In a candid “Ask Paul Anything” session livestreamed on his Facebook page, Professor Paul Tambyah (Prof. Tambyah) who is currently the Chairman of the Singapore Democratic Party as well as a doctor and professor of infectious diseases, answered a whole host of audience questions on COVID-19 and its vaccinations.
In a nutshell, Prof. Tambyah provided reassurance to those who were apprehensive to the vaccine and also shed light on aspects of the coronavirus that the layman may not understand. He also touched on the pitfalls of the over-commercialisation of science and medical care.
Prof. Tambyah explained the science behind how mRNA vaccines work. For those unaware, this is a new type of vaccine that has been rolled out to combat COVID-19. The Pfizer vaccine is one of them. Unlike previous vaccines which put a weakened or inactivated germ into our bodies (like the Sinovac and Sinopharm vaccines), the mRNA vaccine teaches our cells how to make the protein that triggers an immune response inside our bodies. That immune response, which produces antibodies, is what protects people from getting infected if the real virus enters our bodies.
In relation to how long he thought the effects of the vaccination would last, Prof. Tambyah was of the opinion that it could last for up to between 8-10 years although he stressed that there was currently not enough data to state this conclusively. He did however say that the coronavirus did not mutate as quickly as the flu virus.
Prof. Tambyah was also asked if vaccines should be mixed. “For example, if my first dose was from Pfizer, can my second dose be from another company?” asked the question. Prof. Tambyah clarified that at present, there is only one type of vaccine available in Singapore so that was a moot point. However, there was currently no research to show the effects of taking different vaccines and that there would not be any research on this for a long time because the research was undertaken by different private companies and no companies would want to fund research about the efficacy of a competitor’s product.
In explaining the risk period between test dates, Prof. Tambyah provided this analogy. If a person took a test on Monday which was negative and another test on Friday that was positive, it would mean that the person could have been contagious from Tuesday to Friday depending on when he or she actually became positive. If the person became positive on Tuesday and one came into contact with them then one might be exposed whereas if the person only became positive on Friday after one came into contact with them on Tuesday then one should be fine. But for the days in between tests, one would not actually know and that does remain a risk. Prof. Tambyah also reminded Singaporeans to seek medical treatment if they developed flu-like symptoms if they did not have a history of allergies or if they did have a history of allergies and self-medication does not work after a day or if they lose their sense of smell, taste or both.
Prof. Tambyah also explained why test patients should not smoke or drink and eat for at least 30 minutes before a COVID test. One should not smoke because the heat from smoking would kill the virus and the cells near the surface and could create a false negative because the COVID virus could be below the cells and undetected by the test. One should not eat or drink because if the food or drink has not properly gone down, the swab could cause a gag reflex which could cause choking.
When queried on whether the vaccines were reliable, Tamnyah pointed out that the science behind the vaccines was not completely new given that they were based on SARs research. The SARs research only came to a standstill because SARs was no longer a threat. The COVID vaccines were therefore not formulated from ground zero.
Prof. Tambyah stressed the importance of washing and sanitising hands, using masks and social distancing even after taking the vaccines because while the vaccines reduce the risk of the virus, it was not foolproof. Its efficacy depends on the situation. For example, if one works in Changi Airport and come into contact with lots of people or if one fails to utilise PPE properly, one will be at higher risk even post-vaccination.
Further, Tamyah clarified that research has shown that the vaccine is still effective against the new strains of the virus and that people should still take the vaccine despite new strains.
In relation to whether pregnant women should take the vaccine, Prof. Tambyah said that there was insufficient data to conclusively say. As for nursing women, he said that it is currently recommended that women throw out the milk for the first 5 days post-vaccine. Thereafter, they should resume breastfeeding as such antibodies could be passed on to the baby.
When queried about the potential side effects and whether the set up of the compensation fund was the Government’s way of admitting that the vaccine might have long term side effects, Prof. Tambyah explained the history of why there is a compensation fund in the first place. He said that out of the over 100,000 people vaccinated, only 4 developed severe allergic reactions to date and that the Government was very cautious about who it gave vaccinations to.
In relation to the compensation fund, Prof. Tambyah explained that this was a requirement of the vaccine manufacturers because it was a question of risk. The vaccine is given to healthy people to prevent them from catching a disease that they may or may not get. It is different from treatment for a disease that a patient is already suffering. For example, a cancer patient will undergo chemotherapy despite the risk of its side effects because he or she wanted to be rid of cancer. This is very different from a healthy person taking a preventative measure. In 1976, the US thought that they would have a Swine flu pandemic and started a vaccination process. No swine flu outbreak took place and a rare side effect from the vaccination did occur which led to a lawsuit against the manufacturer of the vaccine. The US government took over the liability of such a lawsuit because if it didn’t, no manufacturer would ever take the risk of manufacturing vaccines again.
In setting this out, Prof. Tambyah switched hats from doctor to SDP Chairman and highlighted the problems with the privatisation of medical care. He used the analogy of defence. A country would never outsource its defence to many different private companies so why are Singapore and many other countries doing this for healthcare?
Apart from the high-level scientific questions, Prof. Tambyah was also quizzed on what he thought was the worst-case scenario and what was the best-case scenario. Ever the optimist, Prof. Tambyah said that the best-case scenario was the vaccination programme to be rolled out globally and for the virus to eventually disappear just like polio in the 1950s. Mass vaccination eradicated Polio in a few years and there have been no cases of Polio in Singapore for over 40 years. The worst-case scenario could be if the vaccine programme was not rolled out properly and that its side effects caused more damage than the disease such as the Dengue vaccine.
As for global travel, Prof. Tambyah is of the opinion that vaccination certificates could apply by the end of the year. For example, one would not be allowed into a certain country if you did not have a certificate to prove that you have taken the COVID vaccine. This is already happening for diseases such as Yellow fever where certain countries will not allow you to enter the country unless you have had the vaccination. In a similar vein, Saudi Arabia requires all pilgrims on Hajj or Umrah regardless of age to be vaccinated against meningitis before he or she is allowed to enter the country.
There will be a follow up of “Ask Paul Anything” on 9 February at 8pm here.