A DIFFERENT VIEW by Dr James Adjogatse
On the 10th of January 2022 a group calling itself CONCERNED GHANAIAN DOCTORS wrote a Petition to the President of the Republic of Ghana calling against Covid-19 Vaccine Mandate, in which citizens must show proof of vaccination before they are allowed into certain public spaces. They also requested the President “pause immediately” further roll out of the Covid Vaccination Programme. This is a very bold ask. To ask the President to stop one of the most important tools to fight Covid-19. I wonder whether they think we should close all borders and close our air space to all flights as well. These days you need evidence of vaccination to travel. They gave explanations and justifications for their petition. Coming from doctors, the public is likely to take the contents of the petition very seriously. They may even think the views in the petition represent those of the generality of doctors. The unintended consequence of the public publication of this petition is that it would fuel vaccine hesitancy and give ammunition to anti-vaxxers. I disagree strongly with some of the claims made by the Petitioners.
Covid-19 is a new virus of which the world is continuously learning about. It has caused a global pandemic and there have been many mutations with various degrees of ability to spread and cause disease and sadly death. New and old treatments have been tried, evaluated, recommended, or discarded. There are a number of vaccines currently being used under Certificates of Emergency Use Authorisation. There are also new vaccine
candidates in development.
Covid-19 Vaccine Mandates
The usefulness or need for Covid-19 vaccine mandates is a hot topic which has been debated and resisted all over the world, particularly in the US and Europe. For a country with a relatively small total Covid-19 infection rate and large informal economy a vaccine mandate is probably not necessary. In this regard, I agree with the petitioners. More education and persuasion are required to ensure increased take up of the offer to get vaccinated. Coercion isn’t likely to yield positive results
Call to Pause Vaccine Roll out. Really?
As to the call to the President to pause the vaccine roll out in Ghana, I totally disagree with them. I disagree with their assertion that to continue vaccinating the people of Ghana is to “gamble the lives of innocent Ghanaians away”. We are lucky in Africa (excluding Southern and Northern Africa) to have been spared the ravages of this pandemic. We have a young population profile, a lot of our activities take place outdoors and we may have other advantages like prior immunity from similar infections, diet, the sun, and others not yet determined. But we must not be complacent because this virus is mutating all the time and we may not be so lucky next time. A Ghanaian proverb says, “when you see your neighbour’s beard on fire get some water by your side”. The water here is to get vaccinated so that if you were unfortunate enough to be infected with Covid-19, you would be less likely to be seriously ill or die from the disease.
The Current State Covid-19 worldwide as at 14th January 2022
Total infections 313,676,517
Total Deaths 5,506,474
Total Vaccine doses given 9,508,690,425
Deaths from Covid in Selected Countries
Source: John Hopkins Coronavirus Resource Center (as at 14/01/2022)
We can see from the above chart that Northern and Southern African countries have not been spared the ravages of Covid-19. So, we cannot be complacent. Although Ghana has done relatively well in combatting Covid-19, we have not done as well as our immediate neighbours.
Reliability of Covid-19 Diagnostic Tests
I think that the petitioners are right about the non-reliability of some of these diagnostic tests. What we must realise is that these tests were developed at pace in an emergency pandemic situation. Refinements are being made to the tests to improve their accuracy and reliability.
Is Natural Immunity from Infection better than from Vaccination?
The doctors group which petitioned asserted that immunity from infection is better than vaccination. You get immunity from either natural infection or vaccination. With Covid we now know there have been reinfections in people who got infection naturally or were vaccinated. Unfortunately, it would be unethical to do an experiment with Covid-19 where you divide the population into two groups, subject one to Covid infection and vaccinate the other half. You hen measure hospital admissions and death rates between the two groups. Clearly the natural immunity group would come out worse. But we don’t have do that because we have the answer from past vaccinations. Measles and smallpox viruses killed millions of people worldwide, even though some got natural immunity. As a young doctor working in the Children’s Department of the Korle Bu Teaching Hospital in the late 1970s it was always heart wrenching to arrive on the ward in the morning to find many of the children you saw the night before had died from complications of measles. Vaccines helped eradicate these diseases. Polio and yellow fever are some of the other diseases prevented with vaccines. Hopefully effective vaccines for malaria will be developed in the not-too-distant future to reduce the incidence of one of the greatest killers in our country with its attendant economic consequences. Vaccines have been a greater saviour of mankind.
Concerns about Speed of Development of Covid-19 Vaccines
Of course, there have been a lot of apprehension and anxiety, even among doctors, of the speed with which the Covid-19 vaccines have been developed. What hasn’t been explained properly and widely enough is the method of production and safety of Covid-19 vaccines. Traditionally, vaccines take about 10 to 15 years to develop. So why was it possible to have a Covid-19 vaccine ready in 11 months? Understanding this will go a long way to allay the fears, anxiety, misconception, and misinformation about Covid-19 vaccines. The traditional method of making vaccines involves taking a weakened or killed virus, injecting it into bacteria, where they multiply millions of times. Then the vaccine is injected into volunteers in different phases of trials to assess whether it is safe, whether it works and how it can be deployed on a mass scale. Then comes the regulatory approval stage which can take about 10 months.
