Many are wondering when the pandemic will end. On a event recently organized at Unicamp Researchers have discussed this issue. I come here to reflect on several aspects.
The pandemic affects populations in all countries, low, middle and high income. We are seeing that the advancement of vaccination, combined with non-pharmacological measures such as the use of masks, physical distancing, hand hygiene habits, avoiding closed places with little natural ventilation and even open places, but with crowds, have been fundamental tools for us save from this disease. According to the website WorldMeters, at the moment there are just over 244 millions of people infected worldwide, with almost 5 million deaths caused by covid-19 (underreported, of course).
As Sars-CoV-2 is an RNA virus, thousands of mutations have already occurred in the virus, but only four variants of concern have emerged, Alpha, Beta, Gamma and Delta. A variante Alfa, around 60% more transmissible than the original virus, was detected in September 2020 in the United Kingdom and spread around the world, being more dangerous for people over 80 years of age. The Beta variant emerged in December 2020 in South Africa and has the capacity to affect younger people, who develop more severe forms of the disease.
The Gamma variant was first detected in January 2021 in Amazonas and spread throughout Brazil and neighboring countries. Gama has 17 mutations, 3 of which are in the Spike protein, which help the virus to enter cells more easily and then multiply. The Delta variant was detected in October 2020 in India, is more transmissible, more contagious and causes different symptoms than those caused by other variants. These variants have in common the fact that they are more transmissible, but fortunately they are neither more pathogenic nor more lethal. This is a good sign. Another good sign is that all vaccines in use against Covid-19 protect against all of these variants. This leads us to believe that the next mutations will not lead to variants capable of escaping the protective response provided by vaccines. But the scenario of slow vaccination in low-income countries is worrying.... Let's talk about it.
According to the website Our World in Data, 6.84 billion doses of vaccines were administered worldwide, with around 48.5% of the world's population receiving at least one dose of vaccines. However, only 3% of populations in low-income countries, mainly in Africa and the Middle East, have received the first dose (D1). Populations in poor countries remain exposed to a deadly virus. In Brazil, vaccination started slowly, but is accelerating, with around 71.76% of Brazilians having already taken the first dose (D1) and 51.43% having taken both doses (D1 + D2) or a single dose of the Janssen vaccine. . We are also advancing in the application of the booster dose for priority groups and have reached just over 6 million vaccinated.
But then, what do we need to get out of the pandemic?
Collective immunity through mass vaccination is essential to reduce the circulation of the virus, so we need to reach a quota of vaccinated people that prevents the virus from continuing to spread. Due to the more contagious variants such as Delta, we will most likely need to vaccinate around 85-90% (or perhaps more than 90%) of the population with both doses (D1 + D2) or with a single dose of Janssen.
Second dose (D2)
We need to carry out an active search to apply D2 to the approximately 12.5 million people who took D1, but did not return within the correct period to take the second dose, according to the website VIGIVAC COVID-BR. According to website, are Individuals who did not take D2 of the vaccine after 15 days of the expected date of application of the second dose were considered late, which corresponds to 12.499.857 people.
Booster doses
The booster dose for the elderly, immunosuppressed and healthcare professionals is essential to protect these groups. The booster dose is recommended for all of these priority groups, regardless of the vaccine the person took on D1, not just for those who took CoronaVac. Don't believe this fake news. The elderly people either took CoronaVac or the AstraZeneca vaccine, the first to arrive here. Some younger healthcare professionals have had other vaccines, such as Janssen and Pfizer, so everyone who is eligible for the booster dose should take it!
