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Currently available Covid-19 vaccines: Some important considerations

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By Dr. B. J. C. Perera

MBBS(Cey), DCH(Cey), DCH(Eng), MD(Paed), MRCP(UK), FRCP(Edin), FRCP(Lon), FRCPCH(UK), FSLCPaed, FCCP, Hony FRCPCH(UK), Hony. FCGP(SL) 

Specialist Consultant Paediatrician

 

Just about a year or so into the coronavirus pandemic, the thing that is in everyone’s mind, as well as in their hearts and souls, is the COVID-19 vaccine that is thought to be one of the answers to the problem. The disease has taken a frightful toll. Many have died and scores of others have suffered immeasurably, directly as well as indirectly. Many countries are in shambles and most of us are wondering as to what would come next.

As at present, there are several vaccines that have been rolled out and some are being administered in committed immunisation programmes in quite a few countries. This is no mean feat as these vaccines have been manufactured, tested and licensed in double-quick time. We, too, in this resplendent isle, have now got some stocks of the vaccine, through the generosity of several countries and institutions. The future plans are to deploy the vaccines globally in a dedicated effort towards controlling this blight that has caused all this mayhem. It speaks so much for the brilliance, dedication and commitment of many scientists that a process that normally takes several years has been shortened to just under a year.

Yet, for all that, this spectacle of the shortening of the time-frame has led to many questions being asked in several quarters and some inclinations of suspicion, and even mistrust, being expressed by some. This has been further amplified by the novel technology employed in producing the vaccines. However, there is hardly any doubt that vaccines are the principal tool by which we can challenge this pandemic which is now going onto its second year. If we are to have any worthwhile hope of getting back to some sort of “normalcy” and saving countless millions of lives, extensive immunity, through vaccine inoculation, is of the essence. There is incontrovertible evidence that the currently available vaccines do produce a reasonable degree of protection, especially against the severity of the disease, by mobilising the resources of the human immune system. They are likely to reduce the morbidity and the mortality of the disease. However, we do not know for sure whether it would prevent the spread from person to person. In addition, we also do not know for sure as to how long the immunity would last in the vaccinated people. These would need to be sorted out once more scientific information is available post-vaccination.

There is quite a bit of apprehension as to whether the vaccines were ‘rushed’. The scientists assure us that no safety steps were either cut down or even short-circuited. These vaccines have gone through the mill of testing in several Standard Phase Clinical Trials, just like any others that have been in use for many other contagious infective diseases. True enough, the timelines have been considerably shortened but the due processes have been followed. All three phases of research trials have been undertaken, albeit at a fast-tracked pace. The efficacy, safety and tolerability have been adequately looked into. None of these steps have been omitted or side-tracked for the Pfizer, Moderna or AstraZeneca vaccine development processes. In fact, mainly due to the extensive occurrence of the disease and the committed focus on developing a vaccine, there was no shortage of patients with the disease and there were more than enough subjects ready to be enrolled into trials as well as sufficient funds were available to conduct the research work that was needed. It may be a surprise but it is a fact of life in these circumstances and it is indeed most encouraging to see the way science has progressed in leaps and bounds to move that much faster through sheer necessity, to do all the work necessary in producing effective vaccines.

As for the safety of these vaccines, the detailed studies that were conducted over a period of about 9-10 months have shown them to be safe. The Phase 3 studies for all the major vaccine candidates are still ongoing. Furthermore, many side-effects from vaccines occur within a short period vaccination and as trials have been going on since April 2020, these reactions would have already been seen. There has been mild undesirable effect but so far, no major side-effects have been reported in a scale that would invalidate the vaccines. However, we have to await further results of the research endeavours to know about any possible long-term side effects. These would usually come through post-marketing surveillance.

In fact, BioNtech and Moderna have been working on their proprietary messenger ribonucleic acid (mRNA) technology long before COVID-19 came into the arena. They knew a lot even about the vagaries of the process. Scientists view this expertise as a ground-breaker when it comes to vaccine advancement; cutting down development time and thereby making mRNA candidates cheaper and more amiable to be custom-made than the traditional vaccine candidates.

