Understanding covid-19 vaccines: what we need to know?

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Community Voices Zimbabwe (CVZ) reporter Perseverance Javangwe (PJ) had an indepth discussion on covid-19 vaccines with former Health Minister Dr Henry Madzorera (Dr.HM). Below is the full interview.

PJ:Welcome Dr Madzorera. Let me start by asking you on the benefits of vaccines? Why is it important for everyone to get vaccinated?

Dr.HM: Thank you. The concept of vaccines is to put a little bit of a disease in a person so that the body recognises that antigen and start making antibodies to it. Now the body has got cells that are called memory cells there may be B-Memory cells or T-Memory cells. These memory cells, now remember that antigen for a long time, so now when the real thing come, the real virus comes there is already a template for making antibodies, the soldiers that fight the anti-virus so it will take only a day or two for the body to make antibodies and start fighting the virus before it multiplies and colonises the whole body and causes disease. This is how we have conquered diseases such as small pox. Small pox is now a thing of the past, we used vaccines to eliminate it. We are nearly about to eliminate polio from Zimbabwe, we are using the polio vaccines, and you will see that there are a dozen vaccines that we are giving now in Zimbabwe for various diseases in order to train the body to fight the disease before the disease actually comes. Vaccines are extremely important, vaccines are extremely useful

PJ:Who should or should not take vaccines. Can those with allergies accept vaccines?

Dr.HM:At the moment we are vaccinating everybody, 18years and above. So these are various categories of people with different age groups from 60years and above who are a bit elderly. We are not yet vaccinating people under the age of 18 in Zimbabwe but there are other countries which have started vaccinating people from 11years to 17years and the age groups keeps going down. They are doing trials to see if these vaccines are safe in those age groups. So we will get to know as time goes on but for now we are struggling to meet the requirements of 18years and above age groups. People with diabetics, melitas, people with hypertension, people with HIV, all those people should get vaccinated, they are more at risk of covid-19 serious disease. So they should get vaccinated and really probably get priority. The only thing we encourage is make sure that your disease is under control, make sure that your HIV treatment, your immune system is okay, that means your CD4 is normal, because if your CD4 is low you may not even respond to the vaccines, your body might not respond to producing the fight that the body should produce when vaccinated. So make sure that you are relatively well before you are vaccinated even people with allergies can be vaccinated because, there is no body who is immune to covid-19. But what I encourage is if you have serious allergies get vaccinated in a situation that can take care of you if you should react in a bad way. So go to the hospital and get vaccinated there other than being vaccinated at a remote rural clinic where help might be very far away.

PJ:What’s the difference between adverse events and side effects? After taking the vaccines do people witness adverse events or side effects? What are examples of adverse events or side effects from vaccines?

Dr.HM:The term we use is adverse events following immunisation. This term is a general term that describes all bad things that happen to you following immunisation. Now those bad things may be due to the vaccine itself, in other words it might be a side effect of the vaccines or there maybe coincidental, it might be something else that happens. So that is the difference. So adverse events include true side effects that are caused by the vaccines and other adverse events that have probably nothing to do with vaccine. An example of an adverse event that has nothing to do with the vaccine Is a person might pitch up with malaria two days after vaccination but you do not know that it is malaria at the beginning because the patient has fever, rigors, headache and so forth and you investigate and see it is malaria. The malaria is an adverse event following immunisation because it has happened immediately after immunisation but it is not a side effect of the immunisation itself. It is just coincidental, you treat the malaria and you are done with it. But true side effects of the vaccines can also happen, people can develop rushes, people can develop anaphylaxes which means your whole body collapses, your blood pressure goes down. It is a true allergic reaction, those things can happen. We had about cloths forming in the West with Astra Zeneca and Johnson and Johnson, they tried to investigate these whether they were true side effects of the vaccines or were just coincidental because that disease also happens in ordinary life without any vaccination programme. But I think their final conclusion was this is not related to the vaccine let us continue with our vaccination programme. So that is the difference of adverse events following immunisation and true side effects.

PJ:After vaccines were rolled out, is there a process that is being undertaken to measure the effectiveness and safety of the vaccines in Zimbabwe?

