Vaccination and Threat of Virus Mutation

The new chapter opened with the Covid-19 vaccine, which has buoyed public optimism, needs to be accompanied with honesty (and fairness) in government policies.

The new chapter opened with the Covid-19 vaccine, which has buoyed public optimism, needs to be accompanied with honesty (and fairness) in government policies.

The Food and Drug Monitoring Agency has issued emergency use authorization after the Indonesian Ulema Council stated that the Sinovac vaccine is halal. President Joko Widodo became the first person to receive a Sinovac shot on 14 January 2021 to set an example for Covid-19 immunization.

A week earlier, Coordinating Economic Minister Airlangga Hartarto as the chairman of the Committee for Covid-19 Handling and National Economic Recovery announced the enforcement of new large-scale social restrictions (PSBB) for Java and Bali from 11-25 January. This is a good step, as well as a corrective one.

Mobility restrictions are the main pillar for curbing the spread of the virus, and vaccination is a supporting pillar. This corrective step deserves our support.

However, unfortunately, the coronavirus does not seem to care. The number of additional positive cases continues to rise. On Saturday (16/1/2021), two days after the President was injected with the vaccine, the number of confirmed new daily cases rose again to 14,224 people. The coronavirus seems to be sending a message: "Don't play around, don't underestimate me, and don't ever joke about me."

We must be aware that many people hesitate and refuse to be vaccinated for various reasons, including the low efficacy of the Sinovac vaccine. In Indonesia, the efficacy of the Sinovac vaccine is 65.3 percent and in Brazil 50.4 percent, much lower than Pfizer’s, which reached 95 percent, according to the Coronavirus Vaccine Tracker.

Simply put, the Sinovac vaccine hasn't convinced the public enough. In fact, there is a member of the House of Representatives who openly refuses to be vaccinated and calls this vaccination more business-nuanced, thus raising doubts about the Covid-19 vaccine.

In the midst of a situation like this, unpleasant news emerged. On Friday (15/1), the Norwegian government issued a warning following the death of 23 people after being injected with the Pfizer vaccine, although it was stated that those who died were elderly people and had other diseases (comorbidity).

As a rival country, China immediately asked that Pfizer vaccines not be used worldwide. This dispute is clearly not helping to improve vaccine acceptance.

In such a difficult situation, the virus becomes even more ferocious. The first wave of virus attacks in Indonesia has not subsided. Other countries already face the second attack wave, namely a new variant of the coronavirus that is reportedly 71 percent more contagious than its predecessor. The SARS-CoV-2 virus is extraordinarily smart, resilient and tough and agile.

After hitting almost all countries in the world, this virus continues to mutate. Adapting to new environments and strengthening its weapons, it erodes the body's defense system.

Last September, experts in South Africa detected a new mutant virus at Nelson Mandela Bay and named it 501Y.V2. This finding was reported by the country's health authorities on 18 December 2020. Then, on 23 December, British Health Minister Matt Hancock announced that two British citizens who had just returned from South Africa were positive with this mutant virus, which was later named VUI- 202012/01 in Britain.

In just one week, this new variant spread to invade Switzerland, Finland, Japan, Zambia, France and China. In the first 10 days of 2021, this new variant entered South Korea, Australia, Botswana, Ireland, Brazil, Canada, New Zealand, the Netherlands and Israel. All of these cases were detected in passengers who had just arrived or returned from South Africa.

The speed of this new variant’s spread is extraordinary. The US, which has the highest confirmed Covid-19 case toll, has also detected a new variant. Scientists from the World Medical Center and Ohio University School of Medicine discovered the "Colombus strain". This variant is rare, because it has three common gene mutations that have never been seen together. This mutated virus was found in Columbus, Ohio, at the end of December 2020.

The UK has responded with drastic measures to the Covid-19 mutation. Upon receiving the report in December, the British prime minister quickly imposed lockdowns in several cities. Entering the new year, dozens of countries acted quickly to shut down traffic to and from the UK. And, learning from the delay during the previous response, the Indonesian government also quickly suspended flights to and from the UK to avoid the invasion of this mutant virus.



Optimism in facing mutants

This new variant 501Y.V2 spreads very quickly. Reportedly, it is 71 percent more contagious than its predecessor generation. What is still up for debate is whether the vaccination that has just been started in a number of countries can tame the threat of this mutated virus. It's not easy to answer. Experts in countries that have found cases related to this mutant virus are still researching it.

However, there is concern that this mutant virus could reduce the effectiveness of certain vaccines and in people with certain conditions. For example, the X vaccine that is injected into elderly people who have a history of Y disease may be less effective against this mutated virus from South Africa. The Pfizer-BioNTech and Moderna vaccines, for example, use m-RNA technology, which essentially provides instructions to the body to produce a harmless surge in the coronavirus protein. This spike in viral proteins is then recognized and studied by the immune system, which then prepares an antidote.

If one day the body really does take in a virus (marked by a surge in viral protein), the body's system will already recognize and immediately operate the weapon that has been prepared to fight the virus.

This roughly describes vaccination using m-RNA vaccines. Producers of the Pfizer-BioNTech vaccine believe that, with their m-RNA technology, the vaccine is still effective against the N501Y-V2 mutant virus in the UK known as B117, which has spread to many countries.

