Vaccination is one of the top medical discoveries of all time. From the development of the world’s very first vaccine, for small pox, in the late 1700s to the more recent HPV vaccine for cervical cancer, vaccines have prevented millions of deaths and disabilities worldwide.
Now the race is on to develop a vaccine against Covid-19, a virus that in just seven months has resulted in more than 680,000 deaths, infected in excess of 17.5 million people and decimated livelihoods worldwide.
According to the European Medicines Agency, the EU body that will ultimately be responsible for recommending whether or not a Covid vaccine can be safely marketed in Europe, " it might take at least until the beginning of 2021 before a vaccine against Covid-19 is ready for approval and available in sufficient quantities to enable widespread use".
The medicines agency also said that as of July 30th of this year, it has been in discussion with the developers of 38 potential Covid-19 vaccines.
Therefore, as the world races to develop a vaccine, we are still learning about the virus itself.
Prof Karina Butler is chair of the National Immunisation Advisory Committee (NIAC) and consultant paediatrician and infectious disease specialist at Children's Health Ireland. Established within the Royal College of Physicians of Ireland in 1998, the committee advises the chief medical officer in the Department of Health on a number of matters including specific vaccine recommendations for use in Ireland.
Whichever Covid-19 vaccine comes out on top must be proven to be safe and effective. Prof Butler said that no vaccine was 100 per cent safe for 100 per cent of people, but that it was always a balancing of risk – the risk of giving a vaccine versus the risk of not giving it.
“For example, if we take the childhood vaccinations: we know that the very, very small risks associated with them and most of them are relatively trivial – sore arm, little bit of fever afterwards – very rarely serious events are far outweighed by the risks of the natural diseases. So, it’s a balancing of risk in everything.
“Ideally you want a vaccine that is very much tried, tested and proven to be safe in that context, so you can give it to lots of people but that balance may change for different groups of people and the urgency of vaccinating some will be different compared to the need to vaccinate others,” she added.
“There probably will be a prioritisation on both those grounds from wanting to protect those at highest risk first, but also knowing that they stand to gain the most from any vaccine,” Prof Butler added.
Unprecedented
Almost everything about the world now is unprecedented and the speed at which scientists have been working to produce a vaccine is equally exceptional.
Therefore, people may be concerned that this is all happening too quickly, and may lead to hesitancy about getting the vaccine.
Decisions will be based on the need to protect individuals, break the transmission of the virus and protect essential services
“Very reasonably anyone who is sensible will pause and think,” said Prof Butler, “and the only thing I can say is to give the reassurance that those who are looking at the vaccine use will equally be pausing and thinking, and that is where this risk balance comes into play. Do people need the vaccine and is it going to benefit them and what are the risks, if any, associated? And that is where the balance comes.... nobody wants to do this if it isn’t a safe and effective vaccine and if giving it is going to far outweigh any risk of not giving it.”
The reality is that with the global demand for a vaccine, which is estimated to be billions of doses, it will not be possible to give it to every member of the population at the same time, and therefore decisions will have to be made as to which groups should be prioritised to receive it.
While work on recommendations as to which groups may be prioritised to receive the vaccine is ongoing, decisions will be based on the need to protect individuals, break the transmission of the virus and protect essential services. Also it is impossible to say which groups will be prioritised without knowing what type of vaccine will be recommended.
Overall, nearly one in three Covid-19 positive cases here are frontline healthcare workers, so this group is particularly vulnerable to infection
Dr Conor Maguire is a GP in Dublin and the Irish College of General Practitioners representative on the NIAC.
According to Dr Maguire, the priority groups who could potentially be first in line to receive the vaccine would be those who are most vulnerable to Covid-9 and for whom protecting themselves from exposure is incredibly difficult.
Overall, nearly one in three Covid-19 positive cases here are frontline healthcare workers, so this group is particularly vulnerable to infection. Likewise the virus has had a devastating impact on the elderly.
Expressing his personal opinion as to what the priority groups may look like, Dr Maguire suggested that a vaccine could first be given to frontline healthcare workers in a clinical setting; followed by other essential workers such as gardaí, then all adults over the age of 65, followed by residents of long-term care facilities; then adults between the ages of 18 and 64 with underlying medical conditions that puts them at high risk of more severe disease and poorer outcomes if they contract Covid-19 but have the option to cocoon at home; followed by all other adults and then children.
He said there would be an overlap between these groups as, for example, a great number of people in long-term residential care facilities would be also over the age of 65.
However, Dr Maguire said that attempting to compile of list of people who might be first in line to receive a vaccine and how many doses may be needed, was “crystal ball stuff”.
“We don’t know what kind of vaccine it is going to be. We don’t know how many doses are going to be required; if it’s a live vaccine with immunological complications like yellow fever then it can’t be given to the older population, and if its an inactivated vaccine which is given to vaccine naive people, people who have never been exposed to it, they might need one, two or even three doses,” he explained.
Taking the vaccine
Dr Maguire said he would have “no problem whatsoever” getting a Covid-19 vaccine himself as it would the responsible thing for a GP to do.
Commenting on concerns people may have that the vaccine was rushed, he said: “It is important to note that the research into vaccines in this group is not new. Also vaccine research follows the highest level of scrutiny. This will not be a rushed vaccine based on a race to production in my opinion.”
However Dr Maguire added that a vaccine was “not a panacea”.
“It is only one weapon in the armamentarium in the fight against this virus and public health measures such as handwashing, contact tracing, testing and all the things we have been taking about – those are still very, very important.”
What members of the public think
Margaret McCarthy is a healthy 88 year old who lives in Dublin. She gets her flu vaccine annually. regarding a Covid-19 vaccine, she said she would have concerns about taking anything new until it had been proven. “I think that maybe that vaccine should be given to younger people who have their full life ahead of them and it might prevent this awful virus getting to them, and if it does I would be all for it.”
She said she would take the vaccine if it were proven to be beneficial. “I wouldn’t be first in the queue – I would like to find out somebody else who got it first. I will try and protect myself as best I could initially without it.”
Rachel Yaull is in her early 50s and is receiving treatment for cancer. While she would have concerns about the vaccine, she would "definitely take it".
“Because I have underlying conditions I would worry that the Covid vaccine might upset me in some way, it might make me poorly. However, I think that the pros totally outweigh the cons. I don’t want to end up in hospital taking up a bed because I have got Covid and I certainly don’t want to end up on a ventilator.”
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