OP-ED

The Covid-19 vaccine and the danger of creating false expectations

By Barry Schoub 3 January 2021
Caption
South African Health Products Regulatory Authority (SAHPRA) are ready to commence reviewing applications from Covid-19 vaccine candidates.(Photo: biopharma-reporter.com/Wikipedia)

The availability of a Covid-19 vaccine will not be a magic wand and any suggestion that it may be is dangerously threatening the public motivation to continue with the non-pharmaceutical interventions.

There is a growing groundswell of impatience, and sometimes even a demanding anger, resulting from the delay in having Covid-19 vaccines in the country. ‘Why is it taking so long to get the vaccine into the country?’ ‘Has the government dropped the ball?’ 

Undoubtedly the issue is becoming more and more emotional and a hot political weapon. Activist groups, such as the C19 People’s Initiative, have also sprung into action, alluding to the laudable and effective HIV treatment campaign. However, while the intent is commendable, it must be balanced against raising false expectations which could imperil the crucial non-vaccine Covid infection prevention precautions which will still be critically needed for some time to come. 

Let me say at the outset, that I have spent some four decades of my professional life fighting, supporting and advocating for vaccines which, together with the provision of clean water, are the most effective modalities for protecting against disease and maintaining health. However, Covid-19 vaccines are not measles vaccines and the strategies for their control are not the same.

Other than a handful of anti-vaxers, and maybe a few more nervous vaccine-hesitant folk, we all want this vaccine, and we all urgently want it as soon as possible, none more than our heroic frontline healthcare workers. The delay has simply come about as a result of the grotesque selfishness of high-income countries. 

Comprising some 13% of the world’s population, they have jumped in, even before the results of clinical trials to assess the efficacy and safety were known, and bought up 51% of the global production of vaccines – in some cases enough for 3 to 5 times their entire populations’ needs. This was done so that at least some of their vaccine purchases would be effective and safe.

However, middle-income countries, like South Africa, would be roundly condemned should they have considered gambling with their much more limited taxpayers’ money for vaccines still undergoing investigative trials, when it was unknown whether they would be safe and effective. 

The decision was then taken to secure a guaranteed tranche of vaccine for 10% of the population through the pooled procurement facility of COVAX. COVAX would be purchasing vaccine on behalf of some 189 countries to aim for equitable distribution of available vaccines globally. 

Word from COVAX is that the expectation for delivery of this allocation of vaccines to South Africa (one of the first countries in line) would be the second quarter of this year. Importantly, however, over and above this, the government and the business sector are in negotiations with vaccine manufacturers to secure supplies of vaccine as soon as possible, and also for the remainder of the population. For obvious reasons these negotiations are, at this stage, sensitive and confidential – no one with genuine interests for us speedily acquiring vaccines would now wish to jeopardise these negotiations.

The impatience, the anxiety and the dissatisfaction are understandable. The Covid-19 pandemic of 2020 has taken a tremendous toll of illness, loss of life and loss of livelihood. There has also been a very significant intrusion into people’s quality of life. Not unexpectedly, people are tired of these encumbrances, irritations and invasions into their daily living. ‘If only we had a vaccine this would all go away’; ‘If only the government had not been so inept, we would not have to continue with these restrictions’.

Regrettably, the reality is that the vaccine will not be a magic wand and any suggestion that it may be, is dangerously threatening the public motivation to continue with the non-pharmaceutical interventions, which are so critical for the control of the epidemic. 

The vaccine grab by the wealthy nations has not only harmed the middle- and lower-income world (the latter depending solely on COVAX), but it is, in fact, also short-sighted. Pandemic infections can only be controlled if they are controlled globally, and that means every country, wealthy and poor. 

The delay for South Africa is, of course, deeply regrettable and unfortunate, especially for our vulnerable and indispensable healthcare workers. However, it does offer us a short breathing space, enabling us to even better assess and evaluate those vaccines being deployed in the field in the developed world. How are these completely novel vaccines faring in the field situation? How they perform in millions of recipients may not always be identical to their behaviour in the few thousands of volunteers within the structured environment of the clinical trial. (As one example, it has now been reported that severe allergic reaction, anaphylaxis, has been seen, albeit rarely, but 10 times more commonly with the Pfizer vaccine than with other vaccines, which is now necessitating a specific warning to allergy-prone individuals).

In addition, more vaccine manufacturers are now applying for licensing, thereby widening the choice for vaccines for our local conditions, rather than simply grabbing the first available licensed vaccines, as wealthy countries have done. Our vaccine selection and strategic planning could well be influenced by observations and knowledge coming from the field behaviour of these vaccines.

In conclusion, and most important of all, the public must be made aware that the Covid-19 vaccine will not be a magic bullet. Its arrival on our shores will not miraculously and immediately spell the end of the epidemic. 

The United Kingdom, one of the first countries in the world to roll out vaccines at the beginning of December, is currently experiencing a second wave considerably greater than the first wave. It is still experiencing a daily new infection rate nearly three times that of South Africa, while it is battling the disease with one of the harshest lockdowns in the world. 

Clearly, we will still have a way to go even after the commencement of vaccination. For many months after receiving the vaccine, we will still need to depend on public buy-in to the Covid-19 infection precautions. 

We cannot afford to create false hopes and false expectations which, unfortunately, vaccine activism may be in danger of doing. Vaccines will not immediately allow us all to go back to our pre-Covid lives. Sustaining human behavioural dedication to fight an unseen enemy is challenging, uncomfortable and even irritating. But it depends critically on the support of all sections of the community. It is fragile and can be easily fractured by the seduction of a magic vaccine. It is equally easy to look for a scapegoat. 

