Month: January 2021

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Do the vaccines actually work?

Do the vaccines actually work?

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Short answer: Yes they do and the results are available in the detailed Phase III trial data produced by the three companies in the last two months.

Long answer: Moderna & Pfizer/BioNtech vaccines have similar efficacy whilst AstraZeneca has less efficacy but pricing & storage/effective delivery becomes an important factor in deciding which vaccine is best for which country.

Click here for our previous blog on Busting the Vaccine Myths

Pfizer/BioNTech

A two dose vaccine with the second dose to be administered 28 days after the first dose. Study data showed a 95% efficacy rate 7 days after the second dose with efficacy in adults over age of 65 at an excellent 94%. The final analysis was to be done at 164 case mark but instead they were able to surpass and hit the 170 case mark (due to the prevalence of COVID19). 170 people enrolled in the trial contracted COVID19 – when called back, it turns out 162 were from the placebo arm compared to 8 in the vaccine arm.

Approved by the FDA and the EU for emergency use, Pfizer/BioNtech vaccine has been deployed since early December in countries across the world. Due to the sensitivity of the mRNA vaccine compound, the vaccine requires storage at -70C to prevent denaturing of the key compound and rendering the vaccine vials useless. As such, cold storage supply chains are being developed around the world to safeguard against denaturation in transit. Given the freezing temperatures required, the costs associated with deep freeze supply chain equipment and the precision with which the vaccine must be administered post vial opening, this particular vaccine deployment may be difficult to execute in south asian countries such as Sri Lanka.

Moderna

Another two dose vaccine with the second dose administered 28 days after the first. Data showed a 94.1% efficacy rate 7 days after the second dose. Final analysis happened at the 196 case mark with 185 cases in the placebo group and 11 in the vaccine group. Interestingly, the analysis included 30 severe cases of COVID19 – all of which were in the placebo group and none in the vaccine group heralding this vaccine as better at preventing severe outcomes of the disease.

The vaccine can be stored at -20C (normal refrigeration temperatures) for up to six months making them more friendlier to tropical countries and eliminating the heavy investment into logistics that may be required of Pfizer/BioNtech. Given the novel nature of the mRNA vaccines, those who administer the vaccine need to work in a timely and efficient manner to avoid wastage and may require upskilling of existing healthcare staff to ensure the same.

AstraZeneca

Earlier created to be a two dose vaccine, a mistake during one part of the trial resulted in a surprising finding that administering half a dose first and then a full dose second resulted in 90% efficacy vs. 62% efficacy in those getting the two full doses. However, only 2,700 persons were administered the “mistaken” dosage and this requires further study. This leaves AstraZeneca as the vaccine candidate with the least efficacy when compared to the two mRNA vaccine options. Results were based on a 131 case mark with 30 in the control group and 11 in the vaccine group contracting the virus.

AstraZeneca remains the cheapest vaccine at GBP 3/dose and can be stored at room temperature (like most other existing vaccines) allowing health workers to work in a familiar setting.

If you are questioning which vaccine should you take: given what is known of COVID19 (its rapid spread, its attack on the respiratory and vascular systems of the body, long COVID afflicting patients six months post initial recovery and the fatality rate), all of these vaccines appear as attractive alternate options.

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Vaccines: Busting the myths and laying out the science

Vaccines: Busting the myths and laying out the science

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Close to a year into the pandemic, vaccines seem to be on everyone’s mind. It is nothing short of a tremendous feat that we now have not just one but three approved vaccine candidates either already deployed or preparing to be deployed around the world. Taking into context the standard vaccine (or drug) development timeline of ca. 5-10 years, it speaks to the brilliant abilities of scientists when able to work singularly towards one goal, have the funding available and the political will in place for science to succeed.
However this dichotomy of the “usual” vaccine timeframe and the 10 month COVID19 vaccine development timeframe has resulted in some murmurs of mistrust in certain sections of society across the world. Furthermore, the advent of the mRNA vaccines and the novel technology associated with it compared to previous vaccine platforms have also contributed to the same. Vaccines are the predominant method by which we can tackle this pandemic which is now stepping into its 2nd year. If we are to have any hope of getting back to a “normalcy” and saving millions of lives, widespread immunity through vaccine inoculation is essential. As such, we at oDoc have prepared a short primer to address your most pressing questions about the COVID19 vaccines currently available.

