|Year : 2021 | Volume
| Issue : 3 | Page : 199-202
COVID-19 pandemic and the vaccines in the year 2021: Current issues
Department of Obstetrics and Gynecology, MGM Medical College and Hospital, MGM Institute of Health Sciences (Deemed to be University), Navi Mumbai, Maharashtra, India
|Date of Submission||17-Jul-2021|
|Date of Acceptance||17-Jul-2021|
|Date of Web Publication||03-Sep-2021|
Dr. Sushil Kumar
Department of Obstetrics and Gynecology, MGM Medical College and Hospital, MGM Institute of Health Sciences (Deemed to be University), Navi Mumbai 410209, Maharashtra.
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Kumar S. COVID-19 pandemic and the vaccines in the year 2021: Current issues. MGM J Med Sci 2021;8:199-202
Never before the whole world was affected so much by a microscopic creature as it has been for the past 18 months. The total number of cases infected with coronavirus disease-2019 (COVID-19) around the world has climbed to 175,173,365 with the death of 3,777,011 (data as of June 10, 2021). Situation in India has been worse. The second wave of COVID-19 has struck India with tremendous ferocity, worse than a powerful hurricane. The virus has ambushed us when we thought it was about to vanish from the face of the earth. The public and the administrators alike had not anticipated it and were ill-prepared to handle the situation. The health infrastructure of the country (India) cracked under the tsunami of affected patients. There was a shortage of almost everything needed to manage COVID-19. The ambulances, hospital beds, medicines, ventilators, and trained medical manpower were grossly inadequate to handle the situation. Even oxygen that does not require any raw material to produce was scarce. A large number of patients all over India died due to the nonavailability of oxygen in the hospitals. The situation in metro cities such as Mumbai, Pune, Bangalore, and Delhi was unimaginable, especially during April 2021 and May 2021. The only way to prevent this catastrophe was to quickly vaccinate the entire population of a huge country like India, almost an impossible task.
The COVID-19 vaccines have been the most talked-about topic among medical professionals and the general public alike. Dr. PK Gosh has written an invited article on the efficacy of vaccines in the above 60 years population for the current issue of the journal. The author has focused on the efficacy of vaccines on the above 60 years old population. Among many things he discussed are the issues like the interval between two doses, types of vaccines, vaccines approval by the World Health Organization (WHO), complications of vaccines, the need for full-proof laboratory methods to test vaccine efficacy, and the effect of viral mutation on vaccine efficacy. It is a comprehensive article on a very important topic relevant to senior citizens. The COVID-19 pandemic has involved entire mankind. Some of the burning issues in respect to COVID-19 and insight into the science of vaccine making are discussed in subsequent paragraphs.
| WHY THE SECOND WAVE WAS MORE DEVASTATING THAN THE FIRST ONE IN INDIA?|| |
One of the scientific reasons could be a mutation in the virus, now known as the Indian variant or delta variant or more specifically B.1.617. The WHO has classified it as VOC (a variant of concern) due to its increased transmissibility. Even the vaccine’s efficacy becomes questionable when the virus mutates. Another factor responsible for the outbreak could be a drop of guard against the infection. There was a general perception in India that the pandemic was over. There were large social, religious, sports, and political gatherings in different parts of the country. People who were complacent about contracting the infection were moving around without masks and lax about observing social distancing. Both these factors together were responsible for the sudden surge in the number of active cases. The deaths due to COVID infection, especially among the younger population, had also been higher during the second wave. Probably the virus has become more virulent after mutation. The peak infection rate had crossed 400,000/day and the death rate more than 4000/day in early May 2021. The data available as of June 10, 2021 show that India has come to number two position after the USA as far as a total number of cases are concerned (29,182,072 cases) and number three position as far as total deaths due to COVID-19 is concerned (359,695 deaths).
