How long does immunity last after being vaccinated against COVID-19? Who should not be vaccinated? Will vaccines save against a new strain of coronavirus? And can I be vaccinated several times? This is what Medsi's chief infectious disease specialist, Doctor of Medical Sciences, Professor Irina Shestakova in an interview with Ilya Kopelevich, Editor-in-Chief of Business FM.
Medsi participates in clinical trials of the Sputnik V vaccine. As I heard, you are planning to participate further in clinical trials of other vaccines that will be developed in our country, but so far about Sputnik. What are your results, results?
Irina Shestakova:
We have quite good results on the use of this vaccine, although we do not have a very large sample, because so far only about 100 patients have been vaccinated with two doses of vaccines. To date, we have not received any serious side effects from the administration of this vaccine. At the same time, we really saw that a temperature reaction develops, local manifestations develop, some patients really have a reaction from the blood, as in principle, it is written directly in the instructions when this vaccine was registered. But not a single case required medical intervention and prescription of drugs. Therefore, in fact, the result is quite good. But in general, you are probably familiar with the more general information that is available. In the past, you are the main freelance infectious disease specialist of the Ministry of Health, that is, of course, you do everything. Looking at the data provided by the Gamalea Center, Pfizer and Moderna, how can the results be measured for these three vaccines?
Irina Shestakova:
These results are very encouraging, despite the reports (in particular, about those foreign vaccines that you are talking about) about severe side effects. But the results are encouraging, because, judging by the publications, these vaccines are immunogenic, they are quite good, it is the antibody titer that is synthesized. Another thing is that these are very preliminary results, how it will be next, what will happen to these antibodies in four months, in six months, in a year, whether people who are vaccinated will get sick, of course, no one can say now. But we don't really have any other way to defeat this pandemic. Pfizer is being reported in the US - it has become
known
that there were two severe cases of adverse reactions. Apparently, this is anaphylactic shock, that is, when edema, rash appears. Until now, this seems to have not been fixed, but here it appeared. How should we treat these phenomena now?
Irina Shestakova:
In fact, you need to be calm. Despite the fact that such a reaction to the introduction of an immunobiological drug is considered severe, of course, there will be publications on the results of the investigation of this case, it will be analyzed why such a reaction actually took place, it would be possible to eliminate this reaction, that is, to prevent its development. Maybe a patient was vaccinated for whom this vaccine was not indicated at all. A doctor who recommends a particular person to be vaccinated must very carefully analyze his entire history, all his concomitant diseases, in order to recommend anything. The fact that there are anaphylactic reactions to the introduction of vaccines has been described for more than a dozen years. We need a very, very strict selection of patients for vaccination in general, and for vaccination of this vaccine. Fortunately, both of these cases ended well, since these people were in a medical facility, they were immediately treated. If it turns out quickly, then the development of anaphylactic shock can be stopped by the familiar antihistamines. But Sputnik V and other vaccines have very few contraindications. That is, for example, it is contraindicated for acute allergies. A huge number of people have some kind of allergies - many have spring, seasonal, many to some kind of food, but now they are not in an acute form, which means they allow it. What can warn about the possibility of developing the most extreme and unpleasant reaction, what should you remember about yourself and tell the doctor?
Irina Shestakova:
It is necessary to remember the presence of any allergic reactions that you have had in your life before deciding the question of vaccination at all. This must be reported to the doctor without fail. Even if a person had hay fever, some seasonal [allergies], this does not mean that the administration of the drug will only cause some local reactions. That is, the doctor must assess the risks and benefits in this regard and weigh all this. It is imperative to know about yourself what the reactions to the introduction of vaccines in general were before, because we were vaccinated from the moment of birth, and we must nevertheless clearly try to remember and find out from the parents whether there were any reactions to the introduction of any vaccines and if there were, then in what form, and be sure to inform the doctor. It is imperative that you tell your doctor about the drugs that you are constantly taking, because no one has canceled drug interactions, this is also very important. Sometimes, the synthesis of antibodies in response to a vaccine depends on the drugs you are using. Therefore, for some diseases, if possible, they refuse to take medications a month before vaccination. That is, this is also being discussed. In addition, it is imperative to know your concomitant pathology, nevertheless, if possible, the doctor should provide this information. In fact, it would seem that there is a lot of information in this regard, but you all know very well that sometimes vaccination is carried out, as they say, on the run. How to get vaccinated against the flu in mobile stations near the metro.
