Tag Archives: #vaccination

Stanford’s Dr. Nirav Shah on Vaccines VS. Variants

Breaking news that virulent variants from Brazil, South Africa, and the UK are multiplying across borders even as homegrown strains are mutating on US soil, has raised a number of questions.

Are variants more contagious?
Will they cause worse infections?
Are current vaccines effective against mutating variants?
And should we take different precautions to keep safe?

Dr. Nirav Shah, MD, MPH, of Stanford University’s Clinical Excellence Research Center, fielded questions and concerns from ethnic media reporters at a press briefing on March 19. Along with other COVID 19 experts from the Bay Area, Dr. Shah shared information about new strains of the virus and safety net information for communities of color who want to sign up to get their vaccine shot.

“We cannot start to celebrate just yet,” said Shah, even though America reached an important milestone when the 100 millionth vaccine was administered on March 19.

The Story of Virus Variants

The emergence of variants has raised the specter that the current generation of vaccines might be rendered obsolete before they have even been fully rolled out. Are variants gaining ground and will they be immune to distinct vaccines before we reach herd immunity?

“It’s a race between how fast we get people fully vaccinated versus the level of disease in a community and how much transmission is going on,” explained Shah, about how a variant becomes dominant.

In heavily infected communities, the more virus particles there are, the greater the chance of one being different. All you need is a spike protein change, said Shah, which will give the variant a better chance of attaching to cells, so it spreads better and faster, becoming the dominant strain.

Simultaneously, as more people get vaccinated to combat COVID19, “the selective advantage of some particles relative to other particles, allow them to spread much faster.”

Now the race is on to get everyone vaccinated before the B.1.1.7. variant – the most dominant variant takes over.

“The story of virus variants is the story of evolution and natural selection,” added Shah.

Investigations of Variants

Currently, the CDC and WHO are studying the spread of three designated variants. Variants of interest -like the P2 which have ‘caused a cluster of infections’  in some countries, seem to be driving a surge in cases, though less is known about their transmissibility and lethality, or even if vaccine recipients are ‘fully neutralized against them or not’.

Their genetic sequence has some changes which suggest they may be more contagious, said Shah, and likely to be resistant to immunity bestowed by vaccines, treatments, or tests.

People are at greater risk from variants of concern that could reinfect survivors of certain Covid19 strains. Therapies and vaccines may be less effective against these strains which have “proven to be more contagious and cause more severe disease,” explained Shah.

Recent studies report that COVID-19 survivors and fully vaccinated people seem able to fight off infection from the virulent B.1.1.7 variant but may have less protection against the B.1.3.5.1 variant. Shah referred to research that shows the B.1.1.7 variant spreads about 50% faster and is more lethal, relative to prior strains of the virus.

The good news is that the existing range of vaccines (Pfizer, Moderna, Oxford/Astra Zeneca, and Novavax) have proven effective against this variant.  But less is known about the transmissibility and lethality of the P1, B.1.4.2.7, and  B.1.4.2.9 strains.

So far, however, assured Shah, no variants have met the definition for variants of high consequence which refer to strains that cause “more severe disease, more hospitalizations, and have been shown to defeat medical countermeasures” – like vaccines, anti-viral drugs, or monoclonal antibodies.

In the contest between vaccines and variants, “We will win the race by …vaccinating people as quickly…and broadly as possible” noted Shah.

An Annual Shot

Infectious disease experts liken variants to flu viruses which require new flu vaccines every year; scientists are even considering the possibility of multivalent vaccines designed to immunize against two or more strains of the virus.

“It’s a race of the mutant viruses against the vaccines…and to date, none of the mutants have escaped fully the major vaccines. The hope is that with minor modifications, we can get the continued evolution of the vaccines to match the evolution of the viruses.” It wouldn’t be surprising if the COVID vaccine was administered like a flu shot every year, added Shah.

Getting to Herd Immunity

The likelihood of reaching herd immunity will be a reality if at least  70% or more of the population are resistant to existing strains of the virus. However, as states relax public health restrictions as well as mask and social distancing mandates, herd immunity may be challenging to achieve.  “More people getting infected simply means more chance of variants,” cautioned Shah.

