Why vaccines matter: Monkeypox, Polio and Covid
How and why vaccines will be essential to overcome the next big health risks caused by viruses globally. There is only one answer.
Reading some of the current news regarding the status of the global health of our species, it can be easy to think that history is repeating itself despite huge global vaccination efforts to stem the expansion of various viral diseases in our species.
For starters, new variants of covid are proving to be a lot more capable of circumventing our immune system. The most recent omicron variant BA.5 is a lot more contagious than any of the previous variants. Evidence for this is that the most protected human in the world, the president of the US, has managed to catch the virus. Yes, his predecessor did too, but let’s face it, did you ever see that guy with a mask on? No. Recent statistics from the CDC have shown that after a slow growth period, that BA.5 now accounts for nearly 80% of all covid infections in the US. And although overall hospitalisation rates have declined (partly due to historically established immunity in patients,) they are still rising and with this, overall ICU admissions have also been tracking along a similar trend.
Of course there is now the perennial debate about “reasons for hospitalisations” - a debate framed as hospitalised “with” or “for” covid. As this became a major talking point for the general public at the end of last year, the CDC started tracking this data in January this year. As it stands now, over 30% of all covid hospitalisations are “for” covid - meaning the patients were admitted due to symptoms of covid and not for something else. This is a huge number and should be alarming to all. On top of this, I find the debate completely misleading as viruses have a tendency to cause tissue damage months and even years after infection - encephalitis caused by herpes and arboviruses, being a case in point. So that debate is moot. Furthermore, patients presenting other injuries “with” covid, is still a major health risk as they are being treated in clinics where other vulnerable patients are being infected. The number of patients who acquired covid in hospitals is also still on a steady rise.
After Anthony Fauci recently announced that his covid infection had rebounded despite his treatment with the antiviral medication paxlovid, I began to get concerned. This had followed a month after the CDC had issued an emergency health alert regarding the phenomenon of covid symptoms returning, sometimes after months, in certain individuals and that people shouldn’t be complacent after returning a negative covid test, post-infection. It is now known that covid appears to stow away in fatty tissue, making obese people, regardless of age, way more susceptible to infection and even ICU hospitalisation. A study last year from Tulane University, investigated 287 COVID-19 patients that had been hospitalised and found that not only a high BMI but also metabolic syndrome itself, could substantially increase risks of a need for a ventilator and ICU admission, and yes, even death. These results have been echoed around the world in obese people, and again, this is regardless of age! This shows that regardless of vaccination status, the presence of a higher amount of fat deposits in patients seems to correlate with a negative disease outcome.
However, the main takeaway here is still that those vaccinated are still six times LESS likely to die of covid than those who are not vaccinated. This statistic has not changed and has also been corroborated in most countries in the world.
Wherefore art thou Polio?
Polio was recently discovered in the wastewater around London and also in the US. The reason for this re-emergence lies twofold. On one hand, the virus still exists in large numbers in two major countries on Earth, Pakistan and Afghanistan. Two countries that have wholesale refused global vaccination efforts for decades. As such the virus is just an airplane flight away. The other reason for this reappearance is the fact that one type of vaccine can actually give rise to a live, mutated virus - this is called vaccine-derived poliovirus and is rare. There were only about 600 cases recorded last year in the Middle East and parts of Africa, mainly in places with struggling healthcare infrastructure, where the routine administration of the vaccine was not as widely practiced.
The two types of vaccine are a heat-inactivated (dead) virus and a live (attenuated) virus. The former vaccine manages to prevent death and serious disease but doesn’t prevent transmission and the latter, more recently developed vaccine manages to prevent disease, death and transmission and as such it is the preferred vaccine. It is also an oral dose and as such easier to administer than the heat-inactivated dead virus which needs to be injected. The live, attenuated version is modified so as to reduce its pathogenicity but as we have all learned these past two years, viruses mutate and this vaccine is no different and can sometimes give rise to vaccine-derived poliovirus, which is extremely rare but not impossible.
The recent case in New York appears to have originated from a vaccine-derived poliovirus that the person came into contact with on a recent holiday trip, raising concerns about this specific approach to vaccination.
The main point here though is, had this person been vaccinated with either vaccine, they would not have been infected.
This is the whole point of vaccination - it only works when everyone does it. Luckily enough polio isn’t as transmissible as covid but its ramifications on the health system are massive. Polio will never leave our species until 100% of all humans have been vaccinated. Not 98% or 99%, but ALL of the humans on Earth. There are three types of virus that cause poliomyelitis and two of them have already been eradicated in humans, the last one wild poliovirus 1 (WPV1) is still around, mainly in Pakistan, Afghanistan and parts of Africa and only a concerted effort to eradicate it will prevent any future pandemic style outbreak of it.
