The Coronavirus and the Vaccine: How Did We Get Here, and How do We Move On Ahead?

As the pandemic rages on with  fury around the world, the fight for  life  marches on. But in the company of growing struggles, just how successful will efforts of immunization production and distribution be, and is New York — or even the world — properly equipped to face the continued threat of the pandemic?

These are difficult questions, but are important ones we need to tackle. The idea that a fairytale ending has arrived for the pandemic is preposterous, and the struggle is far from over. As a matter of fact, as the wealthy and powerful countries begin hoarding vaccines for their own populations, it is estimated that “many people in low-income countries might have to wait until 2023 or 2024 for vaccination.” If the fight stretches on that long, we’d better understand why and how to prepare for it.

An Overview of Coronavirus Concerns

We are confronted with the shock waves of a global pandemic and in desperate need for a response. Even more worrying, there are now reports of possible (but rare) neurological and dermatologic problems affecting patients infected with the coronavirus, including hallucinations and skin rashes. COVID-19 has left nearly one in five patients with mental illness, including reported brain damage owing to incidents of strokes and haemorrhages, including an occurrence of necrosis and cavitation. Long-term scarring to the tissue of alveoli in the lungs is also described in severe cases of COVID-induced pneumonia.

There are a handful of strains and mutations in the Novel Coronavirus, including one newly discovered in the United Kingdom. The Moderna and Pfizer-BioNTech vaccines are seemingly protective against all the known emerging strains, and the Johnson & Johnson vaccine candidate shows promising signs, but only more research and time will tell of the stumbling blocks we may encounter in the future. Despite that, the virus exhibits minimal variability and its mutation rate remains low. It should not generally impede upon vaccine research, development, or deployment. Although some strains (the Brazilian mutation or the South African one) are more contagious than other, the mainstream symptoms have remained unchanged: a continuous cough, chest pains and tightness, dyspnea, headache, palpitation, conjunctivitis, mild muscle and body aches, and a loss of taste and smell are still the primary symptoms of these coronavirus strains.

In the span of one year, over 75.5 million people became infected with this disease, germinating from a lack of control, a lack of knowledge, and a lack of preprepation. It looks as though the development and deployment of the vaccine must inevitably become the next step forward towards nipping this virus in the bud once and for all.

On Vaccine Development and Deployment

According to the World Health Organization:

“Vaccines contain tiny fragments of the disease-causing organism or the blueprints for making the tiny fragments. They also contain other ingredients to keep the vaccine safe and effective. These latter ingredients are included in most vaccines and have been used for decades in billions of doses of vaccine.”

As any scientist will tell you, vaccine development for infectious diseases of any type is a painstaking process.. This is because the clinical testing process before authorized roll-out tends to evolve in phases of development, ranging from laboratory research lasting several years to eventually thousands of volunteers and patient groups testing the efficacy of the medical treatment. Altogether, the development takes anywhere from six to ten years to complete.

Once gathering enough data that verifies the production of a safe, effective, and licensed product ready to distribute for public usage, the product must undergo regulatory authorization. The vaccine’s roll-out in just small numbers can take months, and safely distributing the vaccine to every country will be a cosmic challenge going forward. Even following this, postmarketing surveillance must continue to ensure that no long-term effects derive from the treatment and that it remains a safe and viable option during the public health crisis.

There are many different vaccines in development right now. For us, the most relevant vaccines are the Pfizer-BioNTech vaccine and the Moderna vaccine, both of which are mRNA vaccines. Being designed to trigger an immune response by producing viral proteins, they are said to offer potent immunity against infectious diseases.

Some people have expressed discontent with the fact that six volunteers have died during the Pfizer vaccine trial, two of whom were given a dose of the vaccine. The FDA has come out and said that “none of these deaths were assessed by the investigator as related to study intervention.” There have been other cases as well, but no data shows a link between individual deaths and this vaccination. Investigations are underway in Norway reviewing similar cases with the frail and elderly, but in the United States, the CDC claims there are contraindications and precautions are in place to prevent this from happening.

Due to the fact that the coronavirus is an immediate concern, a classical vaccine (one that takes at least ten to fifteen years to develop) is often said to be something we cannot wait on. The swift race for a vaccine therefore makes sense to many people, but what about the risks? People have raised concerns over possible long-term repercussions on the grounds of going at this in one fell swoop. For starters, no coronavirus vaccine has existed prior to this pandemic, and no mRNA vaccine — which may pose unique risks of autoimmune diseases for some patients — has been distributed for widespread usage. “Until now,” says Jennifer Abbasi, a mRNA vaccine “hasn’t been tested in large-scale human trials.” We are still unsure whether or not the vaccine will provide for a sufficient immune response, nor how long it may potentially last, though it does appear formidable as we move ahead. Another cause for concern is that the Pfizer vaccine, for instance, is extremely fragile and can spoil if not stored at negative 70° Celsius. 

