• Experts finger expired, poorly stored vaccines, other factors
By Chioma Obinna
There is nothing strange about a fully vaccinated person dying of COVID-19 related complications and this, according to infectious disease experts, does not discredit the efficacy of the vaccine and, in no way suggests that getting vaccinated is a wasted exercise, Sunday Vanguard reports.
Conspiracy theories about COVID-19 vaccines took a dangerous twist last weekend in Nigeria when the news of the death of Chief Ladi Williams (SAN), son of the late legal icon, Chief Rotimi William, was confirmed to be related to the virus. The theories gained more traction because the deceased was fully vaccinated.
His brother, Chief Kayode Williams, who confirmed that his late brother died of COVID-19 complications, was quick to add that the late Ladi was fully vaccinated.
The news, however, raised several unanswered questions on social media while some of the questions raised bordered on the reason people should take the vaccines in the first place if they cannot protect them from dying.
Meanwhile, experts maintained that COVID-19 vaccines are highly effective at preventing severe disease, hospitalisation, and death from COVID-19.
They acknowledged that a small share of fully vaccinated individuals do become infected, and some become hospitalised or die, but argued that they are rare occurrences and known as “breakthrough cases” which are to be expected, and historically known to occur with other vaccines as none is 100 percent effective.
However, in the wake of negative theories propounded around the death of the late Ladi Williams, some experts, who spoke to Sunday Vanguard, laughed them off, saying they were products of ignorance.
For them, it is not impossible for someone to die from COVID-19 after receiving full doses of COVID-19 vaccines as vaccination does not imply immunisation.
Vaccination does not mean immunisation -Prof Ogoina
According to the President of the Nigerian Infectious Diseases Society, and a professor of medicine and infectious diseases at Niger Delta University Amassoma, Dimie Ogoina, clinical trials suggest that the efficacy of COVID-19 vaccines may range from 60 to 97 percent and this means that of every 100 vaccinated persons, between 60 and 97 will be fully protected after vaccination.
Ogoina, who is also a consultant infectious diseases specialist and Chief Medical Director of Niger Delta University Teaching Hospital (NDUTH), Okolobiri, Bayelsa, said that most of the COVID-19 vaccines in use today will protect individuals against severe disease, hospitalization and death and, in some cases, the vaccines may protect a few persons from getting infected or from transmitting the infection if infected.
“Vaccines are rated based on their ability to protect a larger proportion of the population and no vaccine is 100 per cent protective”, he said. “Besides protecting the vaccinated individual, the major benefit of the COVID-19 vaccine is its ability to protect a larger proportion of the population from severe disease, hospitalization and death.
“Vaccines, like any other health intervention, are not 100 percent protective. It is not impossible for someone to die from COVID-19 after receiving full doses of COVID-19 vaccines. “Vaccination does not imply immunisation. For several reasons, some persons might be vaccinated without being immunized or protected.
“Some of the reasons might include receiving expired vaccines or vaccines that have lost potency due to improper storage, insufficient dosing, wrong technique or site of injection, and suppressed immune system or genetic factors that may suppress protection after vaccination”.
Noting that the actual duration of protection after vaccination was not yet established, he said: “It is also possible that immunity achieved from prior vaccination waned after some time.
“Consequently, it is possible that some might lose their immunity after a period even after receiving full doses of COVID-19 vaccines.”
Ogoina, however, insisted that barring some of the reasons stated above, COVID-19 vaccines have been shown to protect the majority of the population from severe disease hospitalization and death.
According to him, vaccines and the concept of vaccination is as old as the history of medicine and many years of vaccination has shown that vaccines are generally safe and highly effective in disease prevention.
“Currently, over 5 billion people across the globe and over 4 million people in Nigeria have received one or more doses of COVID-19 vaccines”, the specialist stated.
“The evidence suggests that COVID-19 vaccines are very safe and well tolerated by the majority of those vaccinated. Minor side effects such as fever, pain at the site of injection, and body weakness, among others have been reported following vaccination in some persons.
“However, these side effects are self-limiting and resolve within 1 to 2 days. Although a few cases of serious adverse effects have been reported following COVID-19 vaccination in Nigeria, there are no confirmed reports of death due to COVID-19 vaccines in Nigeria.
“It should be emphasized that death from COVID-19 vaccines is very rare. In Europe and America, the death rate due to COVID-19 vaccine is reported to be less than 0.002 percent.”
Giving reasons why people can die even when fully vaccinated, he said, before attributing any death to COVID-19, it was important to exclude other diseases that might have directly contributed to death.
“It is not unusual for people with COVID-19 to die from complications of diabetes or hypertension which may not be directly related to or caused by COVID-19”, Ogoina said.