So it wouldn’t be at all surprising if there is another global push towards polio vaccinations, even in adults.
The good news is that a new type of safer oral vaccine for polio has been created, one that has had a stop codon put on its ability to mutate to a more pathogenic form. This is brilliant news, but we still have to educate people globally to accept this new vaccine. Otherwise we’ll just be caught on a hamster spinning wheel with this disease for the next century. Once the WPV1 species is eradicated, the world will be able to go back to using the safer heat inactivated vaccine as the risk of transmission becomes essentially zero.
History repeats, the resurgence of pox viruses
The earliest case of monkeypox was recorded in the UK in early May this year. It was found to be a mild version of the virus, the West African type. Since May, the numbers have risen to around 2200 in the UK and over 2800 in the US, with nearly 14 000 cases reported worldwide. So far there have been ‘only’ 5 deaths reported, but this is misleading. Yes, 99% of those infected will survive but the problem comes in children under the age of 8, immunocompromised people and those pregnant and breastfeeding. Here the symptoms can become a lot more severe.
The main (milder) symptoms of monkeypox are fever, headaches, muscle aches and a lack of energy reported. Normally infection with the West African strain, leaves a rash that develops all over the body, a rash that looks a bit like pimples or pus-filled boils that can form all over the body. When the infection spreads unchecked, it can cause major pulmonary distress and even bronchopneumonia - which can be fatal. The really scary thing about this virus is that it can also lead to severe infections of the eye, corneal scarring, and even in serious cases, it can cause permanent vision loss.
The problem is that not EVERYONE gets the rash post infection and as such as you can see from the milder symptoms listed above, some might interpret these as the result of a cold or flu and hence people may not present themselves to a hospital. Meaning they are walking about transmitting the virus unbeknownst to them. Not good. Two children in the US have already been infected.
Monkeypox doesn’t mutate as fast covid does, but there have been recent reports that there is something strange going on with the ‘expected’ mutation rate of monkeypox. A Portuguese study, published in Nature Medicine last month, looked at the mutation rate of monkeypox over the last 10 years and it concluded that it was mutating at a rate 12 times faster than expected. This is what biologists term accelerated evolution and it is not a good sign for the future. Monkeypox belongs to the orthopoxvirus family, which also includes smallpox, camelpox, cowpox (the one we got our first vaccine from) and horsepox - but not chickenpox (that’s a completely different virus family.) This family of viruses usually show about 1-2 significant mutations a year, this monkeypox strain showed 50 significant single nucleotide polymorphisms (a fancy word for single base pair mutations,) that could result in increased transmissibility and also virulence.
So caution is needed here.
Be vigilant and take the vaccines when they come
In conclusion, the risk of contracting monkeypox is "believed to be low," yet anyone who has close contact with an individual carrying the disease is at a major risk of infection. The virus can spread via droplets from your saliva when talking to an infected person, skin contact, touching a rash or otherwise coming in contact with someone else’s bodily fluids. This can be via direct contact or even touching surfaces that an infected individual had touched before.
So frequent hand washing is advised, as well as washing bedding consistently and yes, wearing masks in crowded places.
Following the WHO’s recent declaration of the monkeypox outbreak as an international public health emergency, New Zealand has now recorded its second case and as such vigilance is required. This is not a virus transmitted solely by those of a certain sexual orientation, this virus will affect EVERYONE. We made the mistake once, stigmatising a certain subset of the population with being carriers of HIV, we can’t make that same mistake again. So every time you hear someone talking about monkeypox, like it is a “gay virus” be sure to shut them down immediately. This virus knows no bounds and the sooner we take that on board, the safer it is for everyone.
European authorities have approved the smallpox vaccine Imvanex for use against this strain of monkeypox as the viruses are so similar that it confers immunity. So be prepared for another big vaccine roll out worldwide. Though this will take some time as there simply aren’t enough vaccine stockpiles to make a significant enough dent to global infection rates. Though the producer of the vaccine, Bavarian Nordic, are working on up scaling their production lines.
So, whether it is covid, polio or monkeypox, just listen to the health authorities and get vaccinated when these become available.
Think about the children, your grandparents, pregnant women and those who are already immunocompromised.
This ain’t over yet, not by a long shot.
Or look at the status of women, about which finally the planet is coming to its senses in our own time. Or even things like smallpox and other disfiguring and fatal diseases, diseases of children, that were once thought to be an inevitable, God-given part of life. The clergy argued, and some still do, that those diseases were sent by God as a scourge for mankind. Now there are no more cases of smallpox on the planet. For a few tens of millions of dollars and the efforts of physicians from a hundred countries, coordinated by the World Health Organization, smallpox has been removed from the planet Earth.
Oh Carl Sagan, how much we wish you were right here. But it will happen. One day.
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Great article, thank you