Revisiting some challenges in COVID19 vaccination

Revisiting some challenges in COVID-19 vaccination: Paternalism, pregnant women and children vaccination, and the booster dose

Paternalism is an attitude where people are forced to perform actions that bring good consequences and promote the satisfaction of people's long-term desires. It is permissible to prevent people from doing what they want where they don't know all the relevant facts or where the simple accretion of facts doesn't help because they don't handle the facts adequately. The discussion of cognitive bias shows that being informed is no guarantee of a beneficial rational decision. Typically, the people who smoke know the basic facts about smoking; its health risks, economic costs, and effects on their children; after all, it's hard not to smoke because of cognitive failures in applying these facts. In such cases, paternalism through the law (coercive paternalism) could be justifiable to a certain extent, especially when public health is concerned. In some instances, restricting one's autonomy is justifiable if it is necessary to protect others in society. COVID-19 vaccination could be viewed as one example of such cases, where refusing the vaccine is not only putting yourself in danger but putting others at risk that may be tremendously vulnerable to the coronavirus. Indeed, paternalism in COVID-19 vaccination could protect some other autonomies such as returning to education at schools, the workplace, and other essential places. However, the conditions that have been suggested as suitable for coercive paternalism need to meet the following criteria. First, the activity to be prevented on paternalistic grounds is opposed to our long-term ends. Second, coercive measures have to be effective; which is considered in two ways; an immediate goal (to minimize death, severe disease, and overall disease burden, for example) and an ultimate goal to which that immediate goal is to lead (e.g., improving an individual's health, reduction of pressure on the healthcare system, re-opening of society and disease elimination). Third, the benefits have to be greater than the costs from both physical and psychological aspects, and forth the measure in question needs to be the most efficient way to prevent the activity.

It seems that a coercive paternalistic action in the case of COVID-19 vaccination is justified given the fact that liberation and soft paternalism (education, for example) have proven not to be the most effective approach. After two years of misery, we need to acknowledge that an authoritarian approach to a nationwide vaccination is the most promising policy to be taken.

Another arguable topic about COVID-19 vaccination is related to pregnant and lactating women. "The vaccines are safe and effective, and it has never been more urgent to increase vaccinations as we face the highly transmissible Delta variant and see severe outcomes from COVID-19 among unvaccinated pregnant people", says CDC Director Dr. Rochelle Walensky. CDC encourages all pregnant people or people thinking about becoming pregnant and those breastfeeding to get vaccinated to protect themselves from COVID-19. COVID-19 causes remarkable mortality and morbidity in about 5% of all SARS-CoV-2-infected pregnant women. The rising circulation of the highly contagious Delta variant, the low vaccine uptake among pregnant people, and the augmented risk of severe illness and pregnancy complications related to COVID-19 infection among pregnant people make vaccination for this population more urgent than ever. In line with the importance of pregnant women vaccination, on 16 April 2021, the Joint Committee on Vaccination and Immunization advised that all pregnant women should be offered the COVID-19 vaccine at the same time as the rest of the population, in line with the age group rollout. A previous study showed that COVID-19 messenger RNA vaccines induce vigorous humoral immunity in pregnant and lactating women, with immunogenicity and reactogenicity observed in non-pregnant women. Vaccine-induced immune responses were statistically significantly more significant than the response to natural infection. Indeed, protecting antibodies could transfer to neonates via placenta and breastmilk.

Another challenging issue is childhood vaccination against COVID-19.  Do we actually need to vaccinate children? Do the advantages outweigh the risks? If there is a shortage of vaccines, does anyone else require it more?

To date, the COVID-19 vaccine has not been approved for children younger than 12 years old, and no country has yet added it to their required vaccinations roster. Nonetheless, some facts need to be noticed on whether or not children should get vaccinated. First, more than one-fifth of the world population is below 18. Second, according to the latest scientific reports, children are more prone to new coronavirus variants. Third, COVID-19 hospitalized children may suffer "long-term neurological effects," some quite possibly permanent. The fourth and more important one from sociological aspect is that without including children in the COVID-19 vaccination program, reaching herd immunity is barely possible. These facts imply that vaccination of children should be seriously taken into consideration. Nonetheless, outweighed benefits over costs should be precisely evaluated and related clinical trials pertaining to vaccine safety and efficacy in children should be run before the final decision could be made. 

The main problem with COVID-19 vaccination backs to the parents. They are suspicious of the COVID-19 vaccine being safely in their children. A recent survey found that almost half were either unsure about letting their children be vaccinated or firmly against it. This is the responsibility of the governments that by providing fast and robust data on the potential safety of COVI-19 vaccines in children to remove worries from parents.   

The booster dose is among the challenging issue that recently had taken the scientist's attention. In this regard, the booster dose has been proposed to restore vaccine effectiveness.  Critics of COVID-19 vaccination believe that the need for a booster dose is due to the ineffectiveness of the available vaccines. Although in some instances including elderly people and conditions with immunocompromised immunity, including patients with primary immunodeficiency, HIV or cancer or those receiving immunosuppressive drugs, the overall response to vaccination is not optimal, making it necessary to receive the third shot, most people respond properly to COVID-19 vaccination. This means that vaccination is effective per se to mount protective immune responses in most vaccinated individuals.  As with many viral infections, natural or vaccine-induced immunity against SARS-CoV-2 is proved to be not long-lasting and wane over time, making the immune people vulnerable to be infected aging. Although for those people with high titers of protective humoral immunity booster is not necessary at the moment, CDC recommends booster dose for people who completed their initial series at least 6 months ago and are 65 years and older, aged 18+ who live in long-term care settings, who have underlying medical conditions such as cancer, who work in high-risk settings such as healthcare workers and who live in high-risk settings.

By: Parisa Feizollahi, Mahdi Akbari, Ata Khosh Lahni,  and supervised by Dr. Amir-Hassan Zarnani

References:

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