Covid vaccines. Facts, goals and dreams
Conversation of Quotidiano Sanità with Donato Greco, medical specialist in Infectious and Tropical Diseases, Hygiene and Preventive Medicine and Health Statistics, former Director of the National Epidemiology, Surveillance and Health Promotion Center of the Higher Institute of Health and then Director General of Health Prevention Ministry of Health
The vaccines
Effective and safe Covid-19 vaccines will certainly be available in 2021, reasonably starting from summer 2021: some limitations are foreseeable:
1. Vaccines will act to contain the damage, not to control the incidence (this is the experience of all human respiratory viruses of zoonotic origin)
2. Of the 70 vaccines in the pipeline, none is presented as a conjugate capable of fighting not only the disease, but also the infection (such as that for hemophilus Influenzae). (4)
3. Most vaccines in the pipeline so far require two doses to reach a significant level of antibodies: so many months will be needed to have a real mass antibody barrier, if ever attainable .
4. 100% effectiveness against infection is highly unlikely, so there will always be a cohort of vaccinees susceptible to infection.
5. All ongoing or planned Phase 3 trials have a duration of a few months, which is insufficient to demonstrate a duration of immunity greater than the observation time in the trial.
6. The prediction of a miracle vaccine, which solves the Covid-19 problem is unrealistic and harmful; for twenty years we have had excellent seasonal flu vaccines that are up to 90% effective against confirmed flu, we use them massively, but we do not change the seasonal trend of flu epidemics by one iota.
The costs of containment
At this point it is necessary to evaluate the side effects of the containment measures implemented and being implemented.
There is still no comprehensive analysis of the damage associated with these measures, nor studies on these aspects yet appear, but dramatic data rains everywhere on the concrete and palpable social and economic damage suffered, in the absence of studies on the future consequences caused by the containment measures. .
The list of damages of the lockdown is difficult to compile: deferred treatment with a consequent increase in morbidity and mortality, preventive activities interrupted with the loss of significant quantities of lost years of life, economic losses from commercial and production activities interrupted or greatly reduced, only for name a few.
The ones that strike me the most are three:
1. The reduction or suspension of teaching activities: damage to our children and grandchildren, present and future, of incalculable dimensions.
2. The extraordinary expansion of state welfare: generations of clients deprived of initiative and the desire to work are being built.
3. The conversion of social relationships is the foundation of our history: from brotherhood and solidarity to distrust and informing, from the next brother to the next potential enemy.
Both total (Lockdown) and partial containment measures have very high social costs that cannot be replaced by the continuous progressive state debt that will heavily affect our future and the next generations.
What future scenario?
These observations form a credible picture of a scenario in the near future (2-3 years?) Of an endemic trend of the infection with alternating epidemic peaks, even with effective vaccines available.
Therefore they impose an ordinary coexistence with this infection similar to the many other respiratory infections with which we have always lived.
So a return to a responsible and equipped normality .
Accept the risk
Pneumonia is the cause, before Covid, of about 15 thousand deaths a year, about the 14th cause of death in Italy, about 0.25 deaths per thousand inhabitants; many of these pneumonia have a viral etiology, from the influenza virus to the many other viruses that prefer the respiratory tree: mortality slowly decreasing over time thanks to the best diagnoses and treatments .
The mortality from Covid in Italy has so far been more than double of all deaths from pneumonia in the recent past, but the hope that the tremendous epidemic peak of spring 2020 will not repeat itself and the virus aligns with the "normal" mortality of other respiratory viruses circulating in our country.
In terms of morbidity, hospitalizations for pre Covid pneumonia are ten times higher, and to these must be added the cases treated at home for a total of at least 300,000 cases / year, five cases per thousand inhabitants every year.
To the "normal" risk of getting sick with pneumonia or dying from it, we must add Covid pneumonia, confident that the strengthening of prevention, diagnosis and treatment activities will progressively decrease this risk, also knowing that effective containment measures are also valid for pneumonia from non-Covid virus.
(Short extract from an in-depth study from Quotidiano Sanità )
This is a machine translation from Italian language of a post published on Start Magazine at the URL https://www.startmag.it/sanita/vaccini-anti-covid-fatti-tesi-e-sogni/ on Sat, 21 Nov 2020 16:49:18 +0000.