Corona Vaccine

[This is a translation of an article I published in Tamil on the Solvanam.com magazine. Used Google translation to get the first cut and did minor clean up. Thus, it may not be highly polished but may help get the main points across.]

It is a well-known fact that the incidence of corona is the highest in the United States among all the countries in the world. Whether it is due to the public that do not listen to reason or the government that is in disarray is a topic with enough fodder for endless debates. Globally, Covid-19 has infected 71 million people so far out of which 1.6 million people have died. The United States alone has contributed 16 million cases and 300 thousand deaths! When you consider the fact that the US population is only 5% of the world population and still there are more than 3,000 Covid related deaths occurring in this country each day these days, the seriousness of these numbers become terrifyingly apparent.

Despite the dire situation, many people, not only in the United States but also in India, have said that they will not get vaccinated for various reasons related to politics, policy, boredom, apathy and skepticism. Is such reluctance appropriate or reflects irresponsibility? There is an urgent need to analyze what kind of myths and rumors skeptics are listening to that are flowing in via the various media, including FB and  WA forwards. It goes without saying that if the concerns are appropriate, they should be addressed correctly.

There can be no doubt that the quality of our lives has improved significantly thanks to vaccinations over the past one hundred years. The progress made by the industry is one of the main reasons why we now encounter diseases such as polio and smallpox only on the history books. Most of the vaccines we know carry small amounts of dead or inactivated pathogens into the human body. They do not bring the disease into our body because the specific pathogen is killed or inactivated during the preparation of the vaccine. But the genomic signature, which is like the face of the parasite found in the vaccine, awakens our body's immune system and prepares the body to fight the disease. Because of this immune response, when we are vaccinated against the flu for example, it is natural for us to have a body ache and fever, as if we had a mild case of flu itself. Because what came in was a inactivated virus, the body returns to normalcy in a day or two without the inconvenience becoming anything bigger. But since the body has thus been trained to recognize the invading pathogen on sight, if the real pathogen ever comes in, it quickly fights back destroying it while saving us from the disease. We can see the vaccines that work in this way as law enforcement personnel who bring the "Wanted" poster of a criminal or terrorist and stick it inside us. Since what was brought in is just a poster and not the real terrorist, we just get to familiarize ourselves with the terrorist's face. The mild fever that lasts for couple of days, can be equated to the town’s people looking at the wanted poster getting excited shouting out, “Ah.. Is this the terrorist? If he ever shows up in this town, we will promptly get rid of him!” as they go through preparatory exercises to get ready for the fight.

Manufacturing and distributing vaccines of this kind around the world is tantamount to printing millions of Wanted posters of the terrorist and distributing them around the world. While this is a well-known process, it takes a lot of time to physically print and distribute millions of posters, pasting them on town squares and ensuring the localites familiarize themselves with the face and remain vigilant. For example, it is still necessary to run virus farms in chicken eggs for about six months to produce the required amount of flu vaccine each year using this biological manufacturing process. What if instead you could just send an e-mail to every town with a note on how to print the image of the terrorist and tell them to print it out locally and hang it up in the town square? This is the model followed in the new mRNA (Messenger Ribonucleic Acid) vaccine development process. Although this mRNA method was introduced ten to twenty years ago, the corona vaccine is the first attempt to implement it on a large scale.

Decades back when we were growing up, Tamil magazines that used to get delivered on a weekly cadence used to carry serials that will deliver a long story in installments spanning a whole year. There were famous artists like Jayaraj and Maniyam Selvam who will pick up the details of the story characters or scenes from the author’s descriptions and create very nice looking illustrations to go with the published stories. In an analogous scenario, instructions for how to build our body parts like an ear or a nose are delivered to our body via these mRNA instructions derived from the long strands of DNA. Our bodies, like those artists, can read these instructions and create the needed parts. Scientists explore the Covid-19 horoscope (i.e. the genome of the virus), to determine which segment should be used as its signature (i.e. mug shot in the wanted poster). They then make that sliver into something like a jpg computer file that is equivalent to mRNA instructions. Similar to emailing the jpg file to individual towns and asking them to print and hang the posters using local printing presses, these mRNA instructions are placed in the vaccine and injected into human beings. Once the mRNA instructions are in hand, just like the illustrators that create the drawings, our body will get to work to produce the virus inside our body. But since the mRNA messages do not give the details needed to fully create the virus, but only the details of the face, the construction stops with the mug shot found in the Wanted poster in place of the real-life three-dimensional virus. After a mild round of rabble rousing (i.e. light fever, body aches), the villagers get ready to chase the extremist whenever he actually shows up in the town. Like traditional vaccines, this type of vaccine is usually given twice, with an interval of a few weeks in between. This is equivalent to the sheriff deputy returning to the town a month after posting the poster in the town square to update the poster/mugshot and reminding the town folk yelling, “Don't forget this extremist. Is everyone ready?” If you don’t do that, people may become busy with their daily lives and forget the importance of fighting the terrorist altogether.

