By Jaymie White Local Journalism Initiative Reporter WEST COAST — With the beginning of every school year comes flu season. Unfortunately, there is no way to completely avoid the sicknesses that come along with it, but there are ways to protect yourselves and your loved ones, including those who are immuno-compromised. Ajit Johal, founder and CEO of Immunize.io, which is a Canadian not-for-profit organization dedicated to improving community and global immunization rates, wants the public to understand the importance of getting vaccinated against COVID-19, RSV, and influenza this fall to avoid the ‘triple-demic’. “The triple-demic is three viral respiratory diseases, so that is COVID-19, influenza and RSV, also known as respiratory syncytial virus. Obviously, we're all familiar with COVID-19, which came on the scene in March of 2020. Influenza is something we know about because obviously we get seasonal influenza vaccinations that have been going on for decades, and RSV, respiratory syncytial virus, has also been a very prominent respiratory pathogen,” said Johal. “It's typically understood to be a terrible disease for newborn infants in the first year of life, but it also affects older adults as well, especially those with underlying medical conditions. So the triple-demic really refers to the trifecta of respiratory diseases that will be circulating in higher quantities, especially in the fall, winter months.” It's important to remain cognizant of which one is more prevalent at any given time during the year. “Just with seasonal patterns, we can all expect cases of all three will be higher. It's tough to predict which one will be the most predominant, so we will have to see, I think, with better surveillance and better testing, which we have, especially in hospitals now, with the advent of COVID-19, we'll be able to tease out which one is putting people in hospital the most,” said Johal. Mutations may crop up, meaning that numerous vaccines will have to be developed to better match the additional strains. “A lot of people are wondering what is the strain in the current vaccine, how did it come about, what am I getting, and is this the best match to what's out there? So the way I like to explain is the COVID virus has mutated and evolved quite a bit since it first arrived in March of 2020. Each viral evolution can potentially lead to three things. The first one is what we call increased virulence and that's a really bad thing. That means the virus actually makes people really sick and causes more people in hospital, and if it becomes more virulent, more young and healthy people might show up in hospital,” said Johal. “But more typically, what we've seen is the virus is more transmissible, so it is easier to spread. People get it more often. And the other one is immuno-evasiveness, and immuno-evasiveness is a really important one because immuno-evasiveness means that even if you've had vaccines and you've had COVID, your antibody response, that you're firing up when you see this new immuno-evasive strain might not be able to neutralize it as well. It might be able to replicate and do things and make you really sick. So to better match immuno-evasiveness, the current vaccine is being deployed this fall season, so most provinces and territories are doing it during the flu season. And as I always say, and as the chief Medical Health Officer of Canada says, it's recommended to get both vaccines at the same time. There's no issue with safety or side effects.” When COVID first arrived in Newfoundland and Labrador, individuals and families showed up in droves to get their first dose of the vaccine. Others were skeptical, especially since the vaccines were rolled out relatively quickly. “There's, of course, patients and individuals who are eager to get vaccinated. They understand their risk, they understand the importance of maintaining their immunity and obviously protecting themselves and others from this communicable disease, but there is elements of what we call a vaccine fatigue,” said Johal. "I think when COVID-19 hit the scene, it was extremely impactful. It grinded the world to a standstill. Lockdowns, etcetera, were not easy on anybody, and then when the vaccines first came out, obviously we had high vaccination rates and a lot of people thought it was going to be a one and done. But in reality, when we look at seasonal diseases like COVID-19, even though it's no longer a pandemic, it's still an endemic disease, and the best analogy we can give it is influenza. In 1918, it came out on the scene, the Spanish flu, and we vaccinated against that every year, and the difference is in 1918 we didn't start rolling out seasonal influenza vaccination until after World War II in the late 40’s and the 50’s. Here we have the ability to do seasonal COVID immunizations very quickly and that'll reduce a lot of strain on our (healthcare) system, as well as death.” While skepticism is expected and understood, Johal cannot stress enough the importance of continuing to get vaccinated. “I think the big sort of skepticism, it came from the fast deployment of them and there's a number of reasons why they were available so quickly. The main one is global cooperation and money. There's a lot of stages in vaccine development that we often don't think about that delay traditional vaccines and that includes building plants, facilities to produce it, even making vials, and that was all done ahead of time, so that saved a lot of unnecessary delay because we needed the vaccine to fight the virus in our population,” said Johal. “We've seen the impact of the vaccination both from an effectiveness and a safety perspective. So from an effectiveness perspective, as soon as vaccines rolled out, we saw hospitalizations and rates of infection decline, as well as the phenomenon known as post COVID condition, also known as long COVID. The impact of post COVID conditions and the terrible long-term effects from the disease that people are still experiencing who had this condition was more prominent before vaccine was available. So we've seen the impact of vaccine from a number of avenues and it's important to note that with waning immunity and viral mutation and evolution, it's important to restore our immunity to best protect us each season.” Johal explained that the safety of the vaccines is not an issue. “In terms of safety, the safety of vaccinations has been extensively monitored, so it was proven to be safe in well-designed randomized controlled trials, and then after the vaccines were rolled out, it was extensively studied across the globe, and it's very closely monitored,” said Johal. “So any adverse event or safety issue that's seen as healthcare professionals and Health Canada, it's all documented. So any safety signals are very closely investigated and this type of safety surveillance is more robust than any other therapy or medical treatment because vaccines are given to healthy people. So we want to make sure that they benefit from the intervention and there's no harm.” One prevailing argument is whether or not natural immunity outweighs the benefits of immunity obtained by receiving a vaccine, but that’s not the case. “There's actually benefits to both types of immunity. There's vaccine induced immunity where you get an MRNA vaccine or a protein-based vaccine and your body makes antibodies to that specific target, and that's a very targeted immunity. It's to the spike protein of the virus, and that's something that it's important for our body to recognize because that's what drives what we call pathogenesis,” explained Johal. “That's what really drives it to replicate in our body, so that's a very good type of immunity to have. When you actually get the actual disease, you do also make antibodies to other parts of the virus. So that could be like the spike protein, it could be to other proteins and things like that. That one typically isn't as good because it's not as focused and it doesn't give your body that long-lasting ability to recognize it. But having both the vaccine and getting the disease gives you something called hybrid immunity, which is actually better than either one alone because you've got the benefits of both worlds. But I always explain to people the benefits of having hybrid immunity is you don't have to pay the price of the actual infection.” Even if an individual is immunocompromised, that shouldn’t stop them from getting vaccinated. “There's a lot of patients who might be immuno-compromised and they should definitely get vaccinated. They might not mount as good of an immune response, so that's why it's important for those around them to also be vaccinated because it has been shown that those who are vaccinated shed less virus for less period of time. Also a large European study in Belgium showed that those who were updated on their vaccines were able to reduce transmission to households and close contacts versus those who were unvaccinated, and those what we call ‘partially vaccinated’ where they're not updated and they haven't had a vaccine in the past six months,” said Johal. “One particular population that we always worry about is those receiving stem cell transplants and that typically is in the oncology space. So those individuals, because they have hematological malignancies and they undergo a stem cell transplant, it takes about a good three months at least for them to build up a decent immune system and they can't get vaccinated until three months after that, and that's a really critical time where everyone around them needs to be vaccinated — patient, family, caregivers, friends, family. If you feel like you're at risk or immunocompromised, definitely talk to your doctor or pharmacist because in most cases it's highly recommended you get vaccinated. And then just to cocoon your effect, your protection, make sure those around you also recommend that they get vaccinated as well.”
Jaymie White, Local Journalism Initiative Reporter, Wreckhouse Weekly News
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