A dose of scepticism in a dose of Covid-19 vaccine

The debate about any government policies based on anti-science and science are similar to the debate of faith versus reason dating back to the days of Aristotle and Plato. However if we ask Aristotle today, what is your view about faith and reason debate in modern science, Aristotle would have said, well in our days philosophy is motivated by the desire to understand and began with a sense of both wonder and confusion. Aristotle would have further expand his view by saying that in your days Karl Popper has made thing more complicated when he said that the scientific knowledge is provisional.

 On the other hand Plato would have said only reason can reveal the nature of being. Plato had no interest in the scepticism and also critical about the relativism expressed by Protagoras, in his remark that 'Man is the measure of all things'. Plato maintained that if all viewpoints are equally valid, then presumably we should respect the point of view of a tadpole. Plato also argued that if you are a relativist you must rate the beliefs of people who disagree with you just as highly as your own beliefs, including your belief in relativism. Plato suggests that the mind is a familiar combination of reason and desires, but moderated by motivator, known as 'spirit', which can be channelled for or against reason. In this situation if Popper says scientific knowledge is like 'the best we can do at the moment', then scepticism among the general public should not be ignored. We are aware that Popper is known for his attempt to refute the classical positivist account of the scientific method, by replacing induction with the falsification principle.

Considering the view of Karl Popper about any scientific finding and its' transient nature, the current debates about Covid-19 vaccine's safety, efficacy and other cultural viewpoint is not an irrelevant one. Policy makers can and should inform the public- what it is in the vaccine that one should or should not worry about? In order to achieve such a non-judgemental objective, I first turn into the question- what AstraZeneca Vaccine for Covid-19 contains? And what are their side effects found so far based on the clinical trial. One dose of AstraZeneca vaccine contains Covid- 19 Vaccine (ChAdOx1-S* recombinant) 5 � 10^10 viral particles. The word 'recombinant' in the active ingredient suggests that this product contains genetically modified organisms (GMOs).

 For example, a recombinant DNA molecules are DNA molecules formed by laboratory methods of genetic recombination that bring together genetic material from multiple sources, creating sequences that would not otherwise be found in the genome. So, in this vaccine recombinant, replication-deficient chimpanzee adenovirus vector encoding the SARS CoV-2 Spike glycoprotein. The other excipients in this vaccine are: L-histidine, L-histidine hydrochloride monohydrate, magnesium chloride hexahydrate, polysorbate 80, ethanol, sucrose, sodium chloride, disodium edetate dehydrate and water for injections. The advice is given that because it contains genetically modified material, any unused vaccine or waste material should be disposed of in accordance with local requirements. Spills should be disinfected with an appropriate antiviral disinfectant. This medicine contains a very small amount of alcohol.

Like all medicines, this vaccine can cause side effects, although not everybody gets them. Side effects that occurred during clinical trials with AstraZeneca Covid-19 vaccine are that in more than 1 in 10 cases tenderness, pain, warmth, redness, itching, swelling or bruising, generally feeling unwell, feeling tired, chills or feeling feverish, headache, feeling sick (nausea), joint pain or muscle ache. In 1 in 10 cases shows a lump at the injection site, fever, vomiting and flu-like symptoms. In 1 in 100 cases during clinical trial has reported dizziness, decreased appetite, abdominal pain, excessive sweating and itchy skin.

Now I turn into Pfizer/BioNTech vaccine. This vaccine is known as mRNA vaccine used for active immunisation to prevent Covid-19 disease caused by SARA-CoV-2 virus. The vaccine triggers the body's natural production of antibodies and stimulates immune cells to protect against Covid-19 disease. The active substance in the vaccine is BNT162b2 RNA. After dilution, the vial contains 5 doses, of 0.3 mL with 30 micrograms mRNA each. This vaccine contains polyethylene glycol/macrogol (PEG) as part of ALC-0159. The other ingredients are: ALC-0315 = (4-hydroxybutyl)azanediyl)bis(hexane-6,1-diyl)bis(2-hexyldecanoate), ALC-0159 = 2[(polyethylene glycol)-2000]-N,N-ditetradecylacetamide, 1,2-Distearoyl-sn-glycero-3-phosphocholine, cholesterol, potassium chloride, potassium dihydrogen phosphate, sodium chloride, disodium hydrogen phosphate dehydrate and sucrose.

In case of Pfizer/BioNTech vaccine, during clinical trial observed that more than 1 in 10 people get some side effects that include pain at injection site, tiredness, headache, muscle pain, joint pain and fever. Common side effect up to 1 in 10 people includes injection site swelling, redness at injection site and nausea. Some uncommon side affect up to 1 in 100 people includes enlarged lymph nodes and feeling unwell. Some, rare side effects has been reported for 1 in 1,000 people that includes temporary one sided facial drooping.

