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Coronavirus vaccines have arrived – will this rescue us?

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OP-EDS

After a great deal of public clamour, media noise, and anxious expectations, the first batch of COVID-19 vaccines have finally arrived. What can we expect?

Undoubtedly, we have in vaccines one of the most powerful weapons to combat disease. It has been said that, other than the provision of clean water, vaccines have done more for public health than any other intervention.

One only needs to look at the eradication of smallpox, the near eradication of polio, and the drastic reduction of many infectious diseases – which almost all of our young doctors of today have never seen, such as polio and diphtheria and even measles – to marvel at the power of vaccines.

Unfortunately, but realistically, we cannot have the same expectation for COVID-19 vaccines. Viruses like measles and polio behave themselves and maintain their respective vaccine targets. Not so the COVID-19 coronavirus, SARS-CoV-2. Here, we have a far wilier opponent.

Truth be told, we didn’t expect this virus to be as changeable as it is. (The genome, the total genetic structure of this virus, is a long piece of RNA, unlike the fragments of the influenza virus, and also unlike the mutable reverse transcription mechanism of the HIV virus.)

It did indeed surprise us, for it didn’t take long for its many mutations to appear. Surprise turned to anxiety when it became apparent that some of these mutations were positioned in critical parts of its structure, that very part of the virus which is targeted by the immune defensive response following infection or vaccination.

Fortunately, our immune system and our immune responses to infection are more complex than merely making antibodies, and vaccines may still work in spite of worrying signals coming from the laboratory. However, what it does tell us is that we cannot presume that what you find with many other vaccines will similarly apply to controlling COVID-19.

Nevertheless, there are two factors in our favour in dealing with the challenges of this virus. First, there is our science of vaccinology. The development of vaccines and understanding of how they work is now advanced and sophisticated. So much so that the necessary adjustments to the vaccine needed to meet the changing of the virus’ targets can be done quite effortlessly and relatively quickly.

Second, and fortunately for us, as contagious as the virus is especially in certain superspreading settings, its infectivity is considerably less than (say) measles, and the herd immunity threshold is correspondingly lower.

So, what does all this mean with regard to planning how vaccines will be used to control the epidemic? The rollout will basically be structured into two parts. The aim of the first part, consisting of two phases, is to protect those most at risk of being infected. The highest priority of these will be healthcare workers, who will be the first phase. The most vulnerable of society will be in phase two – the elderly, those with underlying illnesses (comorbidities), key personnel for the running of the country, and people living in crowded or congregate environments.

Attention can then be turned to part two, to reach as many of the rest of the adult population in order to achieve herd immunity. Children aren’t currently approved to receive the vaccine.

What do we hope the vaccine will achieve? We cannot expect it to do what the polio vaccine did for polio or the measles vaccine for measles. What we do want to see, however, is a future which avoids the healthcare system, hospitals, and healthcare workers, from being swamped, as we experienced during the first and second waves.

We will want to return to our pre-COVID-19 lives, without the restrictions, without the masks, and having functions and celebrations as before.

This will certainly not happen as soon as the vaccination kicks off. It didn’t happen in the United Kingdom, the first country to commence population immunisation. In fact, two months after commencing its rollout, the United Kingdom is in the midst of a second wave considerably more severe than the first wave, and necessitating the strictest of lockdowns.

Until herd immunity is reached, we will still need to continue strict adherence to non-pharmaceutical interventions while the vaccines do their work. That target will take many months and beyond the year to reach.

The COVID-19 pandemic will go away and vaccines will certainly play a major role together with human behaviour. The virus won’t disappear. The only virus that has ever been eradicated is smallpox.

What we are hoping for in the post-COVID-19 era is a virus which will no longer be totally new to the human population. In history, it has been those viruses introduced into totally naïve and therefore totally susceptible populations, causing so-called virgin-soil epidemics, which have devastated populations. (Measles and smallpox introduced by European invaders in the 16th century to the native populations of the Americas resulted in catastrophic epidemics, wiping out major portions of indigenous populations.) When COVID-19 is no longer new and the virus no longer meets a totally susceptible human population, immunity from vaccines and past infections will produce barriers to stop the spread of the virus.