There are some concerns expressed by many as to whether the mRNA vaccines could alter the deoxy ribonucleic acid (DNA) of humans. So far there is no tangible evidence that this is the case. Apparently, mRNA does not alter or interfere with DNA as it does not hang around in humans for long periods of time. It crumbles and disappears after a certain short time and thereby are thought to be even safer than old-style vaccines. Traditional live vaccines inject small amounts of the live virus and attenuated vaccines inject the inactivated virus into the body. With mRNA, it is only a kind of a blue-print of a recognisable component of the organism that is injected.

The well-known target of a vaccine is to teach the body defences to detect and recognise the causative organism of a disease. When a virus infects a host cell, the virus releases its RNA which gets into the host cell nucleus and reproduces itself using host cell machinery. Viral mRNA then copies viral RNA into proteins which then reassemble as more viruses. These newly synthesised viruses enter into the host cell blood stream and then all hell breaks loose.

The current mRNA vaccines generally recreate the blue-print of the outer shell or the spike protein of the virus. The spikes are the components that enable the virus to attach itself and get into the host cells. Therefore, anything that can interfere with these spikes will knock off the virus before it can get into the human cells. All that the vaccines do is to induce the human immune systems to recognise and interfere with the spike proteins. Our immune system recognises Sars-Cov-2 via the spike protein and by sending some “placebo-like” spike proteins into the system via the vaccine, it gives them an early start in being prepared for potential infection. Members of our immune system are usually moving around in the bloodstream looking for possible ‘none-self’ intruders. When these sentinels come across the spike proteins, they launch an immune response. That would be the end of the story for the virus.

Having said all this, there is a current dilemma that needs to be addressed urgently. Very recently, both AstraZeneca and Pfizer have reported considerable delays in production and supply of their vaccines. As if we do not have enough problems on our hands due to this blight of a virus, this adds another dimension to the equation of the equity of provision of the vaccines to those desperately needy people of our planet. This graphically highlights the massive constraint the world is facing in getting everyone, everywhere, vaccinated because of the exclusive rights pharmaceutical companies hold over who is allowed to produce and manufacture their vaccines. Given the current crisis, this is very definitely quite unacceptable. While every week higher and higher new infection records are hit, hospitals are overwhelmed, and people struggle to feed their families, pharmaceutical companies ‘cherry-pick’ as to who gets access to vaccines. Commercial interests and filthy lucre seem to rule the entire scenario. The market will not solve this challenge. What we need are exceptional measures and incomparable leadership from the statesmen and stateswomen of the world to solve this problem. It is time to call a spade, just that – a spade.



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UNFORGIVING CONSEQUENCES OF DEFORESTATION

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By Eng. Thushara Dissanayake

A forest is much more than a group of trees. Clearing of forests for agriculture has been an age-old practice. We accepted chena cultivation as a traditional livelihood of the rural poor. Secondly, we had ample forestlands throughout the country. Another cause of deforestation is development activities, besides logging and gem mining in some cases. Because of these acts, either legal or illegal, our forest cover has fast dwindled posing many serious environmental issues.

According to the World Food and Agriculture Organisation (FAO), by 2015, the estimated forest area in the world equaled 31 per cent of the earth’s surface area, most of which was located in tropical areas such as Africa, South America, and Indonesia. Today, according to experts, we have only 17 per cent of the forest cover left in this country.

People are the ultimate managers of forests and the higher their level of knowledge and awareness, the better their ability to conserve forests. It is unfortunate that recent incidents prove that people are not serious about the environment.

We are living in an era where climate change has become a major challenge. Ever-increasing amounts of carbon dioxide emitted to the atmosphere, mainly by the burning of fossil fuels has caused global warming, which renders myriads of bitter consequences. In the meantime, deforestation has been identified as the second major driver of climate change. It is forests which can help us reduce the excessive amount of carbon dioxide in the atmosphere playing a leading role in the fight against global warming. Forests act as a carbon sink and probably the only entity that is capable of carbon regulation. On average, the amount of oxygen produced annually by an acre of trees is about 2,500 kg while the annual oxygen consumption of a person is 750 kg.