As we can easily see, there is no need to incubate the chicken eggs for six months to grow the virus in this mRNA vaccine manufacturing process. Because the vaccine we send into the body is only for the preparation of the face of the virus within our body, the chemical compounds containing those instructions can be easily and quickly produced in abundance. The problem is that these mRNA instructions remain very fragile and are very easily destroyed after being made. You can casually wrap paper posters into a bundle, carry them on the back of a bicycle and stick them anywhere with simple glue. But when you are handling computer files, you are forced show some respect. Right? Otherwise file may get corrupted making it completely useless. Similarly, these mRNA vaccines have to be kept in deep freezing temperatures as they are transported. If not, it promised to break up quickly becoming a bucket of useless water within hours.

The Covid-19 vaccine, which is now in its final stages of mass distribution getting loaded on trucks and aircrafts for transportation, has been introduced by three companies. Pfizer's version of the drug should be kept at -70 degrees Celsius and Moderna's at -20 degrees Celsius. We can say the -20 degrees Celsius is not that far off from our home refrigerator’s freezer. But -70 degrees Celsius is less than the temperature of the Antarctic ice sheet. The big puzzle that needs to be resolved is whether machines that maintain that low temperature could be made readily available around the world. On the other hand, they are now looking for answers to questions such as how quickly the drug should be loaded into the hands of people when the fridge is opened and taken out, and whether it can be taken out of the freezer and kept in the refrigerator for few days. The current understanding is that the drug will remain intact for up to six months in the freezer and once taken out of the freezer it will remain effecive for about five days, if it is refridgerated properly. Since these vaccines cannot be relied upon to be dispensed at regular drug stores, Pfizer plans to pack the vaccine into boxes that hold about one thousand vials, make freezers to maintain the required ultralow temperature, pour tons of dry ice on its head and load it onto planes to ensure the  cold chain is never broken. If you start digging into details, you will come across other logistics related issues. For example, if we set the home A/C at 72 F degrees at home, the room temperature will not be exactly 72 degrees. The system starts to run when the temperature touches a 75 degrees and stops when the temperature reaches 69 degrees. When the systems runs this way repeatedly, we know that the room temperature will be 72 degrees on average. That 69 - 75 degree difference is called Hysteresis. This is how everything from our refrigerator to the freezers in most hospitals work. Since this delicate mRNA vaccine has to be treated like a VIP, it can increase the need for freezers that do not do this periodic cycling but maintain exactly the same temperature without any oscillation. This freezer demand will add to the cost of distribution until we develop enough expertise in managing this supply chain smoothly. On another logistics front, medical institutions need to train physicians and nurses who are goin to deliver the vaccine on precise equillibration procedures, so that the drug is taken out of the fridge/freezer at the right time to bring it up to room temperature before it is injected into someone’s arm. This time will be different for different company vaccines. If the vaccine is injected a little too soon not paying attention to these procedures, the cold drug may cause a lot of muscle pain and cramping unnecessarily. There are quite a few logistical issues involved in getting these vaccines delivered into people’s arms, particularly on the last mile. Hopefully the entire world will stand up to meet the challenge.

The vaccine, developed by Astra-Zeneca with the help of Oxford University, is a slightly different version of the old model we saw earlier. In this method, a virus found in a chimpanzees called the adenovirus is used as the vehicle to carry the face of the Covid-19.  As the figure above shows, the Covid genetic code is implanted on the inactivated adenovirus, which is then injected into the body as the new vaccine. That original adenovirus is a harmless one that only gives mild colds to chimpanzees. It does not bother human beings at all. Therefore, it can be considered as the equivalent of an inactivated virus. As we implant the Covid-19 (called SARS-CoV-2) face in it, our body gets to recognize the Covid mugshot brought in. As in other cases, this helps our body develop immuno response that may still result in mild fever/body ache but then provides the needed corona resistance in case if we encounter the virus in future. Since it uses an inactivated virus without depending on mRNA method, no deep freezing is required. Regular refrigeration will do. Russia has announced with a lot of chest thumping that it has developed a vaccine of this kind called Sputnik-V. The vaccine developed by China follows this well-oiled adenovirus groove as well. Since they eliminate the deep freeze temp requirements, these vaccines are likely to be far cheaper and less complex when it comes to distribution worldwide using regular refrigerator that are more easily available. Of these variations, test data on the Sputnik-V vaccine are not widely available, creating skepticism in the medical community that wonders if Putin is trying to pull a fast one for national pride related reasons. There have also been news articles saying due to unexpected side effects, anyone taking Sputnik-V vaccine is required not to consume any type of alcohol for two months, Putin is reluctant to take the vaccine himself, etc. Hopefully all that is not true so that cheaper vaccines can be made available worldwide.