In the future, there may well be spikes of COVID-19 respiratory infections, hopefully much more trivial, which we will come to tolerate. This will be much like we do for their coronavirus cousins, which are responsible for our annual winter colds, along with many other viruses.

Perhaps some lessons of hygiene practices may continue to be part of our everyday lives. We may well even adopt some of the cultural practices so common in the Far East, like wearing masks in public places when we have a cold, or hand-hygiene practices.

We will come out of this miserable pandemic, but the more conscientious we are about maintaining our non-pharmaceutical interventions to assist the work of vaccines, the sooner that day will come.

  • Professor Barry Schoub is the Chair of the Ministerial Advisory Committee on COVID-19 vaccines. He is emeritus professor in virology at the University of the Witwatersrand, and the former director of the National Institute for Communicable Diseases.

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Every doctor’s COVID-19 jab is one step closer to your vaccination

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The myalgia I awoke to this morning isn’t unfamiliar to me. It’s the common achy feeling we all experience at the onset of a touch of flu. The mild malaise I’m also feeling, after a shorter night’s sleep, is a physiological effect I try to avoid, but it’s the result of a habit that seems to creep into most of our busy lives.

Perhaps more particular, last night was the close constant attention I paid to my glucose levels as a Type 1 diabetic. Thankfully, all remained normal. Barring my mild symptoms, I’m feeling fantastic this morning, 24 hours after receiving the Johnson & Johnson COVID-19 vaccine.

My mind drifts back to almost a year ago, when I contracted a simple rhinovirus (the common cold). In spite of experiencing similar symptoms, I would certainly not have described myself as feeling “fantastic” at the time. These same symptoms used to conjure up uneasiness that my family had to bear as part of the role in life I have chosen. That’s what happens when you live with some comorbidities and work in a busy practice that had started to screen its patients vigilantly for the new “Wuhan flu”.

I welcome the vaccine’s side effects as do my colleagues as we enrol this week as the guinea pigs of the Johnson & Johnson trial. This is the only vaccine to date that has shown significant efficacy in preventing severe COVID-19 or death as a result of the 501.V2 variant, the most common strain of COVID-19 in South Africa today.

It’s a single-dose vaccine, with 500 000 doses secured to inoculate healthcare workers over the next four weeks. This is a trial still at stage 3b, which means that it’s not yet registered anywhere in the world for commercial use, in spite of its rolling application in the United States, the United Kingdom, and South Africa.

The vaccine is being rolled out as an emergency measure while it awaits FDA (Food and Drug Administration) approval potentially at the end of this month. Should the vaccine prove to be effective amongst South Africa’s healthcare workers, it will give SAHPRA (the South African Health Products Regulatory Authority) the green light for commercial rollout to our citizens.

My social media feed has been preoccupied with posts by colleagues receiving their vaccines. I, too, have added my own story to this noise. In reality, it’s far from noise. The supportive response we have all received from the public has been overwhelming.

A dear pulmonology colleague and I engaged in conversation yesterday as to whether doctors should be “flaunting their receipt of a vaccine” on social media or rather just quietly receiving the jab under the radar.

After some meaningful thought, we both agreed on the former. The palpable excitement by the public to doctors’ Facebook posts is fuelled by some valuable perspectives which I would like to share with you. These are the reasons that our community members should feel joy that our healthcare workers are finally being vaccinated this week.

The healthcare worker’s safety perspective: during surges of COVID-19 infection, patients have described the thought of not being able to see their doctors, nurses, and paramedics with ease as a terrifying dynamic. Statistics have shown that healthcare workers are three to four times more likely to develop COVID-19 than the general public. As many as 54 685 healthcare workers in the public sector alone have been infected with COVID-19 over the past year, with 779 losing their lives.

Unfortunately, every community doctor knows another doctor who has either contracted a serious COVID-19 infection or even lost their life to this plague. The vaccine offers you the promise that your doctors will be protected and able to help you when you may need them whether for COVID-19 or another reason.

