(Conclusion)
Many have been asking us when we could attain herd immunity in our country. Many still have the impression that once majority of the population is vaccinated, we can finally say goodbye to COVID-19 and look forward to a postpandemic scenario where we could get our lives back.
Our health officials and pandemic managers are promising dates between November to first quarter of next year to reach herd immunity. Local and global experts are also encouraging the public to get their jabs so we can all have a COVID-free Christmas.
Just a few weeks ago, noted global infectious disease specialist Dr. Anthony Fauci strongly urged everyone to get vaccinated because it’s supposed to be our only hope to attain herd immunity. Most experts nodded in agreement.
We thought that the global pressure might have put Fauci and the experts in a befuddled state. For sure, they all know the science very well, but we simply could not understand why they have to continue making the public expect that herd immunity is still attainable.
Too distant reality
With the current state of dwindling efficacy of all available vaccines with each new variant that emerges, herd immunity has become a far too distant reality for COVID-19. However, all is not lost, as we’ve been reiterating for quite sometime now.
Herd immunity has been shown to be attainable with vaccination for some diseases like measles, chicken pox and polio. The eradication of smallpox is a good example of how herd immunity could work. It’s a form of indirect protection for the whole population when a sufficiently big percentage—usually 70 percent or higher—has become immune to an infection, either by getting infected or through vaccination.
When we say that one is immune to the infection, that means that one has acquired the immune defenses to prevent full replication of the virus in one’s body. Since the virus is no longer able to replicate or multiply, transmission is stopped.
An immune person is supposed to be no longer susceptible to acquiring the infection and transmitting the virus to another person. And individuals who lack immunity, like those who were not vaccinated or have not been infected, can be protected from getting infected.
As early as March this year, there was already an indication that current vaccines cannot totally prevent infection and transmission of the virus to the level of herd immunity. They have been shown to prevent severe disease and reduce hospitalization, which is a major goal, but this is not what will get any population to herd immunity. It’s getting clearer and more apparent, but our experts and health officials seem to still be in a state of denial.
During one of the town hall meetings of the Department of Health (DOH) around three months ago, we suggested that our vaccine experts be transparent and disclose that vaccination cannot prevent infection and transmission as previously thought.
Up to now, young people with robust natural immunity are told to get themselves vaccinated, supposedly to protect their parents and grandparents and other vulnerable members of the household. We should level expectations and tell everyone that the vaccines have fallen short of this expected protection. In fact, young people who are vaccinated may get asymptomatic infection, and unknowingly spread the virus.
In Israel, for example, it was reported last week that a fully vaccinated student got infected but was without any symptoms, and transmitted the virus to more than 80 of his schoolmates during an event. Almost a third of new infections are in fully vaccinated individuals.
Overvaccinating
Most of the reports on the efficacy parameters of vaccines are on their effectiveness in preventing death and severe disease, or symptomatic infection, but with scarcely any report on the vaccine’s efficacy in preventing asymptomatic infection, which admittedly is difficult to determine.
Indeed, a symptomless individual will not get himself routinely tested to see if he has gotten the infection despite his vaccination.
But since the vaccination has shifted disease severity to mild and asymptomatic, one can only presume that there is quite a big number of these vaccinated individuals who get infected, remain asymptomatic, and are therefore potential super-spreaders. The challenge is how to detect them.
An important reminder, particularly for our elderly and vulnerable individuals, is to never let their guard down, even if all the young members of the family are fully vaccinated.
Our health officials and experts should open their minds to the possibility that overvaccinating the population—even those who are not vulnerable—may be contributing to the development of possibly more infectious and virulent variants. When we first mentioned this potential risk several months ago, we were severely criticized as spreading a baseless proposition. After that, several other noted virologists from Europe and the United States also came out with much more detailed explanations on how mass vaccination can possibly do more harm than good.
Israel and the United Kingdom were touted to be the success stories of mass vaccination. Indeed, it seemed so for a while, as a massive decline in cases and deaths was quickly achieved with mass vaccination of close to 60 percent of the population. But barely two months later, the cases are now spiraling upward again due to the Delta variant.
By the way it looks, the daily confirmed cases in these countries will soar to higher levels compared to prevaccination levels. However, it’s comforting to note that the number of deaths is mercifully lower. Somehow, the declining immunity provided by the vaccine can still prevent deaths and severe disease, but does not seem to accomplish much in preventing infection and transmission. Ergo, there’s no herd immunity.