On the other hand, however, mutations involving the E484K strain found in South Africa, Japan and Brazil are of real concern, because they have the potential to reduce the effectiveness of the vaccine. Cambridge University microbiologist professor Ravindra Gupta thinks the Pfizer and Moderna vaccines might deal with the E484K mutant strain. These mutants produce spikes in viral proteins that make it easier for them to attach to and bind tightly to human cell receptors, meaning they are more infectious. That is according to findings published by University College London researchers on 28 October 2020 regarding the special properties of the E484K variant.

Warning also came from Francois Balloux, computational systems biologist and director of University College London's Institute of Genetics. The E484K mutation found in South Africa, according to him, was proven to have a special ability, namely reducing the introduction of antibodies to catch this variant of the virus that entered later. Although it is presently stated that it is unlikely that the vaccine will provide no protection at all against the South African variant, antibodies derived from the vaccine or previous infection may decrease in effectiveness.

Essentially, the effectiveness of vaccines has decreased. With an electron microscope, Balloux discovered a strain of E484K that was able to escape the antibody barrier formed by vaccination. There was also a Covid patient who was infected twice in just a month. Normally, it should take at least three months to get infected again, even by a mutated virus. This E484K mutation is said to be able to escape antibody monitoring, meaning that it can trick the body's defense memorial formed by the vaccine. Balloux reports these findings in a paper in the journal Medrxiv that has not yet been peer-reviewed.

How will the new mutant virus affect the effectiveness of vaccines other than those of Pfizer and Moderna? Based on the literature, no one has clearly stated the impact. However, based on general studies, the mutation of the E484K virus has the potential to escape the antibody barrier that monitors the increase in spike (a nail shape attached on the surface) in the protein. At this time, there is no explanation as to which vaccine can completely block this mutant virus type. However, there is concern that this mutant virus reduces the effectiveness of all vaccines, contrary to the goal of forming antibodies against the virus.

In this situation, it is necessary to remain optimistic. Optimism and tawakal (submission) are good for the body's systems, including immunity. Apart from health protocols, vaccination still provides major hope to curb the rate of transmission. The government does not hesitate to spend tens of trillions to order vaccines from several producers in the hope that it will be effective in holding back the increasingly out-of-control transmission.

So, it is much better to stick with the original plan while carefully monitoring its implementation to identify any symptoms of irregularities. Because, until today, experts say that vaccination is the main medical step to build herd immunity, which in turn will curb the rate of transmission.



Trust as the key

Vaccination provides more benefits than harm. In people who have not been vaccinated, if they get infected, their body is at a high risk of developing a lung infection (pneumonia), acute respiratory syndrome and respiratory failure, infections in the bloodstream and other failures in organ function. Children can experience severe inflammation. Keep in mind that Covid-19 is part of the severe acute respiratory syndrome (SARS) virus, which attacks our respiratory system with a consequent effect on other organs, including the following which is also very scary: blood clot disorders at various levels throughout the body's blood vessels.

If vaccinated, the body will immediately respond by forming a special army to destroy the infiltrator, before it can enter and damage the function of various vital organs. There may be side effects in people with certain situations. However, in general the side effects are tolerable, such as nausea, dizziness and allergies for a certain period of time. All vaccines can have side effects in certain people. The side effects in the long term cannot be seen yet, but it is clear that currently we are all in grave danger of the Covid-19 attack.

The third phase of the clinical trial of this vaccine has been completed, so that it can get an emergency use authorization. Why is it urgent? Because we are racing against time to hold back the increase in cases that has spiked out of control. If you wait for normal vaccine research, it might just be five years from now and the number of victims will increase. Remember, now the death toll has exceeded the 2 million mark and the number of infections has reached nearly 100 million people globally. This is an emergency situation, a serious emergency, so emergency preparedness is needed.

It is hard to argue that the virus is very clever, it continues to mutate and is increasingly contagious. Therefore, it is hoped that vaccination can establish herd immunity before the mutant virus enters Indonesia. Vaccination can create a network of fortifications before a new type of enemy attacks.

The non-medical problem that needs to be addressed immediately is the issue of distrust in the government, which is also caused by the policies and behavior of the elite officials. This feeling of being distrusted is reflected in the government, which uses threat of criminal charges (including against those who refuse vaccines). In fact, many of these started with mistakes committed by government officials themselves, who from the start underestimated (the coronavirus). Plus, there was an impression that they abused the pandemic situation for personal gain and power. There are more and more cases of law enforcement that seem to reflect favoritism.

Vaccinations are important, but they are definitely not a panacea. The main pillars for reducing transmission are mobility restrictions, tracking, and — this is very important — increasing testing. Why is the Covid-19 test getting more expensive for people? In fact, there are already very cheap alternatives invented by the nation itself and that have passed the test, such as UGM GeNose, which can produce tests on the spot, because the results come out in about one minute. Why don't we include it in the regulations, just like the antigen and PCR test kits, which are mostly imported? Obviously, such an unwise policy can trigger further distrust, because it can be perceived as less transparent, unfair and unpatriotic.


Djoko Santoso, Professor of Medicine at Airlangga University and Covid-19 Survivor

(This article was translated by Kurniawan H. Siswoko).