By Dr Edward Nazareth
Jan 23: India started the world's largest Covid-19 vaccination drive on January 16, 2021 and over the last one week lakhs of frontline workers, doctors, nurses and paramedical staff received the first dose of vaccine across India. The medical fraternity is given either Covishield or Covaxin as per the supply from the government. Fortunately not many adverse reactions are reported.
I received the first dose of Covishield four days ago. In my institute many of my colleagues, associates and assistants also received the vaccine. We all are fine and on duty as usual. As we, in the medical field received the vaccine without hesitation, we hope people who are not in the medical field get the confidence to take the vaccine.
Unfortunately, social media is flooded with so many reports about adverse effects of vaccination. Some of the information is portrayed in a horrifying manner and with scare tactics; people may not mind having the infection, but not vaccination. Is vaccination really harmful? Who should take and who should not? Some of these general questions have been answered here.
*Why do some people who receive the vaccine develop side effects?
Almost all the medicines and vaccines which have effects on the human system also have one or more side effects. Even a paracetamol tablet, the commonly used medicine for fever can have side effects from skin rashes to bleeding inside the oral cavity or in the intestine in higher doses in some individuals. These side effects are rare. Normally a potent drug has more side effects. For example, aspirin is an effective analgesic and anti-inflammatory drug; but it can produce severe side effects in many people. It is generally believed that any medicine which does not have any side effects does not have any effects either.
The unwanted effects or side effects are termed scientifically as ‘adverse drug reactions’. The adverse reactions depend on several factors; some of these are individual related while others are drug related.
Some people have a tendency to develop allergies and may show excessive reaction to many of the medicines. Few people are allergic to a particular chemical compound or a group of medicines. A drug allergy is the abnormal reaction of the immune system to a medication. A good number of people are allergic to any drug related to the penicillin group while some cannot tolerate drugs with sulfa molecule.
Age, also has a very critical impact on the occurrence of side effects; both very young and very old individuals are more vulnerable to these reactions than other age groups. Alcohol intake also has a crucial impact on medicines. Other factors are gender, race, pregnancy, breast feeding, kidney problems, liver function, drug dose and frequency. Some of these factors can be changed like smoking or alcohol intake; others cannot be changed like age, presence of other diseases or genetic factors.
*Are there any differences in the side effects of the COVID19 vaccines used in USA and the ones used in India?
In USA and in some of the European countries, mRNA vaccines are being used since the third week of December 2020. In India two different types of vaccines have been approved and they are now in use all over the country. Though these vaccines are of different types, the side effects or adverse reactions do not differ much.
The most common side effect of COVID19 vaccines are pain/soreness at the injection site. Other commonly reported side effects include fever, fatigue, muscle aches or headache, but these are usually mild and resolve in a few days. These side effects are normal signs that the body is building protection against the virus. It is quite common to develop fever after any vaccination. This normally happens within 48 hours of the vaccination and usually goes away after 48 hours. Some people are advised to take paracetamol if they feel uneasy.
Serious reactions are uncommon and include rare cases of severe allergic reactions.
*There are reports of deaths after COVID19 vaccination in Europe and USA. Deaths are also reported in India. Are these deaths not due to COVID19 vaccine?
The death of twenty nine people within a few days of receiving mRNA vaccine in Norway was a matter of concern. It was later reported that these people were elderly, fragile and sick. These people should not have received the vaccine in the first place, as those who are very frail can have serious consequences from even relatively mild side effects.
In India vaccination for health workers was started on 16th January 2021 and till today four people who had received the vaccine died after a day or two of vaccination. The deaths in India are unlikely due to vaccination. All the four deaths are related to heart problems and vaccination is more likely to be a co-incidence rather than the cause of death.
If a person dies within hours of vaccination, the death may be attributed to vaccination. The death directly due to any vaccine can be explained by a phenomenon known as ‘anaphylaxis’. It is a very severe allergic reaction and can cause death immediately after any injection or medication if not attended promptly. If these people have become sick immediately after vaccination, the blame of death could have been on the vaccine. The deaths that occurred hours after vaccination cannot be due to the vaccine.
*There are reports that mRNA vaccine causes anaphylaxis. Are the deaths due to vaccination not due to anaphylaxis?
