Features
Currently available Covid-19 vaccines: Some important considerations
By Dr. B. J. C. Perera
MBBS(Cey), DCH(Cey), DCH(Eng), MD(Paed), MRCP(UK), FRCP(Edin), FRCP(Lon), FRCPCH(UK), FSLCPaed, FCCP, Hony FRCPCH(UK), Hony. FCGP(SL)
Specialist Consultant Paediatrician
Just about a year or so into the coronavirus pandemic, the thing that is in everyone’s mind, as well as in their hearts and souls, is the COVID-19 vaccine that is thought to be one of the answers to the problem. The disease has taken a frightful toll. Many have died and scores of others have suffered immeasurably, directly as well as indirectly. Many countries are in shambles and most of us are wondering as to what would come next.
As at present, there are several vaccines that have been rolled out and some are being administered in committed immunisation programmes in quite a few countries. This is no mean feat as these vaccines have been manufactured, tested and licensed in double-quick time. We, too, in this resplendent isle, have now got some stocks of the vaccine, through the generosity of several countries and institutions. The future plans are to deploy the vaccines globally in a dedicated effort towards controlling this blight that has caused all this mayhem. It speaks so much for the brilliance, dedication and commitment of many scientists that a process that normally takes several years has been shortened to just under a year.
Yet, for all that, this spectacle of the shortening of the time-frame has led to many questions being asked in several quarters and some inclinations of suspicion, and even mistrust, being expressed by some. This has been further amplified by the novel technology employed in producing the vaccines. However, there is hardly any doubt that vaccines are the principal tool by which we can challenge this pandemic which is now going onto its second year. If we are to have any worthwhile hope of getting back to some sort of “normalcy” and saving countless millions of lives, extensive immunity, through vaccine inoculation, is of the essence. There is incontrovertible evidence that the currently available vaccines do produce a reasonable degree of protection, especially against the severity of the disease, by mobilising the resources of the human immune system. They are likely to reduce the morbidity and the mortality of the disease. However, we do not know for sure whether it would prevent the spread from person to person. In addition, we also do not know for sure as to how long the immunity would last in the vaccinated people. These would need to be sorted out once more scientific information is available post-vaccination.
There is quite a bit of apprehension as to whether the vaccines were ‘rushed’. The scientists assure us that no safety steps were either cut down or even short-circuited. These vaccines have gone through the mill of testing in several Standard Phase Clinical Trials, just like any others that have been in use for many other contagious infective diseases. True enough, the timelines have been considerably shortened but the due processes have been followed. All three phases of research trials have been undertaken, albeit at a fast-tracked pace. The efficacy, safety and tolerability have been adequately looked into. None of these steps have been omitted or side-tracked for the Pfizer, Moderna or AstraZeneca vaccine development processes. In fact, mainly due to the extensive occurrence of the disease and the committed focus on developing a vaccine, there was no shortage of patients with the disease and there were more than enough subjects ready to be enrolled into trials as well as sufficient funds were available to conduct the research work that was needed. It may be a surprise but it is a fact of life in these circumstances and it is indeed most encouraging to see the way science has progressed in leaps and bounds to move that much faster through sheer necessity, to do all the work necessary in producing effective vaccines.
As for the safety of these vaccines, the detailed studies that were conducted over a period of about 9-10 months have shown them to be safe. The Phase 3 studies for all the major vaccine candidates are still ongoing. Furthermore, many side-effects from vaccines occur within a short period vaccination and as trials have been going on since April 2020, these reactions would have already been seen. There has been mild undesirable effect but so far, no major side-effects have been reported in a scale that would invalidate the vaccines. However, we have to await further results of the research endeavours to know about any possible long-term side effects. These would usually come through post-marketing surveillance.
In fact, BioNtech and Moderna have been working on their proprietary messenger ribonucleic acid (mRNA) technology long before COVID-19 came into the arena. They knew a lot even about the vagaries of the process. Scientists view this expertise as a ground-breaker when it comes to vaccine advancement; cutting down development time and thereby making mRNA candidates cheaper and more amiable to be custom-made than the traditional vaccine candidates.
