The pandemic has accelerated scientific research and helped make important medical breakthroughs that could have positive implications for world health in the long term.
That’s the verdict of Dr. Frank Koentgen, the Cayman Enterprise City-based scientist who helped set up and run Doctors Hospital’s COVID-19 testing centre.
Koentgen argues breakthroughs, in particular the creation of the Pfizer-BioNTech and Moderna vaccines, will have a lasting impact that may otherwise have taken decades to achieve.
He said the pace of development was not something to be concerned about.
Rather than being the result of rushed or experimental research, he said, the pioneering vaccines were the product of funding, regulatory agencies and scientists coming together in an unprecedented way to focus on an imminent global emergency.
He likened it to the kind of technological breakthroughs – such as the earliest versions of the internet – made during war time.
Koentgen, who is a leading researcher in genetics through his company Ozgene and has a doctorate in genetics and immunology, says he understands the concerns around the vaccines.
But he believes most can be allayed through a better understanding of how they were developed and how they work.
He helped the Compass answer some of the key questions and concerns around immunisation and demystify the process of how they work.
Are the vaccines working?
The vaccines have virtually eliminated the principal threats posed by the virus: hospitalisation and death.
While there are still cases of vaccinated people catching COVID-19, there are very few cases of anyone needing to go into intensive care or dying from the virus after being immunised.
The vaccines have varying degrees of efficacy but, collectively, says Koentgen, they have achieved the primary aim of preventing hospitalisation and death from COVID.
“I have not seen any reports where the vaccine has not slowed the level of impact and has not stopped hospitalisations and deaths,” he said.
“That is the first and foremost aim because that is why we shut down in the first place – to prevent the overwhelming of the healthcare system.”
But can you still get COVID after being vaccinated?
It is possible to still contract COVID-19 after being immunised, says Koentgen.
Studies suggest a vaccinated person is 96% less likely to get the virus with symptoms and 90% less likely to get the virus at all.
If you are vaccinated and get COVID-19, it is much less likely to be a serious case and your chances of spreading it are reduced.
“If a non-immunised person gets the virus, it replicates and generates more and more of the virus. If you are immunised it doesn’t have that growth rate,” says Koentgen.
“You might still carry it but you are less likely to have symptoms and less likely to infect someone else.”
If you are not concerned about getting COVID-19, why get the vaccine?
The virus is changing and mutating all the time and new strains, particularly in Brazil, are impacting younger, healthier people at a greater rate. The perception that this is a virus that only impacts older people with comorbidities is shifting, says Koentgen.
There is also a risk of long-term impacts of COVID, including lung scarring in serious cases. He suggests contracting the virus is not a risk worth taking when an effective vaccine is freely available.
He also suggests the more people who get immunised, the less possible it becomes for the virus to ‘find new hosts’ and to mutate and become more dangerous.
The virus, he warns, is evolving at hyper-speed. The only way to stop that from occurring is to break the chain of transmission.
“The virus is in a race against time to find a new host,” he said.
How does herd immunity work?
Herd immunity is reached when enough people in a community are vaccinated to prevent the virus from spreading and impacting the unvaccinated.
Those that are immunised effectively form a protective shield around those that are not, which stops the virus from spreading.
Scientists vary on the threshold at which this is achieved but Koentgen argues it is possible for Cayman, particularly once children start to become vaccinated.
Once a critical threshold of vaccinated people occurs that makes new community outbreaks less likely, he said.
Are there risks involved in taking the vaccine?
In terms of the comparative risk of taking the vaccine versus the threat of contracting COVID-19, Koentgen points to the statistics.
More than 1.5 billion doses of the vaccine have been administered worldwide and there have been no reports of any deaths directly associated with it.
“We can’t say it is zero because we don’t know that for certain; but even if we say it is 100, the odds are very small compared with the threat of COVID,” says Koentgen.
Globally, there have been almost 164 million cases of COVID-19 and almost 3.4 million deaths.
“Which one do you think is the higher risk?” he asks.
Is there a risk-free route to reopening for Cayman?
Vaccines reduce, but do not totally eliminate, the risk of COVID-19, says Koentgen.
If the goal is for Cayman to remain totally free of the virus the island could never reopen, he argues.
However, he says the risk is radically reduced once Cayman has vaccinated a high percentage of its population and when arriving visitors are required to be vaccinated.
If 70% of Cayman is immunised, for example, and if, as suggested, the vaccine has a 95% efficacy rate in preventing COVID, 30 out of 100 people would be potentially susceptible to catching the virus if exposed, he says.
That risk reduces significantly, however, if the majority of arriving visitors are vaccinated.
“There will be some cases; it is a question of what risk are we prepared to accept and how do you manage that risk,” he said. “We need to get as many people vaccinated as possible and continue to test a sufficient number of people that are in contact with those coming on to the island,” he said.