Irina Shestakova:
Yes, but as far as covid is concerned, we are in a slightly different situation. Today, almost all vaccines in the world are vaccines in the third phase of trials. Today we do not have so much experience in using them to say: yes, we can inoculate near the metro. Therefore, in this regard, there is such a more careful selection of patients. Since we are talking about what needs to be told to the doctor, an important question. Since the vaccination rules prescribe being in a medical institution after vaccination for at least 30 minutes, is it possible to be sure that anaphylactic shock develops instantly and, thus, the risk is taken into account, and in any place where the vaccine is given, you will be saved from such a development events?
Irina Shestakova:
Yes, absolutely, this, as they say, is prescribed by life, so 30 minutes are really allotted to observe the vaccinated person. If you are worried about staying longer, you can stay longer. Usually 30 minutes is valid. Such acute allergic reactions, which are really dangerous after vaccination, are they instantaneous?
Irina Shestakova:
They tend to develop very quickly, within a very short time. In specially equipped rooms where vaccination is carried out, there are first-aid kits with sets of these drugs. For these patients, not only antihistamines are used, it all depends on the reaction. According to my observations, everyone in everyday life is discussing this topic. I have heard from many of my acquaintances that ordinary doctors - a dentist, an otolaryngologist - who observe the whole process from the outside, according to the media, very often say: you know, I would not get vaccinated yet. Actually, we see that when they opened vaccination primarily for doctors, they did not rush to get vaccinated. As a rule, they have one argument - too little time has passed. Those doctors, again according to my observations, who are more familiar with this topic, who work with this vaccine, who are deeper in the material, are much more determined to vaccination, but there are few of them. But those doctors with whom people communicate in everyday life, they are mostly, in my opinion, skeptical. They say that little time has passed and people are listening to them. How can this be explained?
Irina Shestakova: I would look at this problem through the eyes of both a layman and a doctor. We found ourselves in this pandemic in a rather unusual situation. A very serious scientific medical information was thrown into the untrained population and medical circles, which, among other things, are far from understanding the essence of this process. After all, man is a shy creature. The situation is so complicated and incomprehensible, the number of patients is growing, this information is constantly coming from everywhere, cheating oneself, psychological pressure has not been canceled either. Doctors are no different from an ordinary person, you must agree. Probably, once you need to see this patient in intensive care, or at least in the intensive care unit, and many questions would be removed completely, not even discussed. The fact is that we really have now begun to use vaccines in the world that are registered using this accelerated method. In this regard, one cannot consider oneself to be experimental, the fact is that it is just really an emergency situation.
There is not yet, and I often say this, a golden pill, namely an antiviral drug that will allow us to treat patients, which in the early and early stages will allow us to interrupt this whole process and not start any other serious lesions. Until this pill is available, it turns out that either it is sanitary and epidemiological standards, or it is vaccination. There is simply no other way. When we talk about the fact that doctors are not ready, I think that those who do not understand the very essence of the vaccine, from what it was created, how it was created, that this vaccine is not the first, that there was an experience of using such vaccines and with very a lot of work experience. That is, in this regard, no one tests anything on us. After all, already on the basis of many years of experience in creating vaccines, in particular, a vaccine was created in Russia. Although we are pioneers in this regard, we were the first to really create a vaccine in the world and register it, but we are not trying to test something unknown on the population, know-how.
Doctors who have not seen these patients probably do not understand the dangers of the virus and the benefits that the vaccine will bring us. Sputnik V is not the first vaccine of the Gamaleya Center, vaccines have been in use for many years, and no one has seen the long-term adverse effects of these vaccines. Because of this, including at such an accelerated pace, the vaccine is being introduced among the population. Therefore, there is absolutely no justification that this vaccine will harm the health of the population. Let's look at the harm of the new coronavirus, we do not yet know the magnitude of this harm to health in those who have had this disease, that is, delayed harm.
Now the most important question, and everyone is interested in it. For how long will this developed immunity last, as well as the immunity acquired after a natural disease? Increasingly, they say that there is supposedly a positive PCR in a person who has already been ill. It instantly hits the media because everyone is afraid of it. Is it really possible to be ill with this twice? If you can get sick twice, then maybe the vaccine does not protect? Or protects for some time?
