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No One’s Safe Until Everybody’s Safe

5.4.2021

It’s unclear who first made this comment about the Covid-19 pandemic, but it is being used by health care leaders around the world to encourage their people to get the Covid-19 vaccination. Vaccines have played an important role throughout history in keeping us well.

Evidence exists that early attempts to inoculate people against smallpox were reported in China as early as the 16th Century. Smallpox scabs could be ground up and blown into the recipient’s nostrils or scratched into their skin. The practice, known as “variolation”, came into fashion in Europe in 1721, with the endorsement of English aristocrat Lady Mary Wortley Montagu.

The next development which turned out to be much safer than variolation, originated from the observation that dairy farmers did not catch smallpox. The 18th Century English physician, Edward Jenner, hypothesised that prior infection with cowpox, which is a mild illness spread from cattle, might be responsible for the suspected protection against smallpox.

In 1796, Jenner inoculated an eight-year-old boy by taking pus from the cowpox lesions on a milkmaid’s hands and introducing the fluid into a cut he made in the boy’s arm. Six weeks later, Jenner exposed the boy to smallpox, but he did not develop the infection then, or on 20 subsequent exposures. The origin of the term comes from the Latin for cow or “vacca”.

Edward Jenner vaccinating his child against smallpox; coloured engraving.  Image: Wellcome Library, London (CC BY 4.0)
Edward Jenner vaccinating his child against smallpox; coloured engraving. Image: Wellcome Library, London (CC BY 4.0)

In 1881 French microbiologist Louis Pasteur demonstrated immunisation against anthrax by injecting sheep with a preparation containing forms of the organism that causes the disease. Four years later he developed a protective suspension against rabies. Jenner’s approach was to use a virus similar to, but safer than, smallpox to prevent disease. Pasteur on the other hand developed a weakened or attenuated form of the virus or bacteria to treat the patient.  

This was the birth of vaccinations and heralded a new era in the treatment of diseases around the world using injections containing live, weakened, or killed viruses to produce immunity against an infectious disease. In the early 20th century, we saw the development of vaccines to protect against whooping cough (1914), diphtheria (1926), tetanus (1938), influenza (1945) and mumps (1948). Later vaccines were developed for polio (1955), measles (1963) and rubella (1969) with the world being announced smallpox free in 1980.

Vaccine technology still uses the approaches developed by Jenner and Pasteur but has developed enormously in recent years with a number of new approaches. These include:

  • A subunit vaccine, which is made from proteins found on the surface of infectious agents e.g. Influenza, Hepatitis B.
  • Inactivated toxins of infectious organisms e.g., Tetanus, Diphtheria, Whooping cough.
  • Gene sequencing and editing has allowed the mass production of antigens that are used in vaccines and made the production of attenuated vaccines safer and more effective.
  • Recombinant DNA technology has also been used effectively to develop vaccines e.g., Human papillomavirus.

Today there are around 30 diseases around the world that are treated and controlled by vaccination programmes making us all healthier and allowing us to live longer.

So here we are in 2021 and vaccines will once again help us fight against another highly infectious disease, Covid-19. There are currently 10 vaccines licensed around the world that offer protection against Covid-19. Staggeringly, there are 88 vaccines in clinical development and 184 in pre-clinical development.

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The speed of development of these vaccines has been nothing short of remarkable and their efficacy rates are equally impressive. However, public attitudes to vaccines appears to have shifted markedly to what it was when this type of treatment was introduced. People either trust vaccines or they don’t. Then we have the antivaxxers who believe vaccines are unsafe and infringe their human rights. Antivaxxers also use social media to actively spread misinformation to persuade people to their point of view. Antivaxxers have been pumping out misinformation for a number of years now, so it’s useful to see if they have had any success.

Claims about the Covid-19 vaccine made by the antivaxxer community include:

  • The vaccine alters your DNA.
  • The vaccine causes infertility.
  • Bill Gates is inserting microchips into people.
  • The virus is being used as a ploy to move a country to a “police state”.
  • Don’t be a guinea pig for pharmaceutical companies.

A number of surveys have been conducted assessing public reaction to having a Covid-19 vaccination. The Imperial College London YouGov Covid-19 Behaviour Tracker Data Hub gathers global insights on people’s behaviours in response to COVID-19. Data represents the share of respondents who have not received a COVID-19 vaccine and who agree with the following statement: “If a COVID-19 vaccine were made available to me this week, I would definitely get it.” Respondents were presented with a 1 to 5 scale, ranging from “Strongly agree” (1) to “Strongly disagree” (5). The following chart shows monthly data on the willingness of unvaccinated individuals to receive the COVID-19 vaccine. They asked this question in November 2020 with the following results:

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You can see that in those countries surveyed there is a wide variation in the willingness to be vaccinated ranging from 67% in the U.K. to only 40% in France. A study conducted by Ipsos on behalf of the World Economic forum found similar results.

Is this vaccine hesitancy the result of antivaxxer misinformation? There is no doubt that some of the claims made by antivaxxers will have resonated with some people. However, when you ask people objectively about vaccine hesitancy the reasons are quite straight forward. “Side effects”, “long term effects on health” and “how well the vaccine works” were the top three reasons for reporting negative sentiment towards the vaccine and this was consistent across all population groups. These concerns are not unreasonable. It is important to note that as more and more people are vaccinated, vaccine hesitancy is declining. In fact, in England 95% of the over 50’s have been vaccinated which is way higher than scientists thought could be achieved.

To ensure high rates of vaccination so that a population can gain “herd” immunity, health care leaders need to target vaccine hesitancy messaging very carefully. This is because hesitancy rates vary by population sub-group.

A survey carried out by the Office of National Statistics in the U.K. in early 2021 revealed that vaccine hesitancy was highest in:

  • 16–29 year olds.
  • Black or Black British adults.
  • Parents with child aged 0-4 years.
  • Adults living in the most deprived area.

It’s pretty clear that as vaccine programmes are rolled out around the world, governments and health care workers will have to work hard to ensure the majority of their people are vaccinated. Only then can we stop saying no one’s safe until everybody’s safe and we can start getting back to a normal life and fix some of the other issues this pandemic has caused.

  • We need to be more vigilant against infections, particularly with vulnerable hospitalised patients. That’s why sterile EyePro™ should be the only eyelid cover used to maintain eyelid closure during general anaesthesia or deep sedation.
  • As surgery returns and we start to reduce the huge backlog of patients waiting for routine surgery, hospitals must ensure they deliver a great patient experience by protecting patients’ eyes from trauma by using NoPress™, our foam and rigid plastic shield designed specifically to protect anaesthetised patient’s eyes from externally applied pressure.
  • Enhance the patient experience further, by guarding against dental damage and/or negative pressure oedema through the use of BiteMe™ our purpose designed, air-filled, soft plastic bite block.

So, no one’s safe until everybody’s safe and although vaccines will help the world recover, it’s important we do our utmost to protect patients from infection as well as non Covid-19 complications that can be easily avoided. By using our products, you will optimise your care and ensure your patients have the best experience they can possibly receive.

Author: Niall Shannon, European Business Manager, Innovgas

This article is based on research and opinion available in the public domain.

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