I asked Dr. Shah if we would need a new generation of vaccines before the current vaccine roll is complete and if boosters would be introduced. “I am an optimist”, said Shah. “I imagine we would have booster shots by the fall but what’s important is that we all get that first shot, and make sure the vulnerable and elderly get theirs. That will make us collectively win”.

Dr. Shah reiterated that the Moderna, Pfizer, and Johnson & Johnson vaccines authorized by the Food and Drug Administration (FDA) for emergency use, are still the most powerful tools to fight all the strains of COVID-19.

“This is a race for the world,” said Dr. Nirav Shah. “We know the virus doesn’t respect any borders, and so we should be as broad as possible in our thinking about getting the vaccine to everyone across the world.”

Helpful links:

Meera Kymal is the Contributing Editor at India Currents

Suvita’s Solution to Mass Vaccinations Involves Gossip

(Featured Image: Pippa Ranger, Innovation Advisor, DFID)

In the wake of the COVID 19 pandemic, vaccination is a hot topic globally. In America, 400,000 people have died. We still don’t have a uniform understanding of the efficacy, distribution, availability, and side effects of the COVID-19 vaccines.

Thankfully our 46th President, Joseph R. Biden has signed several executive orders including a 100-day mask mandate, to use the Defense Production Act to ramp up vaccine production, mount a vaccination campaign and expand testing and treatment. While we struggle to rid some people of their vaccine hesitancy in the US, countries with less robust economies, have problems with logistics. 

Vaccines are available but children are not getting vaccinated against communicable diseases like polio, mumps, measles, and rubella. The majority of the world’s undervaccinated children are in India (about 10 million each year). A child dies in India every 4 minutes from a disease that could have been prevented by a vaccine.

What an appalling loss of human life in the 21st century! The government of India is aware of this problem, and they have vaccines but local health departments in rural and semi-urban India need assistance streamlining access to children. As a medical student at LTMMC, we went on vaccination drives to the Dharavi slums, but door to door vaccination, although effective, is very labor-intensive and may not be feasible because of the lack of manpower and portability of temperature-sensitive vaccines. WHO is encouraging think tanks to come up with innovative solutions. 

Last week, I talked to Varsha Venugopal who is the point person in the United Kingdom for Suvita, a non-profit organization.

Suvita came up with a practical solution brainstorming with a network of young like-minded affiliates. What if they used the most accessible communication device, a cell phone, to solve this problem? Team Suvita recognized that most families in India have at least one cell phone. If they could send an SMS reminder to the parents to take their kids for immunization, they would improve compliance.

Prevent disease! Save lives!

But to make the message more effective, they went one step further. They based their policy and procedures on a Nobel prize-winning work of Abhijit Banerjee, who received 2019 The Sveriges Riksbank Prize in Economic Sciences in Memory of Alfred Nobel “for their experimental approach to alleviating global poverty.”

It employed the idea of using the so-called “village gossip” or euphemistically speaking, an ambassador to influence human behavior. Having them send personalized SMS reminders to caregivers, informing them when their child is due for a vaccination, worked. Not only did this approach reduce the workload of individual health care workers, but emerging evidence also suggests that a combination of both these methods is more effective and more cost-effective than either in isolation.

Mother and child in Saran district, Bihar

So far 200,000 parents have enrolled in Suvita”s SMS program. Their staff has achieved the following milestones: a signed Memorandum of Understanding with the Maharashtra Family Welfare Bureau and partnerships with Maharashtra and Bihar state governments. There are 100,000 eligible children in the Saran district of Bihar. They plan to reach at least 50,000 eligible children in 2021. Scaling up SMS reminders program starting with 2 districts in Maharashtra and the whole of Saran district over the course of 2021.

Like all wonderful projects, Suvita’s efforts have faced a few challenges. The COVID-19 pandemic lockdown has affected access to ambassadors and parents. As the program expands, there will be a need for additional funds for staff workers and carefully selected volunteer immunization ambassadors. Measures are in place to protect the personal information of users, thereby limiting the risk of a data breach and exposure of personal information to data-hungry merchants.

If Suvita takes appropriate security precautions and the model thrives, this nudge technique can be expanded to many health, wellness, education, and safety programs. It’s wonderful to harness the self-proclaimed busybodies/gossips for social and economic betterment.

