Alternative Approaches - Part 2 The Vaccine Approach

Updated: May 3

From today [April 12 2021] we have marginally reduced Level 5 restrictions. The good news is one can meet up with another household outdoors, enjoy takeaway pints and travel within our county or 20KM from home if crossing county boundaries.

The removal of the 5KM restriction is great for Dublin, surrounding satellites and other city dwellers, but only marginally benefits rural communities, particularly those in counties with little to no amenities.

So is this the beginning of the end for lockdowns or just respite only to tighten up our 'house arrest' again when figures on a page start to rise?

Call it what you want, we are living under a form of house arrest and have done so for over twelve months with occasional easing like today, last Christmas and end of summer 2020. Today's new terms for 'house arrest' have been cleverly crafted to begin on a Monday, after Easter and with no major upcoming events. This means people don’t have the same distractions that were the catalyst to the surge in activity that impacted case numbers and hospitalizations at Christmas. But I'm sure the powers that be are watching things very carefully and Nphed are already warning about risks for a fourth wave if we ease restrictions too quickly.

In part one of "Alternative Approaches" I gave my opinion on managing international travel. Much like international travel, a big focus (if not the entire focus) centres around the vaccine. In Part two I want to focus specifically on a vaccine strategy. We know that once everyone is vaccinated the need for house arrests (Sorry… Lockdowns) and other draconian restrictions should be significantly reduced. However, three challenges will influence the vaccine strategy.

1. Variants and virus mutations

2. Longevity of vaccines effectiveness

3. Access to vaccinations

All three are serious threats to future lockdowns. The Access to vaccinations challenge is more immediate and likely risks lockdowns for the remainder of 2021. But as more and more receive the jab, the longevity of the vaccine and potential variants become the bigger problem.

Focusing first on Longevity; How long will the vaccine's effectiveness remain?

A year, 6 months… We still don’t know! Pfizer made a press release on April 1st that indicated six months. The same was concluded for Modernas' in a study reported by NBC Chicago. I'm no biomedicine expert by any means but one would assume a vaccine that’s less than a year old has a lot of research remaining to conclude long-term effectiveness.

There seems to be a growing conversation around booster shots too. Pfizer has begun research into the idea and a lot of talk seem to suggest COVID-19 potently evolving into an endemic meaning like the flu, its hear to stay, liveable, with flareups from variants every now and again. Nature.com surveyed 100 virologist, Immunologists and researchers of infectious diseases who 89% concluded an endemic with 62% of them believing elimination is either unlikely or lacks the evidence to support a likelihood of elimination.

Intelligencer reports that Dr Peter Gulick of Michigan State University who is an expert in Infectious diseases believes in testing/monitoring people’s antibodies levels for decline and provide such a booster shot if required. Then there is T-Cell theory, discussed by The Atlantic which places T-Cell and B-Cell memory as an area of interest ahead of antibodies. This is based on similarity's in Yellow Fever treatment offering life long protection or 2003 SARS treatment, lasting 17 years. But within that same article, another expert quashes the theory.

What we can conclude is the vaccine still holds a lot of unknowns.

Variants are another cause for concern because the question over whether vaccines are effective or partially effective on all variants including new ones isn’t clear, although a general consensus is leaning towards confidence that they will protect. Both the CDC and The WHO expect some level of protection against new variants because they “elicit a broad immune response” and the vaccines should not be ineffective. The WHO also states that where a variant does impact effectiveness vaccine composition will be readapted. The J&J vaccine trials for example were conducted in South Africa and Brazil when two of the new variants were prevalent so they are already experimented with the new variant and not the original, while BBC reports the AstraZeneca vaccine shows promise to protect against the UK just as well as the original.

So let's stay positive and assume vaccines can protect at least some level on all variants or be readapted to handle any new variants if/when they evolve. But let's continue to watch this space none the less.

So what do we know?

We'll the general consensus is, we need to get everyone fully vaccinated. This reduces the overall risks of serious infection, hospitalisation and death for the immediate term. But this returns us back to Access. The vaccine strategy only works if the majority have the jab. We are currently nowhere near this. Supply is the most obvious problem area, exacerbated by the 'YoYo chronicle' that is AstraZeneca blood clotting.

So our supply is limited…The most obvious is stretching out the second jab's due date. If we had a hunger for greater risk but within reasonable parameters, we could push out the second vaccine, perhaps even indefinitely? In a CDC report published at the start of April, they suggest that both Pfizer and Moderna were 80% effective with jab one, only increasing to 90% with the second jab.

However, that second jab does give a higher level of protection and according to Dr Anthony Fauci (Chief medical officer to POTUS), only 'tenuous' protection is offered from the first shot. But if the second shot isn’t 100% effective anyway then in an environment of slow rollout, short supply and a potential requirement for booster shots in the near future anyway then perhaps getting everyone a single shot first might be a better priority and as effective as rolling out second jabs head of those yet to receive a jab at all.

One study published in March suggested that those who already contracted COVID-19 had "higher antibody titer responses to a single dose of mRNA vaccine than those who were not previously infected." Speaking frankly this means those who had the virus (including Asymptomatic cases) may only need one shot. Therefore those who had or suspect they had COVID could test for antibodies and subsequently receive only one shot? The HSE advise those who have COVID not to get the vaccine but to "wait until it has been 4 weeks since you first tested positive". With close to 241K cases reported In Ireland that is 241K vaccines potentially saved having to be rolled out.

The UK has taken this approach and has delayed the rollout of vaccines by up to 12 weeks. Although AstraZeneca recommends 12 weeks between its does, Pfizer and Moderna both recommend 3 weeks. The risk that the UK has taken is that the clinical trials were not conducted that way by manufacturers and this outcome isn’t clear whether it will work. So far UK's rollout has been significantly better than the EU. With 47% of the population having received its first jab. The Eu and Ireland, for example, are both around 15%. We will have to wait and see if the UK's risk pays off.

It has been made clear that COVID Passports (Or Certs, Credits or Bonus or something like that) is not a question of "if"… but of “when" and when they arrive many of us will be left as second class citizens restricted from freedoms simply because Government didn’t roll out fast enough. The WHO in a statement on their website criticised the EU roll-out of vaccines calling it “unacceptably slow”

The WHO has clearly stated Lockdowns should not be utilised in the long term due to the societal and economical carnage that comes with closing up a country. Therefore as we unlock in Ireland, the objective should be not to return to the same level of lockdown again. If vaccines supply can’t be increased and rolled out faster then we need a Plan C. We need to start thinking about the mass on-demand antigen testing that allows non vaccinated people to regulatory test themselves and once they remain negative can enjoy the same level of freedom enjoyed by those who have been vaccinated.

I for one don’t necessarily enjoy the idea of having to regularly test myself in order to have freedom… however if it was a choice between regularly testing until vaccinated versus restriction in freedoms until vaccinated… I most certainly would choose the former, once regular testing was free, on-demand and unlimited (Or limited to a reasonable number such as two tests a week whose results last 72 hours) but we’ll explore this more in Part 3.