How to make the most out of Covid-19 vaccination

Vaccination against Covid-19 has been at the centre of most discussions related to the pandemic management across the world. Many countries have enforced certain regulations, including restrictions on movement within their territories as well as beyond their borders without completing vaccination. There have been sporadic but strong protests against these standard operating procedures (SOPs)—with claims that these measures enforced social division rather than social distancing—in several developed countries. Like it or not, without taking all the vaccine shots, one's life could come to a standstill, unless one wants to stay isolated.

However, what makes Covid-19 vaccination "complete" still remains a mystery. Is it a regimen of two or three doses, or yearly shots? Scientists, vaccine producers, and the World Health Organization (WHO) seem to differ in their opinions in this regard. The emergence of the deadly SARS-CoV-2 variants could be a consequence of a lack of "mass" vaccination, WHO Director General Tedros Adhanom Ghebreyesus has cautioned.

While everyone wants this pandemic to end, and vaccination is widely considered to be the most practical measure to reach that goal, the global inequity in vaccine distribution—or vaccine apartheid, if you will—is still the reality on the ground. The British Medical Journal (BMJ), in its editorial published on August 16, 2021, summarised the problem this way, "Some vaccine-rich countries are destroying excess, unused doses. And some have imposed export bans and restrictions to protect their stockpiles. Ironically, vaccine companies prevent poorer countries from insisting on similar measures."

Nonetheless, the major vaccine producers are counting their revenues in billions, while the 50 least wealthy nations, home to 20 percent of the world's population, have received just two percent of all vaccine doses—which the BMJ has termed "a crime against humanity." The hard reality, which seems to be not fully appreciated as yet, is that the occurrence of a single case of Covid-19 in any part of the world means the entire world is at risk. The quicker the Western world understands this, the better.

Meanwhile, even the vaccine-rich countries have not made getting the Covid-19 vaccine obligatory. To make it legally obligatory, the first obstacle would be the guarantee of safety—or lack thereof. The vaccine-producing companies would not want to compensate anyone who might suffer for the vaccine's side-effects, no matter how insignificant the number of the affected vaccine recipients. In most countries, vaccination is optional with certain conditions. It is by law a choice whether someone wants to be vaccinated. At the same time, informed written consent is obtained before the vaccine doses are administered—mostly to provide immunity to the vaccine producers for any possible harmful after-effects.

Against this global backdrop, the very first question that may come to our minds is: Should we make Covid-19 vaccination obligatory in Bangladesh? If so, for whom? Should it be based on age, or should it be based on the nature of one's job or profession?

In a recent round-table discussion organised by the Bangladesh Society of Microbiologists, Dr Saif Ullah Munshi, professor at the Department of Virology in Bangabandhu Sheikh Mujib Medical University (BSMMU), explained how an infection with coronavirus boosts the human immune system. He also explained how the risk of re-infection remains similar for both those who develop natural immunity after recovering an infection and those who are vaccinated. Therefore, he suggested prioritising vaccination for those who have not been infected—i.e. have not developed natural immunity—rather than vaccinating everyone, including those who have already developed immunity.

The notion was supported by other panellists in the discussion, including Dr Nazrul Islam, former vice-chancellor of BSMMU; Dr Mahmuda Yasmin, professor at the Department of Microbiology in Dhaka University; Dr AM Zakir Hossain, former director of Primary Health Care at the Directorate General of Health Services (DGHS); and Dr Be-Nazir Ahmed, former director of Disease Control at the DGHS.

To find and scrutinise the individuals who require vaccination, a test to detect the presence of the antibody against the SARS-CoV-2 is more useful than the one that would detect its presence. The antibody test will not only identify the part of the population who need the vaccine more urgently, but will also reveal what percentage of the general population have acquired natural immunity against the virus. The measurement of the level of immunity in an individual's sample is, therefore, a key performance indicator (KPI) for the vaccination programme.

An appropriate tool to detect the antibody is, of course, essential and is technically similar to what is used to detect the presence of the virus itself.

Given this scientific rationale, it is not necessary to impose vaccines directly or indirectly on everyone. Rather, the authorities concerned could give the vaccine to those who have not developed any form of immunity against the virus.

On the same note, it can be safely recommended that there is no need to wait until all university-going students get the vaccine before the universities physically resume academic activities. Rather, it might be more practical to see who have yet to develop immunity through natural infection, and plan to vaccinate them on a priority basis. The same may be applied to schoolteachers who are now physically attending to their jobs.

However, the plan for school-going children and adolescents presents two added issues to consider: First, who will sign the informed consent on behalf of them, and how; and second, the actual safety records of childhood vaccination. Before implementing any policy to vaccinate school children, those two issues must be thoroughly looked into, by getting healthcare professionals and other stakeholders involved in the process. According to the WHO, more evidence is needed on the use of Covid-19 vaccines in children to be able to make general recommendations on vaccinating children against the pandemic.

The Covid-19 vaccination can be more effective if it is administered to those who need it the most and those who are least likely to manifest any lethal side-effects. Policymakers in our country as well as in the world may want to work hand-in-hand to make the vaccination process more effective to get rid of the pandemic.

Dr Mohammad Tariqur Rahman is professor at the Faculty of Dentistry in the University of Malaya. Dr Muhammad Manjurul Karim is professor at the Department of Microbiology in Dhaka University.