Vaccination in Ireland

A very interesting twitter thread from Dr Ronan Glynn (Ireland’s Deputy Chief Medical Officer) inspired me to write something in response to the very positive recent developments with regard to a SARS-CoV2 (Covid-19 vaccine). In Switzerland the regulator does not feel that there is enough data yet for approval to be granted yet, so I have some reservations about the fast-tracking of the process in the United Kingdom. Nevertheless there has to be a tradeoff between the risk of potential reactions or side-effects of a vaccination and the immediate danger to public health arising from Covid-19. As someone recently said to me on Twitter: “if you’re not going to fast-track during a global pandemic, when would you?”.

Here in Ireland it is likely that a vaccination programme will commence early in the New Year. To answer a question I posed a few weeks ago, priority will be given to front-line health care workers, especially those working in care homes, and the elderly. If all goes to plan there will be something like full vaccination of the population by September 2021.

I am not in a priority group so will have to wait a while for my jabs, but I will certainly take the vaccine as soon as it is available to me.

No doubt there are some people out there who for various reasons will refuse to be vaccinated. I doubt anything I say here will persuade them but it is I think valuable to look at the history of vaccination programmes in Ireland for various illnesses, which is what Dr Glynn’s thread does.

To give a few examples:

  • Smallpox. In 1863 vaccination against smallpox was made compulsory for all children born in Ireland. Deaths fell from 7,550 for the decade to 1880 to the last reported death from smallpox here in 1907. Smallpox was declared eradicated in 1979 – this one vaccine saved 100s of millions of lives globally.
  • Diptheria. Diphtheria was a very common cause of death among children until the 1940s – there were 318 deaths from it reported in Ireland  1938. With the introduction of a vaccine, the number of deaths fell year on year with 5 deaths in 1950; the last death notified from diphtheria was in 1967.
  • Poliomyelitis. In Ireland, polio infection (mainly affecting young children causing long term paralysis) became more common after 1920 with major epidemics during the 1940s & 1950s. A vaccine was introduced in 1957. The last reported case of polio here in Ireland 1984.
  • Measles. The number of cases of measles declined dramatically after introduction of measles vaccine in 1985, from 10,000 cases in 1985 to 201 cases in 1987.
  • Meningococcal Meningitis. In 1999, there were 536 cases of meningococcal meningitis in Ireland The meningitis C vaccine was introduced in 2000, with the meningitis B vaccine introduced in 2016. Cases of meningococcal meningitis have dropped more than 80% since these vaccines were introduced.

These are of course wonderful advances in public health, but none of them provided total relief immediately. It will be the same with Covid-19. The availability of a vaccine will not end the pandemic overnight, but at least it will enable us to plan for a phased return to normal.

 

While there is great cause for long-term optimism, there are still reasons to be anxious in the short term. There will be many months before a full vaccination programme is in place and in that time cases (and, sadly, deaths) could rise substantially. There is a real danger will think that it’s all over, that they can let down their guard and ignore social distancing.

Ireland is currently relaxing its Covid-19 restrictions for the Christmas period, but it is doing so from a level of over 260 new cases per day. The Coronavirus is currently circulating in the community at a far higher rate than it was in the summer and if it increases at a similar rate to August then we could be in for a huge surge. I fear that by the New Year we might be in real trouble again. It would be tragic if people lost their lives owing to complacency with safety so nearly in sight.

 

23 Responses to “Vaccination in Ireland”

  1. Anton Garrett Says:

    Vaccination has been a great blessing to the human race, but I don’t think it should be compulsory and I don’t think there should be discrimination against the unvaccinated. After all, once a vaccine is available, anybody worried about catching the virus in question can just get vaccinated (supposing it is free on demand). Self-interest will ensure a large takeup, so let it.

    I have concerns about how rigorously these vaccines have been tested, not for efficacy but for side effects. I’m also not about to accept something designed to stimulate my autoimmune system at a time when it is still over-stimulated by long covid, albeit fairly mildly. Once those two worries can be allayed, I’d take it like a shot…

    I gather that the anti-SARS-CoV-2 vaccines are novel in functioning at a deeper level than regular antiviral vaccines, to overcome the problems with virus mutation that foiled anti-HIV efforts. Also, the differing anti-SARS-CoV-2 vaccines have slightly differing strategies:

    http://www.rationaloptimist.com/blog/temper-your-excitement-about-the-covid-vaccine/

    If anybody can explain at smart nonexpert level the difference between regular vaccines and these vaccines, and between the differing vaccines, I’d be very interested to hear it, or to read a link. I’ve read stuff on websites I don’t particularly trust about these vaccines “altering your DNA”. I’m aware that viruses themselves hijack your DNA in order to reproduce inside you, but any cell that gets hijacked by a virus either gets destroyed by your immune system or is destroyed in the process of being hijacked and releasing further virus particles (virions); so the cell does not reproduce. But that’s what the virus does. What about the vaccine?

