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The wonder and promise of vaccines

Vaccination will not end our fears, but it does bring a reason to believe in miracles

Last week, GPs witnessed both joy and relief as many older people rolled up a sleeve and received a SARS-CoV-2 vaccine. It could be considered a miracle of medical science that this vaccine has been developed, tested, manufactured, deployed worldwide, and more than 140 million doses administered in just over 12 months. For years, we have taken vaccines for granted.

They seem to magically appear and get incorporated into our vaccination schedules. We have (almost) forgotten the devastating effects of pneumococcus or meningococcus. We even had the luxury of worrying about giving our children too many vaccines. Not until Covid-19 highlighted our vulnerability and powerlessness have we had cause to think again about the scientific community’s role in keeping us safe from these invisible threats.

Fortunately, for the developed world, scientists have never stopped working on vaccine development. Viruses, bacteria and parasites still cause death and disease worldwide and many such as schistosomiasis, respiratory syncytial virus (RSV), and HIV are still waiting on a vaccine. The vaccine development processes already tried and tested were rapidly applied to the quest for a SARS-Co-V-2 vaccine.

Scientists, researchers, governments, and health experts committed to the process, with no guarantee of success. The knowledge, expertise, and dedication of this scientific community meant that within a relatively short time a variety of SARS-Co-V-2 vaccines were created, tested, and manufactured. The average time for a new vaccine to become available is 10 years. MMR was one of the quickest and this took four years from development to administration.

Further Herculean efforts were required from governments, departments of health, public health specialists, and in Ireland, the HSE, to acquire and deploy these vaccines for timely administration. It is a privilege to be at the end of this long line of dedicated workers, to witness the joy and accept the gratitude from the recipients. I accept it on behalf of everyone, as I tell them I am merely the messenger. Most people, including myself, have no idea of the mixture of motivation, dedication, skill, and luck required to make that moment of injection possible.

But even miracles have limitations, and while vaccination may reduce the severity and limit the spread of disease, we are a long way from eradicating it. The evidence indicates that we will be living with Covid-19 for many years to come. Many challenges still lie ahead. Outside of the developed world, 85 per cent of countries have yet to start their vaccination programme. New variants of the virus will render vaccines less potent, and it will be necessary to receive booster doses as immunity wanes.

Minority communities in many countries tend to be less trusting of medical professionals and will, almost certainly, have low immunisation rates. Vaccines are not yet licensed for children. Among some care workers worldwide, up to 50 per cent have refused vaccination despite seeing the effects of the disease first-hand. Achieving the 80 per cent vaccination rate necessary for this pandemic to subside may not be possible, and there will always be new cases once lockdown measures are relaxed.

There is no room for complacency. GPs are ideally placed to encourage the continuation of the infection control habits that we have become accustomed to, such as handwashing, mask-wearing and the avoidance of crowded places. GPs can also address vaccine hesitancy. In general, our patients trust us and are willing to accept our advice.

We will need to continue to educate the public about both the benefits and limitations of vaccination. There is a delicate balance between both and communicating the ongoing risk of the virus while acknowledging the beneficial effects of vaccination will be challenging. We need enough people to accept the vaccine to generate herd immunity, but to also behave as if they are still at risk of infection.

For doctors, 2020 was a year of scrubs, telephones, videos, Zoom calls, and webinars. This has not changed, but 2021 brings the excitement of vaccination and a chance to re-consider the wonders of science. Vaccination will not end our fears, but it does bring a reason to believe in miracles.

With each vial that I reconstitute, each syringe that I draw up and inject, I breathe a silent, heartfelt thank you to the people responsible for making this moment possible, from manufacturers to the person at the end of the Cold Chain who delivered it to my door. I am old enough to remember when maintaining the Cold Chain meant collecting vaccines from the County Clinic in a cool box.

To quote Dickens, we do indeed live in the “best of times… the worst of times… the season of Light… the season of Darkness… the spring of hope”.

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