It was on February 11, 2020, that COVID-19 was named by the World Health Organisation [1]. Less than a year later, the first vaccination campaigns were organised. The apparent speed with which vaccines were being developed reaffirmed the fears and susceptibilities that still existed in some people's minds about vaccines. Very quickly, it was reported that the new technology of vaccine engineering was still in experimentation, which would turn all those vaccinated into guinea pigs. The main concern raised was that the vaccines might not be safe [2].

 

All fears about vaccines are legitimate. At individual scale, there is no more value in accepting the vaccine than in refusing vaccination. Both positions stem from the same desire for protection against uncertainty. However, it is important to note that these days, evidence of the quality and safety of vaccines should leave less room for doubt or hesitation, let alone refusal of immunization. Vaccines have proved their value and effectiveness. As major public health revolution vaccination has gone from strength to strength since variolisation.

 

As for the new vaccines, upon closer reflection, the speed of the scientific response in producing the COVID-19 vaccine is not as exceptional as it may seem. Five years ago, science produced vaccines against the Ebola virus, albeit after years of hesitation. Similarly, H1N1 flu, which had not yet caused such widespread destruction, also prompted the rapid development of vaccines, which more than 60% of Quebecers, among them almost 50% of Montrealers, including children, took up between October 2009 and April 2010[3]. 

 

The development of vaccines against Covid-19 is not unexpected. It is the result of a long thought-out process and previous research. In fact, as noted by the CDC, both Severe Acute Respiratory Syndrome (SARS) and the Middle East Respiratory Syndrome Coronavirus (MERS-CoV) are diseases caused by coronaviruses very similar to the current virus responsible for COVID-19. Vaccine research initially targeted these two earlier viruses. The lessons learnt from these research activities were used to design and develop vaccines against Covid-19.

 

The evidence suggests that messenger RNA (mRNA) technology is not in its infancy either. The process began in the 1980s.[4][5][6] Experiments using viral manipulation for immunological or therapeutic purposes have existed for over a quarter of a century, as can be seen in the work of Inserm, notably with Dr. Drillien and colleagues (1996)[7]. Promising applications of mRNA in immunotherapy have been well-documented[8]. In an article in L'Obs, virologist and President of the French CVC (COVID-19 Vaccine Committee) Marie-Paule Kieny informs us that trials with mRNA vaccines have been around for at least fifteen years, especially at Moderna, targeting various viruses, including MERS, information that we can already deduce from CDC data. Vaccines against Covid-19 are therefore the logical outcome of a race that we can even describe as endurance and hurdles rather than a sprint if we consider the overall platform of contenders[9].

 

The data published in The New England Journal of Medicine by Dr. Fernando P. Polack, Dr. Stephen J. Thomas, and their colleagues on December 10, 2020 indicate that the Pfizer and BioNTech vaccine is effective. Many experts even consider that its efficacy exceeds expectations. The efficacy of the vaccine for different social groups, age and ancestry, ethnicity, weight or conditions ranges from 90% to 100%, with a mean of 95% according to the researchers. As for safety, it appears that the vaccine posed no more danger than the placebo. These pieces of information convinced various regulatory authorities to grant their emergency use authorizations, even if they couldn't proceed with full approval[10].

 

There is a global agreement that the long-term adverse effects of these vaccines are still to be documented. Close monitoring of the various effects will be carried out during the campaigns. Certainly, events temporally associated with vaccine administration will be attributed to vaccine adverse events. A careful analysis of their normal incidence in different contexts may help determine the probabilities and types of links with the vaccine, as Black and his colleagues indicated in the case of H1N1 in 2010[11]. Admittedly, for the transition to vaccination at our doorstep, everyone would have preferred that this so-called messenger RNA vaccine technology had been used for smaller-scale vaccinations first. However, we can all be reassured that there has been no Frankensteinology, but rather advanced immunology, and undoubtedly, a step forward in human immunology.

 

While we must certainly pay tribute to the researchers for the work they've done, is there anything more motivating for a researcher than to see the result of his work eagerly awaited and utilized during his lifetime? Is there anything more motivating than knowing that the medal of merit won't be hung on their tombstone but proudly worn on their chest while they are still standing? Researchers have benefited from a very favorable context of political commitment and international collaboration based on a new pandemic paradigm, different from the traditional linear approach to vaccine development[12]

 

 

S. Kery

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[1] OMS (2020). Appellation de la maladie à coronavirus 2019 (COVID-19) et du virus qui la cause. https://www.who.int/fr/emergencies/diseases/novel-coronavirus-2019/technical-guidance/naming-the-coronavirus-disease-(covid-2019)-and-the-virus-that-causes-it

[2] Aloweidi A., Bsisu I., Suleiman A., Abu-Halaweh S., Almustafa M., Aqel M. et al (2021). Hesitancy towards COVID-19 Vaccines: An Analytical Cross–Sectional Study. Int. J. Environ. Res. Public Health, 18(10), 5111; https://doi.org/10.3390/ijerph18105111

[3] Brien S., Kwong J. C, Charland K. M., Verma A. D., Brownstein J. S., & Buckeridge D. L. (2012). Neighborhood Determinants of 2009 Pandemic A/H1N1 Influenza Vaccination in Montreal, Quebec, Canada. American Journal of Epidemiology, 176(10):897–908  

[4] IRSC (2021). Le long chemin vers les vaccins à ARNm. https://cihr-irsc.gc.ca/f/52424.html

[5] Malone, R. W., Felanger, P. L, and Verma, I. M. (1989). Cationic tipsome-mediated RNA transfection. Proc. Nail. Acad. Sci. USA, 86: 6077-6081. 

[6] Conry R. M., LoBuglio A. F., Wright M., Sumerel L., Pike M. J., Johanning F., et al. (1995). Characterization of a Messenger RNA Polynucleotide Vaccine Vector. Cancer Research 55, 1397-1400.

[7] Drillien R., Howley P., Spehner D. (1996). Manipulation moléculaire des virus à ARN de polarité négative (ARN –): vers de nouveaux outils en médecine. Médecine/Sciences; 12: 1228-34.

[8] Maisnier-Patin K., Crabé, S., Breton G., Dupuy F. P., Yassine-Diab B., Sékaly R-P. (2007). Les cellules dendritiques transfectées avec de l’ARN messager Une approche prometteuse en immunothérapie. Médecine/Sciences; 23 : 279-84.

[9] Ura T, Yamashita A., Mizuki N., Okuda K., Shimada M. (2021). New vaccine production platforms used in developing SARS-CoV-2 vaccine candidates. Vaccine 39 (2021) 197–201.

[10] Polack F. P, Thomas, S, J., Kitchin N., Absalon J., Gurtman A. (2020). Safety and Efficacy of the BNT162b2 mRNA Covid-19 Vaccine. New England Journal of Medicine, 31;383(27):2603-2615. doi: 10.1056/NEJMoa2034577

[11] Black S., Eskola J., Siegrist A-C., Halsey N., MacDonald N., Law B. (2009). Importance of background rates of disease in assessment of vaccine safety during mass immunisation with pandemic H1N1 influenza vaccines. Lancet,374(9707):2115-2122. doi: 10.1016/S0140-6736(09)61877-8.

[12] Lurie N., Saville M., Hatchett, R.., & Halton J. (2020). Developing Covid-19 Vaccines at Pandemic Speed. The New England Journal of Medicine, 382;21 1969-1972. DOI: 10.1056/NEJMp2005630.