Part 1: were the vaccines rushed?

Short answer: no safety steps were cut.

Long answer: The drug development process is made up of several steps: 1) a preclinical trial 2) a clinical trial which is broken down into a) Phase I b) Phase II and c) Phase III.

Preclinical stage is about deciding on the desired effect of the drug and getting initial information on its efficacy and safety. The vaccine candidate is tested inside test tubes (in vitro) and in animals (in vivo). Of 100 drugs tested usually only about 32 moves to the next stage. That’s a high level of failure so it’s often hard to find financing for this phase.

The three phases of the clinical stage have different objectives. Phase 1 is about assessing the safety and tolerability of the drug in a small group of healthy people (usually has a 75.1% success rate). Phase 2 is designed to test efficacy of the drug and continue safety testing in a larger group of people (this has a 50% success rate). 

Finally, Phase 3 which follows the gold standard format of trials, the randomised control trial with a large group of volunteers (ca. A few thousands usually but in the 40-50,000 range for the COVID19 vaccines) split into a placebo or control group and the vaccine candidate group. These trials are expensive, time consuming and difficult to run and aim to evaluate the risk-benefit of the drug across a cross section of the target population. 

None of these steps were cut for any of the COVID19 vaccines. As it’s a pandemic and this disease is everywhere and because there is political & economic will to develop a vaccine – there were plenty of volunteers ready to be enrolled into trials and plenty of funds ready to be invested into the process. Both of which resulted in a rapid development process and enabled the deployment of the vaccines for emergency use as early as January 2021. If anything, we can be encouraged that if the money & interest were there, science could move much faster than it currently does.

Part 2, do the vaccines work and are they safe?

Short answer: Detailed studies taking place over ca. 9-10 months have shown them to be safe and effective in the fight against COVID19. Not only did the authorised vaccines reduce the chance of falling sick from COVID19 but they all seem to prevent death and hospitalisation! 

Important to note that none of the vaccines injects COVID19 into the body. No major reactions were seen in the trials since April 2020 or in the 200 million vaccinations made in the real world since December 2020. Minor side effects from vaccines occur very soon after vaccinations, these include injection site pain, fever, chills and end after a few days. We cover these extensively in our articles Three Reasons Why Vaccines are Safe and 200 Million Doses Later, How Have the Vaccines Fared in the Real World.

Long answer:

AstraZeneca

The Oxford vaccine (as it’s commonly referred to) is an adenovirus based vaccine however it was earlier developed and tested for a variety of diseases including on Ebola (2014) and Zika (2016). Those trials weren’t successful at fighting disease but helped researchers test the safety of the vaccine. 

ChAdOx1 was then adapted to COVID19, early clinical trials had safety issues and moved to Phase I trials in early April. Phase II/III trials began in August in four countries: UK, Brazil and South Africa and final results were published in November. In total, ca. 23,000 participants were enrolled in the study. 

AstraZeneca is a 2 dose vaccine, given 28 days apart but now studies show that a 12 week break may increase vaccine effectiveness. The vaccine provides 76% protection after 1st dose, and 82% after 2nd dose (with a 12 week break). It’s shown to prevent deaths and hospitalisation by 100% and even may lower the chance of you infecting other people! Furthermore, it can be stored at normal fridge temperatures making handling it easier for those of us in the tropics. 

Against the UK variant, this vaccine shows 71.4% efficacy after two doses but against the more infectious South African variant, it’s down to 22% (albeit not a large and varied trial).

Pfizer/BioNTech

As mRNA technology is highly customisable, BioNtech developed 20 candidates for early stage research as soon as Chinese laboratories released the genetic sequences of Sars-Cov-2 in Jan 2020. 

As shown in the timeline below, they then teamed up with Pfizer and began Phase I and II trials simultaneously. The results were reviewed by the FDA, it then moved the best performer to Phase II / III trials  enrolling 44,000 people across US, Germany, Turkey, South Africa and Brazil. They then met the objective in November 2020 and conducted safety and efficacy assessments on over 38,000 people that took part in the trials. 

Pfizer/BioNTech is a 2 dose vaccine, given 28 days apart and is shown to reduce the chance of getting sick from COVID19 by 94% (i.e. vaccine efficacy is 94% after 2nd dose). It needs to be stored at -70C making it an expensive and difficult option for tropical countries such as Sri Lanka.

