Dhaka Courier

All’s well that ends well?

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90 year old Margaret Keenan, the first patient in the UK to receive the Pfizer-BioNTech COVID-19 vaccine, administered by nurse May Parsons at University Hospital, Coventry, England, Tuesday Dec. 8, 2020. The United Kingdom, one of the countries hardest hit by the coronavirus, is beginning its vaccination campaign, a key step toward eventually ending the pandemic. (AP/UNB)

It was ‘the shot watched around the world’. Quite understandably too, given the vice-like grip of the pandemic against which it comes as an injection of hope. On December 8, a nurse rolled up 90-year-old Margaret Keenan’s sleeve and administered the first jab in the UK’s COVID-19 vaccination program kicking off an unprecedented global effort to try to end a pandemic that has killed 1.5 million people in less than a year.

Keenan, a retired shop clerk from Northern Ireland who celebrates her birthday next week, was at the front of the line at University Hospital Coventry to receive the vaccine that was approved by British regulators last week.

The UK thus became the first country still fighting an active outbreak of the pandemic on its shores to deliver a broadly tested and independently reviewed vaccine to the general public. The COVID-19 shot was developed by US drugmaker Pfizer and Germany’s BioNTech. US and European Union regulators may approve it in the coming days or weeks.

“All done?” Keenan asked nurse May Parsons. “All done,” came the reply, as hospital staff broke into applause and also clapped for her as she was wheeled down a corridor.

“I feel so privileged to be the first person vaccinated against COVID-19,” said Keenan, who wore a surgical mask and a blue “Merry Christmas” T-shirt with a cartoon penguin in a Santa hat. “It’s the best early birthday present I could wish for because it means I can finally look forward to spending time with my family and friends in the New Year after being on my own for most of the year.”

The second injection, in a fitting bit of drama, went to an 81-year-old man named William Shakespeare from Warwickshire, the county where the bard was born. Was it finally the Taming of the Flu?

Hard Times

Alas, there is some way to go yet. As the UK and other Western countries anticipated imminent relief, the Africa Centres for Disease Control and Prevention director John Nkengasong warned that the continent might not see vaccines until after the second quarter of 2021.

Nkengasong called it a “moral issue” and urged the United Nations to summon a special session to discuss the ethical, fair distribution of vaccines to avoid “this north-south distrust in respect to vaccines, which is a common good”.

He said Covid-19 will not be defeated in the West alone and took aim at “today’s dialogue of suspicion” as rich countries buy vaccines “in excess of their needs while we in Africa are still struggling with the Covax facility,” the multinational initiative designed to deliver at least some vaccines to less developed countries.

Africa will not receive nearly enough vaccines from Covax to reach the goal of vaccinating 60% of the population to achieve herd immunity, Nkengasong said, and he appealed to countries with excess doses to give them to Covax or countries in need.

He said: “We need to show global co-operation, global solidarity. The time to translate those powerful words into action is now.”

He has warned that coronavirus could become endemic in Africa if vaccinations take too long.

Africa’s 54 countries now have a total of more than 2.3 million confirmed infections, including 100,000 in the past week.

“Clearly the second wave is here, no doubt,” Nkengasong said. He called this “a pivotal moment in the history of our continent” with Africa’s development in the balance.

Bangladesh expects the first shipment of the Oxford-AstraZeneca coronavirus vaccine manufactured by the Serum Institute of India (SII) to arrive in early January, Health Minister Zahid Maleque announced on December 10, while addressing the inaugural event of the measles-rubella vaccination program in Dhaka.

“We hope that we’ll receive the vaccines early next month [January]. We have made arrangements to bring the Oxford-AstraZeneca vaccine to Bangladesh through the Serum Institute of India. The government is bringing 30 million doses of vaccine directly,” he said.

A memorandum of understanding (MoU) was signed in November, between the officials of the Health Ministry, SII, and Beximco Pharmaceuticals in Dhaka to collect the vaccines.

Earlier this week, an official of the Indian High Commission in Dhaka also said that Bangladesh is likely to receive its first shipment of the vaccine early next month.

“As we have said earlier, Bangladesh would be the first country to get the Indian Covid-19 vaccine once it is ready. Now we are in the last moments of vaccine approval and manufacturing. Hopefully, the people of Bangladesh will get the vaccine in the upcoming new year, by January,” said the official who asked not to be named.

The vaccine developed by AstraZeneca and Oxford University showed an average efficacy of 70.4% in a pooled analysis of interim data from late stage trials, Oxford said earlier this week.

Questions do remain as to whether the country is ready to properly preserve and distribute it. Experts say challenges are there as it requires complex logistics.