There are a lot of protocols and procedures in place to ensure vaccines work properly and there are no serious side effects. The first, second, and third stages of clinical trials require, respectively, few, many, and several thousands of injections to be given and the receivers monitored closely for several weeks. In the Western clinical trials, double blind studies for the gold standard to assess efficacy of new drugs. Assume that one thousand people participate in a drug test. Half of them (five hundred participants) will be given the drug to be tested and the other five hundred will be given a placebo that looks like the medicine. No one among the participants would know know who is being given the drug and who is just receiving the placebo. Even the physicians or nurses that deliver the drug wouldn’t know who is getting what. The data collected in this way will naturally be pure and unbiased. A separate team of researchers who receive the tables of data without any individual identified, then analyze the numbers to see if the people who got the real medicine actually survived the disease better compared to those who got the placebo.

If it is a new drug is a therapeutic meant to treat cancer, drug trial conductors will select many of the patients suffering from that particular type of cancer, test the effectiveness of the new drug by giving the new drug to one half and placebo to the other half. Everyone who participates in the study will definitely have the disease. But when we are testing a vaccine, it is not possible to catch and test patients who are already suffering from the disease. So, in the third phase clinical trials, a really large number of civilians are selected and half are vaccinated while the other half are given a placebo. Then all the participants are monitored for several weeks to compute the rate of infection. More than ninety-nine percent of those participants are not going to get infected anyway, since Corona infection rate in the general population tends to be less than 1%. Testing them by trying to infect them will be inhumane and a human right violation. So, the efficacy need to be assessed based on the less than 1% of the population that may normally get infected as they go about their lives. This is how the effectiveness of the vaccine can be measured. Thus, for example, 44,000 people took part in the third stage clinical trials conducted by Pfizer. In a few weeks of giving 22,000 people real vaccine and 22,000 participants a placebo injection, a total of 94 people were found to have been infected. When the data was analyzed by another team not involved in the trial giving away the vaccine, they estimated that the effectiveness of the vaccine was over 90 percent. It can be understood as follows. If 47 of those 94 people had been in the real vaccine group and the remaining 47 on the placebo group, it would have been concluded that the drug was of no use. Instead if no one in the group that received the real vaccine became ill, the drug would have been concluded to be 100% effective for the sample population participating in this study. In reality about 91 people who were infected had received the placebo while only about 3 that received the vaccine got infected. So, the efficacy is computed to be north of 90 percent. It should be interesting to note that due to this nature of vaccine testing, even though 44,000 participants were involved in the study, 10 more cases falling one side or  the other will swing the efficacy rate considerably.

The questions or confusions posed by skeptics of these vaccines can be categorized into about eight different kinds. Answers based on our current understanding that addresses these points are listed in parenthesis:

1. This is a new type of vaccine meddles with our DNA. It can modify the core of who we are and can affect all of our descendants. [As discussed at length above, the idea that this new vaccine could modify our DNA, transforming us and our descendants into some other being is highly imaginary. So far there are no rational reasons to be afraid. We saw that common vaccines usually send inactivated pathogens into our body to trigger an immune response. This mRNA method may be considered even safer over time, as these vaccines inject only the instructions to create the signature of the pathogen. The polio vaccine introduced in the 1960s, had a horrible incidence where accidentally live polio virus (instead of the inactivated version) was included in a batch of the vaccine that got shipped out. This manufacturing blunder resulted in many vaccine recipients getting the disease instead of getting protected against it. Though it occurred decades back when the whole vaccine technology was fairly new, it was certainly a horrible mistake. But since mRNA vaccines don’t contain pathogens but only instructions to create their signature, such mistakes can’t happen in this model. ]

2. Because the economy is collapsing, just people are being tested to declare the vaccine safe to allow the businesses to reopen. They say it usually takes six years to develop a vaccine. But the corona vaccine was made in just six months? [It is true that this vaccine is coming to the market very quickly compared to other traditional vaccines. But when data collected from experiments are published to be readily available to everyone, we need not worry unnecessarily. How is it fair to say that vaccine production should not be accelerated while the entire world is in a semi shutdown state for close to an year? If it takes 5, 10 years to complete the process, do we want the world to be on hold for that long? Since that is not practical, Governments and drug companies have come up with a number of steps (at a huge cost) to speed up the process. Thus, companies started large scale manufacturing of the vaccines still being tested in the hope that testing will go well and the governments will grant permission soon. If permissions are not issued, or if the drug is finally found to be ineffective, multibillion dollars worth of medicine will have to be dumped in the trash. Doing so at other times will result in the entire loss falling on the head of the pharmaceutical company and the company going bankrupt. Therefore, companies will not start production until permission is obtained. Since governments have offered to accept losses this time around, production could start in parallel.]

