FEATURE ARTICLE

Friday, October 22, 2021
ibelemedo@yahoo.com
St. Ann's, Port of Spain, Trinidad, West Indies
ADDRESSING VACCINE HESITANCY

accine hesitancy is a real issue that has confronted health workers in this season of the COVID-19 pandemic. To deal with this, many countries have adopted vaccine mandates. Whilst this has partially forced some to get vaccinated, this has actually worsened the issue in many places, and has seemingly provided ammunition for opponents of vaccination to cry discrimination.

It is therefore necessary that we address this issue objectively, using unquestionable scientific data. Though there is no guarantee that everyone will be convinced to be vaccinated, it is important to ensure that accurate information is presented which will help people to make an informed decision on this subject.

Convenience, Complacency And Confidence

It is believed that vaccine hesitation surrounds issues of convenience, complacency and confidence.

Convenience speaks generally to people simply stating that they have not had the time to go and get vaccinated. This is the easiest one to deal with. Provision of vaccines, people being given time off work to get vaccinated, making the vaccines available at multiple and more convenient locations, including providing drive-through locations are some of the ways to handle this. Some government and corporate bodies have even provided incentives to people, to ensure vaccination rates are increased.

Complacency deals with the beliefs by some people that they would not be infected with COVID-19. This is common especially amongst religious people, who say their faith will see them through. Arguing with these people is a waste of time. This is because a man's faith is his evidence, no matter what he sees or feels. Remember that the Bible says "Now faith is the substance of things hoped for, the EVIDENCE of things not seen" - Heb. 11:1.

It requires a trusted person to present new evidence for them to embrace. This is where religious leaders are needed to join in this phase of the fight against COVID-19.

Authorities should find ways to collaborate with these religious leaders because their influence on their followers outweighs any scientific evidence that can be provided. Some of them would be convinced when someone close to them dies or is badly affected by the disease. However, in some cases even this would not change their minds.

Others who display complacency are people who are not religious but are generally cynical and unmoved by happenings around them. They have the attitude that one would die from one thing or the other and are seemingly not bothered by anything. We must continue to highlight the severity of the situation in hope that some of these would be convinced.

Confidence here speaks to people who do not trust the safety and efficacy of the vaccines. This population is varied and the so called antivaxx population are largely people who form this group. These range from the religious, who believe that the vaccine is the mark of the beast or believe that the pandemic is a "plandemic" caused by global authorities to depopulate the world and or those who think the vaccines are damaging and killing people, hence, doing more harm than good. This also includes political figures who use the subject as a way to create social disobedience with the hope of destabilizing the current governments of their country. The USA is a good example of this. During President Trump's time in office, many Democrats formed the antivaxx population who claimed they had no confidence in any vaccines that would be manufactured under him. This was to justify that they had no confidence in his handling of the pandemic. With the advent of President Biden, most of these same Democrats have automatically become great advocates of vaccination and vaccines mandates, while many Republicans suddenly reject the vaccines.

These are the reasons why a strong scientific and objective approach is necessary to overcome vaccine hesitancy amongst various populations. I will address some of the issues that have been raised by many who do not want to be vaccinated.

The Claims that "The Jabs Are Not Working - They Have Failed in Israel, Seychelles and Gibraltar".

We need to address these misinformations and misconceptions head on. We need to show that vaccination has worked all over the world especially in these "stated" countries. We need to address these issues head-on with readily available positive data, which shows that the vaccines have been working in the above stated countries.

All studies done concerning these countries, especially following the outbreak of the Delta variant of concern, have ALL pointed to the fact that vaccination is beneficial.

Gibraltar is generally considered by many as the safest place in the world with regards to COVID19.

Also emphasize how nations like Singapore, Seychelles, Gibraltar, Bahrain, Brazil have benefitted from vaccinations.

The following were noted in the last few days in relation to Vaccination Rate (VR).

