#BTColumn – Barbados and vaccines (Part 2)

Disclaimer: The views and opinions expressed by this author are their own and do not represent the official position of the Barbados TODAY Inc.

by Dr. Colin V. Alert

To date the Ministry of Health and Wellness have made two anti-covid vaccines – the Oxford Astra Zeneca and the Sinopharm –available to citizens and residents of Barbados.  

These vaccines, as well as other mitigation measures like hand sanitising, social distancing and mask-wearing, have resulted to date in Barbados having, compared to our Caribbean neighbours, a relatively low number of deaths from Covid. It is believed that, if the percentage of the population fully vaccinated could be increased, and other mitigation measures are maintained, then we can get back to the good old pre-covid days.

Once vaccinated, protection against hospitalization and death in at-risk groups, such as the large number of patients we have with NCDs, is expected to be greater than protection against symptomatic disease.

While this observation initially became apparent when the alpha (UK) variant was the main strain in circulation, experts are increasingly confident that existing vaccines still work well against the delta (Indian) variant, which is behind most infections occurring now.

Oxford Astra Zeneca vaccine.

The Oxford-AstraZeneca vaccine uses a harmless virus altered to look a lot more like the original covid-19 virus, and stimulate a recipient to produce immunity. The Oxford Astra Zaneca vaccine has an efficacy of 63 per cent against symptomatic SARS-CoV-2 infection after 1 dose, and this rises to 94 per cent after two doses, at least against the alpha variant. Longer dose intervals within the 8 to 12 weeks range may be associated with greater vaccine efficacy. For Barbados, the source of this vaccine was the Serum Institute of India.

Sinopharm vaccine.

The other vaccine made available to Barbadians is the Sinopharm vaccine, coming out of China. The WHO, in May 2021, declared that the Sinopharm vaccine was safe and effective.

The two-dose vaccine, which is based on inactivated virus is one of the most widely used COVID-19 shots in China, and Sinopharm has agreed to provide up to
170 million doses of the shot to COVAX, a global program to provide vaccines mainly
for poor countries.

Because the initial cases of the covid infections were reported from Wuhan China in late 2019, the narrative that China was responsible, either directly or accidentally, of releasing this virus lead to skepticism about this “China” vaccine. [The current state of world politics also is making many people wary of vaccines that come out of Russia
and Cuba].

If one accepts that the scientists at WHO are not influenced by international politics, then one can decide to accept, or reject, WHO’s stamp of approval of any vaccine.

In clinical trials across the world, Sinopharm’s inactivated virus vaccines have been shown to be 50 per cent  to 79 per cent effective in preventing symptomatic Covid infection. The WHO recommends the Sinopharm vaccine for people aged 18 years and older, with a gap of 3 to 4 weeks between the two doses.

The global health agency estimates overall vaccine efficacy to be about 78 per cent, although it notes that less trial data is available for adults over the age of 60 years. This means that the Sinopharm vaccine is not as potent as the Oxford Astra Zaneca vaccine, but both vaccines are saving lives around the world.

• This means that, for either of these vaccines, there will be a few individuals who get both shots, and will be considered to be fully immunised, but in fact will not be immunised against the original covid strain.

• These individuals may subsequently become infected with covid, even though they are ‘fully immunised’. They can then spread covid to other persons.

• Because of the emergence of variant strains, it is possible that someone who is genuinely “fully immunised” after getting both shots may still become infected by a variant strain, e.g. the delta strain. An individual who falls in this category may not feel ill or need to be hospitalised, but may still be able to spread the virus to other persons.

• Current vaccines may not offer us any protection against future variant strains.

The most common side effects of either vaccines are:

• Headaches

• Fatigue

• Pain, redness or swelling on your arm (where you got the shot)

• Tiredness

• Muscle pain

• Joint pain

• Chills

• Fever

• Nausea

• Swollen lymph nodes on the side you got vaccinated

These possible side effects usually happen within three days of getting the vaccine and should only last a few days. The COVID-19 subcommittee of the World Health Organisation’s (WHO) Global Advisory Committee on Vaccine Safety (GACVS) has reviewed reports of rare cases of severe blood clots following vaccination (now known as “Thrombosis with Thrombocytopenia Syndrome” or “TTS”) after getting the AstraZeneca COVID-19 vaccine.

In their statement on April 16, 2021, the WHO stated: based on latest available data, the risk of TTS with the Oxford AstraZeneca vaccines appears to be very low. Data from the UK suggest the risk is approximately 1 case per 250 000 persons who receive the vaccine, while the rate is estimated to be approximately 1 per 100 000 in the European Union (EU).

Experts stress the benefits of vaccination outweigh the risks for the vast majority
of people, but is more finely balanced for younger adults.

Other Covid vaccines not currently available in Barvados.

Both the Pfizer-BioNTech and Moderna COVID-19 vaccines are messenger RNA (mRNA) vaccines and are the main vaccines used in the USA. An mRNA vaccine is
a new type of vaccine that protects against infectious diseases.

mRNA vaccines teach our cells how to make a protein – or a piece of a protein – that triggers an immune response (antibodies) in our bodies. These antibodies then protect us from future infections. These vaccines need to be stored in very cold fridges, unlike the Oxford Astra Zaneca which can be stored in a regular fridge.

Johnson & Johnson’s (J&J) COVID-19 vaccine was developed using viral vector technology. The vaccine uses a harmless version of a different virus (adenovirus) that has been combined with the coronavirus
spike protein gene. When you get the J&J COVID-19 vaccine, the modified adenovirus virus enters your cell and shares instructions with it on how to create a harmless piece of the
“spike protein.” Your cell then creates and displays the spike protein on its surface.

Your immune system sees that the spike protein doesn’t belong there and this causes your body to start building an immune response and making antibodies to fight off what it thinks is a COVID-19 infection.

It is these antibodies that protect you the next time you come in contact with the virus that causes COVID-19.

Barbados today

Covid continues to dominate life in Barbados, as it does in the rest of the world. Our health resources, both personnel and material resources, were both under severe pressure long before covid came to town.

We have attempted to top up those resources by recruiting medical staff from Cuba and Ghana: before covid we even recruited medical staff from China.

In spite of this, regular staff have been recruited to perform covid-related activities like testing, contact tracing and giving out immunisations, at the expense of regular activities like polyclinic visits, some hospital in-patient and out-patient activities.

Covid has even caused us to renovate old buildings, and to recruit schools and hotel rooms for isolation and quarantine purposes, so that more space is dedicated to medical care.

A combination of mitigation measures, including border screening, personal behaviours like mask-wearing, hand sanitising and social distancing, must be maintained if we hope to keep this country “beyond your imagination”.  A fully vaccinated population is an important part of this.

Dr. Colin V. Alert, MB BS, DM. is a family physician and associate UWI family medicine lecturer.