Vaccine is the way out

It was disheartening to learn from recent reports from Kashmir Valley that ‘83% of healthcare workers avoid vaccine’.
Vaccine is the way out
Image Courtesy: gov.uk

The COVID-19 pandemic has brought anguish, pain and death to millions across the globe. Regardless of where you live healthcare systems have been stretched to the limit and there is hardly anyone who has not lost a loved one. The grim truth is that the crisis is not yet over. Currently the pandemic is raging across Indian subcontinent, and Kashmir is no exception. As Kashmiris grapple with the additional challenge of overcoming a deadly virus, this article examines if there are any lessons from the past that might help us to deal with the present and indeed the future.

During the late 19th & early 20th century Kashmir Valley was 'an unhappy place, a land of hopelessness and despotism, despair and disease' (Kashmir in Sickness and in Health by Gulzar Mufti, 2013). The healthcare landscape was particularly depressing. According to the 1892 census the adult life expectancy was 19 to 21 years compared to 44-48 in the UK. Nearly half of the children died during or after birth and of those who survived, a third died within the first year. Regular outbreaks of devastating epidemics of communicable diseases such as cholera, plague, small pox and measles led to thousands of deaths year after year. 15,000 people died from the Spanish Flu (Bombay Fever) pandemic in 1918. The three Ts, Tuberculosis, Typhoid and Typhus, were rampant and escalated the numbers of dead. The vast majority of the population was illiterate, indigent and ignorant. They sought help in overcoming their ill health from hakims (herbal medicine practitioners), naevids (barbers), warrens (midwives) and wattangors (bone setters), and had strong religious and spiritual beliefs. In the words of a local historian, 'the ignorant masses were terribly scared. They would only take the medicine of their hakims or trust the prayers and incantations of the priests'. (History of Srinagar by Mohammed Ishaq Khan, 1999)

With the arrival of Christian missionaries, the Western practice of allopathic medicine started gaining a foothold in the valley and health of the population improved in tandem. A number of other people, including the last Dogra Maharaja, some local politicians and many clinicians of the bygone era contributed to this change, but the essential driver was education. Kashmiris followed to the letter the divine directive 'Read in the name of your Lord who created you' (The Holy Quran 69:01).  Young, educated Kashmiris felt empowered with knowledge, abandoned superstition and got their communities to embrace modern medicine. Like everywhere else, in Kashmir too the two most important modalities to dramatically reduce death and increase life expectancy have been access to clean drinking water and vaccinations. Communicable diseases like cholera and smallpox which were major killers disappeared and life for ordinary folk improved dramatically.

The current healthcare scene in Kashmir looks vastly different to the early 1900s. A range of modern healthcare facilities are scattered throughout the Valley and a number of secondary and tertiary care, general and specialist public sector hospitals are distributed all over Srinagar. With growing wealth there was an exponential growth in the number of private sector clinics and hospitals in the last few decades. This remarkable transformation in healthcare is reflected in the 2012-16 census data which shows the average life expectancy at birth for Jammu & Kashmir to be 73.5 years (71.5 for males, 76.2 for females). We ranked second amongst all the states in India and our figures were significantly higher than the individual averages for Afghanistan, India and Pakistan.

The human race perhaps became too haughty about its own achievements and ignored the advice offered by the Creator more than 1400 years ago: ". . . do not walk pridefully upon the earth. Surely Allah does not like whoever is arrogant, boastful." (The Holy Quran 31;18).             As we triumphed over old enemies like sepsis and communicable diseases, new challenges emerged in the form of global warming, superbugs and new infections such as Ebola and HIV, and since 2020 we have found ourselves engaged in a fierce battle against the COVID-19 virus. Across the globe more than 3 million people have died of COVID-19. The actual figure might be much higher given the discrepancy between the official and unrecorded deaths in many countries. This virus did not spare even the most powerful, with the numbers of deceased in the US approaching 600,000 while in the UK 127,000 people have succumbed to the virus. Jammu & Kashmir has also suffered and lost more than 2000 people so far.

While the medical communities everywhere have struggled to cope with the worsening COVID-19 pandemic, the only glimmer of hope to end this dreadful situation has come from science once again. In record time scientists around the world utilised different platforms to develop a number of vaccines against COVID-19. Subsequent partnerships with biopharmaceutical companies ensured large-scale manufacturing and distribution of vaccines at an unprecedented pace. A husband and wife team of Turkish German researchers became the first to use a novel mRNA technology to develop a vaccine against COVID-19. Similarly, researchers at the University of Oxford used an adenovirus platform to develop another highly effective vaccine in preventing severe disease and hospitalisation. Other countries including China, India and Russia have also developed their own vaccines. The news about the availability of the vaccine was   received with huge relief across the globe. However, despite these successes, it was disheartening to learn from recent reports from Kashmir Valley that '83% of healthcare workers avoid vaccine'. (The Hindu, 12 February 2021).  But why is there such hesitancy in accepting vaccination against COVID-19?