Trees relieve people from stress and make them more comfortable while enhancing their well-being. Without trees, the world would not be beautiful and appealing. The earth has millions of different varieties of trees. Many trees do not remain the same throughout the year. When we plant a tree, we are emotionally attached to it and keen to observe its growth day by day. Sometimes we plant a tree to mark a special event and it may be our birthday, the day of marriage, or the demise of a close relative. Bhutan introduced the Gross National Happiness (GNH) index, which is used to measure happiness and well-being of its people. One of the four pillars of GNH is environmental conservation.

Even our tourism industry, which is one of the main sectors that bring us foreign exchange, vastly depends on the natural beauty of this country. If we fail to maintain its unique natural beauty, the country will cease to be a tourist attraction, jeopardising the industry.

The contribution of trees to the ecosystem is massive. Trees improve air quality by trapping solid particles, retard rainfall-runoff and thereby mitigate floods, increase groundwater recharge, and preserve soil by preventing erosion. The sustenance of our river system largely depends on the central forest area being the source of water. Not only forests but even green areas such as shrubs and turfs inside forests also contribute to the ecosystem immensely. Although they receive less attention, they can filter air by removing dust and absorb many pollutants like carbon monoxide, sulphur dioxide, and nitrogen dioxide.

Forests are home to wildlife. The same is true of humans and the survival of humans is also dependent on forest conservation.

 

The way forward

If the concept of vertical development is followed, not only in major cities but also in other areas, the acquisition of forest areas for human settlements can be significantly minimised as high rise buildings will obviate the need for many acres of land. Modern technology has to be used in agriculture together with methods that could contribute to high water use efficiencies to increase productivity rather than expanding agricultural land areas. Human settlements in less developed rural areas should be discouraged. There are large amounts of barren lands, including abandoned paddy lands, that could be used for afforestation if a proper mechanism is put in place to compensate landowners. These are several effective strategies which should be implemented sooner than later as policy interventions on all fronts are required to protect our existing forests. If the country’s forest cover shrinks further, we will all have to face bitter consequences sooner than expected.

 

(Eng. Thushara Dissanayake is a Chartered Engineer specialising in water resources engineering with over 20 years of experience)

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HYPOCRICY OF OUR COLONIAL MASTER!

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By Dr Upul Wijayawardhana

Irrespective of what happens at the UNHRC, there is one thing we should never forget; the arrogance and hypocrisy of our colonial master! The behaviour of the British Government is despicable. The UK has taken from the ‘nouveau-evil empire’––the US––the task of pressuring member nations of the UNHRC to vote against Sri Lanka! All this for the crime of defeating terrorism! Is this what is expected of the so-called leader of the Commonwealth?

It is a shame that the British representatives have not read Mathias Keittle’s excellent, well-reasoned piece “A German Analyst’s View on the Eelam War in Sri Lanka” which appeared in The Island on 28 February.

Considering there are allegations that some friends of high-ranking politicians of the British government made a mint from Covid-19 epidemic, one begins to wonder whether the Tiger-rump has helped some of them line their pockets. After all, it cannot simply be for a few votes. It will be interesting to see if the British government can counter what Matias Keittle so emphatically stated:

“Sri Lanka eliminated a dreaded terrorist group, with intricate global links, but receives little credit for it. Unlike elsewhere in the world, Sri Lanka has succeeded in resettling 300,000 IDPs (Internally Displaced Persons). There are no starving children for the NGOs to feed but this gets ignored. Sri Lanka has avoided mass misery, epidemics and starvation but the West takes no notice of this. Sri Lanka has attained enviable socio-economic standards for a developing country while eliminating terrorism but gets no acknowledgement. The government of Sri Lanka and its President continue to enjoy unprecedented popular approval through democratic elections but this is dismissed. The economy is functional, but remains not encouraged by the West.”