Anaphylaxis is a severe life threatening allergic reaction when persons with allergies are exposed to a particular allergen like venom, food, or medication. Most cases of anaphylaxis are caused by a bee sting or eating foods that are known to cause allergies, such as peanuts or tree nuts. It happens as soon as the person comes in contact with the allergen. Anaphylaxis causes a series of symptoms, including a rash, low pulse, and shock, which is known as anaphylactic shock. This can be fatal if it is not treated immediately.
Though anaphylaxis has been reported to mRNA vaccine, the deaths reported so far following vaccinations are not due to anaphylaxis. The anaphylaxis reaction is seen as soon as the vaccine is injected into a person. Currently, people are made to wait for a minimum of 30 minutes after vaccination to monitor any sudden adverse reactions like anaphylaxis.
The anaphylaxis reaction appears to be to a component in the mRNA vaccine known as PEG i.e. poly ethylene glycol. In India, lakhs of health workers have received the COVID19 vaccine and no anaphylaxis has been reported so far.
*Can the vaccine trigger a heart attack? It is reported that the deaths in India so far were due to heart attacks.
Most of the deaths reported in people who received COVID 19 vaccinations are after a day or two. Many of these are due to a cardiac event in people who already had heart ailments. The deaths due to heart attack in these people are most likely co-incidences.
During trials of the vaccines in normal people no cardiac side effects were reported. The vaccines are unlikely to cause cardiac problems.
*There are reports that doctors are also refusing to take the vaccine, especially covaxin. Is that vaccine safe?
Dr Randeep Singh Guleria, director, All India Institute of Medical Sciences (AIIMS) has taken the first dose of Covaxin developed by Bharat Biotech to reassure people that it is safe. When the central authority gave approval to use indigenously prepared Covaxin a lot of reservations were expressed because it had not completed the final trials. The authorities were confident that the vaccine was safe as per the initial two phases of trials.
Now it is being used at many places and large number of health workers (doctors, nurses, and paramedical staff) has received the first dose and no major side effects are reported. At present it appears to be as safe as Serum Institute’s Covishield.
*The apprehension is because the vaccines were developed and put to trial and are already in use within a year of the virus outbreak. Previously it used to take a long time to develop and use vaccines. How can we trust the vaccines that are developed so fast?
In 1980s and earlier the technologies were ground breaking for the time, however, we have advanced even further since then. Now it is relatively easier to isolate and identify the characteristics of viruses. A lot of research was already available on viruses similar to the COVID19 virus prior to the outbreak. Due to digitalization, compiling and studying trial data is easy. All of this has helped to develop the vaccines quickly. The trials are at various stages of completion yet, approval has been given for emergency use. It is almost a month since the vaccine was made available for use in health workers all over the world. Fortunately, there have been no major adverse reactions. We have to wait and observe the efficacy of the vaccines and that may well take a few months.
*There are reports that people in Israel who were given COVID19 vaccine have got the infection. Can a person get COVID19 infection from the vaccine?
A small percentage of people in Israel who had received the first dose of mRNA vaccine were tested positive. This infection is not due to the vaccine. They had received only the first dose and were exposed to the virus and got infected. There were a few who had also received the second dose. It is more likely that they were already infected with the virus prior to the vaccination and the infection revealed itself after the vaccination.
It takes a few weeks for the body to build immunity (protection against the virus that causes COVID-19) after vaccination. That means it is possible a person could be infected with the virus that causes COVID-19 just before or just after vaccination and still get sick. This is because the vaccine has not had enough time to provide protection. One cannot get good immunity with one dose or immediately after vaccination.
It has to be remembered that the potency of the vaccine is not yet established and we do not know how many will be protected from the infection and for how long. For example, the efficacy of Covishield vaccine ranges from 62% to 70%. It means for every 100 people who receive both the doses, about 30 to 38 can still get the infection! And if only one dose is received, the protection may be even lesser. The protection from mRNA vaccines are said to be better in trials, but not 100%.
*I was tested positive for COVID19 infection. I had mild symptoms. Do I need to take the vaccine? Will there be any side effects?
At present, the Center for Disease Control (CDC) recommends that those who have had COVID-19 infection should also get the vaccine. There is preliminary evidence that the vaccine offers better protection than having had the virus infection. Moreover, some of the experts doubt the results of COVID19 tests and therefore one cannot be certain whether one had COVID-19 infection or not especially if the symptoms were mild.