Indeed, immunisation has been controversial since its very introduction. There was intense resistance to the smallpox vaccination in British India even from the au fait who described it as 'sacrilege'. (The history of vaccine opposition in India – the case of small pox', The Indian Express, 24 February 2021) Kashmiris opposed it too. In his book, Beyond the Pir Panchal, Ernest Neve, the Christian missionary surgeon at Kashmir Mission Hospital wrote, 'I often wish the opponents of vaccination could be present in our consulting room to see the melancholy procession, day by day, of those who have lost their sight from smallpox.'  However, if one compares the current socioeconomic structure of Kashmir valley with that of the early 20th century, it is clear that our religious and spiritual beliefs are still the same as before, but our illiteracy rates have gone down tremendously and we are no longer indigent, with a significant shift of the population towards middle and lower-middle income families. As such one would expect a greater understanding of various pathways leading to medical discoveries and higher acceptance of medicines that have undergone robust clinical trials to get public approval. Sadly, ignorance still prevails. A major contributor to this phenomenon is digital platforms and social media wherein false information is propagated very quickly and non-credible sources are made to look credible. The advice offered by our very own Sufi saint Hazrat Mir Syed Ali Hamadani (Shah-i-Hamadan)to 'avoid discourse with the ignorant' is as much applicable today as it was seven hundred years ago. (Zakhirat-ul-Malook, Chapter 4: Section: Rules of community responsibilities)

Given the immediacy of the COVID-19 pandemic, there is an urgent need to dispel some of the myths surrounding the COVID-19 vaccines. It is important to recognise that the overall success of any vaccination program correlates with rates of vaccine uptake. The higher the number of vaccinated people in a population, the lower the number of susceptible individuals, and less chance for the virus to spread and mutate. India has already approved three vaccines, Covishield, Covaxin and Sputnik V. Let's look at some of the myths about these vaccines circulating in social circles.

The vaccine was rushed and therefore is not safe: This doubt comes from a lack of understanding of vaccine development pipelines. Given the technological revolutions in biomedical research that have been occurring quietly for years, the technical part of vaccine development does not take long. The time-consuming part is funding bottlenecks, enrolment of participants in clinical trials and setting up expert panels to review any trial data. All of these were accelerated for the COVID-19 vaccines. None of the robust clinical milestones on safety and efficacy were compromised.

The vaccine affects your DNA: The foreign genetic material used in the vaccine to stimulate an immune response does not enter the nucleus, the compartment where our DNA is found in cells. Therefore, no interaction between our DNA and that of the vaccine's genetic material is possible.

The vaccine gives you the disease itself: None of the vaccines contain a live virus which means they cannot make you sick with COVID-19. Even Covaxin which uses a complete COVID-19 viral particle has been modified so that it cannot replicate in human cells. It is however, important to emphasise that most vaccines cause mild side effects, like that of the seasonal flu vaccine which resolve in a few days. Allergic reactions to vaccine are very rare.

The vaccine can cause issues with fertility: There is no evidence to back this which has been confirmed in a statement by the WHO.

I don't need the vaccine if I've already had COVID-19: Some people incorrectly think they do not need a vaccine if they have already had COVID-19.  It is not yet known how long after natural infection the protection lasts and therefore it is recommended to have the vaccine when offered.

The efficacy of the vaccines is doubtful because some have tested positive for the infection even after vaccination: Firstly, vaccines do not work instantly. COVID-19 vaccines teach our immune systems how to recognise and fight SARS-CoV-2 (the virus that causes COVID-19).  It takes a few weeks after vaccination for the body to develop immunity and to prevent the development of COVID-19. Therefore, a person can still get COVID-19 just after receiving the vaccine.  Importantly, the vaccines now in use in Kashmir require two doses a few weeks apart to reach full effectiveness so it is possible to get COVID-19 after only one dose of the vaccine and a person is not considered immune until a few weeks after the second dose of the vaccine. In addition, vaccines cannot prevent the development of infection if a person is already infected at the time of vaccination. Thirdly, vaccines are not infallible but work extremely well. According to the Centers for Disease Control (CDC), American health officials have confirmed less than 6,000 cases of COVID-19 in over 84 million fully vaccinated Americans (breakthrough infections). This represents an infection rate of only 0.007% in people with full protection against the virus. In addition, of the 84 million people who were vaccinated, only 74 people died (a death rate of only 0.0001%). Vaccines are therefore excellent for preventing the development of serious disease and this was the main basis for which they were approved. There is some evidence to suggest that fully vaccinated people are less likely to infect others but this is still under investigation. Therefore, it is vitally important that even after vaccination we still adhere to the current guidelines of avoiding crowds, wearing a mask and maintaining social distance.

Many more myths around the vaccines will continue to appear, but it is always best to seek information from reliable sources to overcome doubt. Prophet Mohammed (PBUH) advised us "to acquire knowledge and impart it to people" (Al-Tirmidhi, Hadith 107). It is a social responsibility for our writers and broadcasters, clinicians, scholars and teachers, religious heads and imams, and the civil society to combat misinformation through media, at religious congregations, educational assemblies and informal meetings.  Logic dictates that if you have no definitive treatment for a disease, we must use every strategy at our disposal to prevent it. The best we can do at present against COVID-19 is prevent its spread by wearing a mask, washing hands with soap and water regularly, avoiding crowds and keeping a safe distance from others.  Luckily, we now have vaccines of different sorts available. Taking the vaccine is the single most important step an individual can take to protect himself and the community at large. Therefore, if you are offered the vaccine, please take it.

Note:

The above was the subject matter of a presentation by the author at the Seminar entitled 'Pandemics and Narcotics; A Religious Perspective' organised by Prof Manzoor Ahmed Bhat, Head Shah-I-Hamadan Institute at Kashmir University Srinagar on 7-8 April 2021.

I am enormously grateful to Dr Shazia Irshad, PhD. Senior Scientist Radcliffe Department of Medicine, University of Oxford for her expert help in the preparation of this article.

Author, a Consultant Urological Surgeon, was Medical Director Medway NHS Foundation Trust, Care UK & BMI Healthcare UK. He is the author of 'Kashmir in Sickness and in Health', Partridge India (2013)

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