TRUE TO MY WORD

One of the front line health workers receiving his first dose of the COVID-19 vaccine at his local clinic.

One of the virtues that my late father passed on to me at a very tender age is to keep my promises to God and to people. He believed that a person could only be as good as his word.

Words have power and when you do what you promise no matter how much it may cost you, you become a reliable and dependable person.  On the 11 th December 2020, I posted an article on this blog entitled: I will gladly queue up to receive the new COVID-19 Vaccine.

By the time I wrote that post, the COVID -19 pandemic had raged on for nine months and vaccine research scientists, pharmaceutical companies and clinicians were working together round the clock to develop and launch COVID-19 vaccines in their attempt to return the world to a sense of normality.

By my Ganda culture, I was sounding the ‘’war drums’’ to mobilize each one of us to prepare for participation in the raging COVID-19 war. It had caught us unprepared and had grown to become the biggest threat to the world since the Spanish Flu pandemic of 1918-1919.

As the Director- General of the World Health Organisation, Tedros Adhanom Ghebreyesus rightly said: “We are not safe until everyone is safe.”

The war demands for collective efforts and collaborative partnerships at all fronts.

On 20^th March 2020, the President of Uganda declared the first lockdown in our country to prevent the spread of this new disease.

21^st March 2020, Uganda confirmed its first case in the country, a male Ugandan

 citizen returning from Dubai.

From the Johns Hopkins Corona Virus Resource Centre, as of the 23^rd March 2021, Uganda had reported 40,687 confirmed cases and 334 deaths while 123,778, 489 cases had been confirmed globally and 2,725,516 Deaths. We have all been touched by this COVID-19 disease in one way or another.

As a medical doctor, I have been all along reading scientific and medical journal articles to understand the COVID -19 disease to stay up-to-date on best practices. We are living in the Digital technology era and the management and control of the pandemic is driven by data.

By early November 2020, four vaccines had been developed. They included:  Pfizer-BioNTech, Moderna, OxfordUnivesrity /AstraZeneca, SputnikV and later the Chinese ones. In December 2020, WHO had approved  these  vaccines on an Emergency use authorization only.

On 8^th December 2020, the 90- year- old Margaret Keenan of UK became the first person in the world to be given the Pfizer/BioNTech COVID-19 vaccine. She received her second dose of the vaccine on the 29^th December 2020 and is still going strong.

On the 11^th March 2021 with the assistance of COVAX, WHO and UNICEF,

 Uganda’s ministry of health launched the COVID-19 vaccination campaign giving the first priority to the frontline health workers: doctors, nurses in government facilities around Kampala city

and some senior doctors from the most vulnerable part of our population. True to my word, I quickly seized the opportunity to be among the first 200 or so who received the Oxford University/Astra Zeneca vaccine at the Women’s hospital in Mulago, Kampala. It was an informed decision and thankfully I have not suffered any side effects.

I took it for the following reasons:

• From the available evidence-based medical literature, I am among the most vulnerable members of the population for the COVID- 19 disease. I am above 65 years of age. The cdc.gov website has co-related age and the risk of hospitalization and risk of death.

40-49 years of age have 3 times the risk of hospitalization and 10 times the risk of death.

50-64 years of age have 4 times the risk of hospitalization and 30 times the risk of death.

65-74 years of age have 5 times the risk of hospitalization and 90 times the risk of death.

75-84 years of age have 8 times the risk of hospitalization and 220 times the risk of death.

• WHO has approved the vaccine I was given as safe and effective. All pharmaceutical products have some side effects, they may not affect everybody and could be minor or temporary. But in medicine the focus is on weighing the benefits of the product against the risks. In the new Covid-19 vaccine, the benefits in the most vulnerable group of the population outweigh the risks. The vaccine has been found to reduce the risk of acquiring the infection, reduce the risk of developing the severe form of the disease requiring admission and care in the ICU and reducing the risk of death from the disease. The final outcome- the health workers and the health care systems are not overwhelmed by numbers and deaths from the disease are greatly reduced.
• A health worker of my standing has her own clientelle and followers who believe in her. Though she makes a purely individual choice to take the vaccine, it impacts and influences her group-

to take or not to take the vaccine. I had to take action. My conscience could not allow me to sit on the fence.