I would like to share an interesting personal anecdote to illustrate Suvita’s role model with you. While writing this article, I was explaining the concept of vaccination to a ten-year-old. After three rounds of easy-to-understand information about the basic concept of vaccination, he had a question. He said: “ Grandma, are you stating a fact, or are you telling me a story?” I was amazed at his query. He questioned my source because I was not in his “peer” group but if the same information would have come from his friend or known social media platform, he would have accepted it! 

Monita Soni is a pathologist. She has one foot in Huntsville, Alabama, the other in her birth home India and a heart steeped in humanity. Monita has published many poems, essays, and two books, My Light Reflections and Flow Through My Heart. You can hear her commentaries on Sundial Writers Corner WLRH 89.3FM.

Pfizer’s Vaccine Expert Discusses Allocating Doses For Low Income Communities

Dr. Advait Badkar, Senior Director of Pfizer’s Drug Design Team.

Radha Rangarajan, CSO of a medical devices company, and healthcare journalist Sujata Srinivasan, interviewed Advait Badkar, a Senior Director in Pfizer’s Drug Product Design and Development organization. Badkar is leading the efforts on the Pfizer-BioNTech COVID-19 vaccine program with respect to the formulation and process development, scale-up, technology transfer, and registration across global markets. The team Badkar heads specializes in novel delivery technologies with emphasis and expertise in nanoparticle-based modalities.

IC: Are there any differences in immunogenicity in subpopulations? 

Pfizer and BioNTech’s Phase 3 clinical trial data demonstrated a vaccine efficacy rate of 95% in participants without prior SARS-CoV-2 infection (first primary objective) and also in participants with and without prior SARS-CoV-2 infection (second primary objective), in each case measured from 7 days after the second dose. Efficacy was consistent across age, gender, race, and ethnicity demographics. 

IC: Participants enrolled in Pfizer’s clinical trials were known not to have been infected previously with COVID-19, for obvious reasons. But now that the vaccine is publicly available, it is not possible to test every person before vaccinating. In India, 70%-80% of people have the asymptomatic disease and are unaware of their COVID-19 status. Are any studies planned to assess the safety and efficacy of the vaccine in previously exposed populations? 

Yes. Immunity after vaccination is a question we continue to explore in our research. The duration of immunity after COVID-19 requires observing a large number of people who have had the disease once until some get it a second time. Because the first known cases of COVID-19 only occurred in December 2019, there hasn’t been enough time to observe a significant number of second illnesses to know the duration of natural protection. 

We will better understand transmission when we have data on protection for those who were previously exposed to SARS-CoV-2 or infected with COVID-19, asymptomatic disease and severity of the disease. Our trial will continue to study those areas to determine the full protection and potential of the vaccine. 

IC: Even though the science behind mRNA vaccine is not new, some fear that it might alter the genetic makeup, or cause other irreversible side effects. How is Pfizer’s outreach arm dispelling these myths?   

There is no evidence to support that notion. To the contrary, the mRNA platform is well suited for a pandemic response on many levels.  

First, one aspect of safety – unlike some conventional vaccines, mRNA vaccines are non-infectious, and there is no need for a viral vector to deliver the mRNA vaccine. Second, because no viral vector is used, mRNA vaccines pose no risk of an anti-vector neutralizing antibody response, thereby permitting repeated boosting, which may be important if additional vaccinations are recommended in the future.  Third, speed, mRNA technology enables rapid development if the vaccine needs to quickly adapt to potential mutations. mRNA vaccines have an efficient, fast production process, without the need for complex mammalian cell systems.

IC: Is there any plan to simplify the vaccination protocol to one dose? 

No. Pfizer and BioNTech’s Phase 3 study for the COVID-19 vaccine was designed to evaluate the vaccine’s safety and efficacy following a 2-dose schedule, separated by 21 days. The study concluded that the two doses are required to provide the maximum protection against the disease, a vaccine efficacy of 95 percent. 

IC: What are your thoughts on how to choose between the different vaccines?

At Pfizer, we understand that mitigating this global pandemic will require more than one vaccine and more than one company’s efforts. In March of 2020, Pfizer announced a 5-point plan calling on the biopharmaceutical industry to join the company in committing to an unprecedented level of collaboration to combat COVID-19. The industry responded. We are rooting for each other’s success and are confident that science will win.  

