Could a COVID-19 vaccine patch be better than injections?

According to a study in mice conducted by researchers at the University of Queensland and Griffith University in Australia, a vaccine administered via a skin patch could offer better protection against COVID-19 than those given via traditional needle injections.

The centimetre-wide (0.39 inch) patch contains 5,000 plastic spikes that are a quarter of a millimetre (0.009 inch) long. Each is coated with a dry version of the vaccine. Unlike the liquid form given in an injected vaccine, the dry version does not need to be stored at cold temperatures.

The researchers tested the skin patch with a COVID-19 vaccine candidate called HexaPro, which has been developed by researchers at the University of Texas at Austin. This vaccine is still undergoing clinical trials but has been shown to be more heat-stable than liquid vaccines. It remained stable for at least one month when stored on the patch at 25 degrees Celsius (77 Fahrenheit) and for one week when stored at 40C (104F). This makes it much more suitable for use in places without the cold storage facilities necessary for many liquid vaccines. It is also cheaper to manufacture than the existing approved vaccines.

According to the researchers, vaccines administered via a patch produced a better immune response because of the high density of immune cells on the surface of the skin. Mice treated with the patch developed more coronavirus antibodies than those injected with the vaccine and none showed any sign of sickness from the disease.

If these vaccines do eventually get the go-ahead, it will be music to the ears of those who are so needle-phobic that it has so far prevented them from taking up the COVID-19 vaccines.

Other advantages of this method of delivery include the ease of administering the vaccine, including the potential for self-delivery, or that it can be given by those who have no medical training. Unlike the Pfizer or AstraZeneca vaccines, the vaccine given as a patch does not have to be mixed or drawn up, and the fact that it can be stored at room temperature makes it easier to transport. The researchers also insist that it is painless.

The HexaPro is not the only vaccine being developed as a patch; Emergex, a UK company, has created a patch it says offers more long-lasting immunity than regular COVID-19 vaccinations. According to Robin Cohen, the chief commercial officer at Emergex Vaccines, their skin patch vaccine elicits high levels of T-cell immune cells that are important for long-lasting immunity and preventing transmission of the disease.

Emergex vaccines have been designed to be administered via the skin using microneedles and to be stable at ambient room temperature for more than three months, facilitating rapid and efficient distribution across the world and making administration of the vaccine more patient-friendly. The company is due to start Phase1 trials in 13 volunteers in Switzerland soon.

If these vaccines do eventually get the go-ahead, it will be music to the ears of those who are so needle-phobic that it has so far prevented them from taking up the COVID-19 vaccines.

Good news: Pfizer to allow developing countries to make its COVID-19 pill

The start of November saw pharmaceutical giant Pfizer announce the results of its trial for paxlovid, its experimental COVID-19 pill. According to its own trial results, which are yet to be peer-reviewed, the pill reduced the risk of hospitalisation or death by 89 percent compared with a placebo in non-hospitalised high-risk adults with COVID-19.

Less than two weeks after it announced this, Pfizer released a statement saying it had signed an agreement with the Medicines Patent Pool (MPP) which could make the treatment available to 53 percent of the world’s population. The MPP is a United Nations-backed public health organisation working to increase access to life-saving medicines for low- and middle-income countries.

[Jawahir Al-Naimi/Al Jazeera]

The agreement will enable MPP to facilitate additional production and distribution of the investigational antiviral, pending regulatory authorisation or approval, by granting sub-licenses to qualified generic medicine manufacturers, with the goal of improving access to the pill. Pfizer will not receive royalties on sales in low-income countries and will waive royalties on sales in all countries covered by the agreement while COVID-19 remains classified as a Public Health Emergency of International Concern by the World Health Organization (WHO).

If the trial results are corroborated, then the pill – designed to be taken by individuals who have tested positive for COVID-19 and have a higher risk of worsening symptoms because of underlying health conditions or weakened immune systems – could help reduce the effect on healthcare systems in low- and middle-income countries.

There has been much criticism over the inequalities in access to COVID-19 treatments and vaccines. Wealthy countries have ordered – and in some cases hoarded – vaccines at the expense of poorer countries who are lagging behind in their vaccination programmes. Many developing nations are relying on charitable donations for their vaccines. Pfizer and other pharmaceutical companies have also pushed back against calls to lift patents on their COVID-19 jabs. So while this announcement is good news, there is much more that could be done, and while the deal with the MPP includes many countries in Africa and Asia, but countries such as Brazil, Argentina and Thailand, which have experienced significant outbreaks, are not part of it.