“Many of these persons who succumb to COVID-19 after vaccination are likely to have lost their immunity or failed to develop sufficient immunity after vaccination”.
The specialist stressed that as a country, we ought to closely monitor and evaluate the COVID-19 vaccination strategy to ensure expired vaccines are not used for vaccination, vaccines are stored according to manufacturer’s specification, and administered according to standard guidelines.
“Since vaccination does not imply immunity, it is also necessary that we conduct research in Nigeria to determine if vaccinated individuals develop immunity against COVID-19 and, if they do, we need to know how long this immunity lasts and what factors contribute to no, short- or long-lasting immunity.
“We will need to identify our population at risk of no or short-lasting immunity and develop a plan to protect them. Notwithstanding limited supply of vaccines, our country ought to have a plan for administering booster doses of COVID-19 vaccines to vulnerable groups identified from local research.
“The campaign to inform all Nigerians about the benefits of COVID-19 vaccination should be factual, free of bias and consistent.
“Vaccines might not be 100 percent effective, but COVID-19 vaccines remain the most effective strategy to halt the challenge of COVID-19. In this era of new coronavirus variants, Nigeria can only be safe if the majority of the population get vaccinated”.
Vaccines part of solution, additional ammunition – Prof Tomori
Corroborating Ogoina’s views, a professor of virologist, Prof Oyewale Tomori, said people should understand certain things about vaccines as they are not the ‘be all or only solution’ to diseases but a part of the solution and additional ammunition in the defence armoury against diseases.
According to Tomori, just as you have different types of guns, bullets and other weapons of war, vaccines are prepared from the causative pathogen of a disease…either whole or parts of the organism, modified or weakened, so that instead of causing disease when injected into the body, the modified pathogen stimulates the body to mount a defense, in the form of antibodies.
“When next the body is exposed to the original unmodified pathogen, the already sensitised body rapidly produces antibodies to counter the pathogen, destroying it and preventing it from multiplying to cause disease.
“It is important to note the following: Not all vaccinations result in immunization or development of immunity or protection; that is, vaccination is not synonymous with immunization.
“For many reasons, including the person, the state of his or her health, the vaccine itself, the dose administered, how well preserved, etc contribute in one way or another to a vaccination resulting in the development and level of immunity.
“This is why vaccines do not attain 100 percent efficacy. “
He explained further that it is not the day of vaccination that a person develops immunity; it takes anything between 10 and 14 days or more after full vaccination to develop high level of protection.
“Therefore, if you get exposed to the pathogen before you are fully protected, you can come down with the disease, get hospitalised and die.
“Immunity developed wanes over time, requiring boosters to improve/raise the level of immunity.
“The rate of waning varies from months to years, and with the vaccine type. From the above, two things are of note. The immunity developed is internal, it does not stop exposure.
“That is my business. If I go around without wearing my mask in crowded places, among other non- mask wearing, free breathing people, some of whom may be Covid virus infected, certainly, my immunity will not protect me from breathing in Covid virus laden air in such an environment. Having inhaled the Covid virus, it can multiply at the point of entry to cause an infection. Here comes the difference between a fully immunised and one not protected.
“The infection (which may be asymptomatic or mild symptoms) is taken care of by the antibodies in an already immunised and protected person, so that it does not progress to severe disease hospitalization and possible death.
“In the partially protected or unprotected/ unimmunised person, the infection can escalate, in the absence of immunity, to a severe disease, hospitalisation and possible death. “ He pointed out that when a person dies of Covid disease after Covid vaccination, there is need not to conclude that Covid vaccine does not work, “but to check if the person was fully vaccinated, how long after vaccination was he exposed, if two vaccinations are required, was the exposure in between the two vaccinations, what information do you have about the vaccine…the batch, where and how it was kept etc?
Tomori said answers to the questions would not only help in determining the efficacy of vaccines, but also help in combating vaccine hesitancy and ensuring that potent vaccines are delivered to all.
The professor advised Nigerians to go for the vaccine whenever they have the opportunity and that they are free to ask questions about facilities where the vaccines are kept.
He said: “Find out, prior to your vaccination, information about the site and their procedures. Get vaccinated and get your authentic vaccination card.
“Do not give bribe to obtain the vaccination. Such a card is fake. The fake card does not protect, it is vaccination that protects.
“Covid disease and Covid vaccine exist. The vaccine protects you against getting sick and dying from the disease.
“The mask and other non-pharmaceutical interventions prevent you from exposure and possible infection as prevention is better than cure. Protect your life with all the ammunition in the defense against Covid disease”.