With that in place, the likelihood of hospitalisations and deaths from COVID – the initial reasons for the border closure – would be extremely small, says Koentgen.
“If you maintain a zero COVID policy, you can’t reopen. You can reduce the risk but you can’t get it to zero. I think we can tolerate the risk of the odd case,” he said.
What about blood clots?
The UK Ministry of Health issued guidance advising of an extremely rare but possible link to non-fatal blood clots from the AstraZeneca vaccine.
The risk was four in 1 million, according to the guidance. The Johnson & Johnson vaccine was briefly put on pause by the US Food and Drug Administration after six reported cases of blood clotting were discovered following the administration of the first 6.8 million doses.
The FDA lifted the pause after an investigation and added a warning about the possibility of blood clots as an extremely rare side effect.
The virus has a one in 56 death rate. The Johnson & Johnson vaccine has an unconfirmed one in 1,140,000 blood clot rate.
There were no concerns about the Pfizer vaccine, which is the one used in Cayman, in this respect.
Was the development of the vaccine rushed?
Another reason cited by those reluctant to take the vaccine is the perception that it was developed in a rush without the proper checks and balances. While it was developed quickly, Koentgen says this was not a case of bypassing due diligence.
He said the funding, plus the political and scientific attention diverted to address a global problem, enabled a process that would have taken several years, to be achieved in one.
Obtaining funds to develop a vaccine, for example, typically takes up to three years.
Streamlining the process to allow for different phases of trials to take place simultaneously also saved time.
Pre-existing research on SARS and other coronaviruses also gave researchers a head start while access to university labs and the ability to bypass administrative bureaucracy also accelerated the process.
In essence, governments, financiers, administrators, universities and other bodies removed all the roadblocks to allow for a vaccine to be created more rapidly than would have been practical in normal times.
How do the vaccines work?
There are three main types of vaccine against COVID-19.
The Chinese Sinopharm vaccine works by injecting a ‘de-activated’ form of the virus into the patient to stimulate an immune response.
The British AstraZeneca vaccine uses a different, non-deadly, virus as a delivery system. T
he research group added the gene for the coronavirus spike protein (this is not the threatening part of the virus but rather the protein which allows it to attach to human cells) to an ‘adenovirus’.
They inject the patient with that virus and the body ‘learns’ to recognise and repel both that virus and the spike proteins of the coronavirus.
The Pfizer-BioNTech vaccine works in a similar way. The main difference is the delivery system.
Instead of using another virus to show the COVID spike proteins to the immune system, this vaccine uses messenger RNA.
What is messenger RNA?
The Pfizer-BioNTech and Moderna vaccines are the most sophisticated.
They use messenger RNA to allow the body to create the COVID-19 spike proteins for long enough to train the immune system to recognise and fight them.
Scientists use the genetic code of the virus and a lipid delivery system, carrying that code, that can be injected into the body.
This allows the temporary creation of spike proteins which enable the immune system to create antibodies that will kill COVID-19 without the individual ever having to be exposed to that virus or any other virus.
“You have an army of antibodies that learn directly to recognise this protein,” says Koentgen. That doesn’t mean the body is always creating antibodies when there is no virus to fight, however.
“In peace time, the army stands down. Production goes down, but the factory is still there and ready to ramp up when required,” he says.
Will we need a booster shot?
There has been discussions that a booster shot may be required. This is not, says Koentgen, because the efficacy of the vaccine wears off. Once you have had two jabs, three weeks apart, you should be good.
What the booster shot will do, if needed, is increase the vaccine’s efficacy against new strains with a slightly different genetic code.
This is easiest to achieve with the Pfizer-BioNTech and Moderna vaccines because they use synthetic mRNA derived from the genetic code of the virus. If a new and radically different strain emerges, the new code can be used to create an adapted vaccine.
What if there is a new pandemic?
According to Koentgen, the mRNA vaccines are particularly exciting, because they can be adapted for any number of viruses.
There would still be testing and trials to go through, but in the case of a different virus, he believes adapting the technology for a new vaccine would be relatively simple.
“What they have created is a universal vaccine platform,” he said.
“This will change the way vaccines work. That is why everyone in the science world is so excited.”
What about existing viruses?
According to Koentgen the same process used for these COVID-19 vaccines could be adapted for any virus.
The key breakthrough, he said, is the ability to deliver the genetic code of a virus as an injectable vaccine, sufficiently stable to survive in the body long enough to stimulate an immune response.
More research is now needed on possible adaptations but in theory, he says, it could be used for anything from gene therapy to fighting Ebola.
“In the future, we will be using the delivery of mRNA for things you can’t even imagine at the moment,” he said.
“If it wasn’t for the pandemic it would have taken another decade to bring this through.”