3. Should we not ask any questions about these new vaccines? Is everything clear already? If making vaccines is so easy, how come we don’t have a vaccine yet for AIDS?! [Questions like how long will the vaccine immunity last, and whether the drug will protect us from it if Covid-19 mutates into new Covid-20 next, are all valid. Answers to these questions are still a few years away. There is nothing wrong with that. Compared to Covid-19, the AIDS virus is even more vicious and effective. The human immunodeficiency virus (HIV) has morphed into many incarnations due to genetic mutations. With almost a hundred different versions of it in circulation, we are struggling to develop a vaccine. It is also capable of hiding inside human cells, making itself impervious to vaccines. So, while scientists are at it, it is not as easy as reading just one virus genome and creating a vaccine as in the case of Covid-19. We better pray that Covid-19 doesn’t keep morphing into newer avatars like HIV in the forthcoming years!]

4. Heard that someone in India has become so ill after taking this vaccine and has sued the drug company in court. [According to biological theories, every human being is unique. No drug works the same way in everyone's body in the world. When 40,000 people are vaccinated in the third round of clinical trials, it is possible that one or two will experience moderate to severe side effects. It is the job of pharmaceutical companies, scientists, and governments to take this into account and revise the vaccine or modify the dosage. Although Aspirin, a common headache pill, has been used billions of times a day worldwide for 40 years, its side effects can still be fatal to a new user. If we completely ban the use of Aspirin because of statistically insignificant instances of bad side effects, we will lose all the positive effects as well. Similarly, even in the case of these new vaccines, it is appropriate to work on improving the medicine and not give this vaccine to people with specific disorders where it is found to be harmful. For example, after the initial roll out, UK noticed that people with extreme allergies experienced a lot of bad side effects. Though with proper treatment, they all had gotten better, UK has advised people with extreme allergies not to take the vaccine at this time. This is appropriate. But it is certainly not the right approach to say that no one should be vaccinated because of a negligible number of bad side effects, no matter how many people die.]

5. This is a conspiracy by China/Trump/Bill Gates/Putin/pharmaceutical companies to bring the world under their control or to make money. [Analyzing them one by one, none of these accusations seem real. Many governments are preparing to make the vaccine available to the public free of charge. Many governments and NGOs have warned drug companies not to indulge in any form of price gouging. People like Trump/Bill Gates do not seem to have benefited from these vaccines. China does not seem to be making big money selling drugs to the world, as it seems to be busy protecting its ownpeople. It is noteworthy that all of the soon-to-be-released vaccines are based on the Covid-19 genetic code published by Chinese scientists circa January 2020.]

6. OK, with all that said, will you dare to get vaccinated once you have access to it? [My wife, kids and I are all going to get vaccinated as soon as it is offered to us in the right order of priority.]

7. OK, now I am convinced. Which vaccine is the best? How do I jump to the front of the queue? [If the clinical trial data clearly shows that the vaccine is more than 90% effective and doesn’t show objectionable side effects, each vaccine can be considered effective and safe. Since the normal flu vaccine is only about 60% effective, the effectiveness of these vaccines may eventually drop slightly when given to billions of people. That is to be expected. However, a community-wide immunity called Herd Immunity can be reached only if more than 70% of the population is vaccinated against a particular disease and becomes immune. Because Covid-19 is extremely contagious and so spreads so easily, it is incumbent upon us, as good citizens, to get vaccinated when it is our turn, after correct priorities have been accorded to healthcare workers, elderly and other special category of people.]

8. Well, I get the idea. What should I do to help dispel the confusion in my community? [Do not forward the unverified social media posts and claims to everyone in your WA groups or email lists. Adding a disclaimer like “Forwarded as Received” does not absolve you of your responsibility. Please do your own research to verify the authenticity of any incoming story/message. In this age of social media, where shocking/threatening negative news speeds around the world several times faster than well researched, boring, good news clips, it is our civic duty to be the firewall that blocks and filters out garbage stories. Take the time/effort to point out and explain to your friends/relatives facts based on science that is free of any political or monetary biases.]

 

The latest television news is that former US presidents Obama, Bush and Clinton have announced that they will be getting vaccinated in front of television cameras for all to see, when it is made available to them as per correct priority. When people were afraid to get vaccinated against polio in the 1960s, Elvis Presley's getting the shot on a television show helped allay public fears.

If you know when Rajinikanth and Amitabh Bachchan are getting their vaccine on Indian TV, let your friends know. It doesn't matter if you forward it as a WA message. Only then the Tamil TV channel debates during 2022 January Pongal season can switch from “Who is to blame for this pandemic?” type titles to “Who conquered Corona in 2021?” type topics. The world will applaud you for you doing your part.

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