Vaccines are no bulletproof – Ifeanyi
On his part, a top medical laboratory scientist, Dr Casmier Ifeanyi, who noted that vaccines are not bulletproof, said the extent they protect sometimes are influenced by certain intrinsic immunogenic factors.
According to Ifeanyi, it remains unclear to what extent the immune system protects vaccinated people against severe forms of the disease or hospitalization or even death arising from COVID-19 re-infection among vaccinated persons.
He said: “Scientifically, following vaccination, what we call neutralizing antibodies are able to intercept viruses before they infiltrate cells and these neutralizing antibodies actually do not have very strong staying power and so, though it typically shoots up after vaccination, they also quickly taper off sometimes in less than a month or thereabouts. “In these cascade of immune protection event, the next thing that comes to play as effective back up is the cellular immune system known to last longer than the neutralizing antibodies and is able to protect much more from the diseases.
“These molecules including memory cells which are rapidly deployed before re-exposure provide reasonable measure of protection against COVID-19 infection”.
Explaining further, he said:” Documented studies particularly immunological studies have shown that following COVID-19 vaccination, induced antibodies in individuals can decline over time.
“Some long-term follow-up studies covering trial participants and health records also indicate that there are growing risks for what has come to be known as breakthrough infection in persons who have had the complete doses of COVID-19 vaccination.
“According to literatures, records from health authorities in countries like Israel, United Kingdom and many other developed countries that have attained significant COVID-19 vaccination coverage also show that overtime in those fully vaccinated, vaccines lose their strength to protect particularly with regards to the ability to halt disease transmission.
“Therefore, how far the Covid-19 vaccine protects remains a subject of much debate. The debate continues because those who had been vaccinated are certainly not 100 percent or totally protected from re-infection with COVID-19.
“Across the world, even in Nigeria, we have had cases of persons who had been fully vaccinated die of COVID-19 including renowned persons all of whom were recorded to have received the full dose compliment”.
Stating that, according to extant empirical evidence, COVID-19 vaccines are adjudged safe, Ifeanyi said Covid-19 vaccine is strictly on the premise of evidence of safety that overwhelms few reported drawbacks.
He stressed that it is also true that when some persons take especially the mRNA based COVID-19 vaccine, they can experience mild conditions such as chest pain, shortness of breath or feeling of having a fast heart beating or pounding heartbeat.
“By and large, these untoward conditions are in small numbers including the case of red blood clots in some people. Overall, those who have not had any negative outcome whatsoever are in millions”, the scientist said.
“Therefore, the small number of those who have had mild reported challenges does not diminish the fact that COVID-19 vaccines are very safe.”
Ifeanyi, who said no vaccine is100 percent effective even after some persons have taken the full dosage of the COVID-19 vaccine, stated that a few may still die out of vulnerability to the disease.
According to him, people who are vaccinated may remain vulnerable to the viral agent.
The scientist said that part of the challenge of SARs Cov-2, like most viruses, was the fact that it keeps mutating and coming up with variants that may not be significantly protected against by the vaccines in use.
“Again, like most viral disease conditions that are fulminant, existing co-morbidities account for most deaths associated with such viral disease”, he said.
“Most of the reported deaths associated with Covid-19 disease amongst people who have had the full doses of the vaccine may be traced to the existence of other underlying morbid disease conditions such as hypertension, diabetes, cancer and other non-communicable disease.
“Most persons who died after being fully vaccinated may not have may not have died as a result of complication of COVID-19 but rather complications arising from the co-morbidities.
“For this reason, it is pertinent that those who have underlying disease conditions even after they have had the vaccination need to guard against re-infection by sticking to COVID-19 non-pharmaceutical protocols”.
He admonished Nigerians to be cautious of the fact that COVID-19 is real and it is still ravaging across the world.
“My appeal to Nigerians is for them take full responsibility for their own lives. We must protect ourselves because we have very weak health system”, Ifeanyi said.
“Someone infected in Nigeria most often has slim chances of accessing quality care and very uncertain chances of survival because of our fragile health system.
“Just recently, I lost two close friends to COVID-19. I got to know because they are high-profile individuals.
“Those who do not have names that are part of the masses die daily due to Covid-19.
“Nigerians should restore their guards, including the use of face mask, avoiding public gathering, the use of alcohol-based hand sanitizer and or frequent washing of hands.
“Many seem to think we have passed this stage of non-intervention but it is not so. Today across the world, because of advances in molecular diagnostic technologies, periodic testing has become common practice.
“Presently in Nigeria you can access the testing readily, so, I will also want to add that Nigerians should from time to time take COVID-19 test to know their status.
“When it is positive they should report to the closest health institution or authorities because early detection of Covid-19 infection is the panacea to the disease”.
Vanguard News Nigeria