    • telescoper Says:

      Isn’t the main difference that some of the Covid-19 vaccines are RNA vaccines?

      My understanding of “conventional vaccines” is that they contain inactivated versions of whatever pathogen causes the disease, or proteins on its surface, to cause an immune response in the body which means it can fight the real infection later.

      RNA vaccines contain messenger RNA (mRNA), which codes for a protein specific to the pathogen’s surface. The body uses this mRNA to build its own copies of these proteins which the immune system responds to by producing antibodies providing protection if the person catches the real disease later.
      The introduction of mRNA into human cells does not change the DNA of human cells and, if these cells replicate, the mRNA would not be incorporated into the new cells’ genetic information.

      • Anton Garrett Says:

        Peter: I kept “mRNA” out of my preceding post although I’m aware of it. This partly because some vaccines don’t use it – but still function at the level of the sequences of bases in RNA and DNA. The link I provided mentions these differences between vaccines but doesn’t give the primer in molecular biology that I’m seeking. I look for something that, among other things, gives the Whys behind your second paragraph of your preceding reply to me. Also, do you understand the mechanisms you state in your third paragraph enough to be able to make the assurance in your fourth?

        To be clear, I’m seeking reliable information concerning molecular biology, not going with the vaccine conspiracy theorists (except that I question whether side-effects can yet be asserted to be absent with confidence).

      • Anton Garrett Says:

        Here’s some good info:

        https://www.bbc.co.uk/news/54893437

        “Injecting RNA into a person doesn’t do anything to the DNA of a human cell,” says Prof Jeffrey Almond of Oxford University.

        It works by giving the body instructions to produce a protein which is present on the surface of the coronavirus.

        The immune system then learns to recognise and produce antibodies against the protein.

        Almond is a professor of microbiology. I’d welcome fuller details, of course.

      • telescoper Says:

        Sorry for missing your earlier comment. That’s basically what a former colleague of mine in Life Sciences at Sussex said to me – the mRNA does not alter the cell DNA. However, as I said in the post, I have reservations about fast-tracking what is a novel form of vaccine. The same person also said that side-effects of vaccines are rare, but that kind of argument is not really applicable to a novel vaccine.

    • Phillip Helbig Says:

      ”Vaccination has been a great blessing to the human race, but I don’t think it should be compulsory and I don’t think there should be discrimination against the unvaccinated. After all, once a vaccine is available, anybody worried about catching the virus in question can just get vaccinated (supposing it is free on demand).”

      That is true as far as it goes, but it doesn’t go far enough. First, there are some people who cannot be vaccinated for medical reasons. The only way to protect them, barring isolation, is if enough other people are vaccinated. Second, if everyone relied on others being vaccinated in order that the unvaccinated can stay safe, then no-one would be vaccinated and no-one would be safe. Third, there is the issue of anti-vaxxers not vaccinating their children. Your own freedom ends when that of others is endangered.

      As far as I know, there are no compulsive vaccinations anywhere against diseases which are not, directly or indirectly, contagious. In other words, people are still allowed to kill themselves, through contracting a fatal contagious disease because they are not vaccinated or through other means. The issue is about the public health and the protection of others, in particular those whose cannot be vaccinated for medical reasons.

      Although the more the better in order to stop the spread, if, for political reasons, vaccination cannot be made compulsory, what about requiring those who don’t get vaccinated to relinquish all medical treatment in connection with the disease if they do catch it? For similar reasons, at least as long as there are more people waiting than there are donors, donated organs should go only to those who themselves had registered as organ donors before their corresponding disease was diagnosed.

      • Anton Garrett Says:

        what about requiring those who don’t get vaccinated to relinquish all medical treatment in connection with the disease if they do catch it?

        Would you also deny State health facilities to smokers who get lung cancer, etc?

      • Phillip Helbig Says:

        I think that that would be a good idea. In cases where the risk is known, and the probability of cause and effect is high, then it makes sense. (There are smokers who never get cancer, and people with lung cancer who have never smoked, but those are exceptions.) Either that, or distribute the cost via compulsory insurance among all smokers. Alternatively, keep things as they are, but pay a benefit to those who voluntarily don’t take such risks. This exists already in some places, and/or benefits for voluntary things such as cancer screening and so on.

        I certainly don’t want to move away from general health insurance, and certainly preconditions over which one has no control should not have a detrimental effect, but, to the extent that there are any voluntary decisions at all, it seems rather strange that people who knowingly engage in high-risk activity can count on others to pick up the tab.

        The situations are not exactly the same, though, since (now that public smoking is rare) smokers are endangering mainly themselves, whereas anti-vaxxers endanger others. Also, I think that it many cases it will call their bluff. Though some really are ignorant, I think that some anti-vaxxers actually know about the benefits of vaccines but express different opinions in public.