There are some concerns expressed by many as to whether the mRNA vaccines could alter the deoxy ribonucleic acid (DNA) of humans. So far there is no tangible evidence that this is the case. Apparently, mRNA does not alter or interfere with DNA as it does not hang around in humans for long periods of time. It crumbles and disappears after a certain short time and thereby are thought to be even safer than old-style vaccines. Traditional live vaccines inject small amounts of the live virus and attenuated vaccines inject the inactivated virus into the body. With mRNA, it is only a kind of a blue-print of a recognisable component of the organism that is injected.
The well-known target of a vaccine is to teach the body defences to detect and recognise the causative organism of a disease. When a virus infects a host cell, the virus releases its RNA which gets into the host cell nucleus and reproduces itself using host cell machinery. Viral mRNA then copies viral RNA into proteins which then reassemble as more viruses. These newly synthesised viruses enter into the host cell blood stream and then all hell breaks loose.
The current mRNA vaccines generally recreate the blue-print of the outer shell or the spike protein of the virus. The spikes are the components that enable the virus to attach itself and get into the host cells. Therefore, anything that can interfere with these spikes will knock off the virus before it can get into the human cells. All that the vaccines do is to induce the human immune systems to recognise and interfere with the spike proteins. Our immune system recognises Sars-Cov-2 via the spike protein and by sending some “placebo-like” spike proteins into the system via the vaccine, it gives them an early start in being prepared for potential infection. Members of our immune system are usually moving around in the bloodstream looking for possible ‘none-self’ intruders. When these sentinels come across the spike proteins, they launch an immune response. That would be the end of the story for the virus.
Having said all this, there is a current dilemma that needs to be addressed urgently. Very recently, both AstraZeneca and Pfizer have reported considerable delays in production and supply of their vaccines. As if we do not have enough problems on our hands due to this blight of a virus, this adds another dimension to the equation of the equity of provision of the vaccines to those desperately needy people of our planet. This graphically highlights the massive constraint the world is facing in getting everyone, everywhere, vaccinated because of the exclusive rights pharmaceutical companies hold over who is allowed to produce and manufacture their vaccines. Given the current crisis, this is very definitely quite unacceptable. While every week higher and higher new infection records are hit, hospitals are overwhelmed, and people struggle to feed their families, pharmaceutical companies ‘cherry-pick’ as to who gets access to vaccines. Commercial interests and filthy lucre seem to rule the entire scenario. The market will not solve this challenge. What we need are exceptional measures and incomparable leadership from the statesmen and stateswomen of the world to solve this problem. It is time to call a spade, just that – a spade.
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There’s an ill more dangerous and pervasive than the Coronavirus that’s currently sweeping Sri Lanka. That is the fear to express one’s convictions. Across the public sector of the country in particular many persons holding high office are stringently regulating and controlling the voices of their consciences and this bodes ill for all and the country.
The corrupting impact of fear was discussed in this column a couple of weeks ago when dealing with the military coup in Myanmar. It stands to the enduring credit of ousted Myanmarese Head of Government Aung San Suu Kyi that she, perhaps for the first time in the history of modern political thought, singled out fear, and not power, as the principal cause of corruption within the individual; powerful or otherwise.
To be sure, power corrupts but the corrupting impact of fear is graver and more devastating. For instance, the fear in a person holding ministerial office or in a senior public sector official, that he would lose position and power as a result of speaking out his convictions and sincere beliefs on matters of the first importance, would lead to a country’s ills going unaddressed and uncorrected.
Besides, the individual concerned would be devaluing himself in the eyes of all irrevocably and revealing himself to be a person who would be willing to compromise his moral integrity for petty worldly gain or a ‘mess of pottage’. This happens all the while in Lankan public life. Some of those who have wielded and are wielding immense power in Sri Lanka leave very much to be desired from these standards.
It could be said that fear has prevented Sri Lanka from growing in every vital respect over the decades and has earned for itself the notoriety of being a directionless country.
