Light at the End of Vaccine Tunnel
By Priyangwada Perera
The word of the year would be ‘vaccine’ and there rests all our hopes. “A vaccine is given for three purposes. First is to prevent getting COVID-19. The second is, if you get infected, to minimise the severity. The third one would be to prevent transmitting. But if one vaccine can provide answers for all these questions, that is brilliant,” Professor and Consultant in Clinical Immunology and Allergy at the Institute of Immunity and Transplantation, Royal Free Hospital and UCL, London, and Health Services Laboratory London UK Prof. Suranjith Seneviratne who is also an old Peterite, explained.
One type of infection is when a person is infected with COVID, but is not infectious. The other is when a person is infected but the condition is not severe. This was the most prevalent condition in Sri Lanka. If we consider the cases per population, Sri Lanka did not have that many severe cases or deaths. The next would be that the person is infected but does not transmit.
How vaccines work
Prof. Seneviratne explained further. “What a vaccine usually does is, it prevents a person from falling ill. Even if a person is infected the patient can be asymptomatic or not get it severely. If the severe disease is not prevented through the vaccine it will eventually result in an outbreak. In such an instance, the health care system is going to be badly affected, putting more lives in danger.”
Taking all this to consideration, the vaccine is first tested on healthcare workers, social workers, and old people.
Older people are more at risk and the thought of having them locked up indefinitely is even scarier. “What happened in Italy was that the spread was rapid and resulted in overwhelming the system.”
Looking at this broadly, Prof. Seneviratne said, “Even if vaccines are approved, is it going to be a one time or does it require two doses in a couple of weeks time, or for how long can it protect us, are important questions. Is it like the vaccine for Influenza? Is it required to be taken every year or will once in five years be sufficient?” Prof. Seneviratne’s questions made us realise this is no easy task. We generally look at the vaccine as the magic portion that would free us from this menace of a virus. But it is much easier said than done. More importantly, it is something that takes time.
“Antibodies and good white bodies have been checked up to four months and they are still persisting. That is great. But if not, we will need a third booster. Then for how long will the protection be?” These were valid questions that we pay little attention to.
As the general public, we hardly know anything about immune changes and clinical implications, antibody responses, and COVID Vaccine and cellular responses. This is why scientists, immunologists, and various medical personnel are working hard. Prof. Seneviratne said, “We expect the vaccine to produce cells that have ‘memory’. So, when a person has an infection in future, that memory will come in handy. Just like us, cells too have different kinds of memory.” If this memory prevails, they will fight the disease.
Affording the vaccine
All this information apart, what is most important is whether Sri Lanka will get the vaccine. Prof. Seneviratne said that as a member country of the WHO, each country has to put in money to buy the vaccine. A certain number would be given free of charge for poorer countries through the COVAX facility. This being a global pandemic, four million doses of an approved vaccine is targeting high-risk groups such as co-morbidity, close contact groups such as health care workers and the military. In Sri Lanka, even if the vaccine is given to those who are older than 16 years, 16 million people are eligible in the country. While only 4 million doses are approved free, another 12 million should be sourced. The US, UK, Australia and Canada have already reserved or bought the vaccine and sometimes even twice or five times more than their population. Governments around the world are negotiating with them to get access to the vaccine, for less money.
Prof. Seneviratne also pointed out what a massive challenge this is going to be. “Governments also have to balance it out against the economy being down, people having to be quarantined and also sanitisation, testing, quarantine, school issues, low output in all industries, and so on.”
Anti-vaxxers spreading fake news
While the anti-vaxxers rage, opposing vaccines and distorting information, Prof. Seneviratne explained, “After clean water, vaccination has been the biggest advantage of humankind. Next are antibiotics. Sri Lanka has a wonderful service of vaccination. It is the most cost-effective of medical interventions. It is the best for countries with small economies. Sri Lanka leads the way in many medical achievements due to our strong children’s vaccination programmes. Countries such as Pakistan are very sceptical about vaccines. However, nothing has a 100 per cent guarantee. There are anti-vaxxers who use a lot of incorrect information to frighten and discourage people. They twist medical knowledge and say vaccines damage DNA. Sadly, they sound very convincing and we still have 1.9 million premature deaths in the world per year because people refuse vaccination.
