Saturday, June 15, 2024

Truth and Trust: Vaccines an Important Part of the Solution to Covid-19 in Botswana

As a nation, Batswana, like the French, are hard to please; in fact, they seem to thrive on unhappiness, this is a statistical fact. The World Happiness Report 2021 is out. It focuses on the effect of Covid-19, on government responses, on why some countries have done better than others, and Botswana ranks 148; third from the bottom with Zimbabwe, even war-torn Libya beats us at 80. Add to this unhappiness the elements of fear and trauma inflicted on the national soul and psyche, and you have people who are very difficult to convince about many things, in some cases, anything at all. 

But there is also another side to our national character that I always find admirable, and that is our love of freedom, honour and human dignity; and this is the side of our national character I want to write about as our country faces the greatest test of survival and morality in its postcolonial health history.

It would, I think, be a terrible mistake, if Batswana allowed Covid-19, a health catastrophe by any measure (the World Happiness Report also factors in trust in government, deaths, living long and living well), to become a health management crisis as well. To do so is to dig ourselves into a hole with irreversible tragic consequences for both the national economy and human lives: my appeal, let’s carry this burden with dignity, and a sense of purpose, let’s embrace the moral responsibility to save our country and salvage whatever pieces of our lives remain after the callous depredations and ravages of this viral damage.

We have lost a lot of things essential to human life and happiness; personal freedoms, jobs, incomes, businesses, loved ones, and, if we are not careful, we will emerge from this scourge with a disturbingly unrecognizable country. All countries are struggling with this existential threat; all countries are praying at the alters of their gods and their ancestors for the survival of their people, their economies, and their livelihoods; all countries are embracing logic, rationality, science and vaccines to fight Covid-19; let’s try to do these same things here at home, let’s use all the intellectual, spiritual and material resources available to us to trunk the evil mark of coronavirus transmission, infection, and deaths resulting from Covid-19.

I want to argue that vaccines are an important part of the struggle to defeat Covid-19; a point simple enough at face value, but   something extremely complicated in reality. What complicates such an apparently simple message? Many things; fear, wilful ignorance, and, perhaps, more important, scepticism about the medical benefits of getting vaccinated in the first place. More still, we have problems associated with the very nature of messaging this simple reality; truth and trust. I just cannot think of two words more essential to the vaccination campaign than the words truth and trust. These words are essential to our understanding and knowledge of the science behind anti-Covid-19 vaccines. These words are essential to public messaging of the necessity for all Batswana to get who can access vaccines to get vaccinated, and these words are essential to the whole campaign to eventual defeat Covid-19 and remove its terrible spectre from the face of the earth.

If we want people to take the vaccine jabs in large enough numbers to achieve herd immunity, we must learn to tell them the truth, all the time. We must be trustworthy in all our efforts to fight this disease. We must not only be prepared and armed with the vaccines but possess sense enough to grow public confidence in the vaccines themselves and display integrity and honest endeavours in the people charged to deliver the vaccines into the arms of Batswana. 

I have seen a lot of confusion in our public communications about mass-vaccination in Botswana. I think much of this can be avoided by sticking to simple truths; good or unpleasant. The deaths of Batswana and the possible destruction of the economy are unpleasant truths we must learn to accept and live with now. This attitude is essential to moving forward, it is a stage of the fight against this disease that we must recognize and accept. Any scientific researcher will always tell you that to develop a vaccine or drug, and bring them to successful application to personal and public life is always risk. Everybody taking a vaccine newly arrived in the market is taking a risk. If you are afraid of risks you cannot accomplish anything in life; health, business, politics, travel, writing, even hunting; all these things involve different, and often substantial, levels of risk, it even takes risks to love someone and have courage enough to vow to spend your whole life with them.

More often than not risky behaviours come from circumstances that provide little space for any other viable choices. The truth is that these vaccines; Pfizer, Moderna, AstraZeneca, and Johnson & Johnson, for example, were produced under great pressure from a human race suddenly struck senseless by a killer disease. But the science and technology behind them is just as rigorous as that behind any other drugs people all over the world use every day. Information about how these vaccines work is available everywhere. Information about their side-effects is available everywhere. Millions of people have been vaccinated, and the results show remarkable progress; drastic falls in transmissions, fewer infections and low hospital admissions; the vaccines do work.