• The effect of COVID-19 on me personally. Like the majority of us, I have lost many relatives, colleagues, friends to the virus.

I lost a niece in Arizona, USA in June 2020, she had worked there as a nurse for over 25 years. In December 2020, I lost some friends here in Uganda. January 2021, I lost one of my best friends of many years Dr. Sarah Namuli Yiga of Bloemfontein, South Africa, followed by a classmate, Dr. David Ssenoga of Durban , South Africa, family friends: Mr. and Mrs. Mikka Sematimba whom we buried within a week of each other! On the 19^th March I buried a brother-in law, who died in London and the list keeps growing.

 These series of deaths have been emotionally and physically draining to me. Available scientific information tells me that the vaccine is safe and effective so I would rather take the vaccine other than allow myself to risk catching the disease and ending up in the ICU.

When at least 70-90 percent of our population is vaccinated against COVID -19 disease, we would have reached the level of Herd Immunity then we can control the pandemic.

It is crystal clear to me that the COVID-19 vaccine is not the solution to the COVID-19 pandemic and that I still have to follow the laid out health and safety rules  by the Ministry of Health:

Masking up in all public places and avoiding crowds.

Practicing regular good hand hygiene.

 Keeping physical distancing of 2 metres.

Being well informed about the disease.

Lastly I may also add eating nutritious foods, taking regular exercises and having regular sleep at night to boost the body’s immunity to fight infections.

Your health is your greatest wealth and it is your responsibility to safeguard it and to protect others in your community.

To help you understand how far we have come with vaccine-preventable diseases ( WHO has 28 on its list excluding COVID-19) I always use the example of the highly contagious and serious measles disease.

The measles vaccine was developed in USA in 1963 but was never widely available to poor countries like mine until around 1994 when WHO specifically developed and supported national Expanded Immunisation Programmes in the least developed countries of the world. By the time I undertook the Internship programme in 1978, at New Mulago, the only teaching hospital in the country, a minimum of ten children under the age of 5 were dying from measles. They were dying from its main complication –  Broncho Pneumonia, in the Acute paediatric admission department almost daily. My heart could not take it so I went into Internal Medicine instead.

Records from the Uganda Health Management Information System show that between 1999 and 2001, routine immunisation and massive Immunisation campaign for children aged 6 months to 5 years were consistent.

This paid dividends: the incidence of measles in this vulnerable group declined by 39 percent, measles admissions declined by 60 percent and the measles deaths declined by 63 percent. Currently, the Ugandan child receives her/his first dose of Measles combined with Mumps and Rubella vaccine(MMR) at 9  months of age and the second dose of MMR at 18 months of age. The vaccine uptake is yet to rise from 85 percent to reach the WHO requirement of 95 percent in any given population if we are to eradicate measles disease in the world. Botswana’s measles vaccine coverage was 93 percent in 2016.

Globally, between 2000-2018, routine measles vaccination had resulted in a 73 percent drop in measles deaths. Safe and effective vaccinations save lives.

Going by these historical developments, there was nothing to hold me from taking the COVID-19 vaccine unless if I had a serious contraindication. I would therefore urge each one of us to make the right informed decision based on scientific facts not Social Media half truths, fake new and misinformation.

Get the facts about the disease from the Uganda Ministry of Health website: http://www.health.go.ug and the WHO one: http://www.who.int/Diseases.

In this digital era, plenty of information is freely available but you have to decipher and you have to keep reading to keep up-to- date with new advances in science and medicine.

Knowledge is power only if applied to improve your quality of life otherwise it remains mere information.

For us the health workers, it is very encouraging to understand that anyone catching the COVID -19 disease today stands a high chance of recovering from it when compared to those who had it in the first 6 months of 2020 when the disease was completely new.

Scientific studies are putting the pathology of the disease together while the public health specialists are sharpening their skills in preventing the disease and the clinicians are gradually learning the best practices to help optimize patient outcomes.

‘’The best way forward is the blended comprehensive approach which puts containment as a major pillar.’’– Dr.Tedros Adhanom Gebreyesus. WHO director- general

Please do your small part perfectly that fits in this big picture.

QUESTION:

Has this post helped you make an informed decision about taking the new COVID-19 vaccine if you are in the most vulnerable group of the population?