The Tribune

By DR GREGGORY PINTO

The COVID-19 outbreak has become a pandemic for a reason, as we humans simply do not possess the natural immunity for the novel coronavirus. Vaccinations are safe and highly effective at reducing severe illness and hospitalizations from the COVID-19 virus.

There is a continued reluctance or outright refusal by a surprisingly high percentage of Bahamians and residents to take the COVID-19 vaccine. Vaccine acceptance by the general public and healthcare workers is crucial in being able to successfully control the COVID-19 virus pandemic. The Bahamian economy is heavily reliant on the tourism industry and the COVID-19 pandemic has had a massive negative impact on our number one industry and our economy. The opening up of the Bahamian economy and the hopeful return to normalcy in our society hinges on the effective control of the COVID-19 virus.

The amber list

The United Kingdom recently placed 16 countries on their travel advisory green list as destinations safe to travel for its citizens and residents. The Bahamas remains on the United Kingdom’s amber list which requires very inconvenient quarantine- at-home or in-place restrictions after return from amber list countries, as well as required COVID-19 testing on or before day two and on or after day eight after return to the UK. Other Caribbean countries such as Barbados, Antigua and Barbuda, Cayman Islands, Turks and Caicos Islands amongst others have all been taken off the United Kingdom amber list and placed on their green list, which means no mandatory quarantine after return to the UK. Barbados has vaccinated nearly 30 percent of its population and there are an average of four daily new COVID-19 cases per day. Only 10.2 percent of the Bahamas’ population has received two doses of COVID-19 vaccine and are fully vaccinated, and there is a daily average of twenty four new COVID-19 cases per day.

Education and open dialogue

Unvaccinated individuals can be grouped into vaccine ready, vaccine neutral and vaccine resistant. Vaccine ready individuals can be further categorised into those avidly seeking the vaccine and those who are simply receptive and willing to get the COVID-19 vaccine if it is readily available with minimal efforts required in obtaining it. Simple and straightforward access to the COVID-19 vaccine may be crucial in converting vaccine receptive members of the public to vaccine ready. Vaccine neutral persons are usually in a contemplative stage of deliberation and education may be key in converting many members of this group to vaccine ready. Vaccine resistant persons should have their mistrust, doubts and misgivings regarding the COVID-19 vaccine addressed through education and open dialogue.

The term vaccine hesitancy is used to describe the delay or refusal of vaccination despite availability of vaccination services. The three ‘Cs’ that can be used to explain the factors related to acceptance of the vaccine are ‘Confidence’, ‘Convenience’ and ‘Complacency’.

The general public’s confidence in the COVID-19 vaccine refers to the trust in vaccine safety and effectiveness as well as the general trust in the healthcare system. Convenience related to the vaccine refers to the affordability, availability and delivery of the actual vaccine in a readily accessible environment without unacceptable time-consuming wait times. Complacency refers to the belief that the COVID-19 virus has a low disease risk and a low risk of serious health complications or death, and vaccination is not necessary.

Commonly stated reasons for vaccine hesitancy

• Concerns regarding possible long-term side effects and unknown future ill health effects of the vaccine

• Concerns regarding the nearly unprecedented speed by which the vaccines were developed and approved

• Previous side effects to other vaccines such as the influenza vaccine

• General low confidence in vaccines and their safety profile and efficacy

• A belief that natural herd immunity can be achieved by the public by exposure and transmission of the COVID-19 vaccine

• Lack of trust in the health care system, government agencies and the pharmaceutical industry

• COVID-19 vaccine conspiracy theories, misinformation and disinformation often disseminated through social media

• A racially based distrust in vaccines based on a medical system that in the United States and the United Kingdom for example, has socioeconomic and healthcare inequalities and inequities

Mistrust of the vaccine among the Black population

Worldwide, people of colour have, unfortunately, been disproportionately affected by the COVID-19 pandemic, with higher rates of serious complications, hospitalizations and deaths. The United Kingdom Household Longitudinal survey asked 12,035 individuals in November 2020 how likely or unlikely they were to take the vaccine. The survey determined that overall 18 percent of participants indicated that they were unlikely or very unlikely to take the vaccine. However, there was found to be a very high level of vaccine hesitancy in people of Black ethnicity, with 72 percent indicating that they were unlikely or very unlikely to take the vaccine.

In the United States, Black, Hispanic and Native Americans are about four times as likely to be hospitalised and three times more likely to die from COVID- 19 than Caucasians. African Americans have the lowest vaccination rates among all ethnic groups. The Centers for Disease Control and Prevention’s figures show that nine percent of African Americans have received at least the first dose of the vaccine, compared to nearly 60 percent of Caucasians.

A comprehensive review of 13 published scientific literature (107,841 participants ) that focused on vaccine hesitancy in the United States found that the overall vaccination hesitancy for all adult Americans was 26.3 percent, but for African Americans it was found to be 41.6 percent and 30.2 percent for Hispanics.

Black COVID-19 vaccine mistrust might be partially related to the stain of the Tuskegee experiments (1932 -1972) in which Black men with syphilis were promised treatment, but they purposefully given placebos so that the negative health effects of untreated syphilis could be documented by scientists. Many of the Black men in the Tuskegee study went blind, suffered serious health complications or died.

A Kaiser Family Foundation poll done in September 2020 found that approximately 70 percent of African Americans felt that individuals are treated unfairly based on race or ethnicity when they seek medical care.