Moderna

The Moderna vaccine, mRNA-1273, is also based on mRNA technology. The short list of vaccine candidates was ready to enter into the research process by January 16th, an amazing 2 days after the Chinese laboratory released the genetic sequence but long before the first cases were detected in the US. Phase I trials began in mid-March with Phase II & III running concurrently from end July with 30,000 participants in the US. 

Moderna is also a 2 dose vaccine, given 28 days apart, reducing the chance of developing COVID19 symptoms by 94%. It also requires cold storage but around -20C which makes it the better mRNA vaccine for Sri Lanka. 

Novavax

This vaccine, NVX-CoV2373 is also 2 doses (beginning to sound familiar) 28 days apart however this is a protein subunit vaccine. That means it injects a lab made version of the outer shell (spike proteins) of the Sars-CoV-2 virus. This vaccine method is used in existing vaccines like the flu vaccines, HPV and Hepatitis B vaccines. Novavax Phase 3 trials spanned multiple countries and enrolled 30,000 people – none of whom had a serious reaction to the vaccine. 

Its UK trial showed that its 89.3% effective at preventing COVID19 symptoms and its South African trial showed a 60% reduced risk against the South African variant. The Novavax vaccine is another suitable candidate for Sri Lanka given its ability to be stored at 2 to 8C. 

Part 4: Do the vaccines alter my DNA?

Short answer: None of the vaccines alter your DNA. mRNA doesn’t hang around in your body for long and disintegrates after a certain short time period and as such are safer than traditional vaccines. The four main vaccines discussed here only allows your body to recreate the outer shell of the virus (a dummy version!) so your body can arm itself against it. When the real thing comes, the body is able to attack it faster now that it knows what the dummy looks like. 

Long answer: The aim of a vaccine is to teach the body how to recognise the virus. When a virus infects you, it enters into your cells and uses your cells to create more versions of itself. If your immune system can’t catch it early, all havoc breaks loose. Vaccines just give your immune system a blueprint of what to expect so it can prepare itself. 

  • None of the vaccines carries the entire viral structure. Much like our blueprint is our DNA, the virus blueprint is its DNA or RNA. We simply recreate an artificial part of this blueprint to help the body build the outer shell of the virus (or the spike proteins). Human equivalent would be to use your DNA to only recreate your skin. 

  • mRNA creates proteins, it doesn’t create DNA. When mRNA vaccines enter your cells, it releases the mRNA. The mRNA does not enter into the nucleus where your DNA is hosted. Helpers called ribosomes come alongside the mRNA strands and like construction workers laying brick after brick following an architect’s blueprint – starts to assemble the spike proteins or dummy outer shell of the virus. 

  • The spike proteins do not cause any harm on their own because they don’t have the ability to replicate. That ability lies within the virus’ RNA or DNA and we didn’t recreate that. The spike proteins are sent to the cell surface and held out (like waving a flag from a window) or released into the bloodstream. 

  • Vaccines help our immune system arm up against a potential intruder. Our immune system recognises Sars-Cov-2 via the spike protein. By sending some “placebo” spike proteins we give them an early chance to get prepared. Immune cells are usually patrolling around looking for potential intruders. When these sentries come across the spike proteins, they launch an immune response. 

  • All four vaccines activate both arms of our immune system: the innate and acquired arm. Once the immune system recognises the intruder, it will start to create antibodies to fight against it and more importantly, activate memory cells that will remember this knowledge for a time period. 

Want to know if the vaccines are safe? Read the next blog! 

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தொற்றுப் பரவலின் போது ஊழியர்களை பாதுகாப்பதற்காக வரையறைகளற்ற வைத்திய ஆலோசனைகளை வழங்கும் oDoc

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நாட்டில் சுகாதார பராமரிப்பு app ஐ அறிமுகம் செய்த முதல் நிறுவனமான oDoc, நாட்டின் வியாபார ஸ்தாபனங்களுக்கும் நிறுவனங்களுக்கும் வழங்கும் உயர்தர ஒன்லைன் சுகாதார பராமரிப்பு சேவைகளை வழங்குவதை மேம்படுத்தியுள்ளது.

