The Shortage of Vaccines and Immunity

An instigate approach to promote a kick-off discussion, considering constraints and forgotten variables.

This post was originally published on March 1, 2021.

An instigate approach to promote a kick-off discussion, considering constraints and forgotten variables.

We have been living under the destructive influence of the COVID-19 pandemic for more than a year. Except for China, every country is viewing its economic downturn. Simultaneously, all lockdowns and social isolation efforts did not avoid second and third waves of contamination and increased deaths. 

After the fantastic research work to develop vaccines pretty fast, we now live in a situation discussed since mid-2020: the demand for doses is vastly higher than the production capacity. An explicit constraint, combined with the current social isolation strategy and lockdowns, postponed putting our lives back on track.

Developed countries are arbitrating who has priority in vaccination, given the scarcity of available doses. In contrast, among the emerging and underdeveloped countries, we are perplexed by a series of absurd discussions ranging from the lack of needles and syringes to expensive vaccines with efficacy rates sometimes meager. 

Corruption and even conflicts of interest are pertinent in analyzing this pandemic period. Everything creates infinite possibilities of public agents and some private players acting against our interest in using public health as an excuse to steal our money. However, the present text will not go into that aspect now. We can start talking about that soon, but now it is time to propose solutions to heal our economy concomitantly to organize the “clearance” process to put people back into their everyday lives.

Let’s focus on immunity.

When I started drafting this article a week ago, WHO informed us that we surpassed 89 million identified cases of COVID-19, with around 1.94 million deaths. As a result, at least more than 87 million people acquired immunity. We have reached 109 million cases, representing three million additional cases on average for a single week, potentially around 107 million people with immunity.

At the beginning of January, CDC also provided research about the asymptomatic spread of COVID-19. According to the CDC model, nearly 59% of all new coronavirus cases may come from people who carry the virus but exhibit no symptoms.

Additionally, the CDC model also provides a breakdown of this 59% of coronavirus transmission would come from people without symptoms:

·      35% from pre-symptomatic people; and

·      24% of those who never showed symptoms at all.

This 24% of really asymptomatic people have probably never been confirmed cases of COVID-19 in the statistics. However, we can assume that many additional people acquired its immunity. 

Despite any scientific discussions about all these models and the total number of cases that could implicate less asymptomatic people with immunity, we have already reached expressive figures, considering all vaccines’ production limitations. In a hypothesis of under-recorded instances, the number of immunized people could be much higher.

Besides, millions of people are acquiring immunity per week. Only in the USA can you observe higher vaccination figures than spreading the virus. In the rest of the world, the total cases growth is a vast multiple of the vaccines applied. 

The approach to arbitrating priority groups to be immunized by the vaccines creates a lot of stress and puts more pressure on the shortage’s harmful effects.

Let me try contributing to this discussion with a managerial approach, especially regarding the several constraints observed. 

The pandemic may finally have shown everyone a sad reality: health systems, public or private, worldwide are not designed to withstand any stress caused by increased demand. 

It is impossible to fund any optimal health systems. More developed and more significant structures will result in idleness without pandemic demand. Apart from the fact that an optimal configuration to absorb moments of stress also requires qualified human capital, we are far from having an adequate minimum contingent.

The practical result is that health systems and their professionals are a permanent point of constriction. Preserving service capacity implies prioritizing the immunity of health professionals.

However, we cannot produce vaccines even to conduct a global action to immunize all health systems agents. It is necessary to create criteria even in the initial efforts. 

The second priority is obviously to vaccinate the risk groups. The number of people in these groups is tremendously higher than in the health system. Defining priority into these risk groups will be a nightmare due to the shortage.

Before discussing the other categories of professionals that should have priority or whether we should prioritize some age groups, we need to create criteria in line with macro-objectives of reducing the number of contagions and mitigating death rates.

Acquired immunity is the path.

In Brazil, where the discussion is much shallower, and the debate currently revolves around using a vaccine with a 50% effectiveness rate, it amazes me to completely disregard the effect of immunity in managing the problem’s solution. 

Suppose a half-ass vaccine, with around a 50% of efficacy rate, can help reduce contagions and allow the health system not to collapse. There is no policy to address the issue of immunity acquired from those who have already contracted COVID-19. What about cross-immunity?

Humanity would have been extinct by now if our immune systems were incapable of dealing with viruses.

The Brazilian example serves as a parameter to extrapolate this issue of the forgotten immunity effect in this puzzle. 

Postponing people with acquired immunity could help to manage the shortage. Somehow, we can assume that we will achieve better results by combining vaccination efforts with acquired and cross-immunity. Please remember that I will not discuss the necessity of vaccination of 100% of the people to ensure a better public health scenario. However, since we don’t have vaccines for all during 2021, creating rules that directly mitigate the real problem is mandatory. 

Additionally, there will be more time to research the necessity of immunizing people with natural immunity acquired once again. Recently, scientists started to discuss how many doses are necessary for people who recover from COVID-19. Today, we are talking about around 107 million doses that can be distributed adequately. It will mitigate all the stress about mandatory vaccination, which is escalating to disrespect our freedom.

Another essential factor that has come to your attention these days is that immunized people can carry and transmit the virus. It is preliminary research of Public Health England and requires further investigation; however, it implies maintaining several procedures to avoid contamination, like social distancing, use of EPIs, etc. Since immunized people can return immediately to their activities, keeping all rules to prevent contamination is mandatory. The objective is to mitigate contamination until we acquire herd immunity.

I do not need to rummage deeply on the effects of a combined immunity and vaccination policy on economic resumption. When we observe that they are talking about vaccinated and unvaccinated registrations, creating even longer restrictions with severe economic conditions, ignoring acquired immunity is a huge mistake. 

It seems that we have not learned the catastrophic effects that lockdowns and restrictions have caused on the economy. 

We will enter new lockdown periods after a full year of living with COVID-19, and at that point, we have millions of people who have survived the virus and have immunity. We already have several studies indicating economic deterioration, combined with delayed follow-up and medical treatment of other “n” diseases, will cause many more deaths than those derived from the virus. 

Even if there were no vaccination problems, we would have to be 100% focused on resuming economic activities.

The high use of resources from the rescue and relief programs in welfare will cause even more significant problems in the medium and long term and solve nothing quickly. From the economic point of view, our focus should never be to survive, as this has consequences.

We are no longer in the Stone Age to worry about staying alive. At least for now, we are not experiencing conflicts of a warlike nature on a large scale that require sacrifices and rationing. If they are there and tend to worsen, it is because of our leaders’ wrong choices. 

The history of humanity and its evolution is written by progress. Only the worst passages are similar to the current times of arbitration, dogmas, and impositions on the threshold of abuse of power. 

The way our leaders have decided to deal with fighting the virus has always been very obtuse, from what they call denialism to the radicalism of shutdowns and lockdowns without considering that the economic effects cause even more deaths than a pandemic. 

They forgot that every decision has consequences, some more harmful and even longer than the pandemic itself. They left everything aside as if a public health problem was to be solved. Solutions will not be achieved when you neglect several other issues and create new problems.

Let’s put additional pressure on topics that will effectively help us to overcome this moment. The immunity debate is relevant in several ways. Avoiding economic shutdown is also mandatory.

This article is a mere starting point in this discussion. Instead of excessive focus on COVID-19 tests with low confidence, let’s start to test antibodies on a larger scale. Even regarding pure expectation management, it sounds like one of the bests ways to mitigate all pressure and frustration due to the vaccine shortage or the lack of vaccination.