After a recent bout of COVID-19 which I survived by God’s grace, I have tried to reweigh how we can really deal with this virus.

I may have several months of protection offered by my now gallant immune system cells, whose memory cells know the virus quite well already, can recognize it almost instantly, and vanquish it more expeditiously and effectively than the first time they encountered it. But we’re not sure how long that will last, as the level of antibodies of post-COVID-19 patients eventually seems to dip.

In the same manner, we also don’t know yet how long is the immunity provided by vaccination. I hope our researchers are keeping tabs on the antibody levels of populations after vaccination.

Will the immunity last six months? Twelve months? How long before the next booster vaccine shot? Will it be like the antiflu vaccine that needs a yearly booster? Or one every five years, like the old pneumonia vaccine?

There’s no question that going for the vaccination route is our only viable option out of this pandemic, but we have to manage our expectations also, as there are still a lot of unanswered questions on the long-term effects of the immunization, and we’re taking a big leap of faith.

Herd immunity

It’s more like a take-it-or-leave-it proposition. And if you’re looking at it from the population perspective, there’s no choice but to get the vaccine.

Individually, though, you may decide not to get it yet, when to take it, where to take it, and how to publicize when you take it. But when everyone is already compelled to make a decision for the general welfare—to attain herd immunity, the optional line may be blurred out—then Cicero’s maxim prevails: “Salus populi est suprema lex!” (The health of the people is the supreme law!)

Theoretically, herd immunity determines the level of indirect protection offered either by actual infection or vaccination. That means that a certain percentage of the population has become immune to infection, and that is pegged at 70 percent.

But it might come at some cost for a small number of those who’ll be vaccinated. The numbers are not really alarming, but if you happen to be the one affected with a serious vaccination side effect, you’d say you didn’t really sign up for that adverse reaction. But, that’s just the way the cookie crumbles, and in the vaccination gambit, people just need to accept things as they develop, even if that’s not what you had anticipated.

Some people criticize me when I say there’s still clinical equipoise in the long-term be­nefit versus harm of vaccines, but that’s how it looks from our current perspective. The short- and midterm effects definitely look beneficial, but the long-term effects vis-à-vis risks remain an equipoise. Our scientists will just need to be transparent to the international public and update them of what to expect as outcome data becomes more evident.

Knowledge gaps

Hopefully, the knowledge gaps will close with more questions answered, such as the duration of immunity. Another knowledge gap is the advisability of the vaccine in elderly and younger but frail individuals. That is still in question. The elderly and frail population are at the highest risk of COVID-19 but they also appear to have the highest risk of suffering from a serious or even fatal vaccination side effect. I believe they’re part of the clinical equipoise at this point and should be studied further.

Family, friends and patients ask me: If the vaccine becomes available soon, should I try to get it ASAP? I’d say it depends on how confident you are about keeping the virus at bay and preventing it from catching up with you.

If you can maintain all your safeguards and precautions, and not show compliance fatigue, like caving in at the next invitation to a safe and intimate gathering, then I’d say you can wait for more postmarketing surveillance reports on the vaccine in the next six to 12 months.

Anyway, realistically, the vaccine rollout should take around two years to implement. So, you’re even doing your part in not jumping the queue to get a jab ahead of the rest.

On the other hand, if whatever reason—your job, your regular activities, and simply natural proclivity for risk-laden behavior—predisposes you to a much higher risk of catching SARS-CoV-2, then you’re better off with a prioritized scheduling for vaccination.