A time-demanding process
Prof. Seneviratne said that vaccines at least take 15 years of study and tests. But when we say that a vaccine is ready, it is not as if shortcuts were taken. “We always have parallel studies. They are at different grades of scientific study and discussions with pharmaceutical companies. This is the reason the vaccine appeared fast because the testing phases; I, II, and III had been ongoing.”
In order to assure people that vaccines are not what you come up with haphazard work, Prof. Seneviratne explained the contracts were already given to major companies to make the vaccine. “An institute in India, one partnering Great Britain and France, an Australian company were all are working on the vaccine. The British and Australian one did not work and they had to abandon it. Around May, last year everything looked doubtful. In December 2019, nobody ever believed the world would be this. Then later on, it looked as if we will never find a vaccine. But things had to change. Sufficient vaccines should be tested and approved to protect people.”
Sticking to basics is a must
Prof. Seneviratne said that where vaccines and medicine have been disappointing and took time, general measures have worked. “We need to remember that social isolation and basic sanitation measures such as washing hands, keeping distance have worked and must continue,” he said. “However, these measures were jutting against people’s freedom. Sri Lanka being an island, the lockdowns and hospitals focusing on COVID-19 have not worked well for the nation. That is why we need to have a plan. General wellbeing is the concern. We have to hope for something beyond masks and social distancing,” Prof. Seneviratne said.
Similarities in Eastern and Western medicine
Registered Ayurveda Doctor Sandun Sarath Kotteyawattha, of Hulugalla, Nikaveratiya Kotteyawatha Veda Gedara and the Chief Physician of Sandun Veda Medura at Independence Arcade said, “We are doctors of indigenous medicine. Whatever the disease, we see it as an imbalance of va, pit, sem or the invisible or invasive species such as worms which invade our body. These forms have remedies and cures, especially for ailments in the chest and related organs.”
There is a great demand for indigenous medicine around the world and COVID-19 intensified it. Ginger and coriander became common from the mansion to the hut. This gave recognition to our medicine. “‘One portion medicine, two portions of wisdom’ is what my Kotteyawattha ancestors have prescribed. From medicine to what gives peace to the mind, are all included in our method of healing.”
The vaccines introduced in Western medicine works on immunity. Similarly, in our medicine when immunity is low, nothing can be healed, particularly when fighting against a virus or a contagious disease. They say in China, their Chinese indigenous medicine is what helped them control the disease. Patients are given the choice to opt for it. In every country, native wisdom helped them overcome. In Sri Lanka, we too should join hands with western medicine and technology.
How indigenous medicine was misused here is common to any field. People will understand who the crow and who the cuckoo bird is. It has become a common cultural aspect. People still believe in traditional medicine. But we have to wait till the investigations and research is done. Where they come to limelight before the results are proven, people get misled. There are versions in traditional medicine. Some are born to it and genetically inherit it and knowledge too is transformed that way. The others have studied it from old valuable books. But to fill the gap of a proper teacher or a family root, they absorb devalas and various other things.
Our ways should also be considered
From the oldest hospital at Mihintale which is 2,500 years old, where theatres and quarantine rooms are all visible, we have had a lot to start with. Just like Ayurveda medicine, the traditional indigenous medicine should also be supported further. Ayurveda doctors too should be given the exposure for experiments and clinical investigations. Usually they are marginalised.
Dr. Kotteyawattha said, “When opting for indigenous medicine, we can check for roots. People should check who their parents are. One medicine can work fine. But that does not mean you are a true healer. One should have a teacher. There is a registration to be done, plus the ethics in medicine. There are also others who have some special calling for this who can also do it methodically. We do not have ‘forever cures’. One has to experiment and find out whether they are foolproof. The recent local ‘cure’ for COVID-19 came from someone who is not a doctor but it has to be carefully, methodically, and cautiously done. Empower these doctors before asking them whether they have a cure or not. Give them space and facilities.”