Arguably, there may well seem to be a lacuna in communicating adequate assurance to the public. But let me state that there are indeed very extensive behind-the-scenes efforts to acquire safe and effective vaccines as soon as possible, and also to develop a comprehensive vaccine strategy.

Finally, I would like to address an urgent and earnest appeal to civil society groups – please stop insinuating false hopes and expectations to the public for immediate solutions to the Covid-19 crisis. These only serve to compromise, and even jeopardise, the critical current imperative to maintain the, maybe less palatable, but critically needed, Covid-19 prevention precautions. The challenges are unique and difficult enough to sustain, and we can only succeed with the support of all leaders who influence behaviour in the country. DM

Barry Schoub is the Chair of the Ministerial Advisory Committee on Covid-19 vaccines. He is Professor Emeritus of Virology, University of the Witwatersrand and formerly the founding Director of the National Institute for Communicable Diseases. This submission is made in his personal capacity and does not necessarily reflect the views of any organisation which he is affiliated with.

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All Comments 11

  • Speculation and expectation grows when information is withheld. Transparency and accurate information from the Department of Health in terms of the vaccination is what people are asking for and not getting!
    Lockdowns, masks and hand washing have also not been magic wands – vaccination so far may be our best hope!

  • Fair enough professor – a candid and sober view that strikes a balance between reality and hope. Less admirable though is the MACs communication effort. You caution against civil society organisations creating false expectations but they have communicated quickly and it is their communication that has found a willing ear. I suggest that the sluggishness of the MAC and by extension the government in getting their communication act together is not doing you any favours.

  • A few more facts might help. Both the Pfizer and Moderna vaccines might cause cold chain logistic problems that might escalate costs but I have just learnt that the J&J one uses one of the two adenovirus vectors used in the Russian vaccine. What are the issues with Sputnik that prevent us from getting our vaccine from Russia if we are willing to have ‘confidential’ discussions with J&J, that’s what Dr Pillay just told us a few hours ago. Transparency that appeals to our emotions will engender more trust. We desperately need to get this virus off our daily lives. A sick country will not progress.

  • When 400 and more South Africans (an increasing number) die of Covid-19 each day, it is pathetic, and most reprehensible, to blame “the grotesque selfishness of high-income countries” for the incompetence and corrupt selfishness of so many in our “government” for not having even started Covid-19 vaccination in South Africa.

    Developing vaccines at the speed needed to avert a much larger catastrophe requires huge resources, and without the investments of those countries, there would be no Covid-19 vaccines as yet. And countries such as India, with a much lower per capita GDP than South Africa, are already vaccinating against Covid. By the first of January, Israel had ALREADY vaccinated a million people (11.6% of its total population), and will have near 100% vaccinated in March.

  • So, the vaccine is not a magic bullet. How about the vaccines for polio, smallpox, measles and a host of other diseases, also not magic bullets? As for your claim that the UK had the first vaccine approved in December, but is now experiencing a second wave, well, that’s totally disingenuous because there has not been enough time to distribute the vaccines amongst a sizeable portion of the population. This article, other than being an obsequious pandering to an incompetent government, is also grist to the mill to the moronic few who call themselves anti-vaxxers.

  • I do not doubt that those countries who bought more vaccines than needed will promptly make their surplus available to low-income countries who need them. Note that South Africa is not a low-income country, even though its vaccination lags that of actual ones like India.

  • The delay has simply come about as a result of the grotesque selfishness of high-income countries.
    Not our fault then !
    Someone else must be to blame .
    Can hardly be critical of your employers lack of action !

  • Thanks Mr. Schoub, ( I omit your title assuming you prefer your advice to stand unaided) I have a few questions; in that untested for asymptomatic and mild symptom contagion is assumed to be widespread, certainly in South Africa, why is so little credence given to immunity acquired through natural infection? In that the principle of vaccination is to stimulate an immune response in a person, why would immunity from a vaccine be any more effective for those who already have antigens? While there are a variety of vaccines in various phases of completion, what legal liability do their manufacturers carry locally for any inadvertent damage their products may cause? And will the said vaccines be effective to counter evolving strains of the virus or will the world be held hostage to vaccination from endless mutations of the same?

    • Natural infection has not been given much credence, I guess, because we don’t know yet whether it provides superior immunity compared to that provided by the new vaccines. Tetanus and the human papilloma virus for example provide inferior immunity after a natural infection when compared to the vaccines, but then ,again ,the immune system is very complex, probably the most complex outside a human brain.

      • Thanks Tods. Whatever complexities one may attribute to the human immune system it’s efficient operation is dependent on good physical and mental health, the conditions for which have been dangerously eroded by the current universal response to Covid. That the official figures of contagion and thus morbidity and mortality are as tested for, suggests the actual recovery rate from Covid is far higher than official figures indicate. I guess, we don’t know and maybe, pretty much sums up the justification for rolling draconian lock-downs, which have anyway been shown to be ineffective in controlling infection in the medium to long term. A pity we have no vaccine for the hunger, poverty, deaths from other dread diseases, suicides and overall devastation the response to Covid has caused. Oh, lets not forget the complete suspension of human rights.

  • Watching the presentation aired on tv yesterday, and reading various peoples views in this and other publications I’d say your cred has taken a knock Schroud!

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