“Light at end of tunnel”: vaccines on their way

With Christmas round the corner, Portugal appears at last to have some reason for festive cheer: health authorities have signed contracts for 22 million doses of Covid vaccines which should start arriving from January; some of those promised billions from Brussels got here on Tuesday, and daily statistics suggest the number of new infections is at last beginning to fall.

There is still a long way to go, but in the words of European Commission president Ursula Von der Leyen, “there is finally light at the end of the tunnel”.

But the minute focus turned onto vaccines, a new controversy blew up. Who will receive them first?

Expresso suggested rather unhelpfully last Friday that healthy over-75s would be ‘left to the end’.

In a slightly dubious exclusive on the national vaccination programme (which was still technically under review), the country’s best-selling weekly paper suggested DGS health chiefs were in favour of giving priority to frontline workers most exposed to the virus, followed by workers in old people’s homes, followed by over-50s with ‘risk factors’ (chronic disorders), followed by 60-64-year-olds without comorbidities (i.e. no risk factors), and finally by all the other elderly over the age of 65.

Somehow this was all presented under a headline that screamed “DGS places old people as last priority”.

As politicians – and even President Marcelo Rebelo de Sousa – rode into almost theatrical defence of ‘these forgotten elderly’, Francisco Ramos, the head of the task force only assembled last week to draw up Portugal’s priorities, did his best to rein in the mounting hysteria.

First of all, he said, there will be one million Portuguese in the first round of vaccination. That, in itself, will be a challenge.

In Ramos’ understanding, priorities will be given to:
■ all residents of old people’s homes
■ the professionals in those homes
■ healthcare professionals elsewhere
■ professionals within the nation’s security forces
■ other old people with severe illnesses

In other words, yes, ‘healthy over 75-year-olds will come further down on the list’, but it is not even certain that the vaccines will work on people this age due to the fact that their immune systems are more compromised (because of their age).

These questions should be answered shortly, added Ramos, when pharmaceutical companies deliver Phase III trial results. But they have nothing to do with health authorities ‘leaving old people to the end’.

Fact versus fiction
For now, these are the facts:

■ The vaccine will be distributed freely (people will not have to pay for it), and it will not be mandatory.
There has been talk both here and abroad of populations being ‘encouraged to take the vaccine’ via a system of ‘rewards’. This is because polls suggest huge sections of countries’ populations don’t want to take such a new vaccine. Those who don’t want it ‘may find themselves barred from a cinema/restaurant/employment even’. But none of this is confirmed, nor are politicians openly advocating it. It’s just ‘out there’ and being aired.

■ Storage facilities with advanced methods of refrigeration have already been earmarked in Portugal with Armed Forces due to be drafted in to help with distribution.

■ Health centres will be in charge of the initial roll-out, which will continue through 2021 until at least the summer, if not beyond.

■ Most of the vaccines require two doses, administered three to four weeks apart.

Portugal has ordered vaccines from BioNTech/Pfizer; AstraZeneca/Oxford; Johnson&Johnson-Janessen; Moderna; Curevac and Sanofi-GSK.

BioNTech/Pfizer and Moderna are currently pushing to be authorised for emergency use first. Both require two doses, and both have been devised from what is dubbed ‘messenger RNA (or mRNA) – genetic material that when injected gives the person’s immune system a preview of what the real virus looks like. This preview gives the immune system time to design powerful antibodies so that if/when the Covid-19 virus comes along, it is essentially neutralised. That is the idea anyway.

BioNTech/Pfizer’s vaccine needs to be stored at ultra-low temperatures, whereas Moderna claims its vaccine can be maintained at most home or medical freezer temperatures for up to six months.

Both claim their vaccines have over 90% efficacy.

Almost as soon as BioNTech/Pfizer announced their ‘groundbreaking vaccine’, so too did all the other companies.

Without further ado, countries started placing orders in their millions and ‘rejoicing’.

In UK, out of the blue on Tuesday evening, the Pfizer vaccine was suddenly green-lighted for use, ahead of authorisation for the rest of Europe/ the world.

Questions hanging
There are multiple questions hanging – hence the decision by so many countries to mount information campaigns designed to persuade people to take up the vaccines and stop listening to any ‘anti-vax’ messaging they may encounter.

If it was this simple – that governments always told the truth – we would all know exactly what to do.

But the mere fact that these vaccines ‘may not be effective in healthy over-75s’ should sound warning bells: The most vulnerable age groups for contracting Covid-19 are indeed those over the ages of 70. Get into the 80s and 90s, and the vulnerability is even more accentuated.

One only has to consult Portugal’s data to see that of the 4,577 people who have died so far (at time of writing on Wednesday morning) 4,000 were over the age of 70.

In other words, millions of euros/pounds/dollars are being ploughed into vaccines that may not actually help those who are most at risk.

Right now, in ICUs up and down the country, there are 521 seriously ill patients. Explains Público, ICUs have been occupied since the start of the pandemic “overwhelmingly by people between the ages of 55 and 79 with other pathologies”. These are not the kind of people who have taken part in vaccine trials – indeed there have been suggestions, for example in the US, that limited trials on this population should go ahead to show the vaccine is indeed safe for this group.

Dr Helen Keipp Talbot, an associate professor of medicine at Vanderbilt University Medical Center, told a meeting of the Centers for Disease Control and Prevention advisory committee on immunisation practices this week that introducing COVID-19 vaccines first to nursing home residents could erode public confidence in the safety of the vaccines.

“I think you’re going to have a very striking backlash of, ‘My grandmother got the vaccine and she passed away’. They’re not likely to be related, but that will become remembered,” she said.

And that’s before one considers that AstraZeneca, for example, has already requested – and been granted – an exemption from liability should issues with the vaccine ‘come out further down the line’.

Ruud Dobber, a member of Astra’s senior executive team told Reuters in October: “This is a unique situation where we as a company simply cannot take the risk if in … four years the vaccine is showing side effects.”

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