CHAPTER 9: VACCINATIONS – A SILVER BULLET?

Vaccinations are nothing new. Edward Jenner (1749-1823) is recognised as being the founder of vaccinology, and he is credited with creating the smallpox vaccine in 1798.

Winding forward 200 years or so, 8 December 2020 was a ‘Red Letter’ day – a day of special significance – for all of humanity. The first approved COVID vaccination was administered outside of a controlled trial, heralding the start of the UK’s COVID vaccine roll-out programme. Other countries were swift to follow. But this does not present us with a panacea or licence to revert to pre-COVID practices either in our personal or professional lives. Indeed, the virus continues to spread, and new variants have been detected, too. However, while the arrival of the vaccine is certainly a massive step in the right direction, for the time being social distancing, wearing a face mask and regular hand washing should continue.

With a number of different vaccines now approved, it was the Pfizer-BioNTech COVID-19 vaccine that was first to receive approval in the UK. The Oxford/AstraZeneca and Moderna vaccines also received approval before the month was out, with around 40 other vaccines in various stages of development around the world. Speaking at a Downing Street coronavirus briefing about the speed of vaccine development and deployment, UK Chief Scientific Advisor, Sir Patrick Vallance, said:

But the person who made history on that ‘Red Letter’ day was Margaret Keenan. She was just a few days short of her 91^st birthday, and received the first injection to be dispensed at 06:31 GMT at University Hospital Coventry. She remarked that it was the “best early birthday present”. Margaret Keenan was soon joined by health workers, care home staff, vulnerable people and many others, as the UK rolls out its vaccination programme.

Developing a vaccine inside a year is nothing short of miraculous, as it is not unusual for the process to take decades if indeed a vaccine is ever found. Around 40 years has been spent, so far unsuccessfully, in searching for a vaccine for HIV/AIDS, and yet a vaccine for COVID-19 was developed, tested and approved inside 12 months.

In the twelve months since the first vaccines were approved, many of the wealthier nations have been quick to drive their vaccination programmes forward. In fact:

• Over 58% of the world population had been vaccinated by year end 2021

• In excess of 9 billion doses have been administered

• Only 8.5% of people in low-income countries have received just a single dose with the African continent lagging noticeably behind the more affluent countries of the world (Our World Data, 2021)

So that was the good news. Now here’s the bad news!

With many nation vaccination programmes making good progress, perhaps it is an appropriate moment to borrow some famous wartime words from the late Sir Winston Churchill. Speaking after the Allied victory at the battle of El Alamein, Egypt, in 1942, he said:

And so it is with the pandemic. We should certainly take some comfort and encouragement from the positive news of vaccine development, but we also should mark well the words of warning from UK Prime Minister, Boris Johnson. While he was clearly very excited to observe the first vaccination session conducted at St Guy’s Hospital, London, he added the caveat that: “We can’t afford to relax now” (ITV, 2020). To relax would be to invite the virus to make the most of its window of opportunity before vaccinations become widely distributed throughout the global population. But exactly how long will that take?

By 8 December 2020, the vaccine roll-out programme had started in the UK. But when will it reach the rest of the world? One thing that is certain is that, initially, the supply of vaccine cannot possibly meet the initial demand. Moreover, Airfinity CEO, Rasmus Bech Hansen, told Bloomberg TV that since it needs to be stored at a temperature of -70°C, the Pfizer vaccine is not a suitable solution for much of the world (Hansen, 2020).

Meanwhile, as BBC journalist David Shukman reports, pharmaceutical companies have had to face challenges in scaling up the vaccine production. Furthermore, with global supply chains having not yet returned to their pre-pandemic capacity, some raw materials required for vaccine production may be in short supply. With the global population standing at 7.8 billion, although not everyone needs to be vaccinated, an estimated 70% would need to be in order to achieve ‘herd immunity’. This leaves the world needing roughly 5.4 billion people to be vaccinated. Manufacturers were looking to deliver 2.6 billion doses by year-end 2021, but they over-achieved by producing over 9 billion. Even so, with vaccine recipients often requiring multiple doses to maximise effectiveness, less than 60% of the global population were fully vaccinated. Consequently, a global roll-out targeting 5.4 million is unlikely to be completed until possibly well into 2023. Moreover, when the poorest nations receive the vaccines, in some cases there will be the immense logistical task of distribution (Shukman, 2020).