The experimental perspective: the AstraZeneca vaccine taught us that in the dynamic, evolving space of COVID-19, variants affect efficacy tremendously. This phenomenon is so significant, that an already procured vaccine at one million units had to be returned. It’s still unknown whether the Johnson & Johnson vaccine will indeed be effective in large numbers on the ground, beyond the limited sample size of the original study in South Africa.

It’s best to run a live trial on largely healthy healthcare workers. I have my predictions that even with the Johnson & Johnson vaccine, modifications will need to be made to the product in the near future. Dr Glenda Gray advised me that a two-dose regimen is also being explored. Other expert vaccinologists have reported that it’s relatively simple to modify vaccines. As a member of the public, you will hopefully have access to the next round of vaccines – the improved version two.

The snowball perspective: this is the mindset that has excited me most since the rollout of vaccines a week ago. Every country with a functional vaccine campaign started off by vaccinating its healthcare workers. They constitute less than 5% of the population. Once healthcare workers start being vaccinated, the rollout soon spreads to essential workers and the elderly and vulnerable. Thereafter, vaccines are offered to younger healthy adults.

There is nothing more my wife and I would like to see than our own parents being vaccinated. I can say the same for my elderly patients. Understanding the procurement plan in South Africa, I’m confident that once the initial snowball of vaccinated healthcare workers has been formed, it’s inevitable that it will grow quickly and our deserving, beloved, vulnerable citizens will be vaccinated soon. Every doctor you see vaccinated means you are one step closer to being vaccinated yourself.

COVID-19 has changed our lives. It continues to place tremendous strain on our community socially, emotionally, financially, and physically. It has been proven that our second-nature, non-pharmacological measures of mask wearing, sanitising, and social distancing are powerful weapons in our armament. These measures dropped COVID-19 cases from a peak of 21 980 a day on 8 January 2021 to 998 today. However, we are finally exploring options of real pharmacological immunity. I’m utterly grateful to be contributing towards the body of knowledge of this development, and I have confidence that as the lightning development of vaccines continues to play out in South Africa, we will slowly get back to normal life.

Dr Daniel Israel is a family practitioner in Johannesburg.

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Tel Aviv rolls out COVID-19 vaccines for illegal foreign nationals

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Although South Africa is only starting to vaccinate its healthcare workers, Israel has already vaccinated nearly half the population.

It’s not only Israel’s citizens who have been vaccinated, but also migrant workers living there from the Philippines, Moldova, and Nigeria, as well as Sudanese and Eritrean asylum seekers. They are receiving the Pfizer-BioNTech coronavirus vaccine at the Tel Aviv COVID-19 Vaccination Centre in the southern part of the city, home to a large migrant community.

As part of an initiative to inoculate the city’s foreign nationals, Tel Aviv City Hall and the Sourasky Medical Center started administering vaccines free of charge to the city’s foreign nationals, many of whom are undocumented asylum seekers.

This was evident on Tuesday, 9 February, the first day of the operation, as dozens of asylum seekers and foreign workers in Tel Aviv lined up outside the building to receive their first dose of the COVID-19 vaccine. Posters provided information in English, Tigrinya, Russian, and Arabic.

“I’m very happy,” Indian national Garipelly Srinivas Goud told Associated Press. Lamenting that foreign workers in Israel don’t have money or insurance to afford to pay for the vaccine, Goud, who has been working in Israel for eight years, welcomed the vaccine drive as a “very good decision”.

Although it’s the government’s responsibility to vaccinate everybody within the nation’s borders, Eytan Schwartz, spokesperson for Tel Aviv municipality, said the city would take the next step and start “to vaccinate illegal or undocumented asylum seekers as well”.

And although far from completing the vaccinating of its own population, having thus far delivered more than 4.4 million first doses of the Pfizer vaccine and at least three million second doses, Israel has started providing the Palestinian Authority (PA) with thousands of vaccines for its healthcare workers. This is in spite of the fact that the ultimate responsibility for health services and vaccine acquisition falls upon the PA, elected by Palestinians to govern the West Bank.

