 a day. You cannot just ramp up contact tracing overnight. The more people infected, the more difficult it is for contact tracers to keep a lid on potential infections. Once you pass the threshold where people can be traced, it will accelerate away. Each new contact will infect progressively more people until it is unstoppable.

Vaccinated but infectious

We can be vaccinated and be infectious. This is how it works – the non-medical explanation. The vaccine trains our immune system to recognise and attack the virus once it enters the body. When it is in the nose or throat, it has not entered the body. It is just in the entrance hall so to speak. Research over the last few months has shown that the viral load in people who have been vaccinated is higher with the Delta strain than with the first strain. It is just hanging around waiting to go inside. This is from The Atlantic magazine.

“Delta could potentially spread from vaccinated people too—a point of recent confusion. The CDC has estimated that Delta-infected people build up similar levels of virus in their nose regardless of vaccination status. But another study from Singapore showed that although viral loads are initially comparable, they fall more quickly in vaccinated people. That makes sense: The immune defenses induced by the vaccines circulate around the body and need time to recognize a virus intruding into the nose. Once that happens, “they can control it very quickly,” Marion Pepper, an immunologist at the University of Washington, told me. “The same amount of virus might be there at the beginning, but it can’t replicate in the airways and lungs.” And because vaccinated people are much less likely to get infected in the first place, they are also much less likely to transmit Delta than unvaccinated people, contrary to what some media outlets have claimed.”

“Still, several lines of evidence, including formal outbreak descriptions and more anecdotal reports, suggest that vaccinated people can transmit Delta onward, even if to a lesser degree than unvaccinated people. That’s why the CDC’s return to universal indoor masking made sense, and why vaccinated people can’t tap out of the pandemic’s collective problem. Their actions still influence Delta’s ability to reach their unvaccinated neighbours, including immunocompromised people and children. “If you’re vaccinated, you did the best thing you can do, and there’s no reason to feel pessimistic,” Inci Yildirim, a vaccinologist and pediatric infectious-disease expert at Yale, told me. “You’re safer. But you will need to think about how safe you want people around you to be.”

The bottom line is that even if most people are vaccinated, the virus will still spread. Vaccination is effective at stopping you from getting seriously ill but only marginally in reducing your ability to infect others. Everyone is going to be exposed to Covid over the coming years.

The anti-vaxers

There is no point in shouting at those who refuse to be vaccinated. That only drives people further into a corner. Most of the arguments put to them come back to “you not getting vaccinated restricts me who has/will be vaccinated”.

Let me digress. When I was a kid, there was no vaccine for measles or chickenpox. It was considered better to get it as a child rather than an adult. If one of our friends had the disease, we were usually told to hang around in the hope we would get it too. I got measles after a visit to my infected cousins.

So we built up immunity by getting the disease at a time when it was less dangerous to us and so became resistant to measles in the future. It is a crude form of inoculation but the mechanics of training our immune systems to watch out for the disease was the same as a vaccine.

Now to Covid. It is inevitable we will all come in contact with Covid over the coming years. It is not going away. My question to anti-vaxers is this.

Why do you think that when you get your first dose of Covid, it will not be serious? Are you not concerned about dying or long-term Covid?

It is their choice as to how they gain a level of immunity. You can go old school and catch it to build a certain level of immunity, or you can get a jab.

Risk of blood clots

The AZ vaccine has got a lot of bad press. But let’s consider the level of risk. One in a million die of a blood clot. About 2,000 people die on Australian roads each year out of a population of 25 million. That is about 80 per million. So it is 80 times riskier to get in a car than to have a vaccination.

In the Olympics, Australia won 46 medals. That is roughly two for every million people in Australia. So you have double the chance of winning a medal at the Olympics than getting a blood clot with AZ.

In any case, since the link between AZ and clotting was identified, the monitoring and treatment have significantly reduced the risk of a clot proving fatal. This will only improve as time goes on.

But mandatory vacinnation takes away my freedom

My question is this. What is freedom? Freedom is not the ability to do anything we like. We cannot walk into a shop and take what we want without paying. We cannot drive a car without a seatbelt. We cannot smoke in a restaurant.

To get philosophical for a moment, in order for people to live together as a society we must agree on rules. If there were no rules, society would not exist. Those rules are there to ensure we all serve the common good. The rules do two things. They protect us from one another and they stop us from doing harm to one another.

The common good is about what is good for the society as a whole, It is not about what is best for the individual above everything else. If the two align so be it. If the two are in opposition, society is more important. If you want to live in a society, you obey the rules. If you don’t want to obey the rules, convince the rest of society to change the rules or leave the society.

Requiring mandatory vaccination is no different to mandatory seat belts or mandatory standards on food production or mandatory safety requirements on building sites. We all have to give up some freedoms if we want to live in a society. You owe it to those with whom you share the society.