Third vaccine developed by Moderna is also in use at present. It is given to adults aged 18 years and older. The active substance in Covid-19 Vaccine Moderna is mRNA encoding the SARS-CoV-2 Spike protein. This vaccine stimulates the body's natural defences (immune system). The vaccine works by causing the body to produce its own protection (antibodies) against the virus that causes the Covid-19 infection. Covid-19 Vaccine Moderna uses a molecule called messenger ribonucleic acid (mRNA) to deliver the set of instructions that cells in the body can use to make antibodies to help fight the virus that causes Covid-19.

This will help to protect against Covid-19. As with any vaccine, Covid-19 Vaccine Moderna may not fully protect all those who receive it. You may not be fully protected until 2 weeks after the second dose of the vaccine. It is not yet known how long protection lasts.

This vaccine contains polyethylene glycol/macrogol (PEG) as part of PEG2000-DMG. This is a multidose vial which contains 10 doses of 0.5 mL. The active substance in each dose is 0.10 mg mRNA encoding the pre-fusion stabilized Spike glycoprotein of SARS-CoV-2. The other ingredients are lipid SM-102, cholesterol, 1,2-distearoyl-sn-glycero-3-phosphocholine (DSPC), 1,2-Dimyristoyl-rac-glycero-3-methoxypolyethylene glycol-2000 (PEG2000-DMG), trometamol (tris), trometamol hydrochloride (tris HCl), acetic acid, sodium acetate trihydrate, sucrose, water for injections.

Primary efficacy analysis demonstrates Pfizer/BioNTech vaccine BNT162b2 to be 95% effective against Covid-19 beginning 28 days after the first dose. Efficacy was consistent across age, gender, race and ethnicity demographics; observed efficacy in adults over 65 years of age was over 94%. Second dose should be given 21 days after the first dose. However, the alternative viewpoint from the user's perspective is that second dose can be given within 12 weeks or within 4-6 weeks.  In case of AstraZeneca vaccine, it has been reported that 2nd dose should be given 3-12 weeks after having the 1st dose. The clinical trial shows that the AstraZeneca vaccine was 70 per cent effective in protecting against symptomatic disease.
 
Some people become sceptic about the different dosing regimes and different scientific opinion about this. Also, recently Germany has said that there was a lack of data regarding the effectiveness of the AstraZeneca vaccine for older people. Germany's vaccine commission STIKO said "There is currently insufficient data to assess the efficacy of the vaccine for persons aged 65 years and older". They further added that "The AstraZeneca vaccine, unlike the mRNA vaccines, should only be offered to people aged 18-64 years at this stage". This debate has generated more scepticism because in Britain 80 and above age group are getting the vaccine first.

According to sequencing studies, there are thousands of variants of the SARS-CoV-2 virus has been discovered that differ from each other by at least one mutation. Many of these variants die out, but others spread and acquire further mutations. In south east of England, where I live, one variant was identified, which is known as B.1.1.7 or Kent variant. This variant has 17 defining mutations. It has been identified as 50% more transmissible than other variants. Another new variant, known as B.1.351 has been discovered in South Africa, which has nine defining mutations. P.1 variant found in Brazil has some similarities with South African variant. So, it is clear that the virus is evolving slowly, so we shall have to take surveillance very seriously. A report published on 26 January 2021 suggests that Moderna is launching trials of a new Covid-19 vaccine to tackle the coronavirus strain that has emerged in South Africa. They also informed that its existing jab is less effective in fighting the variant.  On January 28, 2021, Novavax, a biotechnology company has reported that their vaccine for Covid-19, named as NVX-CoV2373, a protein based vaccine, which contains a full length prefusion spike protein made using Novavax recombinant nano particle technology, met the priory endpoint, with a vaccine efficacy of 89.3% in UK phase 3 trial. It has also demonstrated clinical efficacy against both UK and South Africa variants of  SARS-CoV-2. This is a promising discovery but require further study and regulatory approval.

Above all, I would like to go back to Greek philosopher Aristotle again, who is known as one of the founding further of communication theory. Aristotle believed that persuasion occurs when three components are represented: ethos, logos and pathos. Ethos is credibility. This means we tend to agree with people whom we respect. Logos is the means of persuasion through logic, data and statistics. Pathos is the acts of appealing to emotions. So, when fear and uncertainty are high, it would be prudent to communicate with relevant audience through Aristotelian 'Pathos', which is emotion and values using non-judgemental narratives. This is a standard for an effective communication with a sceptic. It should be recognised that science is all about uncertainty, rather than about certainty. Philosopher Alfred North Whitehead, who was the teacher of Bertrand Russell said, in science 'the exactness is a fake'. One may ask-is there any socially acceptable threshold of uncertainty? This is a culture specific question. So, different countries will act and reasoned differently about the newly developed Covid-19 vaccine.
The writer is a UK based
Academic, Chartered Scientist and
Environmentalist, Columnist and Author