With input from Dr Monica Vasudev

1185: Minutes of Virtual Meeting of CMAAO NMAs on “CMAAO Update and vaccine difficulties”

28^th November, 2020, Saturday, 9.30am-10.30am

Participants: Member NMAs: Dr KK Aggarwal, President CMAAO, Dr Alvin Yee-Shing Chan, Hong Kong, Treasurer, CMAAO, Dr Md Jamaluddin Chowdhury, Bangladesh Medical Association, Dr SM Qaisar Sajjad, Secretary General, Pakistan Medical Association

Invitees: Dr Russell D’Souza, Australia UNESCO Chair in Bioethics, Dr S Sharma, Editor IJCP Group

Key points from the discussion

Discussion point #1: Status of coronavirus in various countries

• The world pattern shows a single wave with three peaks. In the first peak, the mortality was very high, then the mortality and number of cases were equal; in the third wave, the mortality is high as is the number of cases. The mortality is proportionate to the number of cases.
• There have been practically no cases/deaths in China.
• The US pattern is same as the world pattern.
• India is experiencing the first wave and may be heading towards the world pattern.
• Mortality is equal to new cases in Brazil. Spain has been able to control mortality.
• In UK, new cases are increasing, but mortality is reducing. In Italy, cases are increasing and mortality is also increasing.
• Hong Kong is experiencing third wave but mortality is very low. Japan - third peak coming, but mortality is very low.
• Malaysia, Nepal, Australia are experiencing a second wave.
• Pakistan - earlier mortality was increasing as cases were increasing, but now mortality is declining.
• In Nepal, the mortality is equal to new cases.
• There are no cases now in Singapore.

 Discussion point #2: Vaccine status

• Only two vaccines have been approved: Sputnik V developed by the Gamaleya Research Institute in Moscow; EpiVacCorona, another Russian vaccine, has been granted regulatory approval also without entering Phase 3 trials. This vaccine contains fragments extracted from the virus (synthetic peptide antigens).
• Oxford has admitted error in dosing in their vaccine trials; wrong dose was given to over 2000 trial participants.
• FDA has warned that rapid antigen tests can also be false positive. The WHO does not recommend rapid antigen test.
• No vaccine has been shown to be efficacious in preventing infection. Hence, physical distancing, masking and handwashing are key preventive measures.
• We do not know if people can become infected and also transmit the virus even with vaccination.  The Pfizer-BioNTech and Moderna vaccines are about protection from symptomatic disease.
• The Brazilian President has said that he will not take a coronavirus vaccine, while a former vice president and chief scientist of Pfizer has said that there is no need for vaccines to stop the pandemic.
• Less protection is expected with mucosal infections. Injectable polio vaccines are good but do not really protect against the mucosal component, the GI tract.
• RNA is very inflammatory, so we may see more reactions in people who get the highest dose in the Moderna trial and that dose is not being used for further studies. Every mRNA vaccine is different.
• The Oxford AstraZeneca vaccine (AZD1222) is a viral vector vaccine (chimp adenovirus), in phase 3 trials. It is said to be 64% effective.
• PfizerBioNTech (mRNA) vaccine has shown more than 90% efficacy in phase 3 trials.
• Moderna’s mRNA vaccine is also more than 90% effective.
• Other vaccines in phase 3 trials: Ad5-nCoV (Cansino and Beijing Institute of Biotechnology), Coronavac (inactivated; Sinovac; UAE has approved), Covaxin (inactivated, India), J&J vaccine (non-replicating viral vaccine), Novavax, Sputnik V (appears to be the best at present). Another inactivated vaccine from China; no name has been given to this vaccine.
• In most developing countries, the vaccine will be inactivated vaccine (works for shorter period of time). Other vaccines may be available, but in private sector. Rich countries may opt for Moderna, Pfizer vaccines.
• Russia and China made vaccine available after phase 2 trials and conducted phase 3 trial in their respective countries.
• It is a mucosal virus; development of secretory IgA should be demonstrated.
• There are several questions: Will the injectable vaccine prevent GI entry of the virus? How long does protection last? What would their safety record be? Will it work in immunocompromised people? What does the immune response look like?
• In the Oxford vaccine, more than 2000 subjects were given half dose. These cases were taken out of the trial, but now it has been found that protection was more in this group.
• Vaccines in India: Covaxin (Bharat Biotech), Sputnik V, Oxford-AstraZeneca.
• Countries like Bangladesh, Pakistan, and Nepal are likely to have Oxford-AstraZeneca, Sinovac and Sputnik V vaccines.
• Coronavirus vaccination (Pfizer) is likely to start in the US from December 11.

Dr KK Aggarwal

President CMAAO, HCFI and Past National President IMA