Dr.HM:The process for monitoring side effects and for monitoring efficacy of the vaccines which means is the vaccine working, is standard procedure when you introduce new vaccine. We like to hope that the government has put in place the measures to measure efficacy and safety of the vaccination and the reports are being made to the relevant authority which is the Medicine Control Authority on side effects, adverse events following immunisation. The only borne of contention we have with the government right now is they have not published the data yet. We have vaccinated over 650 000people and we still have no data on adverse events following immunisation in Zimbabwe. And they have not yet told us anything about the efficacy of the vaccine. So we are waiting very anxiously to here from government about that.

PJ:Does taking vaccines mean an end to covid-19, and back to normal life?

Dr.HM:Yes once we vaccinate enough people to reach what we call heard immunity, we should expect that covid-19 cease to be a problem in Zimbabwe. Herd immunity, we don’t know what percentage of people must be vaccinated in order for us to reach herd immunity for covid-19. But the government is working with a figure of 60% at the moment. We will see when we get to 60% whether it will be the magic figure because it varies from virus to virus. For some viruses it must be 90% of the population vaccinated and so forth. But let us work with 60% and see what happens. Life should return to normal. Remember there are some people in the community who are so far not eligible for the vaccination that is the under 18s so the target of 60% is quite alright for now. With small pox I have already mentioned we got rid of small pox, life came back to normal, we are nearly getting rid of polio, measles is also under control, as you can see we are no longer getting more cases of measles that we used to get in the 80s. So vaccines do work and vaccines are the answer to this pandemic and vaccines should help us to return to normal within the shortest period of time.

PJ:What do we know about variants? Do these variants differ from the usual virus? Is it unusual for viruses to change? Do vaccines provide protection against these variants?

Dr.HM:Viruses are always changing their protein structures. It is a survival tactic, so they also want to survive, hence they change their proteins. The vaccines that we have are targeting the spike protein on the virus, which is that protein sticking out giving the virus the name coronavirus, so they change a few things here and there in order to escape destruction. That will always happen, we that with HIV, we see that even with bacteria they undergo mutations when you expose them to some optional concentrations of antibiotics and so forth, it is very usual for viruses to change. The vaccines that we have work very well, so far we have no proof that they do not work against certain variants, but that in on going work, we must continue to be on top of our game, so they will continue. You know with the flu virus, the seasonal flu virus every year we produce a new vaccine for the seasonal flu virus, why? Because it mutates all the time and the vaccine you got last year does not necessarily protect you from the flu strain that is circulating this year. We do not know whether it will be the case with covid-19 but we do hope that the vaccines that have already been produced will continue to protect serious diseases. In short yes the vaccines protect against the variants but we have to wait longer to see whether the vaccines that we have now will continue to protect against all variants that will come in the future. So another word on the variants it was on the news today that the world is preferring to stop stigmatising countries by saying this is South African variant, this is Indian variant, British variant. So they have tried to give them simple names like Alpha, Biter, Delta variants and so forth so that we identify these names rather than stigmatising countries.

PJ:With this pandemic the world is in this situation where new evidence comes in almost every day and we are learning new things. But at the same time we have to act in real time to protect ourselves. How in this new scenario, with the new variants, how can people protect themselves and what should be our government doing?

Dr.HM:Yes things are always changing, with this pandemic, new variants coming up, and a lot of things are changing, new treatment modalities coming up, new vaccines coming up, technology that we have not used before. Very unproven technology but very promising technology all the same. All these are things that our government should be able to adopt/ what should the government do in this situation? It is an evolving pandemic. There is no one who has got all the answers, but there are certain common sense things that we have established up to now. The first one is we should concentrate on covid-19 safe procedures, the things that we have mentioned already you know, social distancing, masking up, hand hygiene, cough educate, isolation of those who are positive for covid-19, contact tracing and community surveillance, quarantining people from outside and so forth. In this instance one thing that our government should concentrate on instead of concentrating on lock downs, mind you we believe in lock downs and we believe they help but they are not the panacea to this problem. The government should not just locking don cities willy-nilly. Lock downs should be informed by signs and lock downs should be reasonable, because we can destroy people’s lives and we can destroy the economy by doing unreasonable lock downs. In this instance I think reducing immigration from hotspot countries like in India at the moment. We should not have immigrants from India. If someone comes from India, they should be quarantined for two weeks at a designated place. This things of saying go and quarantine at home does not work because when people get home relatives are excited they come to see that person to greet them and hug them. They will not have seen each other for years so self-quarantine at home does not work. We need institutional quarantine when we are faced with such a difficult situation like the Indian outbreak. Most countries have done that and I am happy Zimbabwe has now announced that we are quarantining people from India. Those are the extra things government can do but most importantly safe procedure, within the country and just patrolling our borders and making sure that we do not get illegal immigrants.