All these ills and more are contained in the current controversy in Sri Lanka over the disposal of the bodies of Covid victims, for example. The Sri Lankan polity has no choice but to abide by scientific advice on this question. Since authorities of the standing of even the WHO have declared that the burial of the bodies of those dying of Covid could not prove to be injurious to the wider public, the Sri Lankan health authorities could go ahead and sanction the burying of the bodies concerned. What’s preventing the local authorities from taking this course since they claim to be on the side of science? Who or what are they fearing? This is the issue that’s crying out to be probed and answered.
Considering the need for absolute truthfulness and honesty on the part of all relevant persons and quarters in matters such as these, the latter have no choice but to resign from their positions if they are prevented from following the dictates of their consciences. If they are firmly convinced that burials could bring no harm, they are obliged to take up the position that burials should be allowed.
If any ‘higher authority’ is preventing them from allowing burials, our ministers and officials are conscience-bound to renounce their positions in protest, rather than behave compromisingly and engage in ‘double think’ and ‘double talk’. By adopting the latter course they are helping none but keeping the country in a state of chronic uncertainty, which is a handy recipe for social instabiliy and division.
In the Sri Lankan context, the failure on the part of the quarters that matter to follow scientific advice on the burials question could result in the aggravation of Islamophobia, or hatred of the practitioners of Islam, in the country. Sri Lanka could do without this latter phobia and hatred on account of its implications for national stability and development. The 30 year war against separatist forces was all about the prevention by military means of ‘nation-breaking’. The disastrous results for Sri Lanka from this war are continuing to weigh it down and are part of the international offensive against Sri Lanka in the UNHCR.
However, Islamophobia is an almost world wide phenomenon. It was greatly strengthened during Donald Trump’s presidential tenure in the US. While in office Trump resorted to the divisive ruling strategy of quite a few populist authoritarian rulers of the South. Essentially, the manoeuvre is to divide and rule by pandering to the racial prejudices of majority communities.
It has happened continually in Sri Lanka. In the initial post-independence years and for several decades after, it was a case of some populist politicians of the South whipping-up anti-Tamil sentiments. Some Tamil politicians did likewise in respect of the majority community. No doubt, both such quarters have done Sri Lanka immeasurable harm. By failing to follow scientific advice on the burial question and by not doing what is right, Sri Lanka’s current authorities are opening themselves to the charge that they are pandering to religious extremists among the majority community.
The murderous, destructive course of action adopted by some extremist sections among Muslim communities world wide, including of course Sri Lanka, has not earned the condemnation it deserves from moderate Muslims who make-up the preponderant majority in the Muslim community. It is up to moderate opinion in the latter collectivity to come out more strongly and persuasively against religious extremists in their midst. It will prove to have a cementing and unifying impact among communities.
It is not sufficiently appreciated by governments in the global South in particular that by voicing for religious and racial unity and by working consistently towards it, they would be strengthening democratic development, which is an essential condition for a country’s growth in all senses.
A ‘divided house’ is doomed to fall; this is the lesson of history. ‘National security’ cannot be had without human security and peaceful living among communities is central to the latter. There cannot be any ‘double talk’ or ‘politically correct’ opinions on this question. Truth and falsehood are the only valid categories of thought and speech.
Those in authority everywhere claiming to be democratic need to adopt a scientific outlook on this issue as well. Studies conducted on plural societies in South Asia, for example, reveal that the promotion of friendly, cordial ties among communities invariably brings about healing among estranged groups and produces social peace. This is the truth that is waiting to be acted upon.
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By Sanjeewa Jayaweera
It was on 3rd January 1972 that our family arrived in Karachi from Moscow. Our departure from Moscow had been delayed for a few weeks due to the military confrontation between Pakistan and India. It ended on 16th December 1971. After that, international flights were not permitted for some time.
The contrast between Moscow and Karachi was unbelievable. First and foremost, Moscow’s temperature was near minus 40 degrees centigrade, while in Karachi, it was sunny and a warm 28 degrees centigrade. However, what struck us most was the extreme warmth with which the airport authorities greeted our family. As my father was a diplomat, we were quickly ushered to the airport’s VIP Lounge. We were in transit on our way to Rawalpindi, the airport serving the capital of Islamabad.
