By Carmen Dulguime

There are people who are still undecided whether to get vaccinated against COVID-19 or not, and we don’t blame them. Even with the wealth of information about vaccination available to us, questions remain and rumors persist. NewsFeed 360 collected a dozen questions – the most common and even ludicrous ones – and asked two infectious diseases experts to address them.

We lifted some information from Dr. Benjamin Co’s presentation to the UST Hospital early this year, and some are direct answers that he sent via email. Dr. Co currently holds clinic at the Department of Pediatrics of Asian Hospital.

Dr. Ana Ong-Lim, who graced us with an interview, is a professor and chief of the Infectious and Tropical Diseases in Pediatrics Division of UP-PGH. She is also a member of the Department of Health Technical Advisory Group.

Since the virus is mutating, will COVID vaccination eventually become necessary as an annual practice? 

CO: I think what will happen from now on is that this will be something that we may need to get on an annual basis, for a while. 

LIM: It’s too early to tell kasi the data that we have right now regarding the efficacy of the vaccine is really about six months to a year, depende sa clinical trials that we’re referencing. When we talk about vaccine efficacy, the numbers that are being quoted, those are not even referencing or referring to how long these vaccines are expected to take effect. They’re actually just talking about how capable these vaccines are in preventing severe disease. We have no information as to whether these vaccines are going to be effective in preventing severe disease and death for a long period, or is it eventually going to be something that we have to take yearly.

Can a COVID vaccine have side effects years after it was first administered? 

CO: I will not venture on that. We only have short-term studies. The vaccines have been here for less than nine months and are currently being rolled out on mostly on Emergency Use Access approval. We will only know as more information evolves after monitoring them over a long-term period.

LIM: Posible ba sya? The answer is yes. How likely is it? Quite unlikely. But even in that unlikely event, there is a monitoring system that will capture those reports and enable us to determine whether they’re actually related to the vaccine – causally related or coincidental. Because that’s another concept that people have to understand: not everything that happens after vaccination should be the fault of the vaccine. Minsan nagkakataon lang.

Since COVID vaccines were developed way faster than usual, does this mean the safety and efficacy is compromised? 

(Author’s note from Dr. Co’s presentation): Since more than one company, researcher and developer have worked together in the development of the vaccine, the results of the vaccine development came faster. What made this possible as well is the extent of financial investments and political support from various groups and health organizations around the world, making sure that the vaccine is developed from the laboratories to the distribution channels. 

LIM: I like the way that this was stated by one of the foremost authorities in vaccines. This is not a rushed process, but rather a process that recognizes the need for prioritization, because of the urgency of the requirements to protect all of us. Kumbaga parang they looked at efficiencies that could be incorporated into the system, recognizing the need to prioritize development for vaccines against COVID.

Would it matter what type of COVID vaccine each individual should take? Why or why not? 

CO: They all have very safe platforms and the technology is not new except for the mRNA platform vaccines. As long as you are not on any immunosuppressive agent or highly immunocompromised or have an allergy to a major component of the vaccine, I don’t think the vaccine will be a contraindication.

LIM: In the current scenario, we’re really hampered by the fact that there’s a scarcity of supply. We might not be able to exercise choice as a parameter. Our system right now includes at least five expert panels that look at how these vaccines are going to be selected and deployed. Whatever makes it into the program has been vetted very well. And if what’s in the program is going to be made available for you, then be reassured that these have gone through a very thorough examination and that safety and efficacy have been taken into account.

(Author’s note: the expert panel is composed of FDA, DOST-PCHRD, Health Technology Assessment Council, National Immunization Technical Advisory Group, National Adverse Event Following Immunization Committee)

How soon will the COVID vaccine start working, and how long can it protect me? 

CO: Clinical studies show that two weeks after the first dose, there are neutralizing antibodies that already form. But the best response is when the second dose is administered because it boosts the immune response to the first vaccine. As to length of protection, we still don’t know. What we do know is that we feel that this will be something like the flu vaccine, which we’ll need to get every year. Year in and year out, depending on the variant that circulates.

LIM: Basically mga two to three weeks after. We’re hoping na sana forever na ‘to, hindi na natin ulit kailangan magpa-bakuna. But really, there’s no one who can tell you for certain kung gano katagal yan magkakabisa.

After getting vaccinated, does it mean I don’t have to observe safety protocols anymore (face mask, face shield, disinfecting items, spraying alcohol, etc.)? 