PJ:When a country receive supplies of a vaccine, the first step is to get regulatory approval of the vaccine in the country. National regulatory officials will closely examine the clinical data and then decide whether or not to approve the vaccine. From your understanding did these vaccines been through this approval process before they were rolled out in Zimbabwe

Dr.HM:Well the truth is that we are in an emergency situation and procedures have not been followed closely and we cannot blame anyone. We cannot follow those procedures closely where a medicine takes two to three years to get registered for use in a country, we are in an emergency. So what the regulatory authority is doing at the moment is simply look at the dossiers provided by the manufacturer and so forth. The WHO (World Health Organisation) is the one which goes out to look at the actual manufacturing plant to check out the good manufacturing practices and they issue an emergency use authorisation but our own regulatory authority also issues an emergency use authorisation and they did that before the WHO did, that is okay. Why is it okay? Because all vaccines, covid-19 vaccines are under trial. There is no vaccine that has stood the taste of time, we need a few years to say this vaccine is good, it is not causing adverse events. But we cannot wait for years while people are dying in their hundreds of thousands. So this is an emergency situation where we are relying on past experience of vaccines and we do believe we have made the correct decisions to roll out these vaccines in Zimbabwe which are actually killed virus vaccines, inactivated viruses which I think are quite safe, but we will see, time will tell. You cannot be a prophet as far as this is concerned. So I think necessary procedures were followed in this emergency, it is all right as it is.

PJ:Let us talk about the storage of vaccines. From what you know how are the vaccines being stored in our country? If they are transported to rural areas for example, how are they being stored? Please kindly share with us the importance of vaccines storage, I understand they should be stored under certain temperatures, what’s the temperature range for the storage?

Dr.HM:The good thing about all the vaccines we are using is that the storage temperature required is the same as the storage temperature for all the other vaccines that we have been using in our expanded programme on immunisation. So we have the infrastructure and the hardware already to use, we have the static stations, the clinics and the hospitals where vaccines are stored between 2degrees Celsius and 8degrees Celsius and we have the cooler boxes that they used to go out on outreach missions to vaccinate. These cooler boxes will have ice packs and they will be able to keep the temperature for the vaccines between 2degrees Celsius and 8degrees Celsius and that is okay. So yes the cold chain is being maintained within the country because the vaccines that we chose are quite friendly to our situation, they do not require any extra infrastructure or hardware. So just to supplement on the importance of vaccines, the importance is that if the vaccines are not stored at the right temperature they will lose its potent, it will not work as a vaccine so you will be giving people a liquid which does not help them to prevent the disease, that is disastrous. So the equipment we are using for the covid-19 vaccine is the same equipment we use for all the other vaccines we have at 2degrees Celsius and 8degrees Celsius and we are sorted out.

PJ:From your perspective what do you think might be the cause of vaccine hesitancy by some sections in Zimbabwe? And how can we best improve people’s perceptions on the vaccines?

Dr.HM:The issue of vaccine hesitancy we just have to be fair and direct about it. The people in Zimbabwe are hesitant to take this vaccines for two reasons. Number one, they do not trust the Chinese made products. Number two they do not trust the government of Zimbabwe and their politically made decisions. People do not believe that the decision to get cinovac vaccines was scientific, they believe it was political and that is disastrous. I still talk to a lot of people who tell me that they do not trust Chinese products and they do not trust the government. They think that the government is doing it for personal gains within the hierarchy of the government and so that is a tragedy. Government must improve its image so that people can trust its decisions that is the major cause of vaccine hesitancy. The second is there is no enough information which has been disseminated, people do not know anything about these vaccines even health workers. I have tried to look for information about sinopharm vaccine and everything is written in Chinese, the package inset for the vaccine is in Chinese and I cannot read that. Government should have made efforts to give a lot of information about vaccines that has not been done. And thirdly even the health workers themselves because they do not have information. They are not able to recommend this vaccination programme to the ordinary people and if the health workers are not able to recommend to ordinary people then why should they take it, they are also suspicious. There are health workers who still have not been vaccinated and some of the will actually be going around vaccinating people when they themselves are not vaccinated. I am sure you see how serious that is, there is lack of trust.

 

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