People are also worried over claims of serious side effects linked to the Pfizer-BioNTech vaccine. Side effects, which typically last several days, commonly include pain at the injection site, muscle and joint pain, fever, chills, tiredness, and headache. According to The Washington Post, “they’re also a biochemical mystery. No one knows what component of the vaccine incited the anaphylactic reactions.” It is true that we are not fully aware of the full-scale risk of mRNA vaccines, in particular these two designed for COVID-19. According to The Conservation, “short-term trials on small population samples relative to the numbers expected to receive the vaccine may also not be able to pick up relatively rare but important risks.”  Generally speaking, those that are worried about adverse effects should mention their medical conditions to their providers prior to getting the shots.

Although less likely, there are issues associated with the other vaccines, such as Moderna’s adverse reactions ranging from pain at the injection site, fatigue, headache, myalgia, chills, nausea/vomiting, and fever to rare allergic reactions. According to the CDC, only 1% of people so far have reported complications with the Moderna vaccine. Administered as a 2-dose series into the muscle, the Moderna vaccine shows approximately 92% efficacy in protecting against the coronavirus. Other data reports an efficacy of 94.1% or 94.5%.

One Greater Amsterdam School District teacher reflected that Moderna vaccinations were made available at Oneonta, which teachers were luckily able to obtain. Unfortunately, their first dose caused some snags, making the teacher feel “dizzy and very hot,” after which their face “turned beat red.” In the face of this rare allergic drawback, the teacher decided to proceed with caution but affirmed their determination to receive their next dose.

Most Americans seem to concur with this sentiment. The Pew Research Center has found that a “majority of Americans now say they would get a vaccine for the coronavirus,” noting a study the group conducted which found 60% confidence in the research and development of current vaccines. Around 7.5% Americans have been fully vaccinated as of 3/01/2021, and more than 75.2 million doses have been administered. It is being reported that more than 49.7 million Americans have received a first dose, which is at least 15% of the population, and more than 24.8 million have been fully vaccinated. The U.S. is currently administering over 1.7 million shots a day.

One should also keep a lookout for Adenovirus-based JNJ-78436735 vaccine by Johnson & Johnson and the AZD1222 vaccine produced by AstraZeneca in the U.K. These show promising signs, demonstrating high efficacy and well-tolerated immune responses. Trials have shown the one-dose Johnson & Johnson vaccine is 85% effective at preventing severe disease and death, but is less effective against more contagious variants now spreading — one of which, the U.K. variant, is already afoot in Upstate New York. It was recently authorized by the FDA. The Novavax vaccine, called NVX-CoV2373, is also a worthy candidate for consideration, since it demonstrates 89.3% efficacy in its latest trial.

These are notable for requiring only a single dose, and are developed by exposing the body to antigens. According to Nature, “The Oxford–AstraZeneca vaccine is made from a cold-causing adenovirus that was isolated from the stool of chimpanzees and modified so that it no longer replicates in cells.” Also revolving around an inactivated and weakened virus, Johnson & Johnson’s vaccine consists of a “recombinant, replication incompetent adenovirus serotype 26 (Ad26) vector, constructed to encode the Severe Acute Respiratory Syndrome coronavirus-2 (SARS-CoV-2) virus spike (S) protein.”

Taking into account issues of distribution, to expect the next months to go over smoothly and easy would be a dream. Suffice to say, there are still rough times ahead. Positive Covid-19 test results are skyrocketing not only in the United States but in many other countries as well. Everyday seems to be another record high in new cases, with days witnessing an average of 3000 deaths in recent weeks and an average of over 200,000 positive cases having been registered every single day. Although transmission rates might be slowing down, this may be caused by a decline in testing. Even while vaccines are being distributed at pharmacies around the country, most country residents are still at a high risk of contracting the virus and should remain heedful of restrictions. Despite what seems to be our country’s “greatest efforts,” every city and county is having immense difficulty keeping up with the large volume of cases and cutting down on the spread of the virus.

During Interval Times, What Can We Continue to Do?