There have been problems with AstraZeneca. 

In South Africa it was found to be less effective or to have lower protection for some patients, especially those afflicted with a new variant mutant of Covid-19 in that country. Recently, a suspicious link with abnormal bleeding or blood clots resulted in some countries suspending its use; a decision now rescinded by most of the countries involved following a greenlight from the European Medicines Agency. 

On Tuesday, 23, 2021 another problem arose at AstraZeneca, forcing American Covid-19 vaccine Czar, Dr Anthony Fauci, to break tradition (usually such incidents or mishaps and scientific disagreements are raised and resolved behind closed doors through relevant medical regulatory authorities without dragging public scrutiny into the process) and speak out:

‘I was sort of stunned’: Dr. Anthony Fauci.

American officials say AstraZeneca released ‘outdated information’ from Covid-19 vaccine trial.  They raised concerns early Tuesday, 23rd, 2021, that positive results announced Monday, the previous day, for its vaccine may have been based on ‘an incomplete view of the efficacy data’ from a clinical trial and relied on ‘outdated information,’ throwing another curveball in the saga of the company’s vaccine. The National Institute of Allergy and Infectious Disease said it had been informed about the data questions by the Data and Safety Monitoring Board auditing the clinical trial. DSMB’s consist of independent medical experts who review data produced from clinical trials.

‘We urge the company to work with the DSMB to review the efficacy data and ensure the most accurate, up-to-date efficacy data be made public as quickly as possible,’ NIAID said.

In an interview with the press, Anthony Fauci, the head of the NIAID, and the public face of America’s Covid-19 campaign, said the DSMB raised concerns because it felt the results in a AstraZeneca press release Monday looked more favourable than more recent data from the vaccine study had shown.

‘I was sort of stunned,’ Fauci said. ‘The data and safety monitoring board were concerned that the data that went into the press release by AZ was not the most accurate and up-to-date data. That is what the DSMB communicated to AZ in a rather harsh note. Having seen that letter we could not just let it go unanswered.’

Asked why the NIAID released its unusual statement, Fauci said, ‘We just felt we could not remain silent. Because if we did remain silent, we could be understandably accused of covering something up. And we definitely didn’t want to be in that position.’’He added: ‘In my mind it’s an unforced error by the company’’.

The results released on  Monday 22nd  by AZ came from an interim analysis of a 32, 000 volunteer trial through February, 17. In a statement Tuesday, the company said it would ‘immediately engage’ with the DSMB ‘to share our primary analysis with the most up-to-date efficacy data.’The company said it planned to announce results from the primary analysis within 48 hours.

‘We have reviewed the preliminary assessment of the primary analysis and the results were consistent with the interim analysis…we are now completing the validation of the statistical analysis.

This incident opens another chapter in the in the chequrered history of the AstraZeneca vaccine. The vaccine was developed along with researchers from the University of Oxford.

This statement came less than 24 hours after the company triumphantly announced in a widely circulated, and celebrated, press release Monday 22nd  that it’s vaccine was 79% effective at preventing symptomatic Covid-19 in an American trial-Chile and Peru also participated, a result that was much better than expected based on earlier trials and appeared to help resolved some lingering questions about the robustness of the vaccine.The company also said the immunization reduced severe Covid-19 and hospitalization by 100%.

It is significant to note that these results were planned as a final step before the company could formally apply for authorization from American medical regulators for its vaccine, which though not yet authorized in America, has been approved in other countries.

The DSMB however said more recent data indicated the AZ vaccine was 60-74% effective at preventing symptomatic Covid-19, according to the Washington Post, which obtained a copy of the letter.

‘The DSMB is concerned that AstraZeneca chose to use data that was already outdated and potentially misleading in their press release….The point that is clear to the board is that the vaccine [vaccine efficacy number]…they chose to release was the most favorable for the study as opposed to the most recent and most complete. Decisions like this are dangerous and  erode public trust in the scientific process.’