We’re concerned that with a vaccine-centered strategy, we’d have a recurring cycle of stability and surges. And with each surge, the number of cases will increase. The death rates may remain low until the monster variant emerges, when all vaccines and treatments would be rendered ineffective. It’s likely to be still a dozen variants away, but every mutation brings us closer to crossing that deadly Rubicon.
Booster doses
As we forecasted last March, booster doses will be required every six to nine months, and the duration of immunity is likely to get shorter and shorter, requiring additional booster shots.
The big question is how long can we sustain this requirement of mass vaccination followed by booster shots every six to 12 months? How many billion dollars do we need to borrow to procure vaccines before we realize that relying on it alone is not the effective exit strategy we thought it would be for this pandemic?
There’s no question that vaccination is important in protecting the elderly and the vulnerable population, but its cost-efficacy goes down as we opt to mass vaccinate the entire population.
We discussed in previous columns the heart swelling (myocarditis and pericarditis) the mRNA vaccines may cause in adolescent and young adults, and we’re glad that the US Food and Drug Administration has now required mRNA vaccine manufacturers to include these potential life-threatening side effects in their packaging materials. Parents should strongly consider this potentially serious, though rare, harm before having their adolescents and teenagers vaccinated.
So, how can we still bail ourselves out of this pandemic if vaccination alone cannot achieve it?
Here are the four pillars of mass protection we have been proposing:
- Targeted vaccination (not mass vaccination). Vaccinate only the elderly and those with comorbidities and other immunocompromised individuals.
- Massive oral prophylaxis versus transmission, which enhances natural immunity that can combat the virus regardless of its mutation (prophylaxis kits containing ivermectin plus melatonin plus other vitamins). With this, the younger population can be more optimally protected in a much safer manner. They may get infected, but because their natural immune systems are adequately primed, their infection will most likely be mild or asymptomatic.
- Enhancement of community interventions to prevent transmission (test, isolate, trace), and treat early disease more effectively with home-treatment pill kits (same components as prophylaxis kits but different doses) so as to prevent requiring hospitalization and health-care exhaustion. Early treatment of confirmed cases is a big gap that we should try to address.
- Mass cognitive behavioral therapy to minimize compliance fatigue, enhance health-promoting behavior and a victor’s—not victim’s—mindset in overcoming this crisis.
Multipronged approach
Will this multipronged approach cost each Filipino an arm and a leg? Not really. Total cost of pillars 2 to 4 is less than 10 percent of what is to be spent for a vaccine-centric strategy.
This multipronged strategy can actually pay for itself. We lose around P50 billion a month with the economic slowdown. With this four-pronged plan, we just need to spend (for numbers 2-4) P5 billion a month for six months, and P2.5 billion a month indefinitely until the last vestige of COVID-19 remains. And by God’s grace, that is attainable in six months.
We have not fared well in global surveys on the countries’ resiliency, economic recovery, security and overall pandemic response. It’s about time we rethink our strategies and disabuse our minds from the belief that mass vaccination is a vital part of COVID-19 recovery.
In summary, we discussed in this three-part series the following:
We’ll likely have another surge due to the Delta variant in the next three months, but mitigating its consequences is still possible so as to prevent health-care exhaustion and excess deaths.
The strategy is to protect the elderly and vulnerable sectors with vaccination, while the rest of the population may be protected with chemoprophylaxis with immune-system-boosting vitamins and supplements, including ivermectin plus melatonin.
Early treatment of even the asymptomatic and mildly symptomatic high-risk or vulnerable sectors should be emphasized.
We must educate the public on the tricky Delta variant, which presents mainly as headache, sore throat and runny nose (colds), and less of the classic symptoms of fever, cough, loss of smell or taste, muscle pains and weakness.
We should do more biosurveillance or genomic sequencing of the virus (including water sewage surveillance).
The DOH and Inter-Agency Task Force for the Management of Emerging Infectious Diseases should reserve the Pfizer, Moderna and AstraZeneca vaccines for the high-risk or vulnerable sectors, since the other vaccines have not been shown to be effective against the Delta variant.
When the elderly and vulnerable sectors are already fully protected, the next sector at risk are the children aged 12 years or younger because their immune systems are not as strong as adults yet. There may be a shift of new cases to this age group, which should be a compelling reason not to resume in-person classes for schoolchildren just yet.
With the rapidly emerging variants such as the Delta Plus that may be capable of totally escaping the vaccines, or may make all current vaccines suboptimally effective—plus the real-life constraints in our antipandemic responses—attaining “herd immunity” will just remain a pipe dream. But we can still aim for “herd protection,” which will just as effectively bail us out of this pandemic.