In some parts of the world, it may simply not be safe to initiate a vaccination programme. In recent years, health workers in Pakistan supporting polio vaccinations have been attacked and killed forcing the suspension of the programme. Similarly, the Democratic Republic of the Congo (DRC) has been the scene of several Ebola outbreaks in recent years, and health workers have been confronted by abuse and violence.

Health workers threatened to strike after two hospitals were attacked and a Cameroonian WHO epidemiologist, Dr Richard Valery Mouzoko, was gunned down in the DRC city of Butembo. Other conflict zones, such as Syria and Yemen, may also prove to be problematical for the vaccine rollout.

Like the virus, there are still things that we need to learn about the vaccines such as:

• How long will it protect us for? As with other countries, the UK started its vaccine booster programme in the autumn of 2021 with many people receiving their third dose.

• For the most vulnerable in society, will it change a potentially fatal disease into a chronic but treatable illness?

• Will we need regular vaccinations, like seasonal influenza?

• Will the vaccine still work against the new virus variants that are being detected?

• Will it prevent transmission of the virus? Although it should stop us getting sick from COVID-19, will it stop us from passing it on to other people? Like other diseases, such as typhoid, HIV, C. difficile, influenzas, cholera and tuberculosis, we know that COVID-19 can be spread by asymptomatic carriers of the virus. So, in essence, could we be creating more asymptomatic carriers with every vaccination?

With these points in mind, for the time being, we cannot afford to prematurely do away with social distancing, face masks and hand washing.

But are some countries cutting corners and taking risks with their vaccine development? China and Russia have apparently approved vaccines without waiting for their efficacy results, and experts agree that the rushed process has serious risks (Zimmer, et al., 2020). The Russian approached prompted John Moore, a virologist at Weill Cornell Medical College, to state:

During 2020, there were credible reports circulating of cyber attacks on COVID-19 vaccine research and development (R&D) organisations. A proliferation of anti-vaccine propaganda has also been witnessed. The UK’s National Cyber Security Centre (NCSC), part of GCHQ, has identified Russia as the origin of the majority of these cyber attacks. The NSCS conclusions are also supported by the Canadian Communications Security Establishment (CSE), the US Department for Homeland Security Cybersecurity Infrastructure Security Agency (CISA) and the National Security Agency (NSA) (NSCS, 2020).

In the UK, a government source said that a hacking attempt by the Russian state had been anticipated from the beginning of the pandemic, adding:

GCHQ proactively placed a protective cyber shield around the vaccine research facilities at Oxford University in the very early stages of the pandemic (Fisher, et al., 2020).

The apparent actions by the Russian hackers does beg some interesting questions:

1. Were the Russians trying to steal information to advance their own vaccine R&D?

2. Were the Russians trying to disrupt the R&D using Advanced Persistent Threat (APT) techniques?²⁸

3. Perhaps, both 1 and 2 above.

As previously mentioned in chapter 3, anti-vaccine propaganda has been rampant, and most noticeably on social media, causing untold damage to the integrity and confidence in the vaccines. In fact, fake news circulated that one of the first two volunteers in the Oxford AstraZeneca vaccine trial, Elisa Granato, had died two days after she received the injection. BBC journalist Fergus Walsh was following the progress of this vaccine trial. He spoke to Granato on a regular basis and was able to confirm that the story of her death was simply untrue (Fullfact, 2020).

When vaccines began to come online, countries were looking to sensible and well respected celebrities for support and endorsement of the vaccine products. This is by no means a new concept:

• George Washington evidently encouraged his troops to receive the variolation against smallpox during the American War of Independence. But, as one comic recently pointed out, none of these early vaccination pioneers are still alive today!