There are studies where people with antibodies against other viral infections had no problems from taking vaccines against the particular virus. For example individuals with antibodies against measles virus had no adverse effects by taking vaccine against measles. There are similar studies about other viral infections also. Taking this into consideration, it can be stated that there may not be any major risks by taking COVID19 vaccine even if one had the infection earlier.
*How long the vaccine can save from infection? There are reports that the vaccine may not protect for long?
At present it is not possible to predict how long the antibodies against COVID19 may last either from real infection or from vaccination. Normally after an infection, the immune system builds up antibodies to protect the body from future infections. There are reports that the antibodies disappear in certain people after few weeks of COVID 19 infection. It is not yet known whether this is a universal phenomenon, that the antibodies disappear in everyone who gets infected or who receive the vaccine or it is only in certain group of people. More studies are required to ascertain the duration and efficacy of the vaccine.
Some of the experts believe that the COVID19 infection is more like seasonal viruses, like the common cold or flu for which we do not have long term immunity. The common cold and flu viruses also mutate substantially that is why flu shots are given every year. If the COVID19 viruses behave like common cold and flu viruses, we may have to get repeated vaccination.
*After receiving the vaccine, do I still need to wear mask and maintain social distancing?
At present it is believed that by getting the vaccine, the individual develops antibodies that can protect the person from severe disease if infected. There is also uncertainty, whether the vaccine protects its beneficiary from getting infected by the COVID19 virus or only from the disease. It is not yet clear whether the vaccine has the ability to decrease the transmission of the viruses from an asymptomatic infected person to others. Therefore the experts still insist on following public health measures to prevent spreading of the infection like wearing the mask and maintaining social distancing.
*With so many uncertainties and side effects of COVID19 vaccination, don’t you think it is prudent to stay from vaccine?
We have seen devastating complications of COVID19 infection in many of the unfortunate who got the disease. A good number of people got infected, remained asymptomatic. Though the virus is more dangerous in those with co-morbidities, it has not spared young, healthy and children also.
A safe and effective vaccine to prevent the COVID19 virus infection is, perhaps, the best hope for ending the pandemic. The information we have is limited because the disease is new. However as per the experts:
• Getting a COVID-19 vaccine can save one from contracting the disease by the antibodies that will be produced in the body following vaccination.
• COVID-19 vaccination might prevent one from getting COVID-19 infection, or, if one contracts the virus, the vaccine might prevent from becoming seriously ill or from developing serious complications. There is no way to know how COVID-19 will behave in an individual, the disease can cause severe complications and lead to death in some people.
• The COVID-19 vaccine might also help to protect people around the individual who is vaccinated from the disease - especially those at increased risk of severe illness from COVID 19 virus infection.
• The complications and side effects of vaccines are blown out of proportion in the social media. Most of the so called complications are co-incidences and not related to vaccine at all. As on today millions of medical professionals have received the vaccination and the complications reported are very few.
• The combination of getting vaccinated and strictly adhering to the COVID-19 safety guidelines, including wearing a mask, washing hands frequently and social distancing, will offer the best protection from the dreaded virus.
*When will common men get COVID19 vaccine in India?
According to the Central government’s health department, the COVID-19 vaccination is planned on priority basis. In the first phase, priority will be given to around one crore healthcare workers, followed by two crore frontline staff, like community health workers and police, who are directly involved in fighting the pandemic. (At present the health workers are getting the vaccine). The vaccine will be free of cost for this group. The next group will be people over the age of 50 years, followed by those under the age of 50 years, but with co-morbidities.
A common healthy man will have to wait for some time to get vaccinated for COVID-19. Their chance will come only after the first group has been vaccinated, which is roughly around 30 crore people. Once all these people are vaccinated, then the common man will be notified. They will have to on CoWIN platform for their vaccination after the notification.
It is not known whether all the people will get vaccine free of cost or some will have to pay for the vaccine. The registration process will be simple; people will need to upload one photo identity card on the digital platform and register themselves with their phone number. Once they are registered, they will get a particular timeline for their vaccination with the date when they have to come and the place name where they have to go and get themselves vaccinated.
According to Dr Randeep Guleria, director of AIIMS and member of the national task force on COVID 19 management, common man may have to wait till 2022 to get COVID19 vaccine.