Covid-19 Vaccine, Between Euphoria and Fear

KOMPAS/ABDULLAH FIKRI ASHRI

A health worker prepares to inject the Covid-19 vaccine into a recipient at the courtyard of Gunung Jati Regional Hospital, Cirebon city, West Java, Friday (29/1/2021). In the initial stage, 2,300 health workers in Cirebon city will undergo vaccinations in the next two weeks.

The period between December and January has really been a “vaccine month". In less than two months, at least 10 types of Covid-19 vaccines have received authorization for emergency use and some of them have even been used in the community.

It is quite unprecedented that various types of vaccines for a type of disease were approved for use in such a short time. This is a milestone. However, the public is faced with a dichotomy. Some enthusiastically welcomed the vaccine. For them, the widespread production and distribution of vaccines is a sign that the pandemic is coming to an end and life will soon return to normal. They are enthusiastic about getting vaccinated immediately.

Also read: Speed Up the Vaccination Drive

Some are against the vaccine. They thought that the vaccine is just part of a business and a conspiracy, while heralding the issue of the negative effects of the vaccine. They are reluctant to be vaccinated.

Community euphoria

The development of the Covid-19 vaccine has indeed taken place very quickly, not only in relation to production but also its distribution and use. Only a year after the pandemic, several types of Covid-19 vaccines have been successfully produced. In fact, in the past it took decades to develop a vaccine. The Ebola and polio vaccines, for example, required 15 and 60 years respectively for production.

KOMPAS/ABDULLAH FIKRI ASHRI

A health worker injects a fellow medical worker with a vaccine during a simulation for Covid-19 vaccination at Puskesmas Talun, in Cirebon regency, West Java, on Wednesday (6/1/2021). The first round of vaccinations in Cirebon will target around 8,009 medical workers.

Unlike previous vaccines made from weakened or killed germs, a number of Covid-19 vaccines are made with new technology. Among them use mRNA, viral vectors and peptides as vaccine ingredients. It means that the variability is wider.

In just a month, nearly 50 million people from more than 50 countries have received the Covid-19 vaccine. Every day, about two million people get vaccinated . This number will increase sharply in line with the increase in vaccine production and distribution.

The rapid development of vaccines has caused euphoria in the community. The mass media is full of news about the efficacy and benefits of vaccines, as if the vaccine is a magic bullet without flaws.

Not a few people believe that after receiving the vaccine, they will be completely immune to Covid-19 and feel they no longer need to keep their distance from others, wash their hands, or wear masks. Such

behavior has been shown by s by a number of public figures. Shortly after being vaccinated, they do not hesitate going out without masks.

Producers’ anxiety

If many people are experiencing euphoria, vaccine producers are experiencing a "period of tension".

These three aspects will determine their business prospects, including whether their vaccine will be further used or will be abandoned.

After the vaccine is produced and used in the community, the crucial step they must pass is to wait for further evidence that their vaccine is truly effective, safe, and has a long protection period (durability). These three aspects will determine their business prospects, including whether their vaccine will be further used or will be abandoned.

The current Covid-19 vaccines are proven to have a good level of efficacy, namely between 50 percent and 95 percent. These results are evident in various standard vaccine trials. However, when used in the field, this potency can change greatly due to a number of factors.

One of these factors is the difference between the population and vaccine trial site and the population and place where the vaccine is administered. When tested in the United States, the Pfizer and Moderna vaccines had an efficacy of over 90 percent.

However, if these vaccines are used in Indonesia, their potency can change significantly. This is why the effectiveness of the Sinovac vaccine in Indonesia is different from that in Turkey and Brazil. The range of efficacy is also very wide. In Brazil, the efficacy is 50 percent, while in Indonesia it is 65 percent, and in Turkey 91 percent, although the vaccine being used is the same.

KOMPAS/TOTOK WIJAYANTO

The community health center (Puskesmas) in Cilincing subdistrict, North Jakarta conducts a COVID-19 vaccination simulation on Tuesday (12/1/2021). The simulation includes registration, screening or health examinations, vaccination and post-vaccination observation. The observation lasts 30 minutes to see if there are any side effects after a person receives the vaccine. The government plans to begin the Covid-19 vaccination program on 13 Jan, 2021. President Joko Widodo will be the first person to be injected with the Covid-19 vaccine.

This suggests that there is no guarantee that vaccine efficacy is universal and constant, especially if the system in storing, distributing, transporting and using the vaccines does not meet the set standard. Their effectiveness in the field can be greatly affected.

Other tensions have to do with side effects or safety. The current Covid-19 vaccines have been approved because they have passed the phase 3 trial. This means that each vaccine has been tested for a year against a maximum of 40,000 people. Apart from that period and population size, no other data are obtained.

Also read: Indonesia Now Leads Asia in Confirmed Coronavirus Cases, Deaths

For example, what are the effects of the vaccine after 2-3 years or what are the side effects if it is given to a population of millions of people. These aspects will be monitored during follow-up stage after the vaccination. If at this stage it is found that the vaccine has serious side effects, the license to use the vaccine can be revoked.

The revocation of vaccine licenses will bring a great impact on economic aspects and credibility of the manufacturers.

You can imagine how much psychological concern the vaccine manufacturers have about this risk. The revocation of vaccine licenses will bring a great impact on economic aspects and credibility of the manufacturers.

