Last week, a young nurse, who must be in her early 20s, asked me if she should have herself vaccinated with the Sinovac vaccine. She actually signed up for the Pfizer vaccine, but with some documentary hitches, its arrival is delayed. The Sinovac vaccine donation was supposed to have arrived over the weekend.
It’s really difficult to make any assessment on the Sinovac vaccine, because most of it will be based on press releases, or other unvetted publications. It’s not like the Pfizer, Moderna and AstraZeneca vaccines, the clinical trial data of which have undergone rigid peer review and have been published in prestigious journals.
As disclosed by Food and Drug Administration Director Eric Domingo, based on the submitted data used for application of emergency use authorization, the Chinese vaccine showed an efficacy rate to prevent mild COVID-19 infection in health-care workers by just a little over 50 percent, which barely makes the cutoff set to adjudge effectivity of a vaccine. Pasang-awa (barely passed)! But in all fairness to it, there were no serious or fatal COVID cases in those who were vaccinated.
Settling for less?
Although the number of deaths was also small in the group that was not vaccinated, we may infer that the Sinovac vaccine was 100-percent effective in preventing fatal COVID-19.
In short, the vaccine can protect one from dying from COVID-19 by 100 percent based on the submitted results, but it can only protect health-care workers inoculated with it by 50 percent from getting infected with the virus. We trust that these figures are accurate and reliable.
That being so, deciding whether or not to be vaccinated with it, one determines what his/her goal is. Is it to prevent death or to prevent getting infected? Ideally both goals should be achieved; in which case, the other vaccines have an apparent advantage over the Sinovac vaccine.
Next question, though, is: When will the other vaccines be available? In the interim, while waiting for them, what if one catches the virus and develops severe disease? Will it be better to settle for a less effective vaccine, which at least, is better than not having any vaccine?
Answers to these questions will depend actually on one’s risk of getting infected, and one’s risk of dying should one get infected.
In the case of the young nurse who asked me if she should settle for the Sinovac vaccine or not, her risk of getting infected is very high since she works in the COVID-19 ward. Her risk of dying from it is extremely low, considering that she’s young and with no concomitant medical problem. So the efficacy of the Sinovac vaccine in preventing death may not really carry much weight for her. She needs more a vaccine that can prevent her from getting infected, better than 50-percent protection. If the waiting time for the more effective vaccines will only be a few weeks, I would recommend that she choose to wait.
However, if the other vaccines are expected to arrive more than three months from now, she’s better off with the 50-percent protection offered by the Sinovac vaccine. Baka masingitan pa ng COVID.
On the other hand, if one is disease-prone and under 60 with other comorbidities like high blood pressure and diabetes, his main goal is to prevent having severe COVID-19 that can likely be complicated and can get him intubated, hooked to a breathing machine, and cause his death in the end. If given the chance, I believe this type of high-risk patients should avail of the Chinese vaccine. That is, again, considering that the other vaccines are not forthcoming yet.
Informed consent
We’ve always emphasized that although we encourage all suitable patients to get vaccinated, and we should aim for at least 70 percent of the population to be vaccinated to attain herd immunity, it will still be an individualized decision, with informed consent as a prerequisite to vaccination.
In clinical trials, where we evaluate new drugs for safety and efficacy, we make sure that everyone knows fully what he or she is receiving, and the potential consequences of receiving that particular drug. The recipient must indicate this by signing an informed consent. Vulnerable populations, such as those who are given no choice, out of fear or compulsion, must be protected.
In the case of COVID-19 vaccination, everyone may be considered as part of a vulnerable population, because of the undue fear the pandemic has caused. Such fear may deter them from making good decisions for themselves and their families.
The safeguard of informed consent may address any issue in the future that some segments of the population were coerced to receive the vaccination against their will, and that the inherent and constitutionally mandated human right to health and welfare was unduly violated. The government may invoke its police power to impose regulations for public welfare—making vaccination for all mandatory regardless of vaccine brands—but this may not be the right way to do it.
Allowing individual decisions and securing informed consent before vaccination may require some effort and time on the part of the government, but that’s the additional cost of living in, and enjoying—or enduring—a democratic form of government.