This, I think, is more than a rebuke of AZ behavior; it’s a harsh censure; and the damage to the vaccine brand may be irreversible.We must remember that AZ’s vaccine has been under intense scrutiny after more than ten European countries suspended its use. This followed safety concerns linked to abnormal bleeding or blood clots. After the European Medicines Agency intervened most of these countries rescinded this decision, saying the benefits of the shots outweighed its risks.

Where does this incident leave these countries now?

This also affects us here in Botswana.What position is Government to take on the use of AZ?We still have to rollout AZ vaccination.When AZ released its press statement Monday, they said the trial identified ‘no new safety concerns.’

A specific review found ‘no risk of blood clots.…[no] specific type of clot in blood vessels near the brain that the EMA said might be associated with the vaccine…’This is what the company said.

But science researchers now point out that this type of blood clot (called a cerebral venous sinus thrombosis) is so rare that it might not be expected to occur in even a large clinical trial.It really isn’t clear how AZ is going to clear up these issues.Let’s not forget the company’s prior mishaps about public announcements like the present one.

First, we know that this American clinical trial was stopped for a month-and-a-half because of a neurological condition in one patient that was later determined to be unrelated to the vaccine.In other earlier trials months ago the data was seemed to suggest at one point that the second dose of the vaccine lowered its efficacy.Researchers have expressed concerns about the company’s unusual strategy of pooling data from clinical trials in its analyses; and this debate continues.These AZ clusters of problems have raised fears that the public may turn away from an immunization that everyone know is absolutely critical to taming, and eventually ending the Covid-19 pandemic.

Health officials are encouraging everyone to get vaccinated when they have a chance.But what is the public to make of all these ups and downs, of these confusions?

As Dr. Fauci said on Good Morning America, the real frustration is that ‘this is very likely a very good vaccine,’ but what is an ordinary person, worried about issues of life and death, expected to make of these almost endless AZ problems?

These vaccine development problems might be matters of little concern to scientists who actually do expect such things to happen in the making of vaccines…but it does little to advance confidence in the vaccine in a moment of such emotional upheaval and great uncertainty about everything once taken for granted ordinary.

Dr. Fauci pleads that scientists ‘have to keep essentially trying to as hard as we can to get people to understand there are safeguards in place,’ but he worries there’s concern ‘whenever something like this happens, that it could erode public trust.’The American Federal Drug Agency still has to review AstraZeneca’s vaccine.Dr. Fauci promised when the vaccines come forward for review, the FDA will make an independent decision.

What about us here in Botswana?

What decision(s) are we going to make about the AstraZeneca vaccine before we roll it out across the country, before we put the shot into the arms of Batswana?Oxford/AstraZeneca is a non-profit and retails  $2-3 a dose. This why so many countries pinned their hopes on it. It is  also relatively easier to store before using it to vaccinate people; another plus for poor countries.This is a terrible blow to vaccine optimism.

Even if these science data issues are eventually resolved AZ is going to be a hard sell to ordinary people, never mind that  more than ten 11 million people have already taken it in Britain alone, and many more throughout the world.

Many argue we should, perhaps, concern ourselves with saving lives rather than worry about a company that is making a train wreck of its health communications…but many countries are actually also making a train wreck of their own vaccine campaign health communications…how are ordinary people expected to cooperate in the vaccine programs? 

Here in Botswana what are we now going to do to fine tune our health communications? These reports are not helping our local efforts at all, and government must re-think its Covid-19 mass-vaccination messaging and communication campaigns.This is a moment of frightful moral reckoning in our lives.The decisions we take now, will determine everything that happens tomorrow and in the future to every Motswana and every aspect of our national life.

Yes, it is difficult to make decisions in moments like these but decisions we must make, guided by truth and trust. Moral philosophy originates from considerations of truth and trust, read Plato, Aristotle. The same applies to political philosophy and jurisprudence; the entire world of science, politics, art and culture. Botswana must now realize that to manage the crisis thrust on us by the health crisis we must call upon our intellectual heritage to success, to just survive. Batswana want government to make decisions, hard decisions; and this decision should be made soon.  