They think a high-profile committee should be formed and a well-designed plan and policy need to be put in place immediately to have the necessary work done before procuring the vaccine.

The experts suggested to our sister newsagency UNB that the government needs to improve the capacity of the existing cold chain and ensure other required logistic support so that the vaccine can be brought to the upazila level for its fair distribution.

Talking to UNB, Dr Abu Jamil Faisel, a member of the public health expert team for the eight divisions formed by the government, said Bangladesh must take necessary preparations in advance for procuring the vaccine, its preservation and distribution.

“As I know, three expert teams, formed by the Health Ministry, have been working out a plan and policy in this regard,” he said.

Dr Faisel said it is certain that the government will not be able to provide the vaccine to the country’s all people at a time, no matter how many doses it receives. That’s why we need a priority list and a vaccine policy to avoid chaos and misstatement.”

He said a vaccine distribution policy should be formed immediately and people need to be informed about it. “The government must communicate with people and prepare them to accept the reality by giving them proper information and presenting the real scenario before them.”

Or else, the experts said, when some vaccine doses will arrive in the country, people may create a chaotic situation in hospitals and vaccine distribution centres. And anything bad can happen at that time. “So, we need to tell people in advance who may get it first and its reasons.”

Preparing cold chain

Dr Faisel said Bangladesh needs to procure a vaccine which is affordable and preservable in the country’s cold chain. “So, we must have a plan for the preservation of the vaccine.”

He said a large part of the country’s current vaccine cold chain is occupied with anti-measles ‘Measles-Rubella (MR) vaccine.

A total of 3.40 crore children, aged between nine months to under 10, was supposed to be given the MR vaccine in March last, but this campaign was not held due to the coronavirus outbreak.

“If we can’t vacate the cold chain by giving this vaccine to the children, where will we keep the new vaccine? So, we need to have a plan about the preservation of the vaccine maintaining its quality,” Dr Faisel said.

Public health expert MH Chowdhury (Lenin), chairman of the medicine department at the Health and Hope Hospital, said Bangladesh does not have the capacity of preserving 3 crore doses of the corona vaccine at a time.

“We should first assess how many doses of virus can be preserved in our existing cold chain. Then we can hire private cold storages to enhance our capacity.  We can also take steps for making makeshift storages in different districts as we’ll have to send the vaccine there.”

Monitoring team needed

Dr Faisel said the quality of the vaccine will degrade if the doses are not properly preserved, transported, distributed and vaccinated. “That’s why we need a monitoring team.”

“We’ll send the vaccine doses to different places across the country. We must do it properly to maintain the quality. The monitoring team will oversee whether the vaccine is transported properly and preserved everywhere maintaining the right temperature,” he said.

The expert said this team will also examine whether there are any reactions or side effects of the vaccine on people since there has been no trial of any vaccine in Bangladesh.

Dr Lenin said a high-powered committee, incorporating capable people, should be formed immediately to make appropriate plans and a policy and ensure their execution. “It won’t be possible to do it by the Health Ministry alone.”

“Making a vaccine policy and its implementation are such important tasks that the UK has appointed a minister to do that job. Our Health Ministry and its different bodies who still couldn’t ensure adequate tests, contract tracing, encourage people to wear masks and maintain health safety rules, ensure treatment for the corona-infected people are making a vaccine policy and plans. How can we keep confidence in them?

Dr Lenin said it will be a daunting task to distribute the vaccine fairly and maintain transparency once it arrives in Bangladesh, no matter the Health Ministry makes how many plans and policies.

“We fear people who exercise power will try to have the vaccine at the initial stage as we saw when PPE and other safety gears were procured, different administrative officials roaming here and there wearing those before getting the doctors. Such an anarchic situation may create over the vaccine,” he warned.

Dr Be-Nazir Ahmed, former director (disease control) of the DGHS, said the committee should be formed, led by a high-official from the Prime Minister’s Office.

“This committee will have to take many crucial decisions, regarding selecting a vaccine, collecting funds to procure it and other logistic support and rightly preserve and distribute the vaccine checking irregularities,” he observed.

Dr Lenin said Bangladesh may face difficulties in procuring an effective Covid vaccine since it is highly dependent on AstraZeneca’s one.

“It’s uncertain when this vaccine may get approval due to controversy over its recent trial results. On the other hand, two American vaccines that seem to be effective are not suitable for us due to the preservation problem,” he said.

Under the situation, Lenin said Bangladesh should intensify its diplomatic efforts to get the vaccine developed by Russia and China and others. “China and Russian started using their vaccines locally. But our media doesn't highlight the two vaccines. I personally think we should take steps to have the vaccines of Russia and China.”