My concerns perhaps are confirmed by what Lord Naseby, a government peer sitting in the British House of Lords, has stated. The following from the statement by Lord Naseby published in The Island of 5 March under the title, ‘Lord Naseby asks why Adele not prosecuted in the UK for child recruitment’, surely, is an indictment on the British government:

“I am astounded how the UK or any other Member of the Core Group can possibly welcome the High Commissioner’s so called ‘detailed and most comprehensive report on Sri Lanka’ when it is riddled with totally unsubstantiated allegations and statements completely ignoring the huge effort to restore infrastructure and rehouse displaced Tamils and Muslims, who lost their homes due to the Tamil Tigers.

“Furthermore, I question how the UK government knowingly and apparently consciously withheld vital evidence from the despatches of the UK military attaché Col. Gash. Evidence I obtained from a Freedom of Information request, resisted by the Foreign Office at every stage for over two years. These dispatches from an experienced and dedicated senior British officer in the field makes it clear that the Sri Lankan armed forces at every level acted and behaved appropriately, trying hard not to harm any Tamil civilians who were held by the Tamil Tigers as hostages in a human shield.

“This conscious decision totally undermines the UK‘s standing as an objective Leader of the Core Group; made even worse by the impunity for not prosecuting the LTTE leader living in the UK, largely responsible for recruiting, training and deploying over 5,000 Child Soldiers – a real War Crime. It is time that the UK Government acknowledges and respects the recommendations of the Paranagama Commission, which involved several international expert advisers, including from the UK – Sir Desmond de Silva QC, Sir Geoffrey Nice QC, Rodney Dixon QC and Major General John Holmes.”

Her Majesty, Queen Elizabeth II, has strived so hard to strengthen the Commonwealth of Nations so that the UK could successfully transform itself from a colonial master to a friend of the past colonies but Her Majesty’s Government seems to be behaving in a manner to undermine Her efforts. Her Majesty’s vision of friendship and cooperation seems to be countered by the bully-boy tactics of politicians.

The excellent editorial “Should SL follow UK?” in The Island on 24 February concluded with the following:

“Anything Westminster goes here. It is the considered opinion of the defenders of democracy that Sri Lanka should emulate the UK in protecting human rights. What if Sri Lanka takes a leaf out of the UK’s book in handling alleged war crimes? In November 2020, the British Parliament passed a bill to prevent ‘vexatious’ prosecutions of military personnel and veterans over war crimes allegations. This law seeks to grant the British military personnel, who have committed war crimes, an amnesty to all intents and purposes. The International Criminal Court (ICC) has ascertained evidence of a pattern of war crimes perpetrated by British soldiers against Iraqi detainees, some of whom were even raped and beaten to death. Curiously, the ICC said in December 2020, it would not take action against the perpetrators! Too big to be caught?”

the UK may argue that it has to protect military personnel against vexatious prosecutions. If so, they should understand the position of Sri Lanka. We know that the US administrations, be it under Obama, Trump or Biden, run more on brawn than brain but we expect better from the UK. Why or why do they have to behave like a poodle of the US.

Is this not hypocrisy of the highest order? Shame on you, the British government!

 

 

 

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ASIAN DEMONSTRATORS AND THE AMERICAN DREAM

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The US was always a selective supporter of democracy, and now it is a diminished one. 

By Ian Buruma

One month ago, in Myanmar, protesters against the military coup gathered around the United States Embassy in Yangon. They called on President Joe Biden to make the generals go back to their barracks and free Aung San Suu Kyi from detention. Her party, the National League for Democracy, won a big victory in the 2020 general election, which is why the generals, afraid of losing their privileges, seized power.

But is the US Embassy the best place to protest? Can the US President do anything substantial apart from expressing disapproval of the coup? The protesters’ hope for a US intervention shows that America’s image as the champion of global freedom is not yet dead, even after four years of Donald Trump’s ‘America First’ isolationism.