What are the implications of a ‘let it rip’ approach

The US carried out this experiment and now there are over 600,000 people dead. Brazil tried it and are pushing towards the same number but everyone agrees that it is underreported. Worldwide there are probably between 5 and 10 million deaths.

If you think that is bad, the Spanish Flu epidemic just after WW1 killed 50m people. That was 30m more than WW1. In the war, there were 20m killed and another 20m disabled. So Covid is only halfway to the death toll of WW1. On the other hand, we have little idea what is going on in third-world countries where testing and reporting is almost non-existent.

On a more specific level, if we let it run we will see high death rates in the elderly including parents and grandparents; those with immunodeficiency problems such as transplant and cancer sufferers; health workers and first responders. If you decide not to have a vaccination and know anyone in the groups above, you are putting them at risk.

In addition, we will clog up hospitals and those needing treatment for other illnesses or problems will not be able to get treatment. There is already a backlog for things like joint replacement.

Why is the advice changing all the time

Basically, because the information is changing. Covid and vaccines are a moving target, The Delta strain was not there 12 months ago and only time reveals what it is capable of. Vaccines were rushed out in a fraction of the time it takes to produce medical products normally so the impact a new vaccine has on a strain of the virus that was not there when it was released has to be monitored and analysed.

Overlay this with lockdowns that are subject to different levels of compliance and you have a fluid situation. People have to operate on a best guess and change when the information changes. It is important to remember that there have been no major hiccups in the Vaccine rollout in terms of the quality of the vaccine. They are as effective as the early testing indicated. Side effects are minimal and are no better or worse than other drugs on the market. If you are taking any prescription medication, do you worry about all the potential side effects listed on the packaging? Many are scarier than vaccines.

Another aspect I did not mention is that things like risk change when circumstances change. For example, if there is no Covid around at a time, the risk of a particular vaccine side effects is higher than if there is an outbreak like we have in Sydney at the moment. You have to balance up the risk of the side effect versus the risk of catching the virus.

Why are there so many stuff ups in policy implementation

Governments are criticised for not thinking of some detail that causes an outbreak in spite of a law that was developed and implemented in a day or two. For example, do this exercise. Sit down and write down every situation a law on compulsory testing of a particular group has to cover.

It is not as simple as everyone in that group has to be tested. There are language barriers, travel limitations, how do you cater for people with disabilities that might make testing a problem? How do you register everyone who has been tested, and find those who have not been tested? Where do you set up testing centres? How do you find the people to staff the test centres? Do you pull them off another testing site, and which test sites? Do you need to put in traffic management plans for the testing sites? Who will do the analysis given most testing labs are at full capacity?

As you can see, policies are being created conceptually but the nuts and bolts are a labyrinth of detail that we cannot expect to happen flawlessly in the space of days. It normally takes months or years to implement and plan a new policy. Covid policies happen in a few days.

Why should schools be closed

Given children have little reaction to Covid exposure, why should schools be closed? Two reasons. Firstly to protect teachers. You might say well, just get all teachers vaccinated. The problem is a child can infect a teacher who may take it home and start spreading it to family and friends.

The second is that children can have Covid, have no symptoms and infect lots of other kids. It is like a secret super spreader. Kids take it home and away it goes through the family and beyond. Schools are a high potential source for community transmission.

Of course, parents and grandparents often bring kids to school so infection is likely to spread to many older people in more vulnerable demographics.

Will herd immunity ever exist?

The short answer is no. Adam Kucharski, an infectious-disease modeller at the London School of Hygiene and Tropical Medicine, said.

“As vaccination rates rise, waves will become smaller and more manageable. But herd immunity – the point where enough people are immune that outbreaks automatically fizzle out – likely cannot be reached through vaccination alone. Even at the low end of the CDC’s estimated range for Delta’s R0 (5), achieving herd immunity would require vaccinating more than 90 per cent of people, which is highly implausible. At the high end (9), herd immunity is mathematically impossible with the vaccines we have now.”

So it will be around for a long time. We will probably have new and more infectious strains evolve, and we will need to get a booster shot every year, but it is not going away. I think governments are still coming to terms with that after seeing the Delta variety cut a swathe through the world.

Should we be afraid

Likely in a few years, we will be back to some sort of normal. We will probably have vaccine passports and those resisting vaccination will have mostly come around when they, or their co-supporters have been through a serious bout. A booster shot will be a regular annual event.

What is of more concern, and nobody seems to be talking about is what comes next? We had SARS, MERS, Swine Flu and Ebola. Covid was perfectly foreseeable to most disease experts. In 1980 in Australia we had an epidemic plan worked up by the government as to what we would do if we were to experience an event just like this. It was reviewed and tested in the late 80s, but due to cuts to the Public Service, it was canned. By the time Covid hit it was totally out of date. It did not even mention the Internet so was useless in helping public officials deal with this epidemic when it arrived.

So will we develop a disaster plan for the next epidemic with all the experience still fresh in our minds? I would ask the PM but he is angry enough.

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