CO: The vaccine does not give you 100% immunity, so there is a chance that you can still come down with it.

LIM: We still continue to be at risk because the data that we have right now for vaccine efficacy is ‘vaccine efficacy against severe disease’. It’s a very specific question that it tried to answer. It does not say ‘vaccine efficacy against being infected’. It does not say ‘vaccine efficacy against transmitting the disease’. Those information are not yet available. That’s what’s going to be answered once we complete the phase 3 trial.

Why do some vaccines require two doses, while others need only one? 

CO: The design of the vaccines are to demonstrate sustained vaccine efficacy. All the current vaccines require two doses except for the J&J vaccine. However, the data for the J&J vaccine, while showing promise with a single dose, show lesser vaccine efficacy compared to other vaccines. This is why J&J is currently doing studies if a second dose will improve their vaccine efficacy data.

LIM: Based na lang on the characteristics of the vaccine, and how they elicit an immune response from the system. In most cases kasi when we talk about vaccination in general, yung ginagamit na concept is prime and boost. Meaning, you get the immune system to recognize the target. And then, by giving the second dose, you create an even more vigorous response. Pero may mga technologies na nakita nila that with just one dose, very vigorous na yung immune response so hindi na sila nagpapa-second dose.

Will the absence of epinephrine make vaccination risky? 

CO: Not really. Epinephrine is only useful for anaphylactic reactions. Note that anaphylaxis is a rare reaction even with the current available vaccines. However, for other mild symptoms expected of the vaccine (e.g., pain on the site, headache, chills, fever, tiredness, etc.), these do not require any other treatment.

LIM: Yes kasi ni-recognize na naman natin na anaphylaxis is a potential severe adverse event following immunization. Ang national program natin, ang talagang balak nyan is unang-una dapat meron silang access to emergency medical services. Dapat merong epi na available to address anybody who might have anaphylaxis. And for everybody, post-vaccination, there is an observation period before people are going to be let out of the facility just to ensure that they don’t develop anaphylaxis. Walang EpiPen (auto-injectable syringe) kasi maikli ang shelf life nyan. Mga isang taon lang, tapon mo na sya. At saka ang mahal, kaya hindi sya cost-effective na i-supply.”

How will COVID vaccine affect me if I’m allergic to certain medicines, food, etc.? 

CO: Patients who have a history of allergy must take into consideration the allergic reactions that they’ve had in the past…I would caution them on proceeding with the vaccine immediately.

LIM: There’s a statement that the Philippine Society of Asthma, Allergy & Immunology came up with. They say that if you have atopic history or a history of allergies, then you can use this time to consult with your physician already so that you can be advised, parang proper measures when the time comes that you qualify for vaccination. Hindi pinagbabawal, pero i-a-assess yung risk versus the benefit that you might achieve.

How will COVID vaccine affect me if I’m on maintenance medication? 

CO: If your maintenance medication is not an immunosuppressive agent then the COVID vaccine will be effective. Hypertension, diabetes, and other maintenance medicines for chronic diseases are not contraindications to receiving vaccines.

LIM: Eto yung population na dapat nga bakunahan. They are the ones who are at risk at getting severe disease. They are precisely the group that needs the vaccine.

Is it safe to inoculate babies and toddlers with COVID vaccine? 

CO: This (COVID-19) vaccine is not indicated for the pediatric population… 18 years old is the youngest.

LIM: No. Right now, we don’t have data that supports giving this vaccine to under 16 for Pfizer, and under 18 for everything else.

We don’t expect questions and rumors about COVID vaccination to end. This is, after all, an emergency situation that we are dealing with. Unfamiliar, and therefore daunting. But both Dr. Co and Dr. Lim believe it all boils down to our humanity.

“It is our moral and ethical obligation that this pandemic comes to a halt,” Dr. Benjamin Co said.

“Having this vaccine available at this point in time is the light at the end of this very long tunnel that we’re going through. Finally, we have an intervention that has a reasonable chance of succeeding. It’s not only for our own protection – but to protect those people around us. Not just our family, but our community – our country. I keep thinking of those people who didn’t make it. People we know. Yung mga hindi nakaabot sa puntong ito. Hindi nila ‘to inabot, e. Tapos tayo ngayon may pagkakataon, sasayangin natin? Hindi dapat. Hindi tama,” Dr. Lim concluded

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