SEOUL – While many parts of the world remain under-vaccinated, multiple high-income countries – including those which suffered some of the most devastating Covid-19 outbreaks in 2020 – are surging ahead in their inoculation programs.
In order to better understand the current trends and the future trajectories of both the pandemic and the vaccination drives that are key to managing it, government disclosures and related media reporting need to be re-jigged, an expert insists.
In the second part of an exclusive interview with Asia Times, Dr Jerome Kim, head of the Seoul-based International Vaccine Institute – who, as his position might indicate, is a firm believer in the efficacy of vaccines in general – expressed frustration at the focus of current reportage, that obscures the critical metric by which vaccine successes should be judged.
He admitted that the increased transmissibility of the Delta variant has changed earlier calculations about the achievement of herd immunity, but mentioned an under-reported initiative that could provide humanity with a silver bullet against mutant strains of Covid-19.
That might be rolled out as early as 2022 – but in the meantime, he admitted that his “biggest nightmare” remains a real possibility.
Severe infections are the key
“They announce an outbreak and ask, ‘Is the vaccine failing?’” Kim complained. “But that is not the question – the question should be, ‘is it preventing hospital entries, ICU entries and deaths?’”
Indeed, while much coverage focuses on infection numbers, fears rise over new variants of the disease and debate rages over the efficacy of different vaccines, the real role of inoculations – preventing critical conditions – is obscured.
“This is what vaccines do!” Kim said. “We know they don’t prevent infection – they prevent severe disease.”
Among those countries with speedy vaccination drives which fully report hospitalization and death rates, the trend is encouraging, Kim said, citing comprehensive data he has studied from Iceland and Germany.
“In areas with high rates of vaccination, we are having cases but not hospitalizations,” he said. “When we reach a certain level of immunity, we may not see a decrease in infections, but will see a decrease in deaths and hospitalizations.”
Iceland, in particular, with its small and manageable population, advanced vaccination drive and efficient healthcare data provision system, provides a near-perfect cohort.
Like other countries, it is experiencing a Delta variant wave of the virus. Despite vaccinating 71% of its 357,000 strong population, Iceland has had 1,459 cases in the last 14 days.
However, it has not suffered a single Covid-19 death since June 4.
Or take the far larger and more chaotic United States, where a virus surge is taking place at a time when the country may have hit an inoculation ceiling of only 51% due to widespread vaccine resistance and scare-mongering among the population.
“Less than 1% of deaths in the US are among the vaccinated,” Kim said. “And only 1-5% of the hospitalized are vaccinated.”
Kim is not alone in his analysis. With infections among Americans aged 30-39 hitting all-time peaks, a US doctor characterized the situation to the BBC as “a crisis of the unvaccinated.”
But regardless of how much data and science they deploy, a major communications challenge lies ahead for governments and health authorities.
“We need to look at the impact of vaccinations rather than simply the impact of infections,” he said. “When do we start that transition, and how do we communicate it? And how do we convince people to get vaccinated?”
Kim admits there is considerable opacity clouding his own understandings. While the numbers of infections and deaths are widely disclosed, there is a lack of information on hospitalization of severe cases.
“Only about 30 countries report their hospitalization data in a realistic fashion,” he said.
Another factor obfuscating analyses is the speed and scale of the rollout.
Vaccines are now being administered by the hundreds of millions – a situation far removed from pharmaceutical companies’ early clinical trials of the vaccines, that were carefully overseen by specialists.
With data collection and disclosure passing on to national healthcare systems and governments, there is a hole in both recording and disclosure – especially in second- or third-world nations.
“Once Covax, or a country, buys a vaccine, the company’s responsibility is done,” Kim said. “It is the country’s responsibility to figure out if the vaccine is working.”
A further issue is an all-too-natural media tendency to prioritize alarmism.
Take South Korea. On August 11, as infection numbers climbed steadily when the country was rocked by a fourth wave of the virus, infections hit a record high of 2,223.