Vaccines alone cannot and will not resolve us of the responsibility of fighting this virus by other means. Health equity and the improvement of strategies for strong global health are imperative in this fight. Some sources indicate that “every American could have access to a COVID-19 vaccine by the end of April,” but the virus will continue to circulate throughout the world for years to come. Other measures besides vaccines must remain in place. Afterall, as history has shown, “only one disease—smallpox—has ever been eradicated from the human population using a vaccine.” We must remain steady and cautious going forward.

It is recommended to proceed with wearing a mask over your mouth and nose while in public, to stay six feet away from others and socially-distance when necessary, to wash your hands with soap and water or hand sanitizer when possible, clean and sanitize frequently touched surfaces, and to stay home so as to temper the spread of the virus. Even after vaccine deployment these measures must remain in place to ensure public safety and health as we go forward.

Our own local county is plagued with this disease. Eighty-two people have died, which is all the more reason to practice good “respiratory hygiene.” It is suggested that the best hope for ending the pandemic is the development of efficient vaccines, but to take full advantage of the opportunity we have, we must commit to wearing masks and avoiding crowds for the time to come.

Is New York Prepared to Continue Crusading?

In truth, there is practically nowhere in the United States that has been hit harder from the pandemic than New York State. We all remember when schools were first being closed down, stores were being mobbed, and the whole country went into shock. Everyday our governor would pop on the television screen to update us on New York efforts to “flatten the curve.”

Local transmissions are pullulating as state-wide and nation-wide missteps are growing with each day. In Montgomery County, cases have been exploding at higher rates than ever before. For the longest time, we were at a minimal number of cases that were relatively stable. Now, we have 3,182 confirmed total cases, and 107 deaths. This has been in tandem with New York’s general trend of skyrocketing cases; our state’s positive rate has recently jumped to 6.79%. Luckily, it has now dropped to 3.18%, “the lowest it’s been since Thanksgiving.”

Locally, we seem to see a downward trend currently in terms of how many cases are being uncovered. With growing frustration over vaccine distribution shortages, letting our guard down would only worsen the situation. Just recently, the state government sent 200 doses to our county of 49,000 people, ordering that half be used for essential workers and the other half going to those working with the disabled. The seven-day positive test rate just a couple weeks ago was 5.1% statewide, while Montgomery is at 8.0% and our neighbors in Fulton are at 7.8%. Montgomery County experienced the highest seven-day average in cases. 

Montgomery County Executive Matthew L. Ossenfort described the situation as one with massive demand but no supply. Officials over at New York State have argued approximately 250,000 vaccines are being administered per week, but our current state of eligibility is not open to everyone. Amsterdam’s St. Mary’s Healthcare has become the leading force for the distribution of the vaccine during Phase 1A, but even following an expansion of the protocol and those qualified for the vaccine, only high-risk individuals — primarily referring to frontline workers (doctors), teachers, and also residents/staff at nursing homes are eligible. We are also just learning that restaurant workers and drivers are eligible as well. Throughout the entire state, this renders about 7.1 million people eligible for vaccination, but this clearly does not correspond to the supply of 1.9 million doses currently in stock. The unrealistic demand for the vaccine, now including many senior citizens, simply cannot match our circumstances at this time.

This is not good news for Montgomery County. Many efforts are being done by Governor Andrew Cuomo to assure more vaccine shipments to the state, but doses are far from encompassing most New Yorkers. Supplies are getting scarce in Western, Central, and Upstate New York. 

We are beginning to see that, in spite of struggles in communicating with the state, local counties are being forced to push forward without a moment to rest. Many different forces — from oral surgeons to Amsterdam Fire Department personnel have come together and united in Montgomery County in order to begin preparing to administer vaccines for the broader community. Though standstills have caused issues, these teams are nonetheless on the cusp of devising and engaging in plans for public distribution once resources become available.

Keep on the Fight — It’s Not Over Yet!

This malignant virus will not be fought without struggle. We are in the midst of an unprecedented war of global proportions, one which threatens the safety and health of mankind.We must remain calm and steady, and continue carrying out the combat tasks of containing the spread of the virus by any means available. Around the world, we are witnessing new levels of deaths and hospitalizations. If we are to curb the virus, we must face this tumultuous problem head-on, and brave the storm ahead. 

“Whatever be the future scenario, it is apparent that we need unprecedented global collaboration and cooperation among national governments, funders, academia, health organizations, regulators, and manufacturers irrespective of their geographical locations,” says researchers Vipin M. Vashishtha & Puneet Kumar.

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