Are We Ready For Covid – 19 Vaccines? – A General Side Effects Overview

A vaccine is considered to be one of the best options in public health safety, specifically when there is no effective vaccine available against that infectious disease. Classic vaccine development often takes years, but developing a vaccine for the prevention of Covid19 has turned out to be a race between viruses and humans, and along with the identification of other similar strains has made it more difficult. COVID19 has serious and life-threatening complications and no one knows how COVID19 is affecting. Firstly vaccines are given to health care workers in public and private. The vaccine is first given to one crore healthcare workers around India working in both government and private hospitals according to the recommendation by NEGVAC. It is mandatory to monitor the patient for the next 15 minutes after taking the Covid 19 Vaccine shot. Most of the side effects occur within the next 3 days after vaccination. If someone has a history of allergic reactions which is not related to vaccines or injectable medications, they can still take Covid 19 Vaccine. If someone getting an immediate allergic reaction after getting the first dose of Covid 19 Vaccine, then he/she should not take the second dose of the vaccine. Even though the vaccination strategy throughout the globe is in peak, the people are asked to follow the similar guidelines to prevent the transmission of corona virus. Therefore throughout the world, several ministries of health and family welfare have asked people to maintain social distancing, wearing facemasks in public, using hand sanitizers, washing hands, avoid crowded places and maintain personal hygiene.

range of symptoms like cough, fatigue, fever, and shortness of breath. 3,4 Patients with severe pneumonia have other complications like changes in the heart and liver function, acute respiratory distress syndrome, or other consequences of the disease, which could further cause multiple organ failures and finally death. 5 Vaccines are responsible for saving millions of patients every year. The body's defenses (the immune system) are prepared and trained by the vaccines. These natural defenses identify and fight off the viruses and other germs they target. The body will instantly destroy them as soon as it gets exposed to the disease-causing viruses and bacteria, thus preventing illness. 6 A vaccine is considered to be one of the best options in public health safety, specifically when there is no effective vaccine available against that infectious disease. 6 Classic vaccine development often takes years, but developing a vaccine for the prevention of Covid-19 has turned out to be a race between viruses and humans, and along with the identification of other similar strains has made it more difficult. Numerous platforms are trying their hands in development, among which the DNA and RNA based platforms are at greatest potential, followed by recombinant-subunit vaccines. 7 Several countries have joined this battle of vaccine development and have speed up the process of clinical trials and is trying to develop an effective and harmless vaccine against Covid-19. 8 The various approaches for the development of vaccine includes both next-generation techniques and traditional methods. In the early days, usually vaccines consist of less virulent (but still immunogenic), inactive whole virus, or subunits of viruses. Live vaccines are not included in the prevention of Covid-19 for safety purposes, whereas inactive whole virus vaccines have been taken into account. 9

Methodology:
This review has analyzed the data collected from various articles, guidelines, healthcare sector organization's strategies to promote and improve the pre and post vaccination strategies and to improve the healthcare system overall.

Vaccination Strategies in Different Countries:
Europe  The main objective of vaccination strategy depends on saving the life, reducing mortality, and reducing pressure on the healthcare system.
 The prioritization mainly depends on the features and characteristics of the vaccine, particularly its effectiveness against infection and further ahead transmission.  If the vaccination dose does not protect against the transmission, the most efficient and effective method is to hierarchize the vaccination of the groups which are at the highest risk of severe disease and death.  Substantially reducing the mortality and pressure on the healthcare system might be achieved by direct protection of groups that are at high risk, even if the transmission of the virus is going on within the population.  Vaccination to the health workers is very much beneficial as it improves the healthcare system's resilience. The advantage would be more if a vaccine was more effective against infection and thus transmission, indirect protection to patients and other high-risk individuals.  Though vaccinating adults with the age group of 18-59 years is not the most efficient or effective strategy when the supply of vaccine is limited, specific groups must be considered or the groups which are at the high risk of exposure.  Regarding the COVID-19 vaccine development of the characteristics uptake and supply, to escape variants from the future appearance, interventions of nonpharmaceuticals which should be applied and continued, as it is recommended by the public health authorities in the initial months of following the introduction of the COVID-19 vaccination.  Vaccination ideas or strategies should be adapted over time to unfold events that are taken into the account in emerging evidence. 10 The Government is negotiating strongly to build a portfolio that is diversified to vaccines for European citizens at fair and less prices.

