By Dr. Daniel Suez
The Covid-19 Pandemic caught the world unprepared. Even though world health organizations have a relatively good understanding of common pandemic viral diseases such as the influenza viral infections originating from Asia on an annual basis with new variants/mutations, the scientific world was caught unprepared for this rapidly developing viral disease. The lack of preparedness, both from a point of view of mitigation and lack of available basic therapy, the rate of viral spreading, and the severity of disease complication and mortality, led to significant confusion among the scientific community and particularly among the population at large.
Adding to the confusion were the frequent social media misinformation and politicization of the matter due in part to a significant global financial burden caused by the pandemic. Leadership was necessary to forge a working strategy to save countless lives from this serious disease.
Early on, and as the disease progressed rapidly, it was apparent that the best approach to stop its progression – other than mitigation strategies that lead to economic devastation – would be to put significant resources in to developing strategic vaccination approaches, using our advanced know how and current biotechnologies in doing so.
Israel is a small country of some nine million inhabitants, with an excellent social medical system. The medical authorities along with the political leadership understood the danger of such a serious viral pandemic and the need to institute aggressive mitigation strategies. They did not hesitate to employ, among other measures, the Shin Bet Israel Security Agency to enforce mitigation policies and minimize viral spread.
Furthermore, as soon as vaccines were available, the authorities were successful in purchasing sufficient stocks ahead of time and launched a mass vaccination drive that was well received by the population. The policy achieved a high rate of vaccination in an orderly fashion, to include first the most vulnerable population, i.e., the elderly and people with underlying medical conditions. The results were quite impressive with the rate of viral spread dropping dramatically over a relatively short period of time and consequently a significant reduction in new cases, hospitalization and mortality. Within few months the country went from full shut down status to almost complete openness and normal daily activities.
The issue of the more recent events of few focal cases of a rebound of variant forms of COVID-19 merits further discussion.
The Pfizer and Moderna vaccines used in Israel, were proven quite effective against COVID-19 variants such as the English (Variant A), the South African (Variant B), the Brazilian (Variant C) and even the new Indian Variant (Variant D). The original vaccination studies were shown to be quite effective (>94%) for reducing dramatically the rate of serious COVID-19 disease, rate of hospitalization, and mortality.
These studies did not evaluate the rate of viral transmission by both study populations – the immunized patients versus non immunized.
As the different variant forms developed, these vaccines appeared to be protective against them. Recently with the emergence of the Delta Variant (the Indian Variant), it was noted that transmissibility of this variant is much higher compared to the original virus, yet, this variant does not appear to be more aggressive or to increase hospitalization or to be associated with higher mortality.
The main idea of the vaccination is to protect the most vulnerable population from serious complications and mortality. We know that the majority of the young population have either asymptomatic occurrence (meaning being tested positive yet with no symptoms) or having mild symptoms for a short period of time.
Side effects post vaccination have been recorded, most of which are relatively benign. However, more recently, a serious side effect was noted in immunized young adolescents who developed acute myocarditis, which is an inflammation of the heart muscle. Even though there were fewer cases than 1 in 10,000 immunized adolescents who developed this serious condition post immunizations, some of these cases were fatal.
It is obvious that one need to weigh in the risk to benefit ratio. Today, there is little doubt that immunizing the majority of the adult population is largely beneficial to the entire population by reducing the number of new cases, the development of severe disease, hospitalization and mortality, which allow us to return to normal life and daily activities. Yet, vaccination in adolescents, even though proven to be effective and with minimal side effects as reported by the pivotal vaccination studies prior to the FDA approval, should not be mandated in my opinion.
We should not forget that these vaccines received approval only on an emergency basis and did not yet gain full approval, something that usually requires several years of experience. We should also keep in mind that adolescents may either have no symptoms or only develop a minor flu like disease in the majority of cases, and that the main goal is to protect the vulnerable population. Since the quasi majority of the vulnerable population have already been vaccinated in Israel, there is a small risk that the immunized vulnerable population may suffer serious consequences.
In addition, due to the geopolitical location of Israel among other reasons, Israelis frequently travel outside of the country for a variety of reasons – primarily for tourism. The COVID-19 pandemic era led to the entire country being almost shut down for most of 2020 and early 2021. Following opening of the country, Israelis have started traveling again, while many travel destination countries have continued to have pandemic related restrictions, which result in a significant social pressure on these adolescents in Israel due to travel restrictions if they do not get immunized.
Hence, in my opinion, the risk/benefit ratio should be left to the parents to decide without a mandate, which is the case today in Israel. My prediction is that a significant number of the adolescents will be immunized and will contribute to an overall feeling of security but I do not believe that it is a crucial element at this time and probably does not constitute a very significant factor.
Dr. Daniel Suez, MD. received his medical degree from Paris Descartes University, Paris France, in 1975. He completed his Pediatric Residency in 1981, training first at the Versailles Medical Center in Versailles, France, then subsequently at the Barzilai Medical Center in Ashkelon, Israel.. Read full bio here.