IC: What is the plan for a global supply? How will these be administered?

Pfizer and BioNTech are firmly committed to equitable and affordable access for its COVID-19 vaccine for people around the world. That commitment includes the allocation of doses for supply to low-income countries at a not-for-profit price. We are actively working with governments all around the world, as well as with global health partners to work towards fair and equitable access to our vaccine. We are also partnering with global health stakeholders to provide expertise and resources that can strengthen healthcare systems where greater support may be needed to deploy COVID-19 vaccines.  

Radha Rangarajan, Ph.D., is Chief Scientific Officer at HealthCubed Inc., a medical devices company. Prior to this, she was the founder and CEO of Vitas Pharma, a drug discovery and development company focused on novel drugs to treat multidrug-resistant infections. Radha has also worked in the Drug Discovery division of Dr. Reddy’s Laboratories. She received her bachelor’s degree from Stanford University, her Ph.D. from Rockefeller University, and was a postdoctoral fellow at the Harvard School of Public Health before moving back to India in 2003.

Sujata Srinivasan is an award-winning, independent business and healthcare journalist with the nonprofit Connecticut Health Investigative Team, whose grant-funded, data-driven reporting is carried by media outlets statewide. Previously, she was the Connecticut correspondent for Crain’s Business, business reporter at NPR’s regional station WNPR, U.S. correspondent for the Indian edition of Forbes, editor of Connecticut Business Magazine, and Interim Chief of Bureau at CNBC-TV 18, Chennai, India. You can follow her on Twitter @SujataSrini

Here to Stay: Important Phrases of 2020

The year 2020 has been so dramatic that mere words are not enough to capture its uniqueness, absurdness, and plain scariness. It needs phrases. And not surprisingly, the top phrases of 2020 seem to fall into two neat catastrophic categories: health and politics. And one can’t forget the inevitable categories: life and future. 

HEALTH

Covid-19. 

Definition: CO for corona; VI for virus; D for disease; 19 for 2019. 

Origin: Ironically, we had never even heard of it in 2019, although there were already some rumblings of the disease in China. And even when we first became aware of it in early 2020, we were referring to it as “the coronavirus”. Then on February 11th, Dr. Tedros (Director-General of WHO) declared it officially as Covid-19. Many of us who had grown used to calling it “the coronavirus” were disturbed to learn that there are also other coronaviruses. And we were more perturbed by the suffix “19”. Does that mean there could be a “covid-20”? “Covid-21”?

Related phrases: pandemic; and for the non-believers, plandemic.

Related movies: Virus (Malayalam film); Contagion; Outbreak; The Andromeda Strain; Panic in the Streets;…  Actually, it may be better for the nerves to watch happy, pretty, totally escapist Emily in Paris on Netflix.

Social Distancing.

Definition: What we really mean to say is “physical distancing”, meaning staying 6 feet away from anyone who is not a member of your immediate household in order to minimize chances of catching covid-19. Social distancing can actually be detrimental to our health, especially when we’re also physically distancing. In fact, to maintain our mental health, we need to be socially close to our family and friends at this time via phone, texting, video chats, social media, etc.

Origin: No one knows, but as long as we practice physical distancing until a vaccine is available, no one cares. However, physical distancing can be very difficult in mega-cities like Mumbai, Sao Paulo, and New York City – especially for the poor.

Related phrases: isolating; quarantine; lockdown; wear the mask (it’s not a political statement); flatten the curve.

Related movies: Think Home Alone 1, 2, 3, 4, and 5. And Home Alone 6 is in the works … but not coming soon to a theatre near you because production is delayed due to covid-19.

The cure is not the vaccine; the cure is the vaccination.

Definition: The CDC defines a vaccine as “a product that stimulates a person’s immune system to produce immunity to the specific disease, protecting the person from that disease”. It defines vaccination as “the act of introducing a vaccine into the body to produce immunity to a specific disease”. Dr. Anthony Fauci and other medical experts have stressed that simply developing a vaccine against covid-19 is not sufficient; people have to take the vaccine to protect themselves against covid-19.

Origin: The reason to make such a seemingly obvious statement is that there are a substantial number of anti-vaxxers: people who believe that vaccines are harmful. A recent study in Lancet reports that “31 million people follow anti-vaccine groups on Facebook, with 17 million subscribing to similar accounts on YouTube”. The anti-vaxxer movement has, if anything, grown during the pandemic. And it may also be influential in other parts of the world – e.g., India, Brazil. 