Even those who have recovered from Covid-19 should get vaccinated
Another important point is that, even those who have already been infected by Covid-19 and recovered, should be vaccinated, as the vaccine increases the production of antibodies. This recommendation is based on the concept of hybrid immunity, a combination of immunity acquired through infection by the real virus, with immunity generated by the production of neutralizing antibodies induced by vaccines. People recovering from Covid-19 can be reinfected by new variants and are not free from transmitting the virus. One study published on 7/10/2021 in the journal Nature points out that vaccination is more effective in neutralizing the virus, but that people recovering from Covid-19 also have memory cells that can fight new variants of the virus. These results show that vaccinated people have greater protection than convalescents who have recovered from Covid-19, as the neutralization action of vaccinated individuals who have not had previous contact with the virus is up to around 12 times greater. The immunity generated by vaccination is also safer than that acquired by infection with the real virus, as the virus can kill and leave irreversible consequences, in addition to long Covid.
Vaccination of adolescents and children
It will also be necessary to vaccinate adolescents aged 12 to 17. At the moment, the Pfizer vaccine is the only one authorized in Brazil for this age group. A dose of 30 micrograms (30 mg) is the same as that used for other age groups and shows good immunogenicity and a good safety profile. We will certainly also need to vaccinate our children aged 5 to 11. The Pfizer vaccine with a 1/3 lower dose of 10 micrograms (10 mg), must be approved for children. The vaccine showed an efficacy of 90.7% and an excellent safety profile and antibody production for children aged 5 to 11 and it was submitted to the US FDA for approval in the United States.
Will we need to get vaccines every year?
Most likely yes, but we still don't know how long immunity lasts with each vaccine. To obtain this answer, monitoring will be necessary. We may also have more robust vaccines and new drug options in the future. Brazil carries out few diagnostic tests, we need to test more and adopt measures to isolate those infected, monitoring their immediate contacts. We will need to monitor the emergence of new variants of attention, especially in places with a low vaccination rate.
Can you be more flexible?
We have a moving average of 337 deaths in the last seven days. It's still a lot! To make non-pharmacological measures more flexible, we will need a more consistent, sustained and constant drop in the number of cases, hospitalizations and deaths. It is essential to reduce the circulation of the virus before adopting measures such as abolishing the use of masks. The pandemic has made it clear that we are totally dependent on each other to live collectively. We all breathe the same air and everything in it.
Vaccination passport
I am in favor of the vaccine passport, I think it is a civilizing measure that seeks to encourage the population to get vaccinated. Vaccination against Covid-19 must be seen as a public health policy and one of the ways to preserve life. Vaccination is individual, but it protects the collective. We need high adherence, which is why we have to adopt measures that preserve the lives of everyone. In a pandemic situation, with a virus that kills and leaves irreversible consequences, individual freedom cannot infringe on the freedom and health of other people. Actions must protect the collective. Health is a fundamental right and a duty of the State, so it is important that the guidelines on the vaccine passport are drawn up at a national level, even to avoid the judicialization of the issue. Later on, when we see more sustained drops in infections and fewer hospitalizations and deaths, this could be reviewed. We just can't relax, think that the pandemic is under control and give the virus a chance to come back with a vengeance.
Are we going to get rid of the virus?
A pandemic only ends when the World Health Organization (WHO) announces its end, based on global epidemiological indicators and data that show a sustained decrease in transmission on all continents. In other words, the pandemic will only end when it ends for everyone. However, there are still many health, social, economic and political challenges. Vaccination needs to advance in all countries, including low-income countries, where vaccination is too slow. Note that only 3% of vulnerable populations (https://ourworldindata.org/covid-vaccinations) in low-income countries took the first dose. We need to face these inequalities, because with such slow vaccination, many people in these countries may die or have serious consequences and new, more dangerous variants may emerge.
Will Covid-19 be eliminated?
With the advancement of vaccination on all continents, I think that covid-19 will become endemic, not eliminated. Sars-CoV-2 is a respiratory virus, which will circulate around and we will cohabit with it. It is a virus that has an animal reservoir, has a high transmission rate, especially the Delta variant, presents symptoms that overlap with other respiratory diseases, which makes diagnosis difficult and has a long period of infection. So we will be able to live in a period of transition, living with some cases, but I hope not so serious, especially because new antiviral drugs are emerging, more robust vaccines will appear, with antigens that provoke a more robust response from the immune system, seeing other parts of the virus, other than just the spike protein. We will certainly have vaccines with a good response to the production of mucosal antibodies, the famous IgA. As we know that even asymptomatic individuals transmit it, we will live with asymptomatic cases, but also with a reduction in hospitalizations and deaths. Human behavior is very important and we will need more empathy and social responsibility, showing the population that getting vaccinated is a collective agreement.