Until now, it is also not known how long the protection period (durability) of the existing Covid-19 vaccines is. After a person has been injected with the vaccine, it is not known how long the antibody levels will last. It can last a month, a year or even decades.

AFP/BAY ISMOYO

An employee works on the production line of COVID-19 coronavirus vaccines at the Bio Farma Pharmacy, which will produce the vaccine early next year with a production capacity of 250 million vaccines a year, in Bandung, West Java on August 12, 2020. - Indonesia on August 11 launched human trials of a Chinese-made coronavirus vaccine with some 1,600 volunteers slated to take part in the six-month study.

If it lasts only for a few months, the vaccine is ineffective, because the people have to be vaccinated every few months. The minimum protection period should be at least a year so that vaccination can be only repeated every year. The issue of the protection period becomes more complex with the emergence of new coronavirus variants. To date, existing vaccines, especially those made from mRNA, have been reported to be effective against mutated viruses.

However, if the mutation of the virus becomes faster and more varied, the available vaccines will no longer be effective. This means that vaccine updates must be carried out periodically.

Another important issue is related to business competition. The essence of vaccines is a public health product. However, vaccine producers certainly have another interest that is to make a profit. With the increase in the vaccine production, the competition among manufacturers will become tighter.

Then, some producers may claim their products are better and others are worse either impliedly and explicitly. So do not be surprised if the Western media is quite excited questioning the low efficacy of the Sinovac vaccine. Meanwhile, the Chinese media also continues to raise the issue related to the side effects of Pfizer and Moderna vaccines that have occurred on some recipients of this vaccine.

Also read: Guard the Vaccine Distribution Process

This is a business war. The situation is further worsened by the fights between pro-vaccine and anti-vaccine movements, between pro-government and government opposition, as well as between adherents of the status quo and non-status quo.

Not a magic bullet

The rise of vaccine production and the commencement of vaccination show good signals in the handling of the pandemic. Experts agree that vaccines are the cornerstone of hopes in the handling of the pandemic. So it is quite natural if the vaccine issue has become a trending topic almost everywhere, especially in the midst of a pandemic that is still not under control.

Until now, Covid-19 has attacked 223 countries. It infected 103 million people, and caused the death of more than 2.23 million people. Vaccines are produced in the midst of this critical condition, so it is quite natural that they bring a hope for the people.

However, the presence of vaccines is not a warranty card to end the pandemic. The current Covid-19 vaccines are new vaccines, not established vaccines like the polio or hepatitis vaccines.

This aspect will be examined in the assessment process after vaccination, including the post-marketing surveillance process.

The efficacy and safety of the Covid-19 vaccine has indeed been confirmed in a number of vaccine trials. However, for a wider population or a longer period of time, its efficacy and safety have not been confirmed. This aspect will be examined in the assessment process after vaccination, including the post-marketing surveillance process.

Also read: Vaccinations for Covid-19 Stalled

This follow-up stage may last several years or even decades. If at this stage an unfavorable effect is found from the vaccine, the authority will have to make a policy revision, including revoking the vaccine license. In Indonesia, the Food and Drugs Supervisory Agency (BPOM) has confirmed that if a serious impact on vaccines is found during the follow-up period, the license to use the vaccine can be revoked. The same is true in other countries.

In addition, the chain of transmission of Covid-19 can be cut off, only if a herd immunity has been achieved. The community immunity requires that 70-80 percent of the population have immune antibodies, either due to vaccination or from having been infected and then recovered.

KOMPAS/AGUS SUSANTO

There was an addition to the first stage on Thursday (28/2/2021) at the health center for those who had not been vaccinated. A total of 3,700 doses of Covid-19 vaccines have been prepared to be distributed to nine hospitals in Setiabudi district. Problems with vaccine data collection and distribution, which caused the first phase of the Covid-19 vaccination program to be prioritized for health workers, persist.

Without the community immunity, the Covid-19 pandemic cannot be ended and the transmission will continue. It means that the broad community participation is needed to ensure a successful vaccination program.

The beginning of the end of the pandemic

Although vaccines cannot guarantee of the end of the pandemic they can be used as the entry point for handling the pandemic. It is the starting point for stopping the pandemic. All Covid-19 vaccines currently in use have proven effective in vaccine trials, with an efficacy rate of 50-95 percent.

Also read: Double War in the midst of the Crushing Pandemic

It means that people who are vaccinated will be two to 19 times more protected than those who don’t get vaccinated. The value of the protection is very high, especially with vaccination target of hundreds of millions in Indonesia and billions around the world.

To maximize the impact of the vaccines in stopping the pandemic, the public must have the awareness that vaccines are not everything. They are not a magic bullet. This means that after receiving the vaccine, people should not feel that they have become “super-human", who will not be infected with Covid-19 under any circumstances.

The people still need to follow 3M health protocols ( wearing masks, washing hands, keeping a distance with others ) and 3T (tracing, testing, treatment). They must also be aware that the maximum effect of the vaccine can only be achieved if 70-80 percent of the population take part in the vaccination program. If it cannot be reached, the pandemic will still continue and further destroy every aspect of life.

UGM.AC.ID

Iqbal Mochtar

Iqbal Mochtar, Doctor and Observer of Health Issues

(This Article was translated by Hendarsyah Tarmizi).