In October, pharmaceutical company Merck, announced a similar deal with the MPP to allow manufacturers to produce its own COVID-19 pill, molnupiravir.

Progress report: Rising rates of COVID-19 infections across Europe

Last week, UK Prime Minister Boris Johnson called a news conference to encourage people more than 40 to take up their COVID-19 booster jabs. He warned about rising coronavirus rates in mainland Europe – which are being described as a “fourth wave” – and said the UK needed to protect itself.

“Storm clouds that are gathering over the continent. A new wave of COVID has steadily swept through central Europe … We don’t yet know the extent to which this new wave will wash up on our shores, but history shows we cannot afford to be complacent,” he said.

With the exception of Russia, the UK has had more deaths from the virus than any other European country and still has high rates of infections.

Many argued that the prime minister’s speech was his way of deflecting responsibility for the rising numbers of infections across the country since mandatory social distancing measures and mask-wearing in indoor public spaces were removed in the summer.

Many scientists and doctors across the UK, myself included, have repeatedly warned that not enough is being done to curb the spread of COVID-19. Simple measures such as mask-wearing in public indoor spaces and adequate air filtration and ventilation in schools and crowded workspaces would have reduced the spread of the virus while people were being given boosters.

The government has so far said there is no need for another lockdown but has referred to “Plan B” measures it has on standby, which include mask-wearing, COVID-19 passports and advice to work from home. Plan B is being kept in reserve should cases, hospitalisations and deaths rise to “unacceptable” levels, the government said. But what these “unacceptable” levels remain a mystery.

[Jawahir Al-Naimi/Al Jazeera]

Despite all this, the prime minister did get one thing right: cases are rising in mainland Europe – and even though the reasons for these increases may differ from the UK’s, some countries are also implementing their own equivalents of a Plan B.

Germany is in the grip of a surge in coronavirus infections, with a record 68,366 cases on November 17. The country’s leaders have announced tighter restrictions for the unvaccinated, including banning them from restaurants, sporting venues and concerts. To protect the most vulnerable, they also agreed to introduce compulsory vaccinations for healthcare workers and employees in homes for the elderly. Unvaccinated people will also be banned from public areas in those parts of Germany where COVID-19-related hospital admissions are particularly high; these already include Hamburg, Lower Saxony, Schleswig-Holstein and Saarland.

Unlike the UK, which has high levels of double-vaccinated people, Germany’s vaccination rates are relatively low, with only 68 percent of the population fully vaccinated. The situation is worst in Saxony, where just 57.6 percent of the population is double jabbed. The ruling parties are hoping these newly imposed restrictions will encourage those who have not yet had the vaccines to come forward for them.

Parts of Austria are also seeing a surge in new coronavirus infections and after an initial introduction of tough new restrictions for the unvaccinated, the country has now announced a full lockdown for all. The measures will continue until December 12 but will be reassessed after 10 days. Austria too has a low vaccine uptake rate with only 66 percent of the population having had both doses of the vaccines. Austria’s federal government announced it would impose mandatory nationwide COVID-19 vaccinations from February 2022 onwards. Unsurprisingly, this caused an uproar among vocal anti-vaxxer groups, with protests against the measures in Vienna soon after the announcements.

In Prague in the Czech Republic, thousands of protesters also took to the streets to denounce the new restrictions that came into force there for unvaccinated people. The Czech government is introducing restrictions on those yet to receive the shots, banning them from public events, bars and restaurants from November 22, in a bid to drive up vaccination rates. The country has struggled with its vaccination programme, lagging behind its neighbours; as a result, it is now recording high rates of infections.

The Netherlands, Italy and Croatia also saw protesters gathering in the streets, some turning violent as they demonstrated their anger over what they feel are curbs on their “freedom”.

The next month will be critical in Europe. How governments act now will determine where this next phase in the pandemic will take us.

There is certainly a worrying picture developing in both mainland Europe and the UK as they again become the epicentre of the pandemic. Europe is grappling with low vaccine rates which cannot be tackled by restricting the unvaccinated alone.

