As you may know, I have been a strong advocate for COVID vaccination throughout the pandemic. On 8th December 2020, a 90 year old from Coventry became the first person to be vaccinated in the NHS. Following that, the campaign for mass vaccination was gradually rolled out to everyone in the UK and with a huge success rate.
Collectively, we let out a big sigh of relief when the vaccine was introduced to us, following its clinical approval by WHO. It came as a ‘first break,’ from the crunching back pain we were starting to struggle with from the physical and emotional burdens of various sorts that were piling one after another over us. I applaud each of my colleagues and all the essential workers for holding their face up and showing up to work diligently despite those struggles gripping them on their backs.
In my daily practice, without fail, I have encouraged all of my patients to get vaccinated. I would say the same for my colleagues. We got vaccinated first ourselves, as we were the primary line of defense between an infected individual and the rest of the community. As I may have mentioned, some of us did have some degree of reservations, as the nature of urgency by which the vaccine had to be developed meant it probably didn’t go through enough rigorous examinations for the risks it might potentially cause versus the curative aspect the drug was providing. At the time, it was important that we kept the faith in our scientists, the field experts and this miracle drug, ‘the vaccine’ they had invented. History says, faith in them saved thousands of us from death, disabilities and deformities.
Amidst the first wave of pandemic, we were desperate to take control of the situation. From the dreadful outlook charted by the steeply rising death tolls. Morgues couldn’t hold enough corpses. Deaths in communities were slow to report, as some had passed away, alone in their homes while trying to stay away in isolation from clasps of Covid. We didn’t know anything about it, for what felt like ages in the beginning. A lot of things we did learn were picked up from watching vigilantly around us. As it happens in the world of medicine, tallying symptoms, signs and parameters of one patient with another. Unfortunately in most cases those that died. Why did that patient die? What can we avoid, what can we do to prevent it, how do we know if someone is heading towards a late stage, at what point do we embrace ourselves for it and notify the family? What can we learn from this case so we can save another.
Only later when they discovered COVID transmission was mainly air borne, it confirmed the suspicion my colleague was raising, why two unrelated wards were having covid outbreaks. The air vents were connected.
We have come to a time now where we no longer fear COVID to an extent we did in the first wave. We have learned as many of the variants as we could have, about this constantly mutating virus itself and the changing vaccinations combinations we had been administered in the period. Outbreaks of flu are getting more common and causing more admissions of the aging population now and as clinicians, for COVID we are more focused on infection precautions like personal protection measures & isolation for 10 days.
We have entered phase 4 of the trial in a sense. Like that for most medicines available out there in the market. Phase 4 trial for any drug means, this is a period where the drug that has proven its efficacy, has been licensed for use by relevant control boards for intended purpose will now be studied on its effects- mainly long term risks and benefits. This is the period where data will be coming in and collected in mass about the minor/major adverse effects/ side effects experienced, complications and sequelae secondary to it. A drug may have completed its phase 4 on research however one can assume phase 4 in the clinical world runs forever. A drug may have certain side effects for a small duration period but may have a completely different adverse effect after years of use on the same patient. By virtue of collective toxicity over prolonged use or by modifying effect of some other medication he might be using concurrently or by adaptation in some forms by his genetics or as his function of organs changes. For example with age our kidney function deteriorates physiologically. That is why our guidelines even for first line drugs after many years of use often changes. When the data collected after long years maybe even decades, prove that the harm outweighs benefits in the contrary of beliefs, it has to be. The drug will either be taken off the market then, used in other diseases where success has been crucial for patients or as a specialist prescription. Every medicine you take comes with a leaflet of its intended use and series of effects.
There had been uproars about violation of individual liberties in many instances. Including government mandated vaccinations that was rolled out for frontline workers with patient facing jobs, with risk of dismissal in most cases and possible redeployment if there was resistance. Legal enforcement of activities as such have led and continues to lead communities marching against protest for breach of their human rights. I must say, although I had never been a big supporter of those marches, especially if it meant less vaccinations in the community at the time of outbreak, mandation by law with no redundancy plans for those who wish to leave spoke volumes of where we stood in roles in the scheme of big picture. In world war one, 97% of British soldiers were inoculated with anti typhoid vaccination. Articles I have read infers that most did not know they had the right to refuse it. And although it prevented deaths and infection by typhoid at the time of sanitary status of the wars; military approaches for domination, affirmation, experimentation without consideration of individual choice and rationale for refusing it in the name of greater glory for the service of mankind, is unacceptable. How many have been trialed since? Ideal candidates of the right age in full physical fitness in a controlled environment. The risk here is reinstallment and propagation of the same behaviour in future, mass human trials, without a second of thought for ethical implications of it?
Most of us experienced local pain, fever, headache and general myalgia with our vaccinations. Similarly, some people had allergic reactions. It is important to remember these vaccines act by modulating your immune system so these effects were to be expected. Most effects were noted in the first few months as that is when immune system is maximally activated against the insult. The later effects, if any because of these insults, may take time to show. There have been circulating reports of various adverse effects experienced attributed to Covid vaccine although the argument is, they could possibly be related to covid 19 infection itself or subclinical infection prior to vaccination as well that he/she did not demonstrate any symptoms of. Blood clots were detected quite early. Studies are now showing, there has been an increased incidence of neurological conditions like guillain barre syndrome, bell’s palsy. Some reports of inflammation in the muscles of the heart. People’s story of their own experiences with vaccinations are coming forward. Like its impact on fertility after experiencing menstrual irregularities, generalised fatigues, recurrent headaches etc. Accounts from brave whistle blowers are coming forward. There is ongoing world wide surveillance and reporting of the adverse reactions, which I hope will be duly studied before dismissing as mass hysteria.
It is important to be transparent, now more than ever, to keep communities’ faith in our profession, and our continuing faith in scientific advances, pharmacological companies, world leader platforms and the government. And most importantly, it is vital that people standing in power including the government work on their approach to reinforcing the means of ‘greater good’ with respect to individual’s liberty in mind. Endemic, epidemics and pandemics are part of human history. Like seasons have their cycle and place in nature, unless there are outbreaks of bio hazards due to human errors, we should expect nature will find us surprises along our course.