“Just get whichever vaccine is available. The virus can no longer win.” – We sat down to discuss the rollout of coronavirus vaccines in Hungary, vaccination in general, and the race against the virus’s evolution, with South Pest Hospital Centre’s chief infectologist, János Szlávik.
Let us jump a couple of months forward in time. It’s May 1st, 2021. Realistically, how many Hungarians will have been vaccinated by then?
By May, I really hope that around 4 million people will be vaccinated. However, it does not primarily depend on Hungary. We cannot say whether the vaccines will arrive on time, so we cannot predict anything. I originally hoped that we would be finished with vaccinations by the beginning of summer, but at the moment it seems like we will finish by early autumn instead.
Let us stick with these roughly 4 million doses. To your best knowledge, which kinds of vaccines will this number be comprised of, and in what proportion?
For the above reasons, I cannot tell you, but it should be just about equally distributed between the five vaccines the country is supposed to receive soon; the Chinese Sinopharm, the Russian Sputnik, the British AstraZeneca-Oxford, and the American Pfizer-Biontech and Moderna vaccines.
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Dr. János Szlávik is chief infectologist at South Pest Hospital Centre. He is one of the most prolific and accomplished medical professionals in Hungary, and also one of the most active healthcare communicators in the country. Before the pandemic, his work was primarily focused on tropical diseases and AIDS.
What are the main differences between these vaccines?
There is a difference in the mechanism that the vaccines use, but the fundamental difference between them from an epidemiological perspective is their effectiveness, which ranges between 80-95%. This means that 5-20% of those vaccinated can still get sick if they catch the virus. Specifically, the Pfizer-Biontech and Moderna vaccines are around 95% effective, the Russian Sputnik is 92%, the AstraZeneca-Oxford is a little lower at around 80%. We know a bit less about the Chinese vaccine, but from what we do understand, it should also be around 80% effective.
However, it is crucial to understand that although you might get a little sick, it is nearly impossible to develop severe symptoms if you are vaccinated, regardless of the type of vaccine. You will almost certainly not have to be hospitalized.”
From a societal standpoint, this is the crucial bit, because people will no longer die or have long-term health problems from COVID, and our healthcare system will not be overwhelmed even if the virus continues spreading.
Therefore, I would advise everyone to vaccinate themselves with whatever they can, regardless of effectiveness, because both from a personal and a societal perspective, the main threat of the coronavirus can be eliminated that way. Even if you do get a little sick despite the fact that you are vaccinated, you could just as well have the flu.
What do we know about how much these vaccines reduce people’s ability to transmit the disease?
Very little. I don’t really like to talk about that, because it is not really that important, even though a lot of people think it is. The fact that somebody who is vaccinated happens to be infected (but likely does not get sick) is not really relevant from an infectological standpoint. Even if some can still transmit the disease, if enough people are vaccinated, the pressure on the healthcare system and the likelihood of anyone getting sick are both immensely reduced.
Depending on the exact proportion of the different types of vaccines, and their effectiveness, the pandemic should come to an end if we reach a vaccination level of around 60-70%. By my prediction, we will reach this in early autumn in Hungary.”
The only problem is that viruses like SARS-Cov-2 mutate, and depending on how that happens, and how variants spread, we may end up needing higher levels of vaccination.
Is it then possible for a “catch me if you can” scenario to emerge, where we try and keep up with the virus, but it keeps mutating too fast, and our vaccines and remedies keep being rendered obsolete?
Technically, yes, but it is not a very realistic scenario in this case. With the type of vaccine developed by Pfizer-Biontech and Moderna, Messenger RNA, it takes only a couple of weeks to adapt the formula to a new strain of the virus. Therefore, even if the effectiveness of the current vaccine against a particular strain fell below, say, 50%, we could have a new, more effective vaccine in a matter of weeks. Moderna is already considering changing its formula slightly.
The virus can no longer win.”
Nevertheless, it is still of some note that the current virus is nothing like the one that appeared in China at the end of 2019, or even the one that was in Spain last spring. It is constantly changing. In fact, it mutates particularly quickly when compared to the influenza virus, for instance. The most famous mutations at the moment are of course the British, the South African, and the Brazilian variants, and I also heard there was a new one in Japan.
Currently, the UK one is the one to look out for, because we know it is 60-70% more contagious, so it spreads significantly quicker. It is therefore likely to soon become the dominant strain. It may also be slightly more virulent, but from a societal perspective, the contagiousness of an already serious disease is more important, because exponentially more people can be hospitalized, and thus more people will die, even if they do so at the same rate. The South African version may also be more virulent, but we do not yet really know that. All of them are already present in Hungary. Luckily, existing vaccines appear to be effective against the UK strain. We do not yet know about the others. [Since the time of the interview, the AstraZeneca vaccine has proven insufficiently effective against the South African variant, and is therefore no longer used to vaccinate people in South Africa. – editor]
Why and how do viruses mutate?
As they reproduce, RNA viruses such as the novel coronavirus frequently make a mistake, and the surface of the resulting virus will be slightly different to what it was before. There are some mutations which result in the virus’s death. Others make it more potent. Larger mutations come about when a virus hops from one species to another. This can be dangerous. We heard, for instance, that the virus infected some minks in Denmark, so they killed all of them. This was a smart decision, because if the virus kept mutating in minks, then jumped back to humans, it could have become a lot more deadly and contagious very quickly. Remember, this was the case with the bird and swine flus.