Demonstrators in Hong Kong last year, protesting against China’s harsh crackdown on the territory’s autonomy, even regarded Trump as an ally. He was erratically hostile to China, so the protesters waved the stars and stripes, hoping that America would help to keep them free from Chinese communist authoritarianism.

America’s self-appointed mission to spread freedom around the world has a long history. Many foolish wars were fought as a result. But US democratic idealism has been an inspiration to many as well. America long saw itself, in John F Kennedy’s words, as a country ‘engaged in a world-wide struggle in which we bear a heavy burden to preserve and promote the ideals that we share with all mankind.’

As Hungarians found out when they rose up against the Soviet Union in 1956, words often prove to be empty. The Hungarian Revolution, encouraged by the US, was crushed after 17 days; the US did nothing to help those it had egged on.

Sometimes, however, freedom has been gained with American help, and not just against Hitler’s tyranny in Western Europe. During the 1980s, people in the Philippines and South Korea rebelled against dictatorships in huge demonstrations, not unlike those in Hong Kong, Thailand, and Myanmar in the last two years. So, of course, did people in the People’s Republic of China, where a 10-meter tall ‘Goddess of Democracy,’ modelled on the Statue of Liberty, was erected on Tiananmen Square in 1989.

The Chinese demonstrations ended in a bloody disaster, but pro-democracy forces toppled Ferdinand Marcos’s dictatorship in the Philippines and South Korea’s military regime. Support from the US was an important factor. In Taiwan, too, authoritarianism was replaced by democracy, again with some US assistance.

But what worked in the Philippines, South Korea, and Taiwan is unlikely to work in Thailand, Hong Kong, or Myanmar. The main reason is that the former three countries were what leftists called ‘client states’ during the Cold War. Their dictators were ‘our dictators,’ protected by the US as anti-communist allies.

Propped up by American money and military largesse, they could continue to oppress their people, so long as the US saw communism as a global threat. Once China opened for business and Soviet power waned, they suddenly became vulnerable. Marcos was pressed on American TV to promise to hold a free and fair election. When he tried to steal the result, a US senator told him to ‘cut and cut cleanly.’ Marcos duly ran for his helicopter and ended up in exile in Hawaii.

Similarly, when South Korean students, supported by much of the middle-class, poured into the streets, angry not only with their military government, but with its US backer, America finally came down on the side of democracy. Dependent on American military protection, the generals had to listen when the US urged them to step aside.

The generals in Thailand and Myanmar have no reason to do likewise. Biden can threaten sanctions and voice his outrage. But with China willing to step in as Myanmar’s patron, the junta has no reason to worry very much (though the military has been wary of China up to now).

Thailand’s rulers, too, benefit from Chinese influence, and the country has a long history of playing one great power against another. And because Hong Kong is officially part of China, there is little any outside power can do to protect its freedoms, no matter how many American flags people wave in the streets.

Dependence on the US in Europe and Asia, and the clout that Americans held as a result, was sustained by the Cold War. Now, a new cold war is looming, this time with China. But US power has been greatly diminished since its zenith in the 20th century. Trust in American democracy has been eroded by the election of an ignorant narcissist who bullied traditional allies, and China is a more formidable power than the Soviet Union ever was. It is also vastly richer.

Countries in East and Southeast Asia still need US support for their security. As long as Japan is hindered from playing a leading military role, because of a tainted past and a pacifist constitution, the US will continue to be the main counterweight to China’s increasing dominance. But as Thailand’s deft balancing of powers demonstrates, US allies are unlikely to become ‘client states’ in the way some were before. Even the South Koreans are careful not to upset their relations with China. The US is far; China is near.

This pattern is to be expected. US dominance can’t last forever, and Asian countries, as well as Europeans, should wean themselves from total dependence on a not-always-dependable power to protect them. Being a ‘client state’ can be humiliating. Yet, the day may come when some people, somewhere, might miss Pax Americana, when the US was powerful enough to push out the unwanted rascals.

 

(Buruma is the author, most recently, of The Churchill Complex: The Curse of Being Special, from Winston and FDR to Trump and Brexit.)

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