Vaccines do not save lives…
It is said that only fear brings people together. And, when the fear is that of death, the world will surely come together. In the wake of the COVID-19 pandemic, we have seen the world unite to develop a vaccine against the disease. Everyone seems to be waiting eagerly for a vaccine that will prevent COVID-19. Even people who otherwise oppose vaccines and those who regard vaccinations as a marketing conspiracy are now pinning their hopes on various trials underway.
However, this unity has turned into a contest, which is reminiscent of the race to reach space. And this time too, Russia seems to have won with its Sputnik-V vaccine for COVID-19. The word ‘sputnik’ means ‘fellow traveller’ in Russian. The word holds a special place in Russia’s history after Sputnik became the first artificial satellite that was successfully launched into space. At the time, Sputnik was way ahead of its time just as Sputnik-V is now. It has left the world, especially Russia’s Cold War rival, the U.S. of A, in a state of shock.
While the competition to master space flight was indeed a race, the development of a vaccine should not be treated as a race or contest. Many compromises are being made in this race to develop the first vaccine for COVID-19. According to various reports, Sputnik-V has not even completed its Phase 3 trials when it was declared a success. Many countries are bound to reject it till it undergoes more rigorous tests. The UK has already said it will not use Russia’s vaccine at the moment. Safety and effectiveness are key components of a vaccine. Most vaccines that are currently being used have taken anywhere from five to 10 years of development and have undergone five phases of testing.
We seem to have forgotten an important principle of medicine. Vaccines are but one strategy to prevent to prevent a disease. We must treat the COVID-19 vaccine as one of many approaches to control the disease and make it our only strategy. There are many different measures and non-pharmacological interventions to control the spread of the virus that can be implemented immediately but remain neglected. Furthermore, in the race to find a vaccine for COVID-19, we have started ignoring all other diseases and routine vaccinations that are putting people at unnecessary risk.
Let me put this in perspective. The seriousness of a disease is calculated in terms of mortality or death that it causes. I pulled up statistical data from the websites of World Health Organization and Medscape for diseases that have a relatively high mortality rate for which vaccines are available but are not mandatory. This includes Varicella (4.2 million complications and 4,200 deaths worldwide each year), Influenza (three to four million and up to 500,000 deaths worldwide each year), Hepatitis A (7,134 deaths in 2016), Pneumonia (2.56 million deaths in 2017), Hepatitis B, which is regarded as 100 times more infective than HIV and causes around 884,000 deaths each year. A total of 570,000 women were diagnosed with cervical cancer worldwide in 2018 and it claimed the lives of 311,000 women that year. Then there are serious bacterial diseases such as meningococcal meningitis whose mortality rate can exceed 50% if left untreated. Vaccines are available for all these diseases but most people do not receive them as they are ‘optional’ in many countries including India. Most people don’t regard these vaccines as necessary as the deaths caused by them are not as ‘visible’ as COVID-19. Many vaccines currently being administered such as BCG and MMR are said to provide a degree of protection against COVID-19. Similarly, the flu vaccine Pneumococcal also seems to help prevent some complications of COVID-19.
The deaths attributed to COVID-19 are visible as we are in the midst of a pandemic. It may soon become endemic or may vanish altogether. Even now, the deaths caused by COVID-19 are less than the number of people who die in accidents, which in 2018 was estimated to be around 151,417 in India alone. There is a common misconception that COVID-19 is lethal in the absence of a vaccine. This is simply not true. So far, the highest mortality rate for the disease has remained below 3%.
Take for instance the case of the Hepatitis B vaccine, which is known to prevent certain cancers of the liver. It has now been included in the Universal Immunisation Programme and every new-born in the country is receiving this vaccine. However, most adults and elders in Leh district have not been immunised with this vaccine. I specifically mention Leh district rather than Ladakh as a whole. The reason is that Kargil recently managed to vaccinate every person in the district. The end result is that most adults in Leh district have not received the Hepatitis B vaccine despite its high prevalence in some parts of Changthang.
I am not suggesting that we should stop looking for a vaccine, stop taking COVID-19 seriously or become complacent. However, safety and effectiveness are two most important qualities of a vaccine. A vaccine cannot be produced overnight. Interestingly, I recently discovered that vaccines have also been a part of disease prevention in Sowa Rigpa. In allopathic systems, vaccines undergo five steps of development. I would argue that we should not rush the process of developing a vaccine and invest in multi-pronged approaches for disease prevention. And most importantly, we must not neglect other diseases that are still infecting people and claiming lives for which we do have vaccines and treatment protocols. Vaccines are said to be humankind’s most important invention after the wheel. However, we seem to have forgotten a very simple principle: Vaccines do not save lives, vaccinations do.
By Dr Spalchen Gonbo
Dr Spalchen Gonbo is a Paediatrician based in Leh.