The British Kashmiri Medical Association (BKMA) have produced a position statement on the COVID-19 vaccination to help our fellow Kashmiris and all other citizens to make an informed decision on vaccination. This consensus statement is specific to the Pfizer/BioNTech, Oxford/AstraZeneca, Moderna, Bharat Biotech Covaxin (BBV152) and Covishield/AstraZeneca and is based on the current published evidence (available on www.bkma.net).
Although we have learnt to treat coronavirus disease much better and many treatments are now available, the death rate remains very high, especially in the elderly and those with other medical conditions. Scientists in the UK and other countries have worked extremely hard to produce an effective vaccine against COVID-19, and we are pleased that a number of highly effective and safe vaccines are now in use throughout the world. So far, more than 200 million people have received a vaccine worldwide. Real-world reports from Israel and the UK have shown that just one dose of the vaccine is already slowing down the death rate, spread of infection and hospitalisation. Major regulatory authorities in the US and Europe alike (FDA, EMA and MHRA) are closely monitoring the safety of the vaccine and so far, no major side effects directly attributable to any of these vaccines have been reported. A small number of allergic reactions have been reported in individuals with a history of drug allergies and were safely managed.
Communities in Jammu and Kashmir seem to be hesitant in taking up the vaccine, including medical professionals. This is unfortunate, concerning and could have disastrous consequences. Even though the rates of infection may seem low in Kashmir, the virus is not fully eradicated from the community. We have seen a third wave of infection in Europe and the US, which has claimed thousands more lives. We must therefore not be complacent.
One does, however, wonder why people may be sceptical about the facts behind the vaccine. We
know that there is lot of misinformation being spread, particularly on social media. The statement by the BKMA (www.bkma.net) tries to dispel common misconceptions and myths about the vaccine and tries to answer some of the questions asked by public.
The vaccines have gone through rigorous trials monitored under strict research regulations in the US and Europe. The Pfizer and Moderna vaccines are RNA vaccines (utilising a piece of viral genetic code) and have been shown to be 90% effective in initial phase 3 trials, whereas the Oxford/AstraZeneca vaccine (an adenovirus vector vaccine) has shown 60-90% efficacy. No untoward side effects were reported in these trials. The vaccines also retain their efficacy against the new UK B117 variant and partial efficacy against the rarer South African variant.
It is understandable that the medical community of India and Kashmir in particular are sceptical about the Covaxin produced by ICMR/ Bharat Biotech, possibly because of lack of published phase-3 data. The Covaxin from Baharat Biotech has strong immunogenic and safety data proven in phase two trials as published in the Lancet Journal [doi:doi.org/10.1016/s1473-3099(20)30942-7].
We are aware of the ongoing phase 3 trial included 25800 volunteers, of which 13000 have already received the second dose. In order to gain the trust of the medical community ICMR must publish its data as soon as possible. The Covishield vaccine (adenovirus vaccine) on the other hand is a replica of the Oxford/AstraZeneca vaccine manufactured by Serum Institute Pune and is backed up by strong Oxford data. Hence, in our opinion there is no reason to believe that this vaccine will not be effective. We also have to bear in mind that there are far greater risks from being infected with coronavirus than from experiencing side effects due to the vaccine.
Common myths include that the vaccines change our DNA, that they make us infertile or that they contain pork, alcohol or beef. The facts are as follows: RNA vaccines, when injected, do not spread to the rest of the body but remain locally in the cells where injected, they induce an antibody response and die within few days. Therefore, there is no question of any changes occurring to our DNA after being vaccinated. Similarly, the AstraZeneca Vaccine is an inactivated viral vaccine; it does not transmit from cell to cell or translocate to the cell nucleus. The vaccines do not contain any animal protein nor do they contain any alcohol, hence should be acceptable to all religious communities.
The vaccines, like all other viral vaccines, do not affect our gonads and do not affect fertility. Most reported side effects of these vaccines are similar to other vaccines, such as discomfort at site of injection, headache, fatigue, myalgia and nausea. These side effects resolve in a few days. Due to the unprecedented nature of this pandemic, the process of the vaccine trials has moved very quickly; many processes working in parallel. Both the FDA and MHRA have a robust process for reviewing the data and no corners have been cut as far as the safety or efficacy of these vaccines is concerned. Like all other vaccines, scientists do not anticipate any long-term side effects. At the moment the vaccine is recommended for all age groups above 16 years including those previously infected with COVID-19, since it is unknown if antibodies developed post-infection are robust enough for full protection against new infection.
COVID-19 infection leads to high mortality in cancer patients. It is recommended that the vaccine be given to all cancer patients and well as those that are immunosuppressed, even though they may not mount a robust antibody response- developing even a small antibody response may be better than not having the vaccine at all. Pregnant and breastfeeding women can also be given this vaccine if they are deemed high risk. Like other vaccines these vaccines are not deemed to cause untoward side effects to the foetus.
This statement should help our fellow citizens of Jammu and Kashmir to make an informed decision regarding COVID-19 vaccination. We urge all of you to think carefully before rejecting the vaccine and consider taking the vaccine to protect you and your loved ones. Remember, the virus does not respect boundaries or races, it may seem worse in Europe but it is only a matter of time before the virus could engulf the valley. Let us act now and save ourselves and our fellow human beings.
(Note: this piece is written on behalf of BKMA)
Author is a senior lecturer and clinical researcher at University of Birmingham, UK and a consultant in NHS, UK. He is the interim president of BKMA.