We quickly realized that the word “we are from Sri Lanka” opened all doors just as saying “open sesame” gained entry to Aladdin’s cave! The broad smile, extreme courtesy, and genuine warmth we received from the Pakistani people were unbelievable.
This was all to do with Mrs Sirima Bandaranaike’s decision to allow Pakistani aircraft to land in Colombo to refuel on the way to Dhaka in East Pakistan during the military confrontation between Pakistan and India. It was a brave decision by Mrs Bandaranaike (Mrs B), and the successive governments and Sri Lanka people are still enjoying the fruits of it. Pakistan has been a steadfast and loyal supporter of our country. They have come to our assistance time and again in times of great need when many have turned their back on us. They have indeed been an “all-weather” friend of our country.
Getting back to 1972, I was an early beneficiary of Pakistani people’s love for Sri Lankans. I failed the entrance exam to gain entry to the only English medium school in Islamabad! However, when I met the Principal, along with my father, he said, “Sanjeewa, although you failed the entrance exam, I will this time make an exception as Sri Lankans are our dear friends.” After that, the joke around the family dinner table was that I owed my education in Pakistan to Mrs B!
At school, my brother and I were extended a warm welcome and always greeted “our good friends from Sri Lanka.” I felt when playing cricket for our college; our runs were cheered more loudly than of others.
One particular incident that I remember well was when the Embassy received a telex from the Foreign inistry. It requested that our High Commissioner seek an immediate meeting with the Prime Minister of Pakistan, Mr Zulifikar Ali Bhutto (ZB), and convey a message from Mrs B. The message requested that an urgent shipment of rice be dispatched to Sri Lanka as there would be an imminent rice shortage. As the Ambassador was not in the station, the responsibility devolved on my father.
It usually takes about a week or more to get an audience with the Prime Minister (PM) of a foreign country due to their busy schedule. However, given the urgency, my father spoke to the Foreign Ministry’s Permanent Sectary, who fortunately was our neighbour and sought an urgent appointment. My father received a call from the PM’s secretary around 10 P.M asking him to come over to the PM’s residence. My father met ZB around midnight. ZB was about to retire to bed and, as such, was in his pyjamas and gown enjoying a cigar! He had greeted my father and had asked, “Mr Jayaweera, what can we do for great friend Madam Bandaranaike?. My father conveyed the message from Colombo and quietly mentioned that there would be riots in the country if there is no rice!
ZB had immediately got the Food Commissioner of Pakistan on the line and said, “I want a shipload of rice to be in Colombo within the next 72 hours!” The Food Commissioner reverted within a few minutes, saying that nothing was available and the last export shipment had left the port only a few hours ago to another country. ZB had instructed to turn the ship around and send it to Colombo. This despite protests from the Food Commissioner about terms and conditions of the Letter of Credit prohibiting non-delivery. Sri Lanka got its delivery of rice!
The next was the visit of Mrs B to Pakistan. On arrival in Rawalpindi airport, she was given a hero’s welcome, which Pakistan had previously only offered to President Gaddafi of Libya, who financially backed Pakistan with his oil money. That day, I missed school and accompanied my parents to the airport. On our way, we witnessed thousands of people had gathered by the roadside to welcome Mrs B.
When we walked to the airport’s tarmac, thousands of people were standing in temporary stands waving Sri Lanka and Pakistan flags and chanting “Sri Lanka Pakistan Zindabad.” The noise emanating from the crowd was as loud and passionate as the cheering that the Pakistani cricket team received during a test match. It was electric!
I believe she was only the second head of state given the privilege of addressing both assemblies of Parliament. The other being Gaddafi. There was genuine affection from Mrs B amongst the people of Pakistan.
I always remember the indefatigable efforts of Mr Abdul Haffez Kardar, a cabinet minister and the President of the Pakistan Cricket Board. From around 1973 onwards, he passionately championed Sri Lanka’s cause to be admitted as a full member of the International Cricket Council (ICC) and granted test status. Every year, he would propose at the ICC’s annual meeting, but England and Australia’s veto kept us out until 1981.