After receiving thousands of doses from Israel, the Palestinian Health Ministry administered its first known coronavirus vaccinations at the beginning of February. It announced the start of the campaign by saying that Health Minister Mai al-Kaila had received a first dose along with several frontline medical workers. While acknowledging receipt of 2 000 doses on Monday, 8 February, the first batch of vaccines sent by Israel, the PA didn’t say where they came from.

Back in May 2020, COVID-19 relief aid from the United Arab Emirates was rejected by the Palestinian leadership because it arrived by freight plane to Israel’s international airport without prior co-ordination with the PA. This resulted in 14 tons of urgently needed COVID-19-relief medical supplies languishing at Ben Gurion Airport. The reason for the PA refusing to accept delivery was because it didn’t want to be seen as condoning the normalising of ties between Israel and the Arab world.

Disregarding the health of his people, Osama al-Najjar, the medical services director of the PA health ministry, explained that Ramallah couldn’t “accept shipments that are a gateway to normalisation between Arab countries and Israel”.

Asked what he thought would happen to the medical supplies, al-Najjar responded, “I don’t know where they will go, but we won’t accept them. They’re free to do with them what they please, but we will neither accept them nor welcome them.”

However, Al-Najjar did acknowledge that the PA was “in need of ventilators”.

What we are “all in need of” is better understanding and co-operation as there are no borders when it comes to the health of the planet and its vulnerable citizens. Israeli epidemiologists agree that it’s in Israel’s interest to ensure Palestinians are vaccinated as quickly as possible, as the populations are too intertwined to have one gain herd immunity without the other.

As recently departed Health Ministry Director-General Moshe Bar Siman-Tov told The Times of Israel in January, “The message is very simple: we are one epidemiological unit. As much as we can, we have to help them address this matter.”

  • David E Kaplan is the editor of ‘Lay of the Land’, and executive director of the Global Investigative Journalism Network. This piece was used courtesy of ‘Lay of the Land’.

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Call to wake up and listen

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The great Rabbi Yehuda says, “The human soul should turn g-dly … Perceive the world, enjoy the sublime, that sublime light and the hearing of the divine speech.” (Zohar)

How far has humanity travelled away from this truth here in South Africa? The dreaded load shedding, darkness upon the face of the earth … hmmm!

It’s time to take a good look at yourself – no television, no devices – could Hashem be asking you to now look inwards?

Then the virus, resulting in the wearing of masks. How many different masks do we wear for our spouse, children, friends, and co-workers, so full of masks covering up our true self, not hearing the divine voice of Hashem. We are now wearing our mask outside of ourselves. Why? No more space inside, full up, the pretence is overflowing.

Then comes a cry of compassion for humanity – a new rule, masks, social distancing, sanitising, or could we say this, could we look at it like this, expose the truth, give each other space, cleanse soul and mind?

Yet, humanity couldn’t obey this simple law of protection, then came lockdown.

Imprisonment not only of your mind – your body, your whole being, locked up.

And now death, what’s more final on this earth than death? Death, giving up or giving in, surrendering. How to die, why, where do we go, what do we do … well this is for another discussion.

If each of us does our best by being still, listening to the voice of Hashem, doing it through prayer is one way to hear his voice.

We have, as some people call it, collective karma, the law of cause and effect, we also have our own individual karma (attaining good merit or drawing negative energy through our deeds and actions). In collective karma, we are all in the same energy, this is where we see how the innocent and guilty suffer together as a result of a situation.

We can open the door to a new energy, a new way of living, we all have the key in our hand, all you need to do is turn the lock and enter.

Let your fancy dress and mask for your Purim celebration be the last mask you wear.

Pesach is nearly upon us. Think of the slaughtered lamb in place of the first born, allow the angel of death to pass you by, the angel will know death has been, she will see the sign written on the door although it’s the blood of the lamb.

What an auspicious time to play your part to turn your life around! A time in which there are no more masks, the truth can be revealed, the doors open wide, children can laugh and play in the park once more, the light of Shekinah shines brightly in your soul once more.

Let’s pray that through the blessing power of Hashem, the truth will set us free and heal us. It’s time to turn to prayer.

Wishing you a spiritual and enlightening Purim and Pesach!

  • Melanie Moritz is a spiritual teacher and healer.

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