Which Covid-19 vaccine is best?

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SARS-2 coronavirus-caused COVID-19 has spawned a global problem of epic proportions, which has not been observed in generations. With the current information infrastructures and widespread use of social media as a “reliable” means of information dissemination, we are seeing information reach from one corner of the world to another at lightning speeds. Unfortunately, a lot of this “information” is unfounded or misinterpreted, and simply misleading. This has caused a lot of confusion in just about every aspect of the current pandemic.

Recent approval and rollout of multiple different vaccines based on different platforms, developed by different companies of different countries have raised a lot of questions among the general populace. The countries involved in developing these vaccines have dealt with development and rollout as nothing short of the space race of yesteryears and made this a matter of national pride.

Obviously, or not so obviously, a lot of misinformation, contortion of facts has occurred. The current market-driven society has instinctively started opining and shopping for the “best vaccine” out there.

First, to determine the best one and to understand how the vaccines work, we need to understand how the virus and our immune system work. The SARS-2 coronavirus, any virus for that matter, is extremely limited in what it can do. It only carries a few genes that code for just enough material to form a new virus. For the rest of the processes that are considered life-giving such as respiration, metabolism, production of raw materials for building blocks of life, etc the virus depends on the host cell. It utilizes all the cellular machinery and, in a sense, incorporates itself and becomes one with the cells of the host. It essentially hijacks the cell for the production of new viruses. This hijacking of the cells can be detrimental to the survival of the host itself. Hence, our body has developed mechanisms to fight back and keep the hijacking from happening.

The virus particle itself is composed of unique proteins that are normally not found in the host, the body can recognize these proteins as foreign objects. Since the proteins on the surface of the virus particle are the most exposed our body is very efficient in recognizing these. These surface proteins are also crucial for the infection as this is what attaches the virus to the host and helps it enter the cells. Our body produces antibodies that can recognize these surface viral proteins. These antibodies recognize and bind to the surface protein, the Spike protein in the case of SARS-2 CoV, and prevent them from binding and entering the host cells. The antibodies also mark the virus particles for destruction. In the meantime, our immune system gets better and better at recognizing these surface proteins and establishes a pool of cells that can in the future rapidly produce antibodies should the body encounter the same pathogen again.

We utilize this property of our immune system in making an efficient vaccine. The idea is to introduce these surface proteins to the body without actually putting the deadly virus in. It can be done in multiple ways, we can simply introduce just the surface proteins, put the surface proteins on another harmless virus, or use an inactivated form of the same virus that can’t replicate or transmit. Once these proteins are introduced to the body, irrespective of the technique used, the body starts making antibodies just like during an active infection. These antibodies are then present in the body ready to neutralize any virus that may happen to enter the host essentially preventing the infection. The memory to make such antibodies is retained and can be activated in the future providing long-term immunity. All current vaccines do just that, they don’t treat an existing infection but prime and train the body to make antibodies to prevent future infections.

As with anything that comes with choices, we have now started comparing vaccines in search of the best one out there. One metric that often gets used to determine the best vaccine is the efficacy rate of the vaccines. Efficacy of a vaccine is a measure of the reduction of cases in a vaccinated population compared to a similar ‘unvaccinated’ population.

However, different vaccines were tested in populations completely different from one another, at different locations, at different times, and probably with different variants in circulation. Under such different test conditions, even the same vaccine is going to give different efficacy numbers. Therefore, efficacy rate, despite its name, is not the best way to compare vaccines. It’s as erroneous as determining who the best player is only based on the number of goals scored by said players in different games against different competition.

Then how do we identify the best vaccine out there? For that, we need to take a step back and ask a slightly different question first. What is the goal of vaccination here? Ideally, we would like to not get infected after vaccination. Next would be to not get any symptoms, then not to fall severely ill, and finally and most importantly to not die. So far, the efficacy is calculated based on a reduction in cases of infection under test scenarios. Although getting infected is not ideal, in today’s pandemic, it’s also not a deal-breaker. Instead, at this point not getting severely ill or dying after vaccination is the most important outcome. In these two metrics, all vaccines work extremely well.

All approved vaccines have been shown to lower the risk of getting severely ill and most importantly almost none of the fully vaccinated people have died of COVID disease. And that is huge! Let me state that again, the total number of people who died of COVID -19 despite being fully vaccinated is negligible given the scale of people infected. And I will state again, hospitalization due to COVID among vaccinated is extremely low and the mortality due to COVID decreases from several percentage points in the unvaccinated population to negligible among those fully vaccinated across all age groups. And that is just what we need.

There lies our answer to our question about the best vaccine. The best vaccine is the one that is available to you. It’s the one that will keep you from getting severely ill and it’s the one that will prevent you from dying of COVID even if you were to get infected. So, stop pondering, get out, and get vaccinated so that we can head towards living a normal life soon.

As for the government, they should focus on getting the economically feasible one, is easy to store and distribute, and most importantly immediately available. Now let’s get back to work to save lives.



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