We have the tools to help control the pandemic; we have to use them

Jan 24, 2021

The arrival of more infectious Covid variants means more of us need to be vaccinated than previously thought, with an uptake of at least 80%. The federal government must now drive that promotion campaign with a focus on vaccine safety.

Fortress Australia

Our priority should centre on keeping the prevalence of infection in our communities low enough for contact tracing to help end the border restrictions that are so financially and psychologically damaging. We need to minimise international arrivals not only because of the expense and difficulty in quarantining them but also because we wish to minimise the arrival of numerous viral mutants that have become more infectious.

I have argued that holding the Australian Open ‘grand slam’ this year is foolish. As predicted, chaos is engulfing the effort. Some 1400 players and officials from more than 100 countries, many of which have significant Covid outbreaks, pose an unacceptable risk to us and themselves.

The elite athletes in hard lockdown for 14 days just before competing in an endurance-heavy tournament are disadvantaged, while even those allowed ‘out’ for five hours a day are hardly likely to be at their best for what is one of the four most prestigious tennis tournaments. Wimbledon, sensibly, cancelled its championships and, understanding the consequent financial hardship to lower-ranked players, distributed the prize money that would have been available based on likely results.

We should have done the same. Tennis Australia is emptying its cash reserves ($40 million) to pay for the travel and housing of all the participants as well as providing the same amount for prize money. At the time of writing, seven Covid infections have been detected and the ongoing risk of more emphasises that on a risk/benefit analysis, the decision to hold the event represents folly.

While we await the rollout of our vaccination program we need to keep away from each other and wear a mask when social distancing is not practical. It will take at least six months to vaccinate Australia and our commitment to sensible restrictions must not weaken in anticipation of vaccines soon banishing the need. Indeed we must educate Australians of the reality that even with a successful vaccination campaign we will need to maintain social distancing for the foreseeable future.

Vaccine controversies

The SARS 2 virus is thriving. Deliberately (in an evolutionary sense) it does not necessarily produce identical copies of itself when it multiplies. Some random variations that develop from this process may be less efficient at entering the target cells wherein they can multiply, while others may become more efficient, hence infectious.

Inferior models soon disappear and the better models dominate. ‘Improved’ models from a number of countries have entered Australia and more are certain to arrive. While we should all appreciate the humanitarian imperatives related to helping poor countries acquire and distribute vaccines, we should also remember that it is in our interest to arrest Covid spread everywhere as unvaccinated hosts for the virus in the developing world will fuel nastier mutants, some of which might not be contained by current vaccines.

When I roll up my sleeve and get the Covid vaccine what do I hope it will do? First and foremost I want it to educate my immune system so that an encounter with the virus won’t result in illness or my death. Because while the virus has killed more than 2 million people it has infected a huge 96 million people. Of those who have had serious symptoms, some 20% continue to suffer a year later.

Second is the capacity of the vaccine to prevent me from being able to infect someone else. While there is no proof that any vaccine can do that, preliminary studies suggest that the Pfizer vaccine may be more likely to do so than the AstraZeneca (Oxford University) vaccine. We are planning to use the Astra vaccine to immunise the majority of Australians. Recently published results (on (January 8) suggested that the Astra vaccine was 70% effective in protecting people in developing countries from succumbing to Covid infections. Pfizer claims its vaccine is 90% effective.

This news prompted a number of calls for Australia to stop the rollout of the AstraZeneca vaccine and switch to the whole of population vaccination with the Pfizer vaccine. What got lost in the headlines, however, was the fact that the Astra vaccine was 100% efficient at preventing serious infections and the need for hospitalisation. Some vaccinated subjects still became infected and had a mild ’cold’ like illness.

Australia’s CSL can manufacture the AstraZeneca vaccine in Australia and we have ordered 56 million doses. The vaccine should be available for about $4 per shot, is stable in a normal refrigerator and can be distributed efficiently to our population just as we distribute influenza shots each year. The Pfizer vaccine is at least 10 times more expensive, must be kept at -70 degrees Celsius until a few hours before use and is in great demand and short supply.

We could get back to most of our pre-Covid lifestyle if vaccinated Australians suffered no significant illness when infected with Covid. We should roll out the program as soon as it is approved by the Therapeutic Good Administration, which should be forthcoming before the end of the month. There are some caveats, however.

What about those of us who, for one reason or another, are not vaccinated?

With all the current vaccines, it is likely the virus could still enter an immune system protected by the vaccine but could be passed by that immune person to another non-immunised individual in the usual manner. What to do?

The SARS-2 virus has a major vulnerability. To multiply, it must infect cells of a host. It has about two weeks to do this before the unwilling host would kill it. So our strategy for control and (probably impossible) elimination of the virus must see us immunise as many as possible while keeping the non-immunised away from the virus by continuing to practise social distancing until the virus has died from a lack of new targets.

Recent modelling tells us that the arrival of more infectious variants means that the above strategy will require even more of us to be vaccinated than previously thought. Original ambitions for a 70% uptake have now risen to at least 80%. Children, who can be very efficient ‘silent’ spreaders of SARS-2, will need to be vaccinated. While we have not finished safety studies with any of the vaccines in children, there is no reason to anticipate this will be a problem.

Of course, we don’t yet know how long induced immunity will last and therefore don’t know how frequently additional doses of the vaccine will be needed. All the currently approved vaccines require two spaced injections to achieve maximum effect.

Some have suggested a primary dose with one vaccine and a second dose with another. In general, immunologists don’t think this is a good idea. The first ‘shot’ stimulates those few immune cells that can recognise the proteins in the vaccine. As our immune systems evolved over the millennia we developed a library of cells that can recognise all the foreign proteins that might enter our bodies. As we can recognise millions of variations, we only have a few cells that can recognise any one ‘antigen’. Stimulation causes them to multiply, with a second dose causing many more multiplications and providing us with an army of cells to attack an invader.

There is nothing stopping us using one vaccine followed by another if it is deemed to be more efficacious.

P&I contributors have emphasised the need to promote public confidence in our vaccination program. From the above, you can see how important this will be. The Federal government has promised a major promotion campaign and it can’t come soon enough. It must emphasise the very encouraging safety profile of all the vaccines in use. Millions of doses have been injected with an allergic reaction occurring in just one in a million doses.

The recent report of deaths among a cohort of terminally ill Norwegians in a nursing home had almost certainly nothing to do with the vaccine. Among these patients, about 400 deaths from natural causes occur each week.

None of the vaccines contains microchips, mind-altering chemicals, or poisonous molecules that can be activated by 5G networks!

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