      • Anton Garrett Says:

        What about people who used to smoke and gave up? How many cigarettes and how long before the cancer was detected? Obese people and heart disease? Cirrhosis and alcohol?

      • Phillip Helbig Says:

        What about people who used to smoke and gave up? How many cigarettes and how long before the cancer was detected? Obese people and heart disease? Cirrhosis and alcohol?”

        All valid points. In practice, it would be difficult. In the case of a vaccination, a) it is a yes/no thing, b) easy to verify, and c) the pressure could serve to reduce the danger to others.

      • Anton Garrett Says:

        Then I think you are being inconsistent. Is that a policy of compulsory vacillation?

      • telescoper Says:

        A birus and a vacillus are two quite different things..

      • Phillip Helbig Says:

        I don’t make the policy. There might be some inconsistency between what I think would be actually best and what could be implemented in practice, but that is not my fault. It seems to me that if the risk of the vaccine is much less than the risk of the disease (the risk being something like the probability of getting it (1 for the vaccine), the severity, and the number of people affected), then the vaccination should be compulsory except for medical reasons. While national compulsion is not that common (but not unknown), it is not uncommon for, say, schools (teachers, pupils, others) and so on.

      • Anton Garrett Says:

        We all know who abolished the right of home schooling in the 1930s don’t we?

      • Phillip Helbig Says:

        “We all know who abolished the right of home schooling in the 1930s don’t we?”

        There are different reasons for home-schooling, and different reasons for banning it in different places, one of which is to make it more difficult for parallel societies to emerge, often due to groups who don’t feel bound by the laws of the land in which they live, which is something we might agree on.

        In any case, just because the same thing is done by more than one person doesn’t mean that it is necessarily good or bad, regardless of the goodness or badness of the persons involved. Invoking Godwin, I note that Hitler was a vegetarian (for moral reasons, i.e. animal welfare, not for health or political reasons), which says nothing about whether vegetarianism is good or bad. And I think that you both like(d) Wagner. 😐

      • Jonivar Skullerud Says:

        Compulsory vaccination is really only considered where this can provide herd immunity, which can only happen when the vaccine provides immunity against infection (ie, the body becoming host to the pathogen) as opposed to immunity against disease. There is no evidence as yet of the vaccines against Covid-19 providing immunity against infection and therefore we should not assume that there will be any herd immunity until such evidence emerges.

      • telescoper Says:

        Yes, that’s one other reason to be wary of the fast-tracking of these vaccines. I’ve heard it said that immunity against infection is likely to be only 50% but I don’t know how reliable the data are.

      • Phillip Helbig Says:

        “Compulsory vaccination is really only considered where this can provide herd immunity, which can only happen when the vaccine provides immunity against infection”

        Consider cases where those ill with the virus are putting a significant strain on intensive-care units. Wouldn’t a compulsory vaccination make sense for that reason alone, whether or not herd immunity is possible?

        Also, the point is that we don’t know there will be immunity against infection and hence whether the vaccine stops the spread of the disease. Assume that at some point we learn that it does. Had there been compulsory vaccinations from the beginning—perhaps for the reason mentioned above—then one would have gained that much more time.

    • SARS-CoV-2 doesn’t have particularly high mutation rate, so it’s a much easier target for vaccination than HIV. I don’t think the vaccines ‘functioning at a deeper level’ (and some of the candidates are completely traditional inactivated virus vaccines) is needed in to overcome the problems with virus mutation in this case.

      • Anton Garrett Says:

        Thanks. I’d love a reference.

        There’s also the issue of the immune period. I’ve learnt enough to know that there are different types of antibody and aside from them T-cells, so mass media reports of “the antibody halflife” are misleading. But what I’m really looking for is a deeper primer on the molecular biology of it all written for the smart layman.

  2. Dave Carter Says:

    What has done most to dent confidence in vaccination in the UK, specifically in the BioNTech vaccine, is the ridiculous posturing by members of the government, Hancock, Sharma, Rees-Mogg and above all Williamson. Benefit of Brexit indeed! Approved first because we have better scientists than anybody! We are a better country than all of them (given that the vaccine was developed by Turkish immigrants to Germany with EU and US funding). This has given the impression, probably false that MHRA was leant on by the government to give fast track approval to provide a few idiotic soundbites for a few idiotic politicians. I would accept the BioNTech vaccine if Ugur Sahin says it is safe. I would accept the Oxford vaccine if Sarah Gilbert and Andrew Pollard say it is safe. MHRA’s opinion is as important or unimportant as that of any regulator, and possibly less important than the EU regulator. Hancock and co., they have no expertise.

    • Anton Garrett Says:

      When a new vaccine strategy is unveiled, I’d prefer practice to theory in determining its safety, and I’d prefer the opinions of persons with no stake in it, whether the manufacturers or politicians keen to restart the economy.

  3. Michel C. Says:

    A vaccine for COVID-19 is necessary, but a vaccine for an imaginary disease which is killing the patient is not!

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