US
Presently, 3 million doses of corona vaccine had been shipped throughout the United States with an equal number and the second dose is held back to maintain the sufficient supply. In the US the priority is given mainly for the first dose to more people as possible, relatively than stressing the second dose. 16 In the first phase all healthcare workers and first responders, in the second phase people who are the underlying condition that put them to the high risk of severe COVID-19 disease, in the third phase to all essential service workers at high risk of exposure, school staff, teachers, older adults who have not been treated for their symptoms, people who are homeless, and in prisons. In phase 4 young adults, children, and essential workers, and in the fifth phase, all the residents will get vaccinated. 17

China
In China, there are certain categories to receive the vaccine which include health care sector workers, workers who help in delivery, public servants, people whose jobs require overseas travel, and utility employees. Recently it got updated that 73,500 people received the first vaccine dose in the first two days of 2021. In-state media of China reported that more than 200 vaccinated sites were placed in the city of Beijing alone. 18 The new information has been released that China's center for Disease Control collected the blood samples from 4.43% of Wuhan's population contained corona antibodies which indicates that the city of infection rate is far higher than originally acknowledged. 18  In clinical trials, reactogenicity symptoms (side effects that happen within 7 days of getting vaccinated) were common but were mostly mild to moderate. Side effects (such as fever, chills, tiredness, and headache) throughout the body were more common after the second dose of the vaccine. Most side effects were mild to moderate. However, a small number of people had severe side effects that affected their ability to do daily activities 22 .

How Covid 19 are vaccines being distributed in India?
Due to the limited availability of the Covid 19 vaccine, everyone will not be able to get the vaccine.
The ACIP (Advisory Committee on Immunization Practices) has advised that in the 1 st phase of the trial Covid 19 vaccine should be given to healthcare workers and adult residents for longterm care.
The next precedence group includes people whose age is 75 or more than that and frontline essential workers.
The next priority group includes people ages 65 -74 and 16 -64 that are at high risk of severe Covid 19 due to immune-compromised status. 21

Who should not get the Covid 19 vaccine in India?
The Covid 19 vaccine which is available in the market is not meant for children under age 16.
The Central government of India has prepared one list of people who should not be vaccinated (Covid 19).
1. People having a history of anaphylactic or allergic reactions should not take a Vaccine.
2. Pregnant women or who are not sure about their pregnancy and lactating mother should not take the vaccine.
3. Covid 19 patients who have been treated with anti-sars-Cov-2 monoclonal antibodies or coalescent plasma should not take the vaccine.
4. Those who are hospitalized due to any sickness should not take vaccine. 23

Different Kinds of Covid-19 Vaccines Available
In India.

Sputnik vaccine:
It is the world's first registered vaccine against Covid 19, Based on a well-studied human Adenoviral vector-based platform.
Efficacy for this vaccine was found to be 91.4%, by Gamaleya Research Institute of Epidemiology and microbiology. Sputnik vaccine was registered in the market on 11 August 2020.
The result of Phase 1 & 2 studies of this vaccine was published on 4 th September 2020. The result of Phase 3 trials was published in December 2020 in which around 22714 participants have participated. The result of phase 3 trials claims that this vaccine has 91.4% efficacy.
After the respective trials, the possible adverse effects were reported like Muscle pain, Weakness, Headache. 24

Covaxin vaccine:
This vaccine was developed by Bharath biotech. On Nov-16, 2020 Bharat biotech started its phase 3 trial. On December 1, 2020, this vaccine got approval for emergency use. The number of participants in the phase 3 clinical trial was around 26,000. The result of phase 3 trials claims that 62% effective against Covid-19 After the respective trials, the possible adverse effects were reported like severe allergic reactions, headache, dizziness. 25

Covishield:
This vaccine is India's first indigenous Covid-19 Vaccine. Covishield vaccine was manufactured by the University of Oxford, AstraZeneca. The result of various trials claims that it is having around 78.8% efficacy towards corona.
It is a 2-dose vaccination regimen, which is given 28 days apart.
A common side effect that was reported after trials are Headache, Nausea, Muscle pain.
There are some uncommon side effect which was reported during trials, those are Enlarged lymph nodes, Abdominal Pain, Excessive sweating. 26

Pfizer vaccine:
The U.S. Food and Drug Administration on December 11, 2020, issued the 1 st emergency use authorization (EUA) for the prevention of Covid 19.
It is known as BNT162b2 in the market. This vaccine was manufactured by Pfizer, INC, and BioNTech. It is an mRNA type of vaccine. The results of trials show that this vaccine is having 52% efficacy after 1 st dose and 95% efficacy after 2 nd dose.
After the respective trials, the possible adverse effects were reported like Pain swelling, redness in the arm where the shot has been taken. 27