வியாபாரங்கள் மற்றும் கூட்டாண்மை நிறுவனங்களை இலக்காகக் கொண்டு oDoc இனால் வியாபார சேவைகளுக்கு வழங்கப்படும் சேவையினூடாக ஊழியர் ஒருவருக்கும் அவரின் 3 குடும்ப அங்கத்தவர்களும் வரையறைகள்ள மருத்துவ ஆலோசனைகளைப் பெற்றுக் கொள்வதற்காக மாதாந்தம் 60 ரூபாய் எனும் குறைந்த கட்டணத்தை வழங்குகின்றது. ஹேஷான் பெர்னான்டோ வைத்தியர். ஜனக விக்ரமசிங்க சொஹான் தர்மராஜா மற்றும் கீத் டி அல்விஸ் ஆகியோர் இணைந்து 2017 ஆம் ஆண்டு நிறுவியிருந்த oDoc, படிப்படியாக வளர்ச்சியடைந்துரூபவ் 200,000 க்கும் அதிகமான பாவனையாளர்களை தன்வசம் கொண்டுள்ளது. இதனூடாக அதன் நம்பத்தகுந்த சேவை மட்டம் மேலும் உறுதி செய்யப்பட்டுள்ளது. கொவிட்-19 தொற்றுப் பரவல் ஆரம்பித்ததைத் தொடர்ந்து இந்த சேவையின் பெறுமதி மேலும் உணரப்பட்டிருந்ததுடன் புதிய பாவனையாளர்கள் பதிவுகளில் 474% அதிகரிப்பு வைத்திய ஆலோசனைகளில் 296% அதிகரிப்பு மருந்துப் பொருட்கள் ஓடர் செய்வதில் 107% அதிகரிப்பு மற்றும் B2B வருமானத்தில் ஒட்டு மொத்தமாக 100% அதிகரிப்பு பதிவாகியிருந்தது.

இணை ஸ்தாபகரும் பிரதம நிறைவேற்று அதிகாரியுமான ஹேஷான் பெர்னான்டோ கருத்துத் தெரிவிக்கையில், ´சுகாதார பராமரிப்பு சேவைகளை இலகுவாக பெற்றுக் கொள்வது, சகாயத்தன்மை மற்றும் பிரத்தியேகத்தன்மை ஆகியவற்றை அடிப்படையாகக் கொண்டு ஆரம்பித்த எமது செயற்பாடுகளை இன்றைய காலகட்டத்தில் மக்களுக்கு மிகவும் பயனுள்ள வகையில் முன்னெடுக்கின்றோம். இதுவரையில் தமது ஊழியர்களுக்கு அனுகூலங்களைப் பெற்றுக் கொடுக்கும் நோக்கில், எம்முடன் 65 நிறுவனங்கள் கைகோர்த்துள்ளன. அதில் AIA insurance, HNB, Crystal Martin மற்றும் Brandix போன்றன சிலவாகும்.´ என்றார்.

ஹேஷான் மேலும் தெரிவிக்கையில், ´ஆர்வமுள்ள சுகாதார பராமரிப்பு துறையைச் சேர்ந்தவர்களிடமிருந்து கடந்த சில மாதங்களில் குறிப்பிடத்தக்களவு அதிகரிப்பை நாம் அவதானித்திருந்தோம். தமது ஊழியர்களின் மருத்துவ தேவைகளை நிவர்த்தி செய்வதற்காகரூபவ் பல நிறுவனங்கள் மற்றும் தொழிற்சாலைகள் இந்தச் சேவையுடன் தம்மைப் பதிவு செய்துள்ளன. இது தற்போது மிகவும் முக்கியத்துவம் வாய்ந்த தேவையாக அமைந்துள்ளது. கூட்டாண்மை நிறுவனங்களின் பாரிய சொத்தாக திகழும் ஊழியர்களின் நலனில் அவை முதலிடுகின்றன.´ என்றார்.

பல்வேறு தொழிற்சாலைகளில் காணப்படும் மருத்துவ அல்லது சுகயீனமுற்றோருக்கான ஓய்வு அறைகளில் oDoc app செயற்படுத்தப்பட்ட tab போன்ற டிஜிட்டல் சாதனங்களை நிறுவும் விசேட ஏற்பாடுகளை oDoc மேற்கொண்டுள்ளது. களத்தில் oDoc வசதியை பயன்படுத்துவதற்கு தாதியர்கள் பயிற்றுவிக்கப்பட்டுள்ளதுடன், அதன் பிரகாரம், ஊழியர்களின் சுகாதார தேவைகளை நிறைவேற்றுவதற்கான பயிற்சிகளும் வழங்கப்பட்டுள்ளன. நிறுவனங்களில் பணியாற்றும் ஊழியர்களுக்கு தமது ஸ்மார்ட் சாதனங்களில் app ஐ பதிவிறக்கம் செய்து இந்தச் சேவையை பயன்படுத்த முடியும். எமது 42% ஆன செயலிலுள்ள b2bபாவனையாளர்கள் இந்தத் தொற்றுப் பரவலின் போது தம்மைப் பதிவு செய்து கொண்டவர்களாவர்.

