Clinical proceedings of First Int. Conference on Covid19 held at UHS Lahore


Clinical proceedings of First Int. Conference
on Covid19 held at UHS Lahore
UHS to establish Dept. of Vaccinology in collaboration with
NIH and Chinese vaccine producers - Prof. Javed Akram
Vaccines boost immunity but they are not treatment of
any disease-Tayyab Hussain

LAHORE: Prof. Nikolai Petrovsky from Elinders University Australia was one of the invited guest speakers at the First International Vaccines Conference organized by University of Health Sciences on April 10th 2021. His presentation was on “Challenges and unanswered questions for Covid19 Vaccines”. Tracing the history of vaccines, he discussed the discovery of various vaccines, death and fatality rates of various epidemics. Talking about risk factors for complications and death from Covid he mentioned age above sixty years, obesity, diabetes mellitus, hypertension, heart diseases, and lung diseases. He also shared information about the various vaccines in the pipeline for development and how fast these vaccines can be rolled out. Many pharma companies have developed Covid vaccines which include Johnson & Johnson, AstraZeneca, SinoPharm Bio, and Russian Sputnik. China Sinopharm and CanSino from China. India is one of the biggest producers of vaccines by Bharat Biotech of India.

Prof. Javed Akram

How effective these vaccines are depends on the proteins. A safe and effective vaccine should offer 95% protection from symptoms, should prevent serious disease and death. But the questions being asked is how long this protection will last, is it for six months but not much is known at present. The other issues being discussed are is herd immunity likely which is also not known at present. Is one vaccine better than the other also depends on certain criteria? To find out whether these vaccines are safe, one needs to do risk benefit analysis, he added.

Continuing Prof. Nikolas said that we will see vaccine escape and it is happening. Many people are reluctant to get vaccinated with Covid vaccine. All vaccines have some side effects. Speaking about the mortality so far, he gave the following figures for various countries:

USA 572,849
Brazil 34, 0907
UK 126,927

Some countries believe that jobs are more important than lives and they are hoping for development of herd immunity. We have also noted emphasis on individual over collective rights. He also referred to the populist leadership’s anti-science agenda. He also made it clear that re-infection with Corona virus is possible in healthy young adults. The second wave killed many people in Brazil. COVAX-19, he pointed out is an adjuvant recombinant protein vaccine against covid19 which is being manufactured. So far it has four major studies including the one at University of Georgia. Phase-1 human clinical trials started on July 2, 2020 in patients between the ages of 18-65 years.

Some of the challenges that we are facing with regard to these vaccines, he stated, include their safety and side effects profile, availability of these vaccines at affordable price particularly for the developing countries. When these vaccines will stop protection and will then a booster dose be required. Other issues being discussed are that can different vaccines be mixed and matched and what should be the recommendation by the healthcare professionals to the patients. There have been reports of AstraZeneca vaccine induced venous thrombosis and thrombocytopenia syndrome which have been documented. In some cases the mortality has been about 50% with AstraZeneca. It mimics heparin induced thrombocytopenia. The patients suffer from fever, chills, hypertension, Tachycardia. As regards vaccination of the population, USA and UK were doing well. He hoped that next generation of Covid vaccines will be effective against all strains.

Responding to questions Prof. Nikolas said that it is an evolving story and variants does change its mode. In Australia, the government ensured social distancing from the very beginning, sparse population and strict lockdown helped to control the pandemic early. Control at local level was also very strict.

Dr. Somia Iqtidar

Prof. Javed Akram Vice Chancellor of UHS was the next speaker who spoke about Vaccines in general and where do we stand today. His advice to the public was that they must get vaccinated with any vaccine which was available and affordable. One of the vaccines has been tried and tested in a trial in Pakistani population and has proved to be safe and effective. Currently Punjab has a very high infection rate as the virus was brought by people returning and coming from UK who brought it here who should have been put in quarantine. Vaccine for smallpox was discovered in 1700.Normally development of a vaccine takes about thirteen years but in case of Covid19 vaccines were developed in a year. At present two to three parallel trials are underway. No vaccine has been tested in pregnant women and children so far though now some trials are being planned.