Comorbid Strategy
This would be the "impetus stage" of the vaccine roll-out and would cover about 15 percent of the U.S. population in total. It would be divided into two parts: Phase 1a groups include: High-risk workers in health care facilities and first responders.
Phase 1b groups includes: people of all ages groups with underlying and comorbid conditions putting them at considerably higher risk. It also includes elderly people living in congested and overcrowded localities.
Although experts couldn't make sure which underlying conditions put people at a considerably high risk of COVID-19 or death, the U.S. Centers for Disease Control experts still is gathering information regarding this topic, per the paper. The following are the list of factors associated with an increased risk of severe COVID-19: Cancer, Chronic kidney disease, Chronic obstructive pulmonary disease (COPD), Immune compromised state from solid organ transplant, Obesity (body mass index [BMI] ≥ 30), Serious heart conditions (e.g. heart failure, coronary artery disease, cardiomyopathies), Sickle cell diabetes, Type 2 diabetes.
However, it would be uncontrollable to vaccinate all patients with any of the listed conditions in Phase 1b, in the meantime millions of individuals in the United States would be involved. Therefore, the initial groups of recipients are needed to be restricted to those with two or more of that comorbid conditions. 28 "It should be noted that as the relationship between severe COVID-19 disease and certain comorbid conditions becomes clearer, this list is subject to evolve," write the authors.
They go on to add that about 75 percent of adults hospitalized for COVID-19 in the United States from March 1 to August 15 had at least two comorbid conditions, and more than 60 percent had at least three underlying conditions, per Coronavirus Disease 2019 (COVID-19) Associated Hospitalization Surveillance Network (COVID-NET) data. 28 Phase 2: This phase covers an approximately 30 to 35 percent of the American population. Estimated 45 to 50 percent of the population are covered in combined phase 1 and phase 2. It also includes critical risk workers (those who are both in industries vital for running the society are at considerably high risk of exposure), teachers and school staff, also people of all age groups with comorbid and underlying illnesses that put them at moderately high risk, people in group homes and homeless shelters with disabilities or in recovery, and people in, jails, detention centers, prisons or any other similar facilities, and staffs working in such facilities.
In this phase, peoples with any one of the above listed conditions in Phase 1b would be able to get the vaccine. The authors noted that other comorbid and underlying conditions might be included for this phase as more research is being done. 29 For instance, the CDC has a list of comorbid and underlying conditions that might place individuals at increased risk and that could possibly be considered for this phase: Asthma (moderate to severe), Cerebrovascular disease, Cystic fibrosis, Hypertension, Immune compromised state from blood or bone marrow transplant, Immune deficiencies, HIV/AIDS, Use of corticosteroids or use of other immunosuppressive medicines, Neurologic conditions, Liver disease, Pregnancy, Pulmonary fibrosis, Smoking, Thalassemia and, Type 1 diabetes.
Approximately 12 percent of adults hospitalized for COVID-19 in the United States between March 1 and August 15 of this year had one select comorbid or underlying condition, per the COVID-NET data.
At this interval, the authors noted that they cannot precisely estimate the number of individuals in this group of population since they can't interpret for those with multiple co-morbid conditions in Phase 1b, but it would include tens millions of people. 29 In the meantime, the older adult population included in this group for study is assessed to include over 49.2 million older adults, if "older adults" is reflected people age 65 and older. (However, the authors write that they submit to the Advisory Committee on Immunization Practices to assess the specific age guidelines as more health and vaccine data are available). 29 "The case fatality proportion for COVID-19 is substantially higher among older adults in the United States, and the rate of hospitalization for COVID-19 increases with age," note the authors. Given the high risk of disease and death due to COVID-19 outbreak among older adults of peoples group, one could debate that age is an indispensible condition for COVID-19. 28,29 Conclusion: Global efforts in development of coronavirus vaccine is at a peek acceleration and hopefully the likelihood of the present vaccines and under developing vaccines will be safe and effective for all age group people. However, this vital landmark is only the first step in an equally vital challenge: to vaccinate the majority of global population. The sole to any success policy is to reestablish trust in the objectivity of vaccine and the honesty in approval procedure. 30 Even though the vaccination strategy throughout the globe is in peak, the people are asked to follow the similar guidelines to prevent the transmission of corona virus. Therefore throughout the world, several ministries of health and family welfare have asked people to maintain social distancing, wearing facemasks in public, using hand sanitizers,