I just cannot ignore the narrative regarding the impending acquisition of a COVID-19 vaccine by the Jamaican Government, a part of which is the scepticism surrounding whether Jamaicans should, in fact, take the vaccine or not.

In contrast, it is heartening to see the technocrats and health practitioners across various countries, such as the USA and Israel, receiving COVID-19 vaccine jabs. Even more impressive is the fact that the first person to receive the vaccine in one state in the United States of America was a nurse of Jamaican descent. I am, however, not convinced that enough is known about this vaccine.

As a health practitioner, I am acutely aware that fear of the unknown may negatively affect acceptability of treatment modalities, as well as health-seeking behaviours generally. In fact, this may negatively affect the Government’s good intention to make the vaccine available to the population, albeit a small percentage.

It is known that the US Food and Drug Administration (FDA) has approved one Pfizer/BioNTech COVID-19 vaccine for emergency use. Individuals 16 years and older will receive two injections, administered 21 days a part. It is believed that within seven days of receiving the second dose the vaccine has an efficacy rate of 95 per cent. It is also felt that individuals who are vaccinated will not become seriously ill should they contact the infection.

Similarly, the FDA has granted approval for emergency use of the Moderna COVID-19 vaccine. Individuals 18 years and older will receive two injections, administered 28 days a part. It is purported that the vaccine has a 94.1 per cent efficacy rate.

How do vaccine work?

Generally vaccines boost immunity by imitating the infectious agent. A key point to note is that, rather than causing the illness, the immune system produces antibodies which identify and neutralise foreign bodies or pathogens. This source of artificial immunity may result in side effects such as fever. Mothers may recall being advised by their health practitioners to observe infants for fever after receiving scheduled immunisation; for example, after the Bacillus Calmette-Guérin (BCG) vaccine. This is considered normal as the body attempts to build immunity. This process results in the body being fortified with memory cells, known as T-lymphocytes and B-lymphocytes, which protect the body from any future attacks by that disease. Of note is that development of this kind of immunity is not immediate and may take several weeks. It is therefore, not uncommon for individuals to develop symptoms of the disease vaccinated against, prior to, or subsequent to receiving the vaccine.

By and large, the Pfizer/BioNTech and the Moderna COVID-19 vaccines utilise what is known as messenger RNA (mRNA) and not the virus itself. The COVID-19 mRNA vaccine promotes the making of harmless S-protein similar to the spike-like structures on the coronavirus. Once the vaccine is received, a cascade of activities will take place:

1) The S-proteins will be displayed on the surface of the cells;

2) The body will recognise them as foreign or invaders; and

3) An immune response will be triggered.

It is believed that the vaccine can produce approximately nine months immunity.

Are the vaccines developed according to established standards?

All things considered, vaccines are good and have been quite effective in achieving herd or community immunity against certain infectious disease. With this in mind, it may be prudent to highlight that for this level of efficacy to be achieved by researchers and pharmaceutical companies the processes have to be extremely robust.

While I will not articulate the processes in this article, a key point to note is that vaccines take several years to develop. One may argue that the processes involved in these vaccines were shortened and as such the safety and efficacy should be questioned. With the use of modern technologies, however, pharmaceutical companies were able to reduce the usual timelines to achieve similar results. In light of this, we were reassured that safety, and efficacy were not compromised.

What say health practitioners?

I had a brief exchange with some health practitioners in order to determine how receptive they would be to the vaccine when it gets to our shores. They were all asked:

1) Will you take the COVID-19 vaccine?

2) Whether ‘Yes’ or ‘No’, state why?

Here are a few responses:

Said one public health nurse: “Of course, just as how I take the flu shot every year. It’s another flu shot. I also have relatives overseas who have taken the vaccine.”

A radiologist commented, “No, I don’t think so. Well not right now… I have to see my friends take it first and hear what they say… I saw on social media where a nurse took it and developed Bell’s palsy even though she was OK for the first few days after receiving the vaccine… Not sure if it’s fake news…”

A pharmacist practising in a rural community noted: “Personally, I will be taking it, because COVID is just another flu. I have to take the flu vaccine every year…”

One medical technologist, in response, said: “No. I am afraid of it…based on the things people are saying… I prefer to [develop] my own immunity to it… I am not 100 per cent sure of the side effects, so, based on what people have been telling us, I wouldn’t want to inject the virus in case my body can’t fight it.”

A midwife offered: “Not right now, because I still need to learn more about it, whether it is going to be like the flu vaccine, which you have to take every year. Now that they say there is a new strain of COVID-19 it means that we are going to need more than one vaccine.”

A nurse educator response was: “No. There are a number of issues. I don’t know how soon I will be immune seeing that the pandemic is still on. When does the immunity kick in? Some say six weeks, some say 8 weeks. Will I need follow-up vaccines. Is it that we are going to need it every year or how much follow-up will be required? The testing that they [pharmaceutical companies] did, was it done on persons with comorbidities or on persons who have no known illness? I don’t say I would not take it…maybe in the future, but for right now I will practise the social distancing [etc] and take a chance with my immune system.”

A nurse anaesthetist said, however, “Yes. We can’t be socially distance forever, we were not made like that. Human beings were made to socialise. I cannot manage the social distancing, especially for my family. [Plus], I am not worried about myself because I have come across so many COVID-19-positive patients, but I am concerned about my mother, my husband, and other family members; I don’t want to put them at risk… Also, schools need to reopen; not every child has access to Internet…some children have not had a day of school since the [outbreak]. We need to go back to some normalcy.”

A director of nursing services in a rural hospital said: “No, I have to see the outcome. At least wait a year to see the reaction… the side effects, the after-effects. Need to see if it was well thought out, developed, and ready…”

A consultant surgeon articulated that, “I am still investigating the vaccines. There are different vaccines. All vaccines are not equivalent. Pfizer and Moderna will not be ones available in Jamaica. Taking the vaccines depends on which ones are coming to Jamaica. I did research on the vaccines myself and I know which ones are better, which ones aren’t, and which ones have more side effects. The better ones are Pfizer and Moderna. The AstraZeneca’s COVID-19 vaccines are not bad, but may have more side effects.”

A male nurse, for his part, commented: “I am not sure yet. I have to see somebody that took it and I need to read more about the vaccine — the known complications and side effects — before I can take it. I am not saying I won’t take it, but I need to get more information about it before I can volunteer.”

A director of nursing services in an urban hospital articulated, “I am undecided right now. I am reading up more about it. I know a nurse who received the vaccine this week and I am doing some background checks. I don’t really gravitate to these things, but it may just become compulsory to travel to some countries.”

Finally, a general surgeon commented: “Vaccines work in two scenarios; (1) to achieve herd immunity akin to polio, etc — that’s not going to happen in Jamaica. (2) To protect the vulnerable population like the flu vaccine. I’m young and healthy. [Why] bother?”

It seems to me that there is a divide among health practitioners concerning embracing the COVID-19 vaccine. While I am not averse to taking the vaccine, there are a number of unanswered questions. It is clear that more information is required on how the vaccine was tested, the effect on the new strains of the coronavirus, and especially information on the vaccine that Jamaicans will have access to.

All things considered, it may be prudent for the relevant policymakers and stakeholders in health to launch a COVID- 19 vaccine sensitisation programme in order to have Jamaicans better informed, generally. This should, no doubt, clarify any misconceptions regarding the vaccine and allay the associated fears.

Dr Adella Campbell is associate professor and head of the Caribbean School of Nursing at the University of Technology, Jamaica