Most media led with that headline. Yet on that same day, only one person died from Covid-19, amid a weekly rolling average of four mortalities.
On that day there had been a total of 2,135 deaths from Covid-19. As of Friday, that number had risen to 2,191, among a population of 52 million. And South Korea has one of the slowest vaccination drives in the high-income world.
Vaccine analyses
An avalanche of reporting has compared the risks and efficiencies of different vaccines. Yet the differing vaccines used in different nations, and the trend for mixing doses, make trend analyses fiendishly complex.
Even so, Kim noted, in a broad overview, that the vaccines that have been approved for use in first-world Europe and North America “appear to be effective in the greater-than 80% range for hospitalization and death,” he said.
And while there are widespread suspicions hanging over China’s Sinopharm and Sinovac, he defied much of the current conventional wisdom, stating that these, too, seem effective – albeit in the metrics of reducing deaths and hospitalizations rather than of controlling infections.
Still, the Chinese vaccines, which have largely been disseminated to medium- or low-income countries, suffer from a lack of information disclosure – particularly regarding their efficacy against the now predominant Delta variant and in terms of vulnerable populations such as the elderly, Kim said.
A rising issue is an increasingly likely need for third “booster” shots, rather than the two jabs thought to be sufficient for current-generation vaccines.
According to news reports, a British public health study found that protection from either of the two most commonly used Covid-19 vaccines – AstraZeneca and Pfizer – against the Delta variant weakens within three months.
The study, by Oxford University, found that 90 days after a second shot of the Pfizer or AstraZeneca vaccines, efficacies in preventing infections slipped to 75% and 61% respectively.
And yet – buttressing Kim’s point that the key issue is severity and death rates, rather than infections – the report admitted that its findings were only a “rough proxy for severity of symptoms.”
Kim agreed with a convergence of both research data and suggestions being made by health authorities in countries including Israel that booster shots look increasingly necessary.
“We could be entering a pretty significant cycle of revaccinating people with various vaccines,” he said. “We have been talking 16 million doses [to vaccinate the global populace] but if we have to have a booster, that is another 8 billion doses,” he said.
That development would add further strain to global output and would almost certainly widen the already troublesome gap between the global North and the global South in terms of speed and scale of national vaccination drives.
Silver bullet vs nightmare scenario
When it comes to the achievement of herd immunity, Delta has changed the earlier calculus. Due to the higher transmissibility of the variant, it pushes the numbers of those required to be resistant to the disease to a higher percentage than had previously been calculated.
In terms of Covid-19’s transmissibility, “Delta has doubled it, from being a little worse than ‘flu, to being more like chickenpox, which is very transmissible,” Kim said. “That raises your level of herd from around 70% to above 80%.”
And of course, Delta is not the only variant.
“Lambda seems more transmissible, more deadly and more resistant [to vaccines], so that is worrisome, though the dominant strain now is Delta,” he said. “We have some information in Latin America, but when we look at the parts of the world with known outbreaks, we don’t have good data on the variants.”
One under-reported initiative, however, may provide the Holy Grail of anti-Covid weapons: The development of vaccines resistant to multiple strains of the virus.
“One thing in our favor is we are looking at universal Covid vaccines,” Kim said. “It may be possible to come up with a universal Covid vaccine, as mutations follow patterns – it may even be possible to come up with a universal coronavirus vaccine.”
Research is underway, as are early-stage trials.
“We may see data early next year,” Kim said. And regulatory approvals of resultant products should not be problematic. “Regulatory pathways should be simpler, as these vaccines are based on platforms that have significant emergency use data.”
Yet despite his general optimism on the efficacy of the current portfolio of vaccines, Kim admits one deep fear: That a truly fearsome new variant of the disease might mutate and spread in the developing world, where minimal oversight mechanisms exist, and spread into the international community before being identified.
“The unknown threats have always been our biggest nightmare,” he said.