The riddle of vaccines and vaccination

One of my New Year’s resolutions was not to write on COVID. The subject had begun to tire people, having reached super saturation point. The roll out of the vaccines in February followed by initial scepticism and hesitancy, gave way to a more robust drive and there was cautious optimism that we finally were over the hill.

But then suddenly all hell seemed to break loose. COVID hospitals are full even in low prevalence states like Bihar and Jharkhand. The numbers are telling a story that is far from encouraging, if not downright depressing. This month, for the first time we crossed the mark of 100,000 cases in a day. The only saving grace, if one call it that, is that the virus this time round seems to be much less lethal compared to its earlier onslaught.

In January, 2021 there were alarming reports of variants (viruses changing their character as a survival instinct by adaptations through varations/mutations)- first the UK variant followed by the South Africa variant and then the Brazil variant. Irrespective of any public health interventions the variants have travelled across the world.

There was concern about the efficacy of existing vaccines against these variants. The placatory public announcements notwithstanding, Rockefeller virologists in the Paul Bieniasz and Michel C. Nussenzweig’s laboratories arrived at a nuanced answer by February. Their findings showed that the vaccines had less power to neutralise these new variants than the original Wuhan strain, but could still offer crucial protection.

Professor Paul Bieniasz flagged his main concern that vaccines themselves can also drive viral mutations and hence COVID-19 vaccines can add to the evolution of mutation of Coronavirus. According to him the time between initial vaccination and the time of the second shot to maximise the immune response might serve as an ideal milieu for the virus to acquire new mutations.

He postulated that while the original virus for which the vaccine was made got suppressed, the new variants may have a free run. One such mutation has been called an escape mutation because it helps the virus slip past the body’s immune defences. Ravindra Gupta at the University of Cambridge and colleagues have confirmed that the new variant substantially increases the amount of serum antibody needed to prevent infection of cells. A Reuters report from Japan on Sunday quoted a figure as high as 70 percent for this escape variant in hospitalised patients.

“Has the roll out of the vaccine added fuel to the fire?’ Indrani Roy, a scientist at University college of London wrote to the British Medical Journal and pointed out, “Globally, the cases started increasing after 5 weeks of a steady decline and coincidentally, the period of rise matches when major vaccination programmes were initiated worldwide. Even for the UK and Israel, where massive vaccination took place, the total deaths in the last three months after vaccination now have reached the overall number of deaths recorded in the past 10 months before vaccination.”

Thankfully a peak is followed by an invariable decline in the natural course (as we have seen in 2020 the world over), and this peak too has started coming down in UK and Israel while others like chile and Brazil are still reeling.

There are pockets of rising infections in spite of a good vaccination coverage signifying emergence of variants/mutants that are not addressed by the vaccine. If one looks carefully at the figures in Chile, Brazil, Japan and India, the concern assumes a worrisome proportion. If that be so, the target of sixty percent 'effective coverage' may turn elusive like a wild goose chase.

Back to the basics then. Why does a peak subside? It does subside even in countries and pockets where there is no worthwhile public health infrastructure. The undisputed answer is a break in the transmission chain due to population acquiring antibodies through infection-overt or subclinical. Emergence of a second wave simply means that either the immunity does not last long enough or variants take the dominant position. Both the postulations may be operative concurrently.

In either scenario the vaccines have an issue to address. In the first, frequent doses may be required whereas in the second, the vaccine needs frequent tweaking as it happens in the case of seasonal flu vaccine- every year a new strain and a new vaccine.

When the world made a hue and cry over the vaccine manufacturers’ obsession with secrecy of protocol and data sharing, trial protocols were reluctantly placed in the public domain. The British Medical Journal carried an editorial By Peter Doshi, Associate editor with a valid observation, “Contrary to prevailing assumptions, none of the vaccine trials are designed to detect a significant reduction in hospital admissions, admission to intensive care, or death. Rather than studying severe disease, these mega-trials all set a primary endpoint of symptomatic covid-19 of essentially any severity.”

He further comments “These studies seem designed to answer the easiest of questions in the least amount of time, not the most clinically relevant questions.”

It is intriguing. If the trial protocol was not designed to study prevention of severe disease and death, how did these trials become the USP of vaccines. Peter Doshi ended his editorial with a cautionary note, “Sixty years after influenza vaccination became routinely recommended for people aged 65 or older in the US, we still don’t know if vaccination lowers mortality. Randomised trials with this outcome have never been done. Observational studies with results in both directions can be cited, and without definitive randomised evidence the debate will go on. Unless we act now, we risk repeating this sorry state of affairs with covid-19 vaccines.”

We have seen elections in Bihar, Hyderabad, and now in five states including Assam and Bengal. We also saw Chhath puja and the wedding season in hinterland as well as a four months long farmers' agitation. None of them would qualify as an exemplary COVID appropriate behaviour. But despite apprehensions of a surge, nothing happened. And yet the same places and the same people, seemingly immune to the virus, have now seen a massive surge in numbers for no apparent reason.

Are we using the principle of Occam's razor (the problem-solving principle that the simplest explanation is usually the right one) that may not be correct all the time? When everyone thinks alike, no one actually thinks.