இலங்கையில் காணப்படும் முதல்தர சுகாதாரப் பராமரிப்பு app ஆக oDoc அமைந்துள்ளதுடன் 1000 க்கும் அதிகமான SLMC, இல் பதிவு செய்யப்பட்ட வைத்தியர்கள் 60 க்கும் அதிகமான விசேட சிகிச்சைகளுக்கான தயார்நிலையிலுள்ள வைத்தியர்களை அணுகும் வசதியை வாரத்தின் ஏழு நாட்களிலும் எந்நேரத்திலும் 3 நிமிடங்களினுள் வழங்குகின்றது. வைத்தியர் ஆலோசனைகளை எந்தவித மேலதிக கட்டணங்களுமின்றி நிறுவனசார் பாவனையாளர்கள் தெரிவு செய்து கொள்ள முடியும். இந்தச் சேவையை பெற்றுக் கொள்வதற்குரூபவ் மாதாந்தம் 15000 ரூபாய் எனும் அடிப்படைக் கட்டணத்தில் வருடமொன்றுக்கு நிறுவனங்கள் தம்மைப் பதிவு செய்து கொள்ள வேண்டும். நாட்டின் எல்லைப் பகுதிகளுக்கு அப்பாலும் இதன் செயற்பாடுகள் விஸ்தரிக்கப்பட்டுள்ளதுடன், இந்தியா, மாலைதீவுகள் மற்றும் கம்போடியா போன்ற நாடுகளில் பெற்றுக் கொள்ளலாம்.

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oDoc provides online healthcare services to Organisations

oDoc provides online healthcare services to organisations

oDoc, one of the first companies to launch a healthcare app in Sri Lanka, has taken the venture one step further offering premium online healthcare services to organisations and business establishments in the country.

Specifically targeted at businesses and corporates, oDoc for business provides companies the facility to subscribe for healthcare advice at a minimal monthly cost of Rs.60 per employee granting them access to unlimited medical consultations for the employee and three family members.

Co-Founder and CEO, Heshan Fernando, said, “We were driven with the intention of making healthcare easily accessible, affordable and truly personal and put our shoulder to the wheel to drive this initiative to what it is today. Thus far we have over 65 corporates who have signed up with us to obtain this service for the benefit of their employees.

“We saw a marked increase in interest in healthcare during the past few months. Many organisations and factories have signed up for this facility to attend to their employees’ medical needs. It has become the need of the hour. Corporates are investing in the wellbeing of the employees who are their largest asset,” he said.

oDoc has also made arrangements to install digital devices such as tabs supported with the oDoc app in the medical or sick rooms at various factories. The on-site nurses are trained to use oDoc and attend to the needs of the workers. In the instance of corporate organisations, employees are able to download the app onto their smart devices and access the services.

View Article on Sunday Observer

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oDoc provides unlimited consultations to protect employees during the pandemic ​

oDoc provides unlimited consultations to protect employees during the pandemic

oDoc, the first company to launch a healthcare app in Sri Lanka, has revolutionised the industry by taking the venture one step further and offering premium online healthcare services to organisations and business establishments in the country.

Specifically targeted at businesses and corporates, oDoc for business is a service which will provide companies the facility to subscribe for healthcare advice at a minimal monthly cost of Rs. 60 per employee granting them access to unlimited medical consultations for the employee plus three family members, the company said in a media release.

Founded in 2017 by Heshan Fernando, Dr Janaka Wickremasinghe, Sohan Dharmaraja and Keith de Alwis, oDoc has grown exponentially acquiring over 200,000 active users.  The venture proved its worth during the recent outbreak of the COVID-19 pandemic, where there was an impressive 474% increase in new user registrations, 296% increase in doctor consultations, 107% increase in medicine orders and an overall 100% increase in B2B revenue.

View Article on Sunday Times

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