For a literate and educated society it would, I think, be irresponsible for us to privilege uninformed public or political opinions-wherever these may come from-over basic scientific truths. Some people say we needn’t worry ourselves with such matters because by the time these vaccines arrive in Botswana they’d have gone through multiple levels of thorough quality review, vetting and licensing; their strengths properly acknowledged and the weaknesses recognized and addressed. This AstraZeneca incident casts serious issues on such intellectual complacence; we need to guard our lives ourselves, to make our own decisions. Rich countries have the advantage of early mass-vaccination, but they also carry the burden of being the first countries to encounter the burdens of vaccine dangers and failures, and these have been very few. We really should have less to complain about given the sacrifices, financial, moral, national and personal, these countries made to bring these vaccines in the market.

There’s one other reality we must highlight. As a country we are preparing for the first round of vaccine jabs. We don’t even have enough vaccines for that right now. After this round we will have to wait for the second and last jab; except for those who get Johnson & Johnson. We don’t know how many Batswana are actually going to get vaccinated; (governments projects a little over 1.6 million at an expenditure of a little over P163 million, but these figures are contingent upon so many unknowns that we should take them to be just sensible estimates.) We only know we must vaccinate enough people to achieve herd immunity. 

Ideally, we should vaccinate everybody. But that’s very unlikely to happen; already under 18 year olds are excluded. Even if we accomplished that the whole country might have, probably will have, to twice vaccinate every Motswana again a few months or years down the line. 

The reality is that Covid-19 will not go away completely. We can cut or reduce the transmissions of the virus, free up hospital space and reduce mortality rates but the disease is not going to go away right away. The expectation is that as more people get vaccinated the Covid-19 threat will change but not die out. As I write, a third wave of Covid-19 is in a disturbing resurgence in countries that already vaccinated sizable proportions of their population: France, Britain, Germany and Italy. After mass-vaccinations these countries are going to continue worrying about the protection thresholds of these vaccines and the possibilities of bringing new generations of vaccines and boosters in the market for the same purpose.

Meanwhile researchers are struggling to get ahead of Covid-19 variants like those found in Brazil, South Africa, the US and Britain. They are working hard to develop vaccines that target multiple strains that are emerging and likely to  reverse the gains brought about by the first-generation of vaccines that Botswana is still to rollout…it’s obvious we are terribly behind…and must quit this mentality that all we need are two jabs for every citizen and thereafter everything will fall into place.

We have a very long way to go yet. The truth is risks from Covid-19 will decline after vaccination, and that vaccines limit the risk of future Covid-19. But the road to reopening the country, the economy, and restoring freedoms to individuals and markets to operate and function, is not going to be a straight line. There’s urgent need to expand and bulk up vaccination production the world over and bring more compassion, empathy, and justice in the distribution and delivery of vaccines. Botswana should not play catch up. We must plan ahead. We must explain to Batswana that vaccination is not just going to be some event or a thing you endure once at no longer bother about. This truth must be communicated to Batswana. 

Vaccinated Europeans are rushing to travel. Here we are still scrambling for hospital beds. Trillions of monies are being pumped into western economies to rebuild them and recover comparative advantage. Here the banks are not only leery of risky loans in the real economy, but furious with crippling domestic loan books…vaccine inequality and economic ruin of the weak is becoming wide. Botswana must be part of the solution to this problem, and not part of the problem.

There’s no money to fund all these anti-Covid-19 vaccines struggles. This is a moment that calls for moral courage. If you have a chance to take a vaccine take it. Get vaccinated. Encourage your family, friends and neighbours to get vaccinated. Educate them to know how vaccines work. Explain the value of vaccines in their personal, professional, and public lives. 

Tell them the advantages of a vaccinated society; the importance of vaccination to the country as a whole, people getting back their jobs, welcoming tourists in their businesses, and guests in their homes, and people no longer encumbered by lockdown restrictions, children getting married as they wish and Batswana burying the dead with dignity and honour. Tell them we can get all these things back if we behave well, take good care of our health, working with scientists and health workers to fight Covid-19 to the best of our abilities. Give them the big picture about the problems and struggles that still lie ahead, and tell them how we can actually get to the other side of this pandemic. 

Be truthful and honest…just the way your doctor always explains everything to you when you are seriously ill and you need drugs to survive; that’s what Botswana is going through, think of Botswana as a sick patient who needs medication, and that medication is the whole citizenry ready to take the Covid-19 vaccine.     

By: Oscar Motsumi*

Email:[email protected]

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