The Covid-19 vaccine was made in record time because of several factors. A new technology which has been developed for the past 20 years was used. This technology was developed for use in attempts to develop HIV, SARS, MERS, and Ebola vaccines. A template was ready and as soon as the genetic code for Covid-19 was known in January 2020, parts of this genetic were inserted into the template to develop vaccine candidates within weeks. Some people refer to this as “Plug and Play”. Then followed the different phases of trials to get a safe, effective vaccine within months. Because the virus was spreading fast it was easy to get answers to safety and effectiveness questions earlier than would have been possible for a slow spreading vaccine. Another factor which shortened the vaccine development pathway is the prioritisation and shortening of the Approval Process. In all these there was no cutting of corners in the safety process. In fact, we should be very happy that this pre-existing technology for vaccine development has enabled scientists to produce a vaccine in record time. It has helped save not only lives but also economies.
Side Effects of Vaccines (Serious Adverse Events)
As with any new drug or vaccine there is intense post-deployment monitoring for serious (sometimes unanticipated) side effects and death. It is true there have been serious side effects, including death associated with Covid-19 vaccines. What the petitioners failed to do is to put the number of side effects into perspective. They failed to state there have been over 9 billion (9,508,690,425) doses given in 184 countries. The question is do whether the benefits outweigh the risks? The answer is emphatically yes. Besides, most of the adverse events resolved completely. Large doses of Paracetamol can lead to liver failure and death. Prolonged and excessive use of Diclofenac can cause Kidney Failure. All reputable publications attest to the safety of Covid-19 vaccines.
Are there other Cheaper Options? The petitioners alleged that we are relying only on vaccination to get us across the line. This obviously cannot be true. Countries bring other measures to break the transmission chain, like working from home, face covering, and closure of venues. There are drugs like Dexamethasone, Tocilizumab, and others. The petitioners claim that cheaper drugs like Hydroxychloroquine, Ivermectin and Azithromycin have been abandoned. Surely there have been controversies about their use and research suggests they are not very effective.
Higher Vaccination Rates lead to Less Deaths
The petitioners claim higher vaccination rates do not equal to less cases and death. This is not true. The petitioners have conveniently ignored the emergence of new variants to which current vaccines are not as effective. Actually, new vaccines are being developed to broaden the coverage of the different and future variants. There is no doubt that vaccines have reduced the rate of death. Can you imagine where the world would be now without vaccines? There would have been even higher losses of life. Air travel and the hospitality industry would have even been more decimated.
They also claim that the majority of deaths are occurring in the vaccinated. This cannot be true, certainly not in the UK, as chart from the Office of National Statistics shows
|Table 1: The age-standardised mortality rate (ASMR) for deaths involving COVID-19 was 96% lower for people who received the second dose at least 21 days ago compared to unvaccinated people between 1 January and 31 October|
|Vaccination status||Deaths involving COVID-19||Non-COVID-19 deaths||All deaths|
|Unvaccinated||938.9 (928.5, 949.3)||1501.8 (1488.9, 1514.6)||2440.7 (2424.2, 2457.2)|
|Received only the first dose, less than 21 days ago||186 (180.1, 191.9)||609.3 (598.7, 619.8)||795.2 (783.1, 807.3)|
|Received only the first dose, at least 21 days ago||116.5 (113.8, 119.3)||1115.7 (1106.5, 1124.8)||1232.2 (1222.6, 1241.8)|
|Received the second dose, less than 21 days ago||7.3 (6.2, 8.3)||464.3 (455.5, 473.1)||471.6 (462.7, 480.4)|
|Received the second dose, at least 21 days ago||33.6 (32.8, 34.4)||816.9 (802, 831.8)||850.5 (835.6, 865.5)|
|Source||Office for National Statistics, Public Health Data Asset, National Immunisation Management Service|
What they have forgotten is that in a highly vaccinated society like Israel or the UK the number of people unvaccinated is small so it possible that the number of people admitted to hospital with Covid-19 could be higher for those vaccinated, but rate is always smaller. Be that as it may, for all countries the proportion of Covid-19 patients admitted to Intensive Care is in excess of 90% for the unvaccinated.
Can Ghana and Africa teach the World how to Manage Covid-19?
They recommend that Ghana and Africa at large should lead the world in the fight against Covid-19, but they have not spelt out any specifics. The GHS and the Government have done well in the fight against Covid-19, and they must be applauded for that. France had over 380,000 cases in 24hr just about 5 days ago. This is more than twice Ghana’s total number of cases since the beginning. For a small country like Ghana with weak health system to teach a country like France how to manage its Covid-19 cases will smack of arrogance and ignorance.
I do not think the petitioners have demonstrated any superior knowledge about how to fight this pandemic. They have misquoted publications to support their petition. They have tried to contribute to the debate on the management of Covid-19, but they have failed in my opinion. Somewhere, along the line they have suggested that because a high proportion of people who die from Covid-19 in Ghana are over 65 years old we don’t need to vaccinate everyone. Perhaps we should leave then to get infected and possibly die. I don’t know the ages of the petitioners, but I struggle to understand this way of thinking. The greatness of any society is how well it cares for its vulnerable.
Covid-19 is a new disease. The world is learning things about it all the time. Vaccines are one of the most powerful tools currently available to us. I do not think we need to embark on vaccine mandates, but we must redouble our efforts, through education and persuasion to get as many people as possible vaccinated. No vaccine is 100% effective, but it can reduce your risk of serious illness, of being admitted to hospital or of dying. The benefits far out way the risks. I would therefore encourage everyone to get vaccinated. Thank You for reading this piece
The writer, Mr. James Adjogatse is a Ghanaian Medical Doctor and Consultant Surgeon in Stoke on Trent in the UK. He has been practicing medicine since 1978 after graduating from University of Ghana Medical School.