Mucormycosis (black fungus) is a dreaded fungal infection with high mortality. The incidence of black fungus has also increased substantially during the second wave. It was found to be more common in COVID patients with diabetes or patients on steroids. In India, post-COVID, black fungus cases are reported to be about 28,252 as of June 7, 2021 as reported by news magazine MINT. The majority of cases of black fungus are from the state of Maharashtra and Gujrat. Here too there was a shortage of antifungal drug Amphotericin-B, which affected the treatment of many patients.
| THE ORIGIN OF COVID-19 VIRUS: IS IT NATURAL, ACCIDENTAL, OR MAN-MADE?|| |
There has been debate on the origin of the COVID-19 virus since 2019. I in my editorial in the same journal in May 2020, I did mention that some of the scientists felt that the virus originated from the Wuhan lab though the majority felt otherwise. However, fresh evidence suggests that the possibility of the lab-made virus does exist even today. WHO team of scientists was sent to investigate the issue did not find any evidence of the virus originated from the Wuhan lab. Two Indian scientists referred to fatal viral pneumonia in Mojiang (China) miners in 2012 and found that the manifestations of the disease were similar to COVID-19 natural history. Later in June 2021 in a television interview, they emphasized that the current evidence points to the possibility that the virus originated from the lab and it should be investigated again. Many scientists around the world are now questioning the earlier consensus that the virus originated naturally. Based on evidence, President Joe Biden of the USA asked for another investigation into the origin of the virus. These investigations may throw light on the origin of the virus whether it is natural, accidental, or man-made.
Recently, there has been a debate on Indian media on a research article from Indian scholars written at the time of the initial outbreak in 2019–2020. The article was later withdrawn but is now available in the public domain. The authors of this article had found that four unique inserts in COVID-19 glycoprotein were not present in any other coronavirus. All four of these inserts were present in short segment amino acids in HIV-1gp120 and gag. This revelation points finger at the possibility of human intervention in modifying the genetic code of the COVID-19 virus. Paul D Thacker, an investigative journalist, writing an interesting article in BMJ giving a chronological order of the events and media reports on the origin of the COVID-19 virus. He concluded that an independent and transparent investigation into the origin of the virus is the way forward. One of fear is if we could modify the functionality of the virus by changing its genetic code it may become a potent weapon for biological warfare.
| THE VACCINES FOR COVID-19|| |
The fascinating new science of vaccinology
COVID-19 has a profound effect on the development of vaccines and vaccine technology. Many of these technologies like “Reverse Vaccinology,” “Structural Vaccinology,” “Synthetic biology,” and “Addition of adjuvants” to increase vaccine potency were used to make a new more potent, and safe vaccine against COVID-19. Teleportation of genetic code by the Internet has helped in the preparation of synthetic vaccines within weeks rather than years. The new term for these vaccines is “Internet-based vaccines”. The only problem at present is the “human trials” that take few months. At the moment we do not have a computer model of the human immune system where synthetic vaccines/drugs could be tested in a very short period. However, the way the science of “Vaccinology” is developing, it is possible that the computer-based biotech model of the human immune system for vaccine testing may a reality in the future.
| THE DEVELOPMENT OF VACCINES AGAINST COVID-19 INFECTIONS|| |
The scientists or vaccine experts have used different approaches to make COVID-19 vaccines. The common ones are RNA or DNA-based vaccine, vector-based vaccine, live attenuated virus-based vaccine, and recombinant protein-based vaccines.
RNA vaccines appear to be the most successful ones with the least side effects at the moment. The “Pfizer” and “Moderna” vaccines are RNA-based vaccines currently being used in the USA and Europe. The main drawback of these vaccines is that they are to be stored at very low temperatures: Pfizer vaccine at 70°C and Moderna at 20°C. In these vaccines, synthetic gene is used to make the vaccine. However, the RNA vaccines are new and have yet to prove themselves on a large human trial conducted over several years.
Thevector-based COVID-19vaccines: The vaccine “Covisheild” was developed by Oxford University, UK, and consists of a replication-deficient adenovirus vector, containing the SARS-CoV-2 spike protein. The vaccine is also produced by the Serum Institute of India under an agreement. The majority of Indians have been vaccinated by this vaccine. The vaccine efficacy varies from 60–90% depending on the doses used. Another vector-based vaccine is the Russian vaccine Sputnik-V where an adenovirus is used as a vector. Sputnik-V efficacy is about 91.6%.
Whole-virion inactivated vaccines, “Covaxin”: A homegrown vaccine, jointly developed by Bharat biotech, ICMR, and Institute of Virology Pune, India. Algel-IMDG (an imidazoquinoline molecule chemisorbed on alum [Algel]) was designed to send the vaccine antigen directly into the draining lymph nodes without diffusing into the systemic circulation. Phase 3 data of this vaccine are yet to be published but the general impression among the medical fraternity in India is that “it is effective.”