In case of Covid19, he said, we saw accelerated development of vaccine in just one year something which used to take about twelve to thirteen years in the past. No vaccine, he said, was 100% safe and effective. Best thing is to undertake local trials and try it in local population’s He also talked about mechanism of development of vaccine. In Pakistan, we had two trials. The first one was done at five centers while the other is now being tried at thirteen centers in Pakistan besides Uzbekistan. Comparison of Pfizer vaccine and the one produced by Moderna showed that both are effective. Both are two dose vaccines. He also disclosed that they were planning to develop Nasal vaccine. This will be a single center trial using nasal vaccine in children. China was currently leading in development of vaccines. Cold chain remains a major problem. CanSino trial undertaken in Pakistan showed that it has 74.8% efficacy in symptomatic patients and was also found to be 100% effective in preventing severe disease. This trial enrolled thirty thousand volunteers and there were just one hundred and two adverse effects which were not serious. There is no safety data in lactating and breast feeding mothers. ZF2001 is also well tolerated in Pakistani population. CanSino is 100% effective in preventing serious disease but repeat booster dose may be required.

Continuing Prof. Javed Akram said that it is also being discussed that why one cannot have two vaccines at the same time for long term safety. Elderly have always clotting problems. This local trial of vaccines has produced local data. He was of the view that we need to conduct more clinical trials. We are a different population, hence local studies are extremely important. We need to go for aggressive vaccination in Pakistan. He agreed to a question that while majority of the population was not yet vaccinated, it was not wise to advice people vaccination with two vaccines to those who can afford it. There are ethical issues involved. Dr. Somia Iqtidar pointed out that in Punjab, 70% of the Covid19 virus was of UK variant which was brought by people who came from UK to visit Pakistan. Responding to yet another question Prof. Javed Akram said that mortality from Corona virus in Pakistan was much less as compared to India which was due to BCG vaccination which majority of our population had which protected them.

Dr. Somia Iqtidar’s presentation was on Vaccine acceptability and side effects in Pakistani population. She also referred to an overseas study of seventy nine cases which were vaccine induced thrombosis cases due to AstraZeneca vaccine out of which nineteen died. Three of them were under thirty years of age. None of the patients in her study got AstraZeneca vaccine.  Sixty five percent of those included in her study were mail and 35% were female. Most of them were healthcare professionals while fifteen others were included in the study. The survey included two hundred doctors, one nurse, and two paramedics while sixteen did not disclose their profession. She pointed out that those who have suffered from Covid must get themselves vaccinated. One hundred ninety one of those included in the study got Sinopharm vaccine, eleven had got Pfizer vaccine, four got Russian Sputnik vaccine,  two had CanSino vaccine and one had Moderna vaccine. About 12% had some symptoms within one hour of vaccination, 42% after six to twelve hours and 52% had after forty eight hours. About 19% in the study had severe symptoms and they had to take leave from work. The symptoms noted included body aches in 22.74%, Headache in 13%, tiredness in 21% and joint pain in 5.3%. Almost 50% of them had to take Panadol to get rid of fever. Most of them had mild symptoms while 14% said their symptoms got worse. She concluded that 87% of the subjects got SinoPharm vaccine, majority had no severe symptoms, and most patients had symptoms after the second dose.

Prof. Tayyab Husnain spoke about vaccine development, History advancements like mRNA platforms, limitations and hope. Talking about the types of vaccine he mentioned whole virus vaccine, Viral vector based vaccines and Nucleic Acid based vaccines. He then discussed in detail how mRNA Covid19 vaccine works. The advantages of this vaccine is that the process is cell free and sealable. It can address current myths and challenges. Moreover within weeks chemical batches can be produced. He also mentioned how to switch from two to one dose. On the whole Covid vaccines, he stated, are safe. These vaccines boost immunity. It is not treatment of any diseases and many new vaccines are being developed. WHO was monitoring the production of vaccines? Cost of mRNA vaccine is much less, he added.

During the discussion, the issue of plant based vaccines was also discussed. On a suggestion from the audience, Prof. Javed Akram said that they will establish a Dept. of Vaccinology at the University of Health Sciences in collaboration with NIH Islamabad and AJM Pharma and their Chinese colleagues. Mr. Adnan Hussain from AJM Pharma who was present on this occasion agreed to be a part of this initiative and support it.