Synonyms: rollout strategies; COVAX initiative. 

Antonyms: I don’t believe in science; The world is flat; I died.

Related movies: Worryingly, a recent study concludes that “Cinematic portrayals of immunization are increasingly unrealistic and negative”. 

POLITICS

Polarized.

Definition: Polarized used to mean the special lenses on our sunglasses that reduced glare. But now it means breaking up into opposing factions – as in Republicans vs. Democrats. 

Origin: The word is old, but it is becoming more ubiquitous and more dangerous, as it relates to an increasingly divided United States. It denotes disagreements on core issues and more worryingly, core values. 

Related phrases: hyperpartisan; narrow-casting; identity politics; populism. 

Related movies: Friendly Persuasion; Glory; Sarkar (Hindi film); Lincoln; Sarkar (Tamil film).

The election was stolen.

Definition: President Trump is saying that he has lost the US 2020 election because of large-scale election fraud: including voter suppression, accepting voters who are not eligible, and manipulation of voting systems. However, the election has been declared legitimate by the OSCE and many other neutral institutions.

Origin: President Trump. 

Synonyms: The election was rigged; Stop the steal; Disinformation.

Antonyms: The election was legitimate; international election monitors; Peaceful transfer of power; The Election Commission of India

Related movies: The Candidate; Kissa Kursi Ka (Hindi film); Good Night, and Good Luck; Swing Vote; All In: The Fight for Democracy; Whose Vote Counts, Explained. 

JUST LIFE

Essential workers.

Definition: those that need to show up to work despite lockdowns due to covid-19. Includes frontline workers in healthcare, childcare, water, energy, food production, food retail, construction, transportation, and social services. Hopefully, this will lead to well-deserved recognition and better remuneration for those whose services we need in our daily lives.

Origin: Covid-19.

Related phrases: frontline workers; ragpickers; migrant workers.

Related movies/shows: Superstore; Scrubs; Anbe Sivam (Tamil film); Norma Rae.

Black Lives Matter.

Definition: a political and social movement protesting against police brutality and racially motivated violence against black people. Not a new phrase, but one that unfortunately needs to be repeatedly voiced.

Origin: It began in the US in 2013 with the acquittal of a white man in the shooting death of a black teenager. The movement has since gone global, with over 450 major protests in 2020.

Related phrases: anti-racism; No justice, no peace; Dalit Lives Matter.

Related movies: Nothing But a Man; Malcolm X; Periyerum Perumal (Tamil film); Stay Woke. 

Zoom meetings.

Definition: An easy way that multiple people can have a video chat. It’s also free if you keep your chat under 40 minutes.

Origin: Hot-shot executives may have known about ZOOM since 2013 but they were keeping it quiet so that they could keep traveling all over the globe on business class. Now even your grandma likely knows about ZOOM and uses it to talk each week to all the members of her bhajan group. However, if your grandma is a Palestinian activist, she may be banned from using ZOOM.

Related phrases: Skype, Microsoft Team, Google Meet, JIO Meet, Say Namaste, etc. etc. etc..

Related movies: None…yet. And therein lies a business opportunity.

THE FUTURE

The next normal.

Definition: While ‘the new normal’ connotes change to a different and stable condition, ‘the next normal’ connotes an ongoing succession of changes. Given climate change, growing inequality, refugees, aging, and future pandemics, our world seems poised for a series of next normals. Hopefully, the next ‘next normal’ will again include trips to India.

Origin: likely the management consulting firm McKinsey, early on in the covid-19 pandemic.

Related terms: the usual unusual; same new, same new.

Related movies: (to be released in the next normal): No Time to Die; Black Widow; Mission Impossible 7; Laal Singh Chaddha (Hindi film); and of course, Emily in Paris season 2. 

May 2021 be less dramatic and less phrase-worthy than 2020. And may the next normal bring with it a subsiding of Covid-19, less noxious politics, greater pay for frontline workers, more racial equality, and face-to-face, hug-to-hug, meetings with all our beloved family and friends.

Ranjani Iyer Mohanty is a writer, editor, and phrase-lover.