I always felt that our Cricket Board made a mistake by not inviting Pakistan to play our inaugural test match. We should have appreciated Mr Kardar and Pakistan’s efforts. In 1974 the Pakistan board invited our team for a tour involving three test matches and a few first-class games. Most of those who played in our first test match was part of that tour, and no doubt gained significant exposure playing against a highly talented Pakistani team.
Several Pakistani greats were part of the Pakistan and India team that played a match soon after the Central Bank bomb in Colombo to prove that it was safe to play cricket in Colombo. It was a magnificent gesture by both Pakistan and India. Our greatest cricket triumph was in Pakistan when we won the World Cup in 1996. I am sure the players and those who watched the match on TV will remember the passionate support our team received that night from the Pakistani crowd. It was like playing at home!
I also recall reading about how the Pakistani government air freighted several Multi Barrell artillery guns and ammunition to Sri Lanka when the A rmy camp in Jaffna was under severe threat from the LTTE. This was even more important than the shipload of rice that ZB sent. This was crucial as most other countries refused to sell arms to our country during the war.
Time and again, Pakistan has steadfastly supported our country’s cause at the UNHCR. No doubt this year, too, their diplomats will work tirelessly to assist our country.
We extend a warm welcome to Mr Imran Khan, the Prime Minister of Pakistan. He is a truly inspirational individual who was undoubtedly an excellent cricketer. Since retirement from cricket, he has decided to get involved in politics, and after several years of patiently building up his support base, he won the last parliamentary elections. I hope that just as much as he galvanized Sri Lankan cricketers, his political journey would act as a catalyst for people like Kumar Sangakkara and Mahela Jayawardene to get involved in politics. Cricket has been called a “gentleman’s game.” Whilst politics is far from it!.
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Believe me, seeing certain videos, on social media, depicting action, on the dance floor, at some of these entertainment venues, got me wondering whether this Coronavirus pandemic is REAL!
To those having a good time, at these particular venues, and, I guess, the management, as well, what the world is experiencing now doesn’t seem to be their concerned.
Obviously, such irresponsible behaviour could create more problems for those who are battling to halt the spread of Covid-19, and the new viriant of Covid, in our part of the world.
The videos, on display, on social media, show certain venues, packed to capacity – with hardly anyone wearing a mask, and social distancing…only a dream..
How can one think of social distancing while gyrating, on a dance floor, that is over crowded!
If this trend continues, it wouldn’t be a surprise if Coronavirus makes its presence felt…at such venues.
And, then, what happens to the entertainment scene, and those involved in this field, especially the musicians? No work, whatsoever!
Lots of countries have closed nightclubs, and venues, where people gather, in order to curtail the spread of this deadly virus that has already claimed the lives of thousands.
Thailand did it and the country is still having lots of restrictions, where entertainment is concerned, and that is probably the reason why Thailand has been able to control the spread of the Coronavirus.
With a population of over 69 million, they have had (so far), a little over 25,000 cases, and 83 deaths, while we, with a population of around 21 million, have over 80,000 cases, and more than 450 deaths.
I’m not saying we should do away with entertainment – totally – but we need to follow a format, connected with the ‘new normal,’ where masks and social distancing are mandatory requirements at these venues. And, dancing, I believe, should be banned, at least temporarily, as one can’t maintain the required social distance, while on the dance floor, especially after drinks.
Police spokesman DIG Ajith Rohana keeps emphasising, on TV, radio, and in the newspapers, the need to adhere to the health regulations, now in force, and that those who fail to do so would be penalised.
He has also stated that plainclothes officers would move around to apprehend such offenders.
Perhaps, he should instruct his officers to pay surprise visits to some of these entertainment venues.
He would certainly have more than a bus load of offenders to be whisked off for PCR/Rapid Antigen tests!
I need to quote what Dr. H.T. Wickremasinghe said in his article, published in The Island of Tuesday, February 16th, 2021:
“…let me conclude, while emphasising the need to continue our general public health measures, such as wearing masks, social distancing, and avoiding crowded gatherings, to reduce the risk of contact with an infected person.
“There is no science to beat common sense.”
But…do some of our folks have this thing called COMMON SENSE!