We need to continue talking to the population
One thing is certain: Covid-19 will not end at the will of any politician. We need to continue fighting the anti-vaccine movement, in an insane and unequal fight, from the bottom up, against charlatanism and against the denialists who relativize the seriousness of the health crisis, attack science and persecute scientists, attack non-pharmacological measures, vaccines and who defend ineffective treatments.
We've learned a lot since the start of the pandemic, but we've just been chasing the virus, all the time. We need to prepare for the next epidemics or pandemics, which could start here, if we continue deforesting the Amazon at the current rate, where thousands of viruses and parasites live in balance with that ecosystem, which we, human beings, are destroying. With deforestation, these viruses and parasites can migrate to rural areas and then to cities. We already have Zika, dengue, chikungunya, malaria, Chagas and other tropical diseases. Mass vaccination through broad vaccination coverage, combined with non-pharmacological measures, are decisive for getting out of the pandemic and must be seen as a collective agreement for life. When you get vaccinated, you help protect everyone around you who, for medical reasons, cannot be vaccinated.
Covid-19 vaccines do not transmit HIV
One of the most absurd and revolting fake news recently spread by the President of the Republic in one of his lives, is that vaccines against Covid-19 transmit HIV and that people who have taken two doses of the vaccines are developing HIV/AIDS more quickly than normal (sic). Around the world, around 7 billion doses of vaccines against Covid-19 have already been administered. In Brazil, around 269 million doses of the four vaccines that are being used here were distributed. To date, around 153 million people have received D1, ~110 million have received D1 + D2 or the Janssen vaccine and 6 million people in priority groups have received the booster dose. There are no reported cases of HIV transmission through Covid-19 vaccines in the world.
This irresponsible and criminal fake news was initially spread by two English websites specializing in conspiracy theories and spreading lies and disinformation. There is no official report or scientific study from any UK government source on this matter. Old, this disgusting fake news is being reheated and reused by far-right groups and supporters of the anti-vaccine movement. The HIV/AIDS Committee of the Brazilian Society of Infectious Diseases (SBI) spoke out through note in which it states that “there is no known relationship between any vaccine against covid-19 and the development of acquired immunodeficiency syndrome and in which it repudiates any false news that mentions this non-existent association”.
The World Health Organization (WHO), as well as the Ministry of Health and SBI, advocates that everyone living with HIV/AIDS also take vaccines against Covid-19. The greatest Brazilian medical and scientific authorities state that there is no possibility of vaccines against Covid-19 transmitting the HIV virus and causing AIDS, as no vaccine against Covid-19 uses any fragment of the HIV virus in its composition. HIV can be transmitted through unprotected sex or by sharing needles and syringes with people with HIV.
Vaccines are our best public health tools, along with food, antibiotics, basic sanitation, drinking water and treated sewage and do not transmit diseases. Vaccines prevent diseases, save millions of lives per year and all vaccines against Covid-19 are saving millions of lives on the planet. Those who spread this cruel lie contribute to vaccine hesitancy and the anti-vaccine movement and increase the stigmatization and discrimination of the thousands of people living with HIV in Brazil. It's bizarre and disgusting!
We have already exceeded 605 deaths from Covid-19, we have 14 million unemployed and 20 million hungry people, how long will these irresponsible people defend the virus, instead of prioritizing the effective fight against the pandemic?
