The two trains of thought with Sinovac
People I’ve known who are generally familiar with the science of vaccination are generally of two minds regarding Sinovac:
- Take the vaccine because it’s the only available one; or,
- Wait a little more because we don’t have definitive proof of Sinovac’s efficacy.
Honestly, I believe both perspectives have merit. People constantly exposed to the virus have to deal with contracting COVID-19, and the idea that 50% is always better than zero makes perfect sense. Other people often compare flu vaccines as barely effective, yet people still take them yearly. However, I think this comparison is fallacious.
First, influenza is a drastically different disease than COVID-19. I made this mistake one year ago — I won’t again. There are almost 200 strains of influenza virus, and one of the reasons why people have boosters yearly is that it’s not the same strain that attacks people all the time. Sometimes it’s one strain, and at other times it’s another. The flu vaccine changes the strains that it contains yearly, depending on the dominant strains of the previous year. On the other hand, COVID-19 is a novel virus. A good thing about SARS-COV-2 is that it isn’t as variable as the influenza virus, which contributed to the speedy creation of vaccines against it.
Second, flu vaccines have been established. What I mean by this is that independent bodies assess these vaccines, which prevent a conflict of interest. When people say that the flu vaccine is 40% effective, the data is double-checked by other groups whether its producers follow the scientific method. This is also known as peer review. Doctors and scientists don’t simply rely on the data given to them without independent review.
Right now, I don’t think the debate is about the safety issues regarding Sinovac. One of the most common reasons why my other colleagues have already chosen to be inoculated is because the technology that was used to design Sinovac was the technology used for vaccination when it was invented. Inactivated whole viruses are injected to the bloodstream of the person being vaccinated, which leads to an immune response from the person. It’s tried-and-tested.
Safety isn’t really the issue with it. It’s efficacy.
Without the Phase III trial data, how sure are we even of the 50%? Sinovac has a history with touting initially high efficacies that are dialed down after further analysis. To me, that’s already suspect.
The counterpoint by many of my peers is: “Why wait for something that could possibly not even arrive?”
The presumption that I am waiting for only the Pfizer vaccine is false. Of course, in a perfect world, I’d love to have it, but I’m all right with any vaccine that has peer-reviewed Phase III data (Gamaleya or AstraZeneca) published in reputable medical journals. Peer-reviewed data means that the efficacy data released has been assessed by an independent scientific body: this means that we’re not only depending on the data that’s given to us, because that represents a clear conflict of interest.
The country where the vaccine would be produced is immaterial: if Vietnam will produce a vaccine with peer-reviewed Phase III trial data that shows an efficacy of 55%, I won’t hesitate to recommend it, because I know what I’ll be getting. What I’m banking on is that the data is transparent and can be assessed by other independent sources — I would then know that the data is then not merely made up.
My central concerns revolve around the lack of data that Sinovac has. Many news and science sites have reached out to Sinovac for comment or explanation regarding its data, but to this date, none have been answered. Isn’t the conflict of interest obvious when the data one relies upon is the one that is released by the vaccine company itself, without any independent review? As vaccines are a scarce resource, however, Sinovac doesn’t really need to release anything, as it caters to the developing countries crowded out by their richer counterparts. That’s also reality.
When the company announced that it is effective against a particular type of variant, it said so without any data to back it up. This is what I take exception with: science is not merely a matter of trust — medicine has evolved tremendously over the course of the 20th century because people learned to listen to evidence that was created through experimentation and the scientific method, and not merely from charismatic people or cool-sounding factoids.
In the recent Philippine College of Chest Physicians conference, Sinovac’s data was also reviewed with Dr. Salvaña. If I recalled correctly, he seems to have essayed what the people in the HTAC group of DOH showed regarding Sinovac: the data that it confers 100% protection against severe disease cannot be computed. This was what the FDA and the HTAC had both observed: at best, the vaccine was safe and had barely acceptable efficacy on healthy people (18–59) who did not work in health care.
Massive immunization drives have been done in Brazil with Sinovac. However, it was recently found out that it was ineffective against the Brazilian variant (the data, however, is pending for peer review). I’m afraid that could be the same case with the UK or South African variant, since all we are getting are responses that “it works,” and not how it works through independently-assessed data. I hope I’m wrong.
I try to avoid hypocrisy as much as I can (though I occasionally fail, because we’re all biased), and will gladly change my mind if the data and science is there. But the data simply isn’t there: the bottom line is that the recommendations from an independent body of vaccine experts show that with the data on hand, it’s best only for the healthy, economic frontliners.
Each person has his or her own perspective regarding the vaccination. But in the words of another doctor, “Hindi ba ang evidence-based medicine ay step by step? Kung walang evidence (literature), why even bother to appraise? Let alone use it? Wagas tayong magturo ng critical appraisal sa med school at hospital pero dun din pala tayo babagsak sa shady ang evidence.”
For my part, I don’t wish to be injected by Sinovac, but I respect other people’s decisions regarding Sinovac. To many others, waiting is indeed not an option. For my part, I’m fine with ANY vaccine with enough data and transparency (although I won’t wash hands, I’d love to be lucky with Pfizer or Moderna). With AstraZeneca’s on the horizon, I wouldn’t mind being inoculated with that at all.
Vaccination saves lives and is important. Vaccination is also evidence-based medicine.