• Elvis Presley made a very public endorsement of polio vaccines in 1956, and was recorded on camera receiving the ‘Salk’ vaccination.

• In the 1980s, the children’s author, Roald Dahl, strongly promoted measles vaccination after his daughter died from the illness.

Writing in The Guardian, Denis Campbell refers to research published in The Lancet:

Certainly, in the UK, the NHS has been making plans to enlist the support of celebrities and influencers to encourage that growing band of doubters among the population to reconsider as detailed in The Lancet. In fact, on 16 December 2020, @NHSEnglandLDN was able to Tweet that actor Sir Ian McKellen (famed for playing the part of Gandalf in the Lord of the Rings film trilogy) had been vaccinated. Speaking on camera after his COVID-19 vaccination, the 81-year-old said he felt “euphoric.”(COVID-19 vaccine, 2020).

Meanwhile, setting a good example in December 2020 in the US, the President-elect, Joe Bidden, and the outgoing Vice President, Mike Pence, were also vaccinated live on camera.

I have one final thought about vaccines that I would like to share with you. Thinking back to my first trip in the 1980s to The Gambia in West Africa, on arrival I had to prove that I had had a Yellow Fever vaccination. Without a valid vaccination certificate, I would have been denied entry into the country. One Australian airline (Qantas) was quick to state that as COVID-19 vaccines began rolling out, it will only accept passengers who can prove they have been vaccinated. Other airlines and some countries have chosen to follow a similar line. It is even possible that some employers may insist on a vaccine being a pre-requisite, too. For example, this might include:

• Armed forces;

• Airlines for flight and cabin crew, in addition to passengers;

• Cruise ships for both crew and passengers. In fact, as the cruise industry started to make its first tentative steps towards reopening in 2021, several operators were insisting that passengers were fully vaccinated before boarding;

• Health services and care homes;

• Food processing plants, some of which have proved to be major concentrations of risk vis-à-vis COVID infection; and

• Austria became the first western country to announce every citizen must be vaccinated by February 2022. Others may follow.

So, should governments consider issuing some sort of universal vaccine passport?²⁹

One final observation I feel worth mentioning concerns the behaviour of the European Union and its attempt to impose vaccine export controls. Its issue was primarily with AstraZeneca and the company’s apparent failure to keep to the agreed vaccine delivery schedule. AstraZeneca has cited production problems in its Belgium and Netherlands plants as the cause of the delay. Although the EU later backtracked on a threat to restrict the flow of contracted vaccines to Northern Ireland, this was not before the WHO chief, Dr Tedros Adhanom Ghebreyesus, criticised the EU for what he called “vaccine nationalism”. He believes this could lead to a “protracted pandemic recovery”.

Speaking on BBC Radio 4 about potential confrontations between states and multinational drugs companies, Director of the Global Health Program at Georgetown University, Thomas Bollyky, said:

On the Andrew Marr show, Irish Prime Minister Michael Martin acknowledged that the EU had a genuine grievance with AstraZeneca. However, he went on to say that threatening to impose controls on vaccines crossing the Irish border crossing was not an appropriate way of resolving the issue (Martin, 2021).

We have already seen several mutations of coronavirus, although it appears the initial batch of approved vaccines can cope with the new variants. But, we need to remember that although the richer nations may be more focused on vaccinating their citizens against the virus, we overlook the developing and poorer nations at our peril. If they are left unprotected, it will provide a massive opportunity for the SARS-CoV-2 virus to continue mutating. The consequence may be to ultimately render any developed world vaccination programmes as ineffectual.

²⁸ Although not an APT, the Stuxnet worm, which was believed to have been active sometime between 2005 and 2010, was designed to disrupt the Iranian nuclear programme.

²⁹ Christmas 2020, Spain announced that it would keep a register of those citizens who refused the COVID vaccine. It has indicated that it will share this list with other European Union nations. Is this the tip of a potentially very large COVID passport iceberg?