The Bahamas is geographically close and strongly influenced by American culture and social media. Thousands of Bahamians and residents have received higher education in the United States or the United Kingdom or have lived in either country at some point in their lives. It is inevitable that a racially based mistrust in the healthcare system abroad will have some influence on the mindset of many Bahamians who are considering taking the COVID-19 vaccine.

You can’t compare COVID-19 vaccine efficacy rates

The COVID-19 vaccine efficacy rate, like that of all other vaccines, is determined by large clinical trials involving tens of thousands of people who are broken down into two groups: half the participants get the vaccine and half get a placebo. These two groups of persons are unaware who received the actual vaccine and who received the placebo. All the large trial participants are then sent out to live their normal lives, while scientists monitor whether they get infected with the COVID-19 virus.

In the Pfizer/BioNTech clinical trial there were 43,000 participants and in the end 170 participants were infected with the COVID-19 virus. How each of the 170 infected individuals fell into either the vaccine group or the placebo group determined the efficacy of the vaccine. For example, if half the 170 COVID- 19 infected participants were split evenly in the placebo and vaccine groups then the vaccine efficacy would be 0 percent. If all the 170 infected persons fell into the placebo group and none into the vaccine group, then the vaccine efficacy would be 100 percent. In this particular Pfizer/BioNtech clinical trial there were 162 participants who were infected with the COVID-19 virus who were in the placebo group and eight participants in the vaccine group, thus the efficacy of the vaccine was determined to be 95 percent.

This 95 percent efficacy shown by the Pfizer vaccine in this large clinical trial does not mean that if 100 people were vaccinated five of them would be infected by the virus. The efficacy of the vaccine applies to the individual receiving the vaccine, thus a person receiving this Pfizer vaccine is 95 percent less likely to get sick from COVID-19 virus.

For each of the COVID- 19 vaccines, Pfizer/BioNTech, Moderna, Sputnik V, NovaVax, Johnson & Johnson and Oxford/ AstraZeneca, the efficacy rates are all calculated in exactly the same way, but each of the actual different vaccine clinical trials might have been conducted under completely different circumstances. The timing of the various COVID-19 vaccine trials and the countries in which the trials took place is vitally important.

The Moderna vaccine was performed entirely in the United States in the summer of 2020; the Pfizer/BioNTech was performed primarily in the United States during approximately the same time period.

The Johnson & Johnson vaccine clinical trial, however, took place in October 2020 to February 2021 when the incidence of per capita COVID-19 rates was peaking and much higher than during the clinical trial periods for both Moderna and Pfizer/BioNTech, thus giving participants much greater opportunity to be infected with the virus. The Johnson & Johnson clinical trial also took place in the United States as well as other countries like South Africa and Brazil, where the per capita incidence rates for the COVID-19 virus were soaring and the virus itself was different, with more contagious variants being present in these countries. Most of the cases analysed in the South African clinical Johnson & Johnson trial were of the much more contagious B.1.351 variant, and despite this fact, the Johnson & Johnson vaccine still performed well and had an efficacy rate of 64 percent.

Likewise, the Oxford/AstraZeneca vaccine trial took place primarily in the United Kingdom and Brazil during a period of peaking rates of COVID-19 and during a time of new more contagious variants of virus. The Oxford/AstraZeneca vaccine was found to be 76 percent effective against the symptomatic COVID- 19 disease and 100 percent effective against severe COVID- 19 disease.

In order to make head-to-head comparisons of the various vaccines it is necessary for all of the vaccine clinical trials to have taken place during the same time period, when the COVID-19 incidence rates were approximately the same and the trials need to have taken place in the same countries and with all the same inclusion criteria.

The efficacy levels of the COVID-19 vaccines are specific to the clinical trials that produced them. Furthermore, those clinical trials were not conducted in the same ways. If the Pfizer/BioNTech and Moderna vaccine trials had taken place during the same time periods as the Johnson & Johnson vaccine and Oxford/AstraZeneca vaccine trials, then the efficacy rates would be expected to be much lower.

The various published efficacy rates for the various COVID-19 vaccines prove the efficacy that occurred during each specific trial and not what really will happen in the real-world scenarios. It is argued by many experts that the efficacy rate of each COVID-19 vaccine is not the best number to judge the vaccine. The goal of the vaccine is not to get to zero COVID-19 numbers, but to tame the virus and prevent hospitalisations, moderate and severe symptoms and death from the COVID-19 virus.

The efficacy rates against death and hospitalisation for each of the numerous COVID-19 vaccines was found to be 100 percent including for the locally available Oxford/AstraZeneca vaccine as well as for the Pfizer/BioNTech, the Moderna vaccine and the Johnson & Johnson vaccine.

All data from the various clinical trials show that they are all highly effective in what is most important, which is preventing hospitalisations and death. The best COVID-19 vaccine for you is the one that is readily available, as they all offer nearly 100 percent certainly that if you are fully vaccinated that you would be protected from needing hospitalization or dying from the virus infection.

We as a nation must band together and achieve herd immunity through widespread COVID-19 vaccinations, as this is the only light at the end of a very long and dark tunnel and nightmare for our small country.

• Dr Greggory Pinto is a board-certified Bahamian urologist and laparoscopic surgeon. He has trained in Germany, South Africa and France, and is a member of the European Association of Urology. He can be contacted at OakTree Medical Center, #2 Fifth Terrace & Mount Royal Avenue. Telephone: (242) 322-1145 (6) (7); e-mail: welcome@urologycarebahamas.com, or visit the website:www.urologycarebahamas.com.