COVID vaccines: risk-benefit analysis

Lately we all have been hearing some news regarding severe allergic reactions after COVID19 vaccinations leading to occasional deaths of the vaccinated people. Today I came to know about a 90 year old gentleman, father of a senior journalist friend in India, who tragically died after receiving vaccination in a remote village, which is very disturbing.

Nobody is immune to death, certainly not at the ripe age of 90 years. However, there is a difference between natural death and a death that could have been avoided if more thought was given into such policies where everyone is aimlessly being vaccinated just to achieve a bureaucratic target in which human lives are counted as numbers.

Few weeks ago, there was a news from Norway where 23 people had died in a short time after receiving the Pfizer vaccine. Of those deaths, 13 have been autopsied, with the results suggesting that common side effects may have contributed to severe reactions in frail, elderly people, according to the Norwegian Medicines Agency.

In modern medical science, no medication/procedure is free from side-effects. However, practices in modern medicine are based on a common principle of appropriate "risk–benefit analysis" which is the cornerstone of modern medical science.

Like any other vaccines, Covishield is also not free from side-effects. Covishield is originally made by Astrageneca/Oxford, however, due to its lower manufacturing cost and large scale production capability Serum Institute of India was given the contract to manufacture it.

While developing Covishield, Oxford-AstraZeneca team used a modified version of a chimpanzee adenovirus, known as ChAdOx1. It can enter cells, but it can’t replicate inside them. However, it can cause colds or flu-like symptoms.

Besides adenovirus in Covishield, there are few other ingredients in this vaccine that can cause adverse reactions. One of them is Polysorbate 80 which may cause severe reactions in some individuals.

However, most important aspect is there is no solid data regarding efficacy and safety of Astrageneca/Covishield vaccine in the individuals above 65 years of age. For those with the most severe frailty, even relatively mild vaccine side effects can have serious consequences.

For those who have a very short remaining life span anyway, the benefit of the vaccine may be marginal or irrelevant.

In my view, policy makers in India and elsewhere should be more careful about deciding as to whether or not someone as old as 90 year should be given this vaccine.

As far as one can rationally think, a 90 year old man/woman is most likely to stay at their home among their loved ones with almost no risk of getting infection or infecting others. Do such old people really need vaccine?

Even if some 90 year old gentleman feels like taking a vaccine, I would advice their family members to get it done in a hospital setting where anaphylactic reactions can be managed by physicians, not in a primary health center or a vaccination booth set-up in a school or some public place.

My long term worry is - if mass vaccinations are used unwisely without risk-benefit analysis, it is going to cause more distress/doubts among those who indeed are at risk for COVID19 infection and can be benefitted by the vaccination in their day to day life.