‘If you don’t want the vaccine, stay in lockdown, nobody forbids it’
12 naive questions about the upcoming vaccination for medical blogger Alexey Vodovozov
The first thousand doses of the vaccine against the novel coronavirus infection Sputnik V arrived in Tatarstan on 11 December. First of all, health workers in the “red zone” will receive them. The Sputnik V designed for the mass vaccination is due to arrive these days, said head of the Tatarstan office of Russia’s consumer rights protection watchdog Marina Patyashina in a recent live transmission. According to Russian Vice Premier Tatiana Golikova, nearly 7 million doses of Sputnik V will be available for citizens from December to late February across the country, the citizens, that’s to say, we have quite a lot of questions accumulated about this generally unprecedented event. Realnoe Vremya tried to answer them with the help of famous medical blogger, toxicologist, scientific journalist and science communicator Alexey Vodovozov.
We should remind you that Sputnik V using a human adenovirus was developed in the Gamaleya Institute. Nowadays more than 150,000 citizens of Russia have already received Sputnik V vaccine. It is the biggest number of people vaccinated with a medicine for COVID-19 around the world using any other analogous medicine.
- The Sputnik V vaccination is about to start in Tatarstan. What are the specifics of this vaccine? How safe and effective is it?
The specifics are that it has two different adenovirus vectors in two doses, nobody has used such an approach around the world. For instance, the Chinese vaccine that’s now examined in our country is built on one adenovirus vector, while that of Oxford uses a chimpanzee’s adenovirus.
Why are there two doses? We face adenoviruses during flu seasons, that’s to say, immunity can recognise and destroy the carrier before the latter lets its antigene part of the vaccine enter the cell for proliferation* (see Vodovozov’s explanation at the end of the report). We can highly likely claim that such an approach is safe. It has been used in medicine since 1971 when the US army began to use adenovirus vaccines. The era of genetic therapy began later, and adenovirus vectors recommended themselves very well. Vaccine developers began using them later too.
Adenoviruses have been thoroughly examined in almost 50 years of use, they don’t have any serious side effects. As for the efficacy, the phase three of the clinical trial will show it, it is carried out for this purpose.
- Should one be vaccinated with Sputnik V considering that the vaccine was registered in Russia precisely before the phase three of clinical trials began, which caused severe criticism among specialists? Or should one wait for a more examined jab?
This registration caused severe criticism among rather rivals. Now the vaccine of Pfizer and BioNTech was registered in Great Britain, which has a way to go to complete the phase three like Sputnik V. The same will soon happen in the USA and EU, while China was the first to register several vaccines for limited use. It is a world practice. These are the unusual conditions of the pandemic. By the way, Sputnik V was registered in total accordance with the government’s decree No. 441 as of 3 April 2020. A lot of countries have such protocols for registration for urgent purposes. So Remdesivir was registered in the USA in the same way, though the WHO declared later that the results of research didn’t allow including the medicine to international recommendations. Was the registration of Remdesivir revoked after that? No, in the end, it got a fully-fledged marketing permit.
The world doesn’t have time for examination that used to be in pre-COVID-19 times. Every day is a very big number of deaths from both COVID-19 and those diseases that patients have and found it hard to receive necessary medical help.
- Why aren’t developed countries interested in Sputnik V?
Because they have their own manufacturers whose financial interests should be taken into consideration. The USA invested $10bn to develop an mRNA vaccine by Moderna. Will they be interested in the Oxford vaccine, four Chinese vaccines, Russian vaccines in such a layout? No.
Moreover, the amount of pre-orders of Sputnik V has already exceeded 500 million doses. Such countries as South Korea that can hardly be named underdeveloped will be licensed to produce the vaccine. In general, a usual competition fight for market shares is taking place around the world.
- When do you think an ordinary Russian citizen can get access to the vaccine against COVID-19? Will the vaccination really be voluntary? Will a person who wants to receive the vaccine have to do a PCR test and a test for antibodies at his own expense? Or should the state carry these costs?
The access to the desire will likely appear by the middle of the next year. As for voluntary vaccination, it is a bit funny. Do we have people who want to voluntarily fall ill with COVID-19? It won’t be possible to wait it out, it is already clear. The course of the disease is unpredictable, both young and healthy people and the elderly with plenty of co-existing diseases die. There are a lot of complications in all organs, moreover, they are long-term, there is a post-COVID-19 syndrome, the probability of secondary infection because natural COVID-19 hits the immune system too, not allowing it to produce normal protection.
Will there be people who won’t want to be vaccination with this background? Well, good luck with natural selection, what else we can say. While the tests before vaccination are done via Compulsory Medical Insurance.
- What side effects should one fear after vaccination?
A pain on the site of injection, a high body temperature for 1-1,5 days.
- Citizens from 18 to 60 will be vaccinated with Sputnik V. What should representatives of the biggest risk group 65+ do? Why can’t they be vaccinated with Sputnik V?
They can’t be vaccinated because the clinical trial wasn’t done on this group of patients. Separate clinical trials on any medicines are required for patients above 65 as well as children around the world. This is linked with their specifics.