Curaçao - 57% VR - No New Cases + No New Deaths.
Tucks & Caicos - >55% VR - No New Cases + No New Deaths.
Singapore - 83% VR - No New Cases + No New Deaths.
Sweden - 67% VR - No New Cases + No New Deaths.
Seychelles - 71% VR - No New Cases + No New Deaths.
*Gibraltar - *118% VR - 11 New Cases + No New Deaths.

*Gibraltor is a tourist destination (hence, the over 100% rate as many people come from other countries to be vaccinated here) and prior to their vaccination drive they had 94 deaths.

From beginning of vaccination drive in April 2021 to now (October 2021) only 4 additional deaths.

*Israel - 64% VR - 997 New Cases + 11 New Deaths.

Israel is the major highly vaccinated country of concern regarding re-infection or breakthrough infections. It was one of the countries to first roll out mass vaccinations. It must be noted a third of the population is below 14yrs. Though many adults were vaccinated, up to 1million of the 9million+ population were unvaccinated. Most of the vaccinated were the vulnerable elderly ones while a lot unvaccinated were the younger ones.

With the advent of the Delta variant many became infected including the vaccinated population.

Since, a lot of the adult population were already vaccinated, it stands to reason that there will be a high percentage of infected people that were vaccinated. Remember, that vaccination does not guarantee that one would not be infected but rather helps to reduce severity of the disease.

However, all Studies showed that the vaccinated did way better than the unvaccinated and were almost ten (10) times more likely to survive to illness.

Understanding "Simpson's Paradox"

This has often led to the misuse of statistical data. Antivaxxers often cash in on this misuse of data, because of their lack of knowledge of this phenomenon, which indicates that the relationship or association between two variables in a population emerges, disappears or reverses when the population is divided or disaggregated into subunits.

This is what happened in Israel. The initial picture that seemed like more vaccinated people were sick with COVID19 was a statistical myth, because the population itself had more vaccinated people in the adult elderly population. However, when you look at the different populations; vaccinated against unvaccinated, in relation to disease severity, it became pretty obvious that the unvaccinated were doing way worse than the vaccinated. Though, there were more vaccinated people in the hospitals, more of the unvaccinated were dying. It is also worth noting that the majority of the vaccinated who contracted COVID19 were people who were immuno-compromised hence, the recommendation that this group receive a third dose of the vaccines.

All studies out of Israel therefore, hailed and recommended vaccination because it was obvious that it was working.

In most other nations 95% of people admitted to the hospital are unvaccinated.

Another example of the "Simpson's Paradox" is in relation to the Case Fatality Rate (CFR) of COVID19 which is 2-3% generally, however when this is disaggregated you realize that this percentage could be very much higher in those with co-morbidities (e.g. over 8% in diabetes, over 10% in heart disease) and even as high as 15-18% amongst the elderly population.

Questions About Natural Immunity?

Contrary to what many think, you cannot be immunized against anything unless you are first exposed to it either via vaccination or by getting the infection. Hence, you have to be exposed to the infection in some way before anything can be said about natural immunity.

It is true that people who have contracted COVID19 do get variable immunity to the virus over a period of time. Hence, this concept of natural immunity speaks to those people who contracted COVID19 before they got vaccinated. Note that the immunity acquired following infection is variable hence, no one can be sure of its level in a particular person. Whereas vaccine immunity is standardized. It can be boosted by simply giving another shot. I'm sure you would not want us to boost your natural immunity by infecting again with Covid-19?

Two important questions for people who are relying on natural immunity.

1) Would you like to risk getting COVID19 in order to prove that you have natural immunity? I'm sure not.

2) Are you sure you'd be among the people that will survive?

How you answer those questions are critical to the issue of being vaccinated or staying unvaccinated.

Be aware that unvaccinated people who had COVID19 infection can also be re-infected and have been reported to have died from a different variant.

The science shows that fully vaccinated people were also less likely to be re-infected than unvaccinated people who were previously infected with Covid-19.

