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SINGAPORE: At the beginning of the COVID-19 pandemic, several countries, such as the United Kingdom, followed a strategy of “natural herd immunity.”
Under this strategy, transmission would be slowed, but not prevented, until enough people had been infected so that those who had not yet been infected were protected by those who had recovered.
The idea was that COVID-19 couldn’t be stopped, and it would be better to let the young get infected while protecting the elderly.
The strategy of herd immunity through natural infection was quickly discredited as hospitals began to overflow in Lombardy and New York, and it became apparent that too many deaths would occur if no effort was made to control the spread of the virus.
Despite this radical change, the advocates of herd immunity were in a sense right. In reality, there are only two exit states from the pandemic: herd immunity or global eradication. Since the first cases began to be identified in Europe and America, the latter has never seemed plausible.
In Singapore, we have tackled local broadcasting, but only at great social cost. However, we must recognize that this success is transitory and is constantly at risk.
It is not feasible for Singapore to keep transmission under control locally while waiting for the rest of the world to control its outbreaks.
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Fortunately, herd immunity can (probably) be obtained through a different route than natural infection.
On December 14, Prime Minister Lee Hsien Loong announced that Singapore has obtained vaccines that will likely be the way we can get to herd immunity without all the deaths and illnesses of the “natural herd immunity” strategy.
The first batch of the COVID-19 vaccine developed by Pfizer and BioNTech arrived in Singapore on Monday (December 21) evening, making it the first recipient country in Asia.
ARE VACCINES SAFE?
However, the vaccines in which Singapore has purchase options, including those developed by Moderna and Sinovac, have developed at historically unprecedented speed.
Singapore’s first shipment of COVID-19 vaccines is unloaded at Changi Airport on December 21, 2020 (Photo: Try Sutrisno Foo)
Typically, development of a vaccine takes a decade or more. Therefore, it is natural to doubt: are they safe? Have the corners been cut?
In fact, the development process has been similar to that of other vaccines, except that everything has been done much more efficiently.
Instead, the steps that would normally be performed in sequence have been performed in parallel whenever possible; provisional information has been channeled to regulators; regulators have worked overtime to review the data; there are many volunteers; And, of course, there are so many infections that it didn’t take long to show protection.
The money that has been invested in the large number of vaccines in development has also contributed substantially to the vaccines reaching the market so soon.
The world leaders, Moderna and Pfizer-BioNTech, have been tested on tens of thousands of test participants. Trials show no major side effects so far. At this size, we still can’t say if extremely rare side effects are possible. Doing so will require hundreds of thousands of vaccinations.
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We also don’t know yet whether infection or just disease is prevented, as trials look for disease among participants. In principle, it is possible that vaccinated people may still be infected with the SARS-CoV-2 virus, but be protected from developing COVID-19, the disease.
However, what we can say right now is that these precursors are really good at preventing COVID-19, the disease. Data from Moderna’s trial clearly shows how almost no vaccine participant felt bad after the first few weeks.
HOW VACCINATION WILL PROTECT SINGAPORE AND ALL ITS PEOPLE
Assuming that further studies confirm that vaccines prevent both infection and disease, these vaccines will be the ones that lead us out of herd immunity from the pandemic. Vaccination, if it prevents infection, provides three forms of protection.
Nurse Practitioner Tabe Mase gives US President-elect Joe Biden a dose of a coronavirus disease (COVID-19) vaccine at ChristianaCare Christiana Hospital in Newark, Delaware, USA on 21st of December. December 2020. REUTERS / Leah Millis
First, it protects the individual who has been vaccinated. Trials show that in the short term, getting the vaccine prevents you from getting COVID-19. Even if infection is not prevented, we are confident in preventing disease.
Second, it protects the people with whom the vaccinated person comes in contact. This is particularly important since some people cannot yet get vaccinated.
The trials do not include children or pregnant women, for example, so neither group can be vaccinated for now. However, both groups may be partially protected by the vaccination of their families or partners.
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At home, my children cannot be vaccinated, but my wife and I can, and that should reduce the risk of our children becoming infected through us.
Third, it protects society. Once enough people have been vaccinated, those who have not been vaccinated are protected by those who have. At that point, although the infection may be introduced by a traveler or someone who has not been vaccinated, sustained transmission is no longer possible.
Assuming the vaccines do indeed prevent infection, the herd will protect itself, but only once enough people have been vaccinated, probably 70-80%.
It will take some time to vaccinate most of the 5.7 million people. Priority will be given to some groups, such as health workers, others on the front line, those who live or work in dormitories, and the elderly.
IT IS IMPORTANT NOT TO DELAY GETTING A SHOT
But once everyone else’s turn comes, it’s important not to procrastinate. There are two main reasons.
The first reason not to delay is the fragility of the control.
Although the risk of contracting COVID-19 in Singapore today is really low, there are numerous case studies of countries or regions where successful control was quickly replaced by an outbreak. Hong Kong, Japan and Korea come to mind.
FILE PHOTO: In this illustration taken on October 31, 2020, vials with a label that reads “COVID-19 / Coronavirus Vaccine / Injection Only” and a medical syringe are seen in front of the Pfizer logo. REUTERS / Dado Ruvic / File Photo / File Photo
We practically can’t wait until an outbreak suddenly breaks out in Singapore and then we rush to find a vaccine. There are simply too many people to get vaccinated, and the weeks it takes for the vaccine to take effect would mean that protection may not be quick enough to prevent a harmful outbreak.
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READ: Comment: Should COVID-19 doses be divided to cover more people?
Instead, it is important to take advantage of the low transmission rate that we enjoy now and hopefully continue to enjoy in the first months of 2021 to boost immunity. Waiting until the need is urgent will mean waiting until it is too late.
There is a second equally important reason to avoid vaccination postponement: achieving herd immunity will be a game changer for Singapore and its people.
Once vaccine-induced herd immunity is achieved, other forms of social protection will no longer be necessary. The herd will protect itself and the government will be able to relax social restrictions.
Businesses that have been badly affected can get back on their feet. School children can play like they used to.
We can save the good things from our great social experiment last year and leave the rest. The lost year will be over.
But before we can enjoy these regained freedoms, we must achieve herd immunity. You need to have enough people to stand up and get vaccinated to get that protection from the herd.
If everyone waits for everyone else to get vaccinated, we will be in phase 3 forever.
As soon as my turn comes, I’ll be in line to get my injection, to contribute that person further to Singapore’s herd immunity threshold.
Dr. Alex Cook is Vice Dean for Research at the Saw Swee Hock School of Public Health, National University of Singapore.