It is no coincidence that in recent times, all such epidemics and pandemics, including SARS and MERS, started in China, where humans have a very different relationship with animals and animal hygiene. This might soon become a serious topic of conversation on an international level, but it will be difficult, of course.
Is there a possibility that despite vaccination, SARS-Cov-2 will become endemic in the human population, and stay with us?
Yes. Based on how the virus has been mutating so far, it is highly likely that it will behave similarly to the common flu, and we will have to be revaccinated every so often in order to remain protected. Even without mutations, however, we do not yet know exactly how long protection lasts. Based on animal experiments done so far, the current vaccines’ protection may last up to two years.
On this note, it is important to understand that reinfection is rather rare even without vaccination. As the virus mutates, reinfection becomes more likely, but in around 95% of such cases, symptoms are mild.
You have previously said that you do not believe people should be able to choose which vaccine they want to have administered to themselves. Do you still believe so?
From an epidemiological perspective, and also from the standpoint of social welfare, the most important thing is getting as many people vaccinated as possible as quickly as possible.
If allowing people to choose which vaccines they do and do not want hinders that, it is not worth doing so, because they are all rather effective, and as I said, they all prevent severe symptoms. They are also all equally safe and equally well-understood, and there is no reason one would be better or worse, or have more potential side effects, or would be more likely to cause allergic reactions for any given patient than any other.
If there were enough vaccines from every kind for everyone, it would be alright to let people choose – I would be the happiest if that was the case, believe me. As things stand, we have a shortage of vaccines, so for the benefit of our society we must vaccinate as quickly as possible with whichever vaccine is available.
By the way, in Serbia, there are four types of vaccines, and people are allowed to choose. They thought very few people would want to have the Chinese vaccine because of prejudices against China as a result of the pandemic, so they allocated a short time slot for when people should come to have it administered, and thousands still turned up. So really, those that want to be vaccinated just want to have the vaccine and feel safer.
So then how will it be decided who gets which vaccine?
It will simply depend on what is available at the time and place of vaccination.
It really makes very little difference which one you get, both to you and society as a whole.”
The only case where there might be a significant difference is that the Pfizer and Moderna vaccines seem to result in a similarly strong immune response among the elderly as among younger people, whereas the Chinese vaccine seems to be doing slightly worse at that. So if anything, older people might be prioritized when it comes to the mRNA vaccines. However, these are really very small nuances, and need not have much to do with our vaccination strategy.
I understand you have already been given the Pfizer vaccine, but if you could choose, which one would you vaccinate yourself with?
I really wouldn’t mind any of them. I am intrigued by the peptide vaccines, so if I could, I would have one of them. Alas, I cannot. None of the existing ones, by the way, have particularly strong side effects. Us medical workers have to get a lot of compulsory shots, and I have also been vaccinated against yellow fever, for instance, and that’s a shot that really puts you through the wringer. But if you have to get the shot, for your own sake and for the sake of those around you, you just do.
Do you agree with the government’s approach that if at least a million people were vaccinated in at least three countries with a particular vaccine with no significant issues, we are free to use it in Hungary? Is this a medically sound approach?
No, of course not. This was a populist announcement. It is of course true that thinking about it in a very straightforward manner, if a million people have been vaccinated with something and it all went fine, it is reasonable to assume that we can safely use that vaccine. Of course, that is not the official and proper way to go about it. The above five I mentioned that Hungary will be getting or have already been authorized for use in the country via the proper, appropriate procedures.
You mentioned that medical workers have to get compulsory shots all the time. Do you consider it responsible that some healthcare workers in Hungary choose not to vaccinate themselves, and yet are allowed to keep working in hospitals?
Firstly, I would say that I do not believe that there could be anyone who works on coronavirus cases and does not want the vaccine.
I find it hard to believe that any of those who see the suffering and devastation this virus causes first-hand would refuse the shot.
Yet, unfortunately, conspiracy theories, misinformation and disinformation regarding vaccines are spreading everywhere. There is nothing to say it cannot spread among medical staff as well. However, the vast majority of doctors and nurses will, and many have already received the vaccine.”
Given that willingness to vaccinate is exceptionally low amongst Hungarians, could we, and should we make the coronavirus vaccine compulsory?
We could, and a lot of people thought about doing so, but I do not believe we have to. There are, of course, compulsory vaccinations; several are compulsory for medical staff, some are compulsory for children, others have to be administered in certain parts of the world. Vaccinations are typically made compulsory when we can completely eradicate a disease. In 1977, no one was asked whether they wanted to be vaccinated against smallpox; everyone just was, and the disease disappeared. We could not necessarily do that with the novel coronavirus.
Moreover, even though willingness is relatively low overall, amongst the elderly, it is somewhere around 85%, meaning that those who are most exposed to the virus’s effects will mostly be protected. Young people often think they do not have to vaccinate, because they will mostly be fine, although I would mention that for no particular reason, in rare cases some completely healthy young people can suffer long-term negative effects or even die from COVID.
Therefore I would generally tell people to vaccinate, but it is not absolutely necessary for everyone; if enough people are vaccinated, the pandemic will be over, although the virus itself may stick around.”
Photos by Zita Merényi/Hungary Today