The science has also shown that people who got vaccinated after previously contracting COVID19 have a highly boosted immunity that is even said to be stronger than that in people who were vaccinated without previously getting COVID19. Hence, this is actually a stronger case for being vaccinated after you previously contracted COVID19.

There is no country on this earth where the unvaccinated are doing better than the vaccinated with respect to COVID19 infections.

Questions About The Third Dose

This is a novel virus that we continue to learn about as we go along. The advent of variants of concern also seemingly throws us a curve ball ever so often.

The vaccine induced immunity, has been very helpful so far. However, with the advent of the variants, that immunity seems to wane in certain populations namely the immunocompromised, the elderly and those with co-morbidities. Immune fragility (reduction is the strength of the immune system or response) amongst the elderly is also a well-known concept. A third dose was therefore recommended for this group.

Multiple vaccine doses are not unusual; for polio, diphtheria, tetanus and hepatitis, we standardly give three shots and in the case of polio, diphtheria and tetanus two additional booster shots are given before people are regarded as fully vaccinated. We must also note that additional booster shots are recommended for tetanus every ten years.

Regarding Vaccine Adverse Effects

I addressed this in an earlier article.

We must all acknowledge that though these are possible they are generally very rare. We must continue emphasizing the very low confirmed adverse effects since the advent of the vaccines. We also need to encourage formal reporting of any adverse effects so they can be documented and investigated. This is to ensure that you are not perceived as being interested in hiding information as some have accused us of being. If it's not reported it cannot be known.

Discourage the "gutter talk" method of "everyone knows someone who has had this or that complication or have died". People must be made to understand that science does not work like that.

We must also make them understand the real essence of CDC - VAERS and WHO - VigiAccess sites. These sites are not objective scientific sites and cannot be used to ascertain causation. No true scientist quotes these sites to prove correlation let alone causation. Hence, no one should rely on them for confirming reports on vaccine adverse effects.

We must continue to drive home the idea consistently that "Correlation is not Causation".

Regarding The Use Of Ivermectin?

This is a great drug; called a "wonder drug" and has been used for over 40years effectively in tropical infections. Theoretically, it appears to work in the lab against COVID19. However, medications working in the lab does not mean that they work in real life. The dose at which it worked in the lab is extremely toxic to humans hence the reason it has not been approved and it is now being examined / studied to see if it will work against COVID-19 at the dosage that is generally recommended in humans

At this time, no convincing trends have been established, hence, no WHO approval has been granted and therefore studies are ongoing. Until then, we will not use or recommend it.

We also distance ourselves from "studies" claiming that it works in the early phase of COVID19. We must remember that 85% of people with COVID19 can be totally asymptomatic. Also, the claims that it stopped the fever in COVID19 means nothing when dealing with most viral illness, where fever abating does not necessarily represent the fact that the patient is better as can be seen with dengue.

COVID-19 the disease, goes through at least three phases. The first phase of COVID19 involves fever, which can resolve on its own even without treatment. If disease persists the next phase (critical / cytokine storm) can be the most lethal phase and this phase is generally afebrile. This means fever abating generally does not reflect that the illness is resolving. The next phase can involve clotting and bacterial infection (because the cytokine storm reduces the patient's immunity and encourages opportunistic infection) which often leads to death and has many saying that COVID is not a virus but a bacteria.

Not understanding the course of the disease can make you think a particular treatment is working when in fact it is not.

Recent Permissions Granted By WHO To Extend Life Span Of Vaccines

The WHO recently granted some developing countries permission to extend the use of the vaccines to three months beyond their stated expiry dates. This is a standard pharmaceutical practice. Most medications can be used up to three months following their stated expiration date.

With respect to COVID19 vaccines, it was important to find out if this is applicable because of the novelty of the disease and vaccines. So, WHO's authorization for use up to three months post initially stated expiration date is simply to give comfort to the population. The medical community already understands this. Therefore, we should be attempting to reassure the population that this practice is safe and not abnormal.

Health Education

Heath Educators should be utilized in communities to ensure that accurate information is disseminated amongst the population.

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