For instance, the elderly have almost no thymus left, one of the two crucial organs of the immune system. Therefore safety, immunogenicity and efficacy of vaccines should be examined in this group separately, which is done now: there is an additional trial of Sputnik V for the elderly now, volunteers are invited.
- How should a person get ready for vaccination against COVID-19? For instance, Vice Premier Tatiana Golikova advised refusing alcohol for 42 days before vaccination. How real is this in the Russian reality? Moreover, the New Year holidays are ahead.
There isn’t any special preparation. As for the 42 days, it would be good to ask Golikova where she found the information that doesn’t comply with reality. The Ministry of Health has already denied it, by the way. It is easy to verify it even on your own, opening the website of the State Register of Medicines and reading the instruction of Sputnik V. The word “alcohol” wasn’t found there. Yes, indeed, participants of the third phase of clinical trials have some restrictions, for instance, they are recommended not to abuse alcohol during the period of the trial (180 days), try to refuse it during the first 3 days after the injection of the first and second doses. The reason is simple: alcohol is an immunosuppressant, so it can distort the results of clinical trials. But as for its preventive effect, alcohol impedes it to a lesser extent.
- What technical difficulties can you foresee in the vaccination with Sputnik V? To transport and store this vaccine, the temperature must be at -18 degrees. Are health establishments and all the chain of vaccine transportation ready for this?
Vaccine developers also foresaw technical difficulties, this is why the second form, lyophilisate that won’t have to be stored in such strict conditions, was already created. The Pfizer vaccine, by the way, requires -70 degrees, while Moderna’s vaccine does -20 degrees, everybody will have to face some difficulties.
I think the expansion of production will be the main problem, and a lot of manufacturers have already faced it. One thing is to prepare laboratory samples or small batches for clinical trials, another thing is hundreds of millions and billions of doses. It is a real challenge for the industry, we can just hope it will address it.
- Do you think that the concept of herd immunity is applicable for COVID-19? What percentage of the population has to be vaccinated and when will it happen in Russia? Won’t anti-vaccine campaigners impede this much?
Herd immunity is rather unattainable. At least more and more specialists agree with it. The virus makes a raid in the immune system too, so it is unclear how long the post-infection immunity will last. This vaccine can be injected even six months if needed, but I doubt some want to have COVID-19 a couple of times a year.
Anti-vaccine campaigners will impede us, of course, as usual. But they have other problems now because not society is against them like it happens to vaccine-managed infections but COVID-19. Good luck, I wish they will come to the agreement with the virus.
- Can COVID-19 be transmitted after vaccination?
This is unknown so far. We don’t know if the post-vaccination immunity will be sterilising, that’s to say, it won’t allow the virus to spread in the organism of the vaccinated person. This is in general possible. And it is the best-case scenario. The second one isn’t the best when the vaccine protects from a severe development and reduces the risk of infection but doesn’t prevent it completely. In this case, the vaccinated person can fall ill (not as seriously as the person who wasn’t vaccinated) and spread the virus for some time. It is similar to smallpox.
- What will happen if a person won’t want to get the vaccine? What should people with chronic diseases do, as they are in the risk group that isn’t recommended to receive the vaccine?
Such a person can contract natural COVID-19. I think it is quite a horrible prospect. The most horrible thing is what the state can make up, either fines or punishment. Though they will rather take another road: many countries already say that vaccinated people will get concessions on mobility, tourist routes will reopen for them first of all and so on. I think it is correct. Positive motivation is our everything. If you don’t want the vaccine, stay in lockdown, nobody forbids it.
People from the risk group who aren’t recommended for vaccination will have to accept that before the appearance of the suitable vaccine, their life will mainly consist of restrictive measures: self-isolation, mask wearing and so on. This is the reality.
- Would you receive the vaccine?
Without doubt. The explanation is simple — an astronomic number of deaths among my friends and acquaintances, a lot of complications when once healthy people, triathletes or alpinists turned into a shadow of their former self who have to stop because of ыhortness of breath every 100-200 metres.
COVID-19 is very dangerous, and the ugliest thing is that it is unpredictable. It equally effectively kills both young, middle-aged people and the elderly regardless of their attitude to medicine, vaccines, conspiracy theories and so on. This is why I became a volunteer of the third phase of Sputnik V clinical trials to approach the day when the vaccines will be available for all and everybody as much as possible.
*Sputnik V vaccine (as well as Oxford and Sinopharm vaccines) consists of vectors. It is adenovirus particles that can’t proliferate. However, they were inserted genes that produce coronavirus S proteins. What’s happening is that the adenovirus gets in a cell but can’t proliferate, that’s to say, the adenovirus infection doesn’t develop. But adenovirus particles release RNA sections with genes of coronavirus S protein. It is synthesised in the cell and goes out through the membrane. The immunity relies on it by training and “understanding” that anybody who comes with such S protein needs to be quickly destroyed.
The problem is that the adenovirus, which is normal that can proliferate, is met during seasonal flu. And there already might be immunity to it. What’s happening: the infected adenovirus and inoffensive particle from the vaccine gets into the organism, and our immunity immediately kills it. Fortunately, Sputnik V has two adenovirus vectors, one is very rare, it is rarely seen during seasonal flu. In other words, if we can have immunity to one of the vectors (the probability is 25-30%), there is certainly no immunity to the second one.