MHM Magazine

There are three main approaches to making a vaccine: 1. Using a whole virus or bacterium (The Whole-Microbe Approach) 2. Using parts of the organism that trigger the immune system (The Sub- Unit Approach) 3. Using just the genetic material (The Nucleic Acid Vaccine) THE ETHICS AND POLITICS OF VACCINATIONS (PROF LUCY ALLAIS) “Bioethics was only established in the 1950s and 1960s and is not well suited to infectious disease. At a time of rapid technological development, bioethics was designed to protect individual choices and rights about birth and death,” explains Prof Lucy Allais, Director of the Wits Centre for Ethics. Infectious diseases have an enormous capacity to create fear and panic. This can result in irrational decision making by both policy makers and individuals. While overly restrictive policies fail to appreciate the patient as ‘victim’, policies based only on autonomy fail to see the patient as ‘vector’. “It’s intrinsic to infectious conditions that an individual’s having such a condition has implications for their interaction with others,” Prof Allais explains. Patients can be a risk to the community and health care providers. Health care providers can pose a risk to their patients. “Communicable disease is not an issue of individual choice.” We are all both vulnerable, potential persons-in- need and dangerous persons-as- threats. There are a number of ethical considerations about how we choose who to vaccinate first. Do we: • Protect those most at risk of death? • Protect those at most risk of being infected and spreading infection? • Protect those who are putting themselves in harm’s way for the sake of others? Infectious diseases raise important issues and a purely individualist approach simply does not work. Empirically, economically, medically, ethically there are more questions and concerns. However, there are no definite answers. COVID VACCINES: SHINING A LIGHT IN THE DARKNESS (PIERRE BROUARD) In May 2020, Lauren Collins wrote: “Diseases don’t have personalities – but if they did, the coronavirus Viral vector vaccines use a mild version of a virus (adenovirus) to safely deliver instructions to our THE VIRAL VECTOR VACCINE cells in the form of genetic code. “This type of vaccine makes your immune system familiar with the ‘spike’ protein so it can kill the virus in the event of infection and prevent the disease.” These vaccines are very stable. “Viral vector vaccines don’t have to stay frozen or in ultra-low temperatures and can last a few months in a normal fridge temperature of between 2 and 8 • C. This is an important consideration for South Africa.” The nucleic acid vaccine uses genetic material that encodes specific proteins – the DNA or RNA. mRNA vaccines use cutting- THE NUCLEIC ACID VACCINE edge vaccine technology to protect you from disease without exposing you to the virus. These vaccines do not contain weakened or inactivated viruses. “Instead they contain mRNA, a type of genetic information, with instructions to the immune system on how to create copies of the coronavirus’s ‘spike’ protein.” mRNA vaccines have an efficacy rate of up to 95% “The ‘spike’ protein is the knob (the red) on the outer edge of the coronavirus that docks and attaches onto our ACE2 receptors (blue) and enter our system”. 22 | MENTALHEALTHMATTERS | Issue 4 | 2021 MHM