We are overcoming hate, but they remain alert and on duty
Science deniers, including supporters of the anti-vaccine movement, are carrying out an orchestrated and well-organized action to persecute groups and individuals who defend vaccines and who take a stand against the farce of the covid kit used in early treatment, a discussion already overcome in all countries and abandoned by the WHO. Along the same lines, the report of 200 deaths of volunteers involved in clinical research with proxalutamide in Amazonas is considered a very serious violation of human rights and one of the most serious ethical infractions in history. There are several actors involved, including pseudoscientists and doctors who do not follow science, but who use their values of scientific authority with the aim of propagating content with misinformation There are also the pseudojournalists, former athletes, religious leaders and politicians who do the same, but take advantage of being public figures to defend false narratives through shady pacts and agreements to spread ineffective treatments, serving a political, financial or religious agenda and spreading news false or with biased use of data, which supposedly confirm their arguments. And let's make it clear here that the medicines in the covid kit have been extensively tested and have not shown efficacy, so they are not useful in treating covid-19. Not to mention some Federal Councils and private health plans with many political and financial interests...
I recently wrote about this on special magazine dossier WithScience about fake news. Among the false narratives, we can include criticism of non-pharmacological protective measures and vaccines and the irrational and irresponsible defense of the covid kit for supposed early treatment, in addition to speeches denying the seriousness of the virus and the pandemic.
Denialists are firm in defending their political flag, their obscurantist agenda to combat Covid-19 and are acting as a block on social media, offending and threatening scientists, communicators and science disseminators. They are not going to abandon these false narratives at all and are now reporting some profiles en masse, so that applications like Instagram can take down some posts against the covid kit.
The focus is to contaminate social networks in defense of the covid kit in the SUS, against vaccines and in defense of even practices without proven efficacy such as ozone therapy, seeking to weaken the CPI report, creating reports with anti-vaccine content, such as this fake news murderer and liar that vaccines against Covid-19 cause HIV infection. This organized movement intends to place the covid kit in the SUS or take advantage of the fact that the decision at the Conitec meeting (National Commission for the Incorporation of Technologies in the Unified Health System) was tied and Anvisa was absent from voting, to create factoids in defense of the covid kit. Now that the pandemic is reaching a point of greater control, in a more favorable scenario, they will come up with speeches to bring the covid kit hoax back and create lies against vaccines.
A blunt fact is that the Brazilian population is adhering to vaccines, Brazilians like vaccines, we have a culture of production and free distribution of vaccines, we have always had mass vaccination campaigns with broad vaccination coverage and Brazilians understood that there is no world without covid if they are not vaccinated, that there is no safe world without science. But there are many political, financial and religious group interests, so they preach to keep their bases mobilized, to inflate hate groups. Of course, they want to put fear in the population, but they have done this since the beginning of the pandemic. They have a lot of funding, but the real scientists, the valuable science communicators, the various professionals from all areas, human, exact and social, together with good journalists, in often individual actions, showed great and extraordinary strength. We are beating the virus, the pandemic and the virus defenders with science, character, ethics and transparency. They, from the hate office, have a lot of money and organization, but they don't have our passion and enthusiasm to help save lives.
Vaccines save lives and free us from denialism
O Fiocruz Covid-19 Observatory Bulletin, released on 21/10/2021, shows that with the advancement of vaccination, the country observes a decrease in transmission of the Sars-CoV-2 virus, with a drop in the number of deaths and serious cases of the disease and stability in tcovid-19 ICU bed occupancy rates for adults in the SUS. Despite Although these results show that vaccination is achieving its main objective, which is to reduce serious cases, hospitalizations and deaths, reducing the impact of the disease, it is still necessary to expand vaccination coverage, maintaining non-pharmacological measures.
Um study published on 9/10/2021, on the preprint platform medRxiv, still unevaluated by other scientists, involving more than 9 million adult individuals in New York City, shows that vaccines against Covid-19 have maintained their effectiveness even after the emergence of the Delta variant. The study results clearly show that vaccinated people have a lower risk of contracting Covid-19 when compared to unvaccinated people. Vaccinated people are much more likely to not need hospitalization if infected compared to unvaccinated people.
Observation: The articles published do not reflect the opinion of Jornal da Unicamp. Its publication aims to stimulate the debate of ideas in the scientific, cultural and social spheres.