Irina Shestakova:
Regarding the duration of immunity, this is really now, alas, no one can say for sure. It is assumed that the immunity will last for at least somewhere from nine months, and all that I saw about the publications and messages of the developers was about two years. This is again speculation, because a sufficiently large number of vaccines in the world are now in the third phase of the study, the experience of using them and observing vaccination is really too short, and we cannot say anything in perfect terms. When we monitor only antibodies, and we are all accustomed to the fact that they look at the antibodies in everyone's blood and believe that if they are above a certain indicator, then you are protected. It cannot be considered so. Why? The immune response in humans has several links, and one link is the cellular immune response. The developers of the Sputnik V vaccine, when the first questions were asked a few months ago, said that the cellular link of immunity in these people will definitely be studied. And even if you have, perhaps, an insignificant titer of antibodies in your blood, or it almost disappears again, this does not mean that you will get sick. And if you get sick, then this illness will presumably proceed easier than you were sick before. And this is due to the fact that the humoral link will work, just antibodies, and there will be a cellular link. Now these studies are being carried out, and those who got into the study in the third phase, from a certain group, the study of this cellular link of immunity is taken. Of course, these publications will go through, everyone will announce to us and tell us what the reaction of the cellular link, the humoral link should be, and how the doctor should evaluate this and tell the person: you should be vaccinated in a year, and you can be vaccinated in another two years. But it just takes time. It is very important. Is it possible to vaccinate several times, if necessary? Antibodies have dropped, can I be vaccinated a second time?
Irina Shestakova:
It is necessary to vaccinate 75% of the population, no one will usually test antibodies before vaccination, because this is a huge job, maybe you don't even need to do this. Therefore, naturally, those who have been ill will also be vaccinated, some of them will be vaccinated. How often will need to be vaccinated, I can not say. Even about the flu: after all, we do get vaccinated against the flu, and we know that antibodies disappear in some after six months, in others after nine months, and every year we need to be vaccinated against the flu. How often we will be vaccinated against covid - well, let's see how it will be. I repeat, there are very high hopes for different vaccines, because somewhere there are vector vaccines, somewhere peptide, somewhere on messenger RNA and whole-virion vaccines. They are different. They develop different immune responses to their introduction, and the duration of this immune response will also be different. Let's see the similarity when the results will naturally be. And what you said about possible cases of the disease …
Everyone is just guided by PCR. Even those who have been ill or vaccinated still take PCR - bam, positive. Is this evidence of a second illness or is it far from it?
Irina Shestakova:
Far from it. At the same time, you can have a virus on your mucous membranes and be the so-called, doctors will understand me, a transient excretory. That is, the virus has sat down on the mucous membrane and, perhaps, in three hours it will leave your mucous membrane. Will be killed by the developed immunity.
Irina Shestakova:
Yes. But at the same time, you can get sick in a few days, for example, but this will not be associated with a new coronavirus, but with some respiratory viral infection, which has nothing to do with coronavirus. That is, here every case must be dealt with. At the moment, are there any scientifically proven facts that could just lead to such a conclusion that new strains appear and people can get sick again? And these strains will be immune to the immunity generated by the vaccines that are now being put into circulation?
Irina Shestakova:
Yes, there are such cases. And I do not want to scare, but even a fatal outcome was recorded when re-infected with another strain. But this patient was serious, with a very severe comorbid pathology, that is, concomitant pathology. These cases do exist, but, I repeat, if they suddenly singled out from you again, it means that you are sick again. Skeptics will again say: what is the point in a vaccine, new strains still appear, and it will not help, only in vain they will expose themselves to the risk of a vaccine. Although, as you say, there is almost no risk of a vaccine at the moment, at least according to the results that we have on Sputnik V, no severe cases have yet been observed. This is a caveat. But, nevertheless, in general logic it looks like this.
Irina Shestakova:
Let's take a look at the risks we actually put on this scale. How many revaccinations will be, even if their number will increase, and how many people may die if we do not vaccinate the population at the same time. If on the so-called first wave the mortality rate among that number of cases exceeded 6%, today the mortality rate in the world is 2.3%, for many months this mortality rate. If you imagine, it turns out that out of 100 people, two people will definitely die. Well, you must admit, the risk in this regard of vaccination is simply not comparable, that is, it cannot even be put on one scale. Even if the vaccine doesn't work, the chances of getting another virus are very low. Really low. All countries of the world are monitoring viruses that circulate on their territory, the introduction of new strains, this is a very serious work carried out by virologists. And just this may be the reason for making changes to the vaccines that are used in this territory. Ready already?
Irina Shestakova:
Ready, of course. Let's go by analogy again with influenza vaccines. Why don't we vaccinate with last season's vaccine? Because new strains appear or in strains the same strain, but with the changes that need to be introduced as a result into vaccine strains. Therefore, every year this strain of the virus changes completely in the vaccine. And the same work will be done for covid vaccines.