We must target the misinformation that feeds into peoples’ fear about the vaccines; social media sites have a role to play in policing the content they allow to be shared and factual education from trusted sources must be promoted.

Vaccines cannot be relied upon alone, it has to be a multi-faceted approach. Mask wearing and better ventilation in indoor spaces are key to reducing the spread of this airborne virus. This is the part that has let the UK down; although it has a high vaccine rate it has all but abandoned other measures and is paying the price. High rates in the UK are most likely driven by a lack of mask-wearing, social distancing and ventilation as well as ambiguous messaging from the central government which continues to tell the public to use “common sense” rather than mandating measures that would reduce the spread of the virus and undoubtedly save lives.

The next month will be critical in Europe. How governments act now will determine where this next phase in the pandemic will take us.

Personal account: A complaint from a patient

I received a written complaint from a patient this week – my first in over five years. I take pride in having such low numbers of complaints from patients, but I knew this one was coming – the patient told me as much as he walked out the door, also saying he had sent a copy of his complaint to MP Sajid Javid, the health secretary for England.

The letter detailed how I had asked the patient to wear a face-covering in my clinic and said I had refused to see him unless he did so. To be honest, this was true.

We have a policy at the surgery: all people attending must wear a face-covering unless medically exempt. We, of course, have access to their medical records and know who is medically exempt. This particular patient was not.

He entered the clinic without a face covering and shouted at the receptionist when she asked him to wear one in the waiting room, which was filled with vulnerable people. When I went to call him from the waiting area, I offered him a free mask that we keep at the front desk. He told me he knew his rights and did not have to wear one if he did not want to. I explained to him that many of the people in the clinic were vulnerable and that we had a duty of care to them.

He agreed about the medical reasoning but still refused to wear a mask. His decision put my patients – including him – at risk, so I had to make a decision too. I told him he was welcome to stay and discuss his medical complaint, but only if he wore a mask; if he chose not to, I would not be able to see him.

He realised I was serious, so after a pause, he took the mask and put it on – making a point of writing my name down and telling me to expect a complaint. The consultation went rather well, I thought. He left with a diagnosis and management plan for his ailment, and I thought we had resolved our differences. I was wrong. Two weeks later, the written complaint arrived and now I must waste time that could be spent with patients penning a response to it.

[Jawahir Al-Naimi/Al Jazeera]

I see almost 50 people a day in my clinic room, ranging from the elderly to newborn babies. I often see pregnant women and those with underlying conditions that make them more vulnerable to infectious diseases. I keep my window open at all times (despite it being cold here in the UK) to improve ventilation, and I wear a face covering the entire time I am there, which is usually about 12 hours. I do this to keep my patients, my staff and myself safe.

I understand that some people have medical reasons for not wearing masks – such as respiratory conditions that affect breathing – and I make exemptions for them. But for other patients, I ask them to wear a mask for the 10 to 15 minutes that they are in my room. Face coverings, along with other measures, can reduce the risk of passing on the virus to others and reduce the amount of the disease circulating in the air. The last thing I want is my room to become a hub of infection, causing illness and potential death to my vulnerable patients. That is why I insist that those who can wear a mask, do.

Reader’s question: Are we likely to see another lockdown over Christmas?

Christmas is around the corner and many people are looking forward to having friends and family over to share in the festive fun. This year, Christmas is especially poignant as winter COVID-19 restrictions in the northern hemisphere last year meant household gatherings were limited. People, I know are really looking forward to Christmas with the family this year and feel they have worked through the pandemic to allow for this.

However, in the northern hemisphere, winter has once coincided with rising numbers of coronavirus infections. Restrictions are coming back into place in a bid to drive infection numbers down and vaccination rates up in time for Christmas. There is a lot of focus on encouraging people to get vaccinated.

While vaccines are no doubt the most important way to protect ourselves against COVID-19, we cannot rely on that alone to save Christmas. We must look at other protective factors too: indoor environments, including schools, remain largely inadequately ventilated; this has to change to reduce the spread of disease. Mask wearing needs to be enforced again in indoor public spaces and people need to be reminded to socially distance themselves. These may all feel like backwards steps, but they are a small price to pay if we wish to spend some of the holiday period with people from outside of our households.

The fight against this virus is not over. And if we look at it through the lens of a war metaphor, vaccinations would be our general, but ventilation, masks, hand washing and social distancing are the all-important foot soldiers.

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