Vaccine hesitancy keeps the virus alive in Asia

SEOUL – Publics across the world need to look beyond scare headlines and take heart in the ongoing successes national vaccination programs are forging, three leading experts said today.

While clinical data is still evolving in laboratories, people need to look at “real-world evidence” said Jerome Kim, who heads the Seoul-based International Vaccine Institute.

When tested on individuals in clinical trials, vaccine effectiveness was found to range anywhere between 50% and 94% percent, but “…for a society, most pandemic responses are above 85%,” Kim said.

When it comes to effectiveness against hospitalization and death, rather than against simply infections, “their effectiveness will be much higher” he said.

The IVI chief was speaking at a webinar on global pandemic responses hosted by the British Chamber of Commerce in Korea this morning. And he was not alone. Other experts warned against misleading media.

Contrary to some reports, there is, as yet, no fully agreed-upon definition on the amount of the population that needs to be immunized for herd immunity to transpire.

“When people are talking herd, some say 75% and some say 90%,” said Yi Deok-hee, a health economist at London University’s Kings College. But even given these figures, she noted that in the UK, with a vaccination rate of approximately 50%, there is already “plunging mortality.”

Kim agreed. Though neither the UK nor the US has reached what he called the “magic 70%” vaccination ratio, both countries are nevertheless “seeing dramatic falls” in Covid’s impact.  

Yi stated that the UK could be out of the woods in September or October, but warned about a new risk: An uptick in seasonal flu given how many vaccine resources are being devoted to Covid-19.

Meanwhile, widespread speculation about the contrasting effectiveness of different vaccines is still largely unproven.

“I don’t think we have complete data on which vaccines are more effective over others,” said Lee Hyun-sook, a professor of Biological Sciences at Seoul National University. “We hear a lot of stories in media which make people biased, but do we really know the maintenance of the antibody, and the effectiveness toward variants? I don’t think the data is really conclusive.”

The risks of blood clotting and other reported complications with certain vaccines – notably AstraZeneca’s – are also overwrought, he said.

Yi noted that statistics suggest that risk is about one in a million, “but people are thinking about the possibility of one, not the zeros.”

In South Korea, there is some pushback against these fears.

With the country currently administering doses to those over 60, there is an abundance of vaccines as some patients – possibly due to fear of the most widely used vaccine in Korea, AstraZeneca, or to a wider fear of vaccinations – are skipping appointments.

As a result, Lee said, “young people are rushing to register to get the vaccine that is left over.”

Today, a new app was set to be launched that would allow those in the under-60 age bracket to add their name to waiting lists in nearby districts to take advantage of surplus jabs.

Even so, the effectiveness of vaccination programs does not rest upon simply vaccinations, but is also part and parcel of a broad gamut of measures.

“At the laboratory level, it is important to see small changes, but in the population level, it is important to have effectiveness mixed with masks and isolation and other measures,” Yi said.

Learnings from Covid

Multiple measures and a nose-to-tail game plan are key.

“The problem is, when one considers a response, you can’t think in a static way, you have to think end-to-end,” said Kim. “Masks were effective, but are only a temporary solution – like lockdowns – to stop transmissions as governments react.”

An imbalance between short-term tactics and long-term strategy explains why some countries that contained Covid-19 well are slow to vaccinate, and vice versa. It also goes toward explaining why there are ongoing bottlenecks with vaccine supply chains, given that so many countries delayed placing orders.

“The whole process, from the start to the laboratory to injecting a person, has to be thought through at the government level,” Kim emphasized.

Even so, Kim praised national regulatory authorities such as those in the EU, UK and US for how fast they approved vaccines, while still maintaining stringency.

“The key concept is we can move through the process in 11 months,” he said, “That is one of the pearls of Covid.”

Another learning from the current, unprecedented, pandemic has been the importance of talking and planning across silos.

“Scientists and clinicians and social studies people should talk much more,” said Lee. “We must abolish all barriers or we cannot react to pandemics. We have learned about risk, and it is a good lesson.”

It’s not over yet

Despite the increasing number of vaccines hitting markets from multiple providers, there is plentiful room for new vaccines that are currently under development in countries like South Korea and Japan to join the party.

“There will need to be at least 16 billion doses for the first round [globally], then booster doses and doses against variants,” Kim said. Hence, even players that have not yet entered the game, “…can contribute to the global effort needed to control this pandemic worldwide.”

So far, 1.7 billion doses have been administered worldwide, according to Pharmaceutical Technology’s vaccine tracker. And even in places where major vaccination programs are underway, it is far from game over.

“We have to continue to study which vaccines are effective toward these variants and how long the antibodies, are maintained and do we need boosters,” said Lee. “We are still, in my opinion, in the stage of clinical trials, we don’t know everything about the outcome of these vaccines.”

More worryingly, gaps are opening up between countries with fast and slow vaccination programs. Many, though not all, of these gaps are between rich and poor.

“There are no free visits or communications, the world will be divided until the pandemic is completely gone,” said Lee. “This is going to change the way people think… racism and things are going to continue. It is not only about health, it is about the division of the world into vaccinated versus non vaccinated.”

In past virus outbreaks, like Ebola and Zika, the developed world was largely unaffected and even if people from prosperous nations traveled to affected regions, wealth provided some level of insulation.

“People from high-income countries could travel to those pandemic areas and stay in nice hotels – that was the solution at that time,” said Yi. But with the current pandemic raging across the entire map, “we need to think more globally,” she said.

Currently, many countries across Africa are not reporting significant infections, but Kim feared that this was not due to lack of infections – but to a lack of testing. In these kinds of unmonitored, viral hothouse conditions, the nightmare scenario could eventuate.

Kim urged the developed world to provide the necessary surveillance and sequencing assets to these countries, otherwise, “We run the risk of developing variants against which vaccines do not work.”