A total of about 13 vaccines have been approved in various countries including the vaccines mentioned above. Others are as follows: Sinovac, Sinopharm, and Anhui Zhifei Longcom all three from China, and Adeno 26CoV2.S from Johnson & Johnson, USA. Hundreds of other vaccines are at various stages of animal or human trials.
| The vaccination program in india|| |
The development of vaccines is a very long and laborious process and under normal conditions, it takes 10–15 years to make a vaccine. The fact is that India could produce a vaccine of its own and produced another one under license in a year is a commendable job. Vaccine priority in India too was based on international norms and appears ethically correct. There were times in January–February 2021 when the vaccines were available but there were not enough takers. I think this fact could have been responsible for administrative complacency. However, the second wave of the COVID tsunami changed everything. Now the people are desperate for the vaccines but the supply is inadequate. In the hindsight, one may say that the government should have woken up early and sign a contract to import vaccines and could strengthen indigenous vaccine manufacturing by giving them firm order and monetary help. The export of India-made vaccines has also been criticized. However now the Government has committed to increase indigenous production and import the vaccine to vaccinate the entire population of India by the year-end. Hopefully, government commitment to vaccination will save India from future waves of COVID-19 infection.
The interval between two doses of vaccines has also been changed many times and this change created some confusion in the minds of the general public. Dr. Ghosh has also mentioned in his article that due to inadequate supply of vaccines; the countries are delaying the second dose. However, in respect of the Astra Zeneca/Oxford vaccine, the protection is for 90 days after first dose. Therefore, the second dose of the vaccine could be given at an interval of 12 weeks. His contention that the data in respect of dose interval should be generated for each age group for different vaccines appears valid and I am sure that these data would be available in time to come.
| FUTURE OF COVID-19 PANDEMIC, MIXING OF VACCINATION, AND VACCINATION OF CHILDREN AND PREGNANT WOMEN|| |
The future of the COVID-19 pandemic may be the most difficult question to answer especially after the tsunami of the second wave of corona infection. Many counties have gone through third and fourth waves of infections. In those countries, the effect of third and fourth waves of infections has been limited due to extensive vaccination programs. In India, as of 10 Jun 21, a total of 25 crore doses have been given and only 4.6 crore population has been fully vaccinated. It means a total of 18.4% received single dose and 3.6% population is fully vaccinated. Under these circumstances the possibility of the third wave of COVID-19 is very much there but when is the question?
Many epidemiologists have predicted third wave in the October–December period involving children. So far vaccination program is only for adults and the age group below 18 years is not included. The phase 3 trials on children have already commenced and hopefully, the favorable outcome of trials will be available before the virus strikes again. The State Governments in India are already strengthening the medical infrastructure for the pediatric group.
Another vulnerable group is pregnant women. So far pregnant women are excluded from vaccination programs. After intense discussion on the subject, the advisory group of the Indian government for vaccines has allowed pregnant women to get immunized against COVID-19 infection. Centers for Disease Control and Prevention (CDC) has also recommended the same as the benefits from the vaccine outweigh the risks.
The question about the mixing of vaccine mixing is often asked. So far there is no large study available in this regard. However, the small numbers of patients who have been accidentally given two different vaccines have so far not shown any serious side effects. India may be in a unique position to conduct these studies as multiple vaccines may be used in the country in due course. Recently, Lancet also published a small series of heterologous vaccination showing robust immune response.
Delta variant breakthrough infection after vaccination with Covishield and Covaxine vaccines is approximately 2%. It means that the vaccines used in India are effective. Even the intensity of COVID infection has been less in the patients vaccinated against COVID-19. Single dose is also said to provide certain protections.
It may be fair to conclude that COVID-19 is here to stay for the next few years but maybe with lesser intensity just like influenza. Social distancing, the surveillance of the virus for the mutation, and the global vaccination programs will play a big role in controlling the pandemic. As far as the origin of the virus is concerned detailed investigations are a must. If the viruses can be modified in the labs, then we are in for more serious pandemics in the future.
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Conflicts of interest
There are no conflicts of interest.
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