Dr Be-Nazir said the vaccines of China and Russia have huge potentials as they are also technologically very sound. “We should maintain regular contact with China and Russia so that we can get their vaccines if WHO approves those."

Relief at last

Back in the UK, the fanfare was good cheer to the nation, if only for a moment, reported AP. Authorities warned that the vaccination campaign would take many months, meaning painful restrictions that have disrupted daily life and punished the economy are likely to continue until spring. The UK has seen over 61,000 deaths in the pandemic — more than any other country in Europe — and has recorded more than 1.7 million confirmed cases.

“This really feels like the beginning of the end,″ said Stephen Powis, medical director for the National Health Service in England. “It’s been a really dreadful year, 2020 — all those things that we are so used to, meeting friends and family, going to the cinema, have been disrupted. We can get those back. Not tomorrow. Not next week. Not next month. But in the months to come.″

But it is important beyond these shores. Britain’s program is likely to provide lessons for other countries as they prepare for the unprecedented task of vaccinating billions.

In the same week, even earlier than the UK, Russia began vaccinations with its Sputnik V vaccine, and China has also begun giving its own domestically made shots to its citizens and selling them abroad. But those are being viewed differently because neither countries’ vaccines have finished the late-stage trials scientists consider essential for proving a serum is safe and effective.

Other vaccines are also being reviewed by regulators around the world, including a collaboration between Oxford University and drugmaker AstraZeneca and one developed by U.S. biotechnology company Moderna.

Documents released by U.S. regulators Tuesday (December 8) confirmed that Pfizer’s vaccine was strongly protective against COVID-19 and appeared safe. New results on a possible vaccine from Oxford University and drugmaker AstraZeneca suggest it is safe and about 70% effective, according to early test results from Britain and Brazil. But that report, in the medical journal Lancet, showed that questions remain about how well it helps protect those over 55.

British regulators approved the Pfizer shot on December 2, and the country has received 800,000 doses, enough to vaccinate 400,000 people. The first shots are going to people over 80 who are either hospitalized or already have outpatient appointments scheduled, along with nursing home workers and vaccination staff.

Others must wait, and health officials have said that those who are most at risk from the virus will be vaccinated in the early stages. For most people, it will be next year before there is enough vaccine to expand the program.

UK health officials have worked for months to adapt a system geared toward vaccinating groups like school children and pregnant women into one that can rapidly reach much of the population.

Questions arose about when the country's most prominent senior couple — Queen Elizabeth II, 94, and her husband, Prince Philip, 99 — would get the vaccine and whether it would happen on camera.

Foreign Secretary Dominic Raab appeared nonplussed when he was asked about it by NBC.

“I’m not sure whether they’d do it on camera,’’ Raab said. “But I’m sure arrangements will be made according to the phased approach that I set out, and like any family, they would have felt the pressures and all the worries that surround this pandemic as well.’’

The 800,000 doses are only a fraction of what is needed in the UK The government is targeting more than 25 million people, or about 40% of the population, in the first phase of its vaccination program, which gives first priority to those at highest risk from the virus.

The program will be expanded when supply increases, with the vaccine offered roughly on the basis of age groups, starting with the oldest. Britain plans to offer vaccines to everyone over the age of 50, as well as younger adults with health conditions that put them at greater risk.

In England, the vaccine is being delivered to 50 hospital hubs in the first wave of the program, with more hospitals expected to offer it as the rollout ramps up. Northern Ireland, Scotland and Wales are making their own plans under the UK’s system of devolved administration.

Logistical issues are slowing the distribution of the Pfizer vaccine because it has to be stored at minus-70 degrees Celsius (minus-94 degrees Fahrenheit). Authorities are focusing on large-scale distribution points because each package of vaccine contains 975 doses and they don’t want any to be wasted.

The UK has agreed to buy more than 350 million doses from seven different producers. Governments around the world are making agreements with multiple developers to ensure they lock in delivery of the products that are ultimately approved for widespread use.

All these logistical challenges culminated Tuesday in Keenan’s vaccination by Parsons, a nurse originally from the Philippines who has worked for the NHS for 24 years.

“I’m just glad to be able to play a part on this historic day,” she said. “The last few months have been tough for all of us working in the NHS, but now it feels like there is a light at the end of the tunnel.”

Additional reporting by A.R. Jahangir & Danica Kirka (AP)

  • AstraZeneca
  • Moderna
  • Pfizer
  • BioNTech
  • Vaccine
  • Covid-19

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