It’s finally Alert Level 1, and we have vaccines to thank
CLINICAL MATTERS
The transition to Alert Level 1 has been a long time coming. After one year of the nationwide rollout of vaccines, Covid-19 has been tamed. But we would not have gotten to this point so quickly if not for the extraordinarily rapid development of safe and effective vaccines. Despite varying efficacies in their ability to block transmission and infection, all current vaccines work very well against preventing severe disease and death. The most striking effect of the global rollout of immunization against Covid-19 has been the drastic drop in severe disease and mortality. Here are four facts clearly showing that vaccines work.
- Vaccines work best to prevent severe disease, but they still protect against infection and transmission.
One of the most common anti-vaxxer arguments is that breakthrough infections, especially with Omicron, show that vaccines are useless and don’t work. This is false.
While there is no 100 percent effective vaccine, our current vaccines clearly show a five to 10-fold decrease in the risk of severe Covid-19 and a 10-fold decrease in the risk of death. Data from DOH shows that since the start of the vaccination program, 85 percent of severe and critical Covid-19 cases, and 93 percent of Covid-related deaths were among the unvaccinated population.
In addition, the risk of breakthrough infection is indeed higher with Omicron, it still effectively prevents 30 to 40 percent of infections. That is not a trivial number. It can mean the difference between staying healthy versus developing long Covid-19 and other complications of Covid-19. In addition, the hybrid immunity that results from breakthrough infection is very durable and offers cross-protection against various variants of concern. It is still better not to get infected at all, but if breakthrough infection does occur it is less deadly and results in greater protection against reinfection.
Finally, breakthrough infection in fully vaccinated individuals results in mostly mild disease and less viral shedding. This means these patients are less likely to transmit the virus to other people. They are infectious for a shorter period of time and are also less likely to end up with mutated virus. If the exposed vaccinated persons are among the 30 to 40 percent who don’t develop infection, then they won’t transmit at all.
1. Vaccines add protection, even if you have had Covid-19.
One persistent myth that continues to circulate is that if you have had Covid-19, you probably don’t need to get vaccinated anymore. This is completely false. Covid-19 immunity from infection is unpredictable, and can vary depending on how much virus was inhaled, what the severity of illness was, and the immune status of a person. People who are asymptomatic or experience mild illness may not even generate any antibody response and can get reinfected, especially with newer variants. Vaccination uses known quantities of antigen (the part of the virus that promotes an immune response), and so the immune response is more predictable. The vaccine schedule of two doses with a set interval plus a booster has been shown to improve immune responses and leads to longer lasting immunity, especially against severe disease, compared with no vaccination.
A recent study shows that if someone with previous infection gets vaccinated, the immune response is even better than that seen with vaccinating a person who has never been infected. This doesn’t mean people should get infected on purpose, since getting infected when unvaccinated is dangerous and should be avoided. If one has been infected, however, the hybrid immunity that one gets from vaccination after infection is one of the strongest immune responses seen in Covid-19 and cross-protects against other SARS-CoV-2 variants.
2. Vaccines are safe and effective, and severe side effects are very rare.
Many antivaxxers have been circulating cherry-picked journal articles that report serious side effects from the vaccines without putting the rarity of these occurrences into the proper context. Moreover, they gloss over the fact that some of the side effects seen with the vaccines occur far more commonly in Covid-19 infection.
The much-hyped but extremely rare myocarditis side effect from the mRNA vaccines needs to be understood itn the proper perspective. Not all types of Covid-19 vaccines have been linked to myocarditis. Only mRNA vaccines have this small excess risk due to an as of yet unknown mechanism.
The average risk of myocarditis from an mRNA vaccine is two to three occurrences per 100,000 doses. While that is concerning, consider that if someone gets Covid-19, his or her risk of developing myocarditis is 11 occurrences per 100,000 infections. That means that even with a slightly elevated risk of myocarditis from an mRNA vaccine, the risk of myocarditis is still nearly four times lower than actually contracting Covid-19. In effect, by inoculating against Covid-19 and preventing someone from becoming infected, you end up with a significantly lower risk of myocarditis. Aside from myocarditis, a whole host of complications that are seen in Covid-19 infection are prevented by vaccines. This includes a 120-fold risk of acute kidney injury, a 160-fold risk of arrhythmia, and an over 60-fold risk of pulmonary embolism.
In other words, the safety signals that are being seen in some of the vaccines are far outweighed by the protection from complications from Covid-19. Additional precautions can be taken, such as using vaccine types other than mRNA vaccines in those who have cardiac problems. One of the best things about the vaccination program in the Philippines is that we have one of the most diverse choices of vaccines in the world. In contrast, countries like the US have approved only three or four vaccine brands.
3. There is no proof that Covid-19 vaccines have caused any excess deaths. In fact, the current evidence shows that Covid-19 vaccines are saving millions of lives.
Disinformation propagated by anti-vaxxers asserts that an increase in excess deaths in the Philippines was coincident with the vaccine rollout and suggests there is a causal link between these two events. Despite having already been debunked by the Population Commission, which published the report, some misinformed sectors are claiming there is no evidence it isn’t related to the vaccines. This is a very unscientific and dangerous line of reasoning. Aside from the clear safety data from phase three trials involving tens of thousands of subjects and real-world studies on millions of people, a look at the causes of excess deaths shows that these are not vaccine related.
There were few excess deaths in the first year of the pandemic because the lockdowns in the Philippines were successful at keeping Covid-19 deaths low compared with many other countries. The excess deaths in the second year of the pandemic are attributed to chronic diseases that have been neglected as a result of the pandemic, aside from some untested Covid-19 deaths.
Understandably, many doctors’ clinics were closed due to the lockdowns, and many hospitals shifted care to those with Covid-19. This resulted in missed clinic visits for people with high blood pressure, heart disease, diabetes, and kidney disease. Some patients with early stage cancer missed the chance for early detection and therefore were diagnosed at a less curable stage.
These excess deaths are collateral damage from lockdowns, and are the reason countries started opening up once the virus was under control. Not locking down would have resulted in many more deaths. Unfortunately, this is part of the price of keeping the virus from spreading. In the presence of a clear alternative explanation, the assertion that vaccines may have caused those deaths is completely debunked.
One of the most challenging aspects of the Covid-19 pandemic has been the fight against misinformation. Whatever their motives, antivaxxers have cause significant harm, particularly among the vulnerable population. By hesitating to get vaccinated and subsequently getting Covid-19, the risk of death among unvaccinated holdouts is nearly 10-fold that of a fully vaccinated person. This is unfortunate because 90 percent of deaths are preventable with the vaccines we currently have. Properly vetted and scientifically sound information, coupled with continued education, are our best tools to fight the parallel pandemic of fake news.