I have resisted the urge to react to the lacklustre petition put forward by eight “concerned” doctors to the president of Ghana. 

However, as a doctor and public health researcher, I am perturbed about the damaging effects that will likely culminate from the misrepresentation and the selective use of data by the concerned doctors.  

Their write-up is full of inaccurate data reporting. Most of their sources do not pass the litmus test of full scientific rigour. The issue of COVID-19 and vaccinations are easily tied to people's doctrines and moralistic views. 

Psychologists define "motivated reasoning" as the potential for people to accept evidence that aligns with their existing beliefs. Even renowned scientists are not immune from falling into the pitfalls of faith vs. science. This apparent conflict is demonstrated in the write-up by my colleagues. However, they failed to declare the other commonality between them but hid behind their professional title to propagate their agenda.

At first glance, I hoped the petitioners would stick to vaccine mandates' ethical and legal framework. However, they completely veered off into arguments made by hardcore anti-vaxxers (Continue reading).  

Our individual biases are the reason why there are mechanisms to ensure there is minimal impact on the scientific process. Faith leaders effectively encourage vaccinations and have the potential to also lead people astray.  

Unfortunately, vulnerable people and politicians will use the petitioner's unscientific write-up to justify their erroneous stance on the COVID-19 vaccine.  

I will not pretend to be an expert in the field of vaccinology or even public health policy. However,  as a medical doctor with little training in public health, epidemiological research, and pharmacoepidemiology has compelled me to respond to the contents of the petition.  I am by this medium addressing some of the conspicuously unscientific misrepresentations in their write-up and not the ethical and legal aspects of vaccine mandates. 

Main Red Flag

References/Sources used by the Petitioners:

Evidence-based practice is the cornerstone for contemporary medicine and public health. The hierarchical system of evidence classification was described in 1979 and has since been a critical component of clinical, public health, and health policy recommendations.  

The strongest form of evidence upon which therapeutic and policy-making decisions can be made is a systematic review of randomized control trials. At the far end of the spectrum, the weakest level of evidence is expert opinions, ideas, and anecdotal (based on stories of people’s experiences) evidence. In between are cross-sectional studies and other observational studies. 

The peer-review process is a quality control mechanism that ensures that scientific discoveries are sound, original, valid, and devoid of personal beliefs as much as possible. Discoveries in science have implications for society as such peer-reviewed publications are scrutinized by other independent researchers before they are accepted as scientifically sound. 

Worrying observation:

The petitioners failed to cite a single reference that qualifies as high-level evidence. Most of their sources were, at best, non-peer-reviewed publications, opinions, commentaries and websites of known conspiracy theorists. I was particularly concerned that my fellow colleagues will use information from known conspiracy theorists. The same website published an article in the early stages of the pandemic claiming that the pandemic was a hoax. In 2016, the same website claimed that Diphtheria, Tetanus, and Pertussis vaccine (DTap) caused a medical condition in children called microcephaly (baby's head is much smaller than expected). This website cited by the petitioners has been fact-checked multiple times. It is rather unfortunate that my colleagues will resort to a website long known to be spreading misinformation about vaccines. The motive of the petitioners is very clear when they rely on information from a perennial conspiracy theory-laden website. 

The most striking reference that got me disturbed is from ChildHealthdefense.org. An organization chaired by the famous conspiracy theorists, who claimed the COVID-19 vaccine is the deadliest ever made. The activist group is known for its anti-vaccine activities. It has been identified as one of the main sources of misinformation on vaccines.

The group has been fighting against proven public health interventions such as childhood immunizations and even fluoridation of drinking water 1, 2, 3, 4. 

Watch this: How a Kennedy built an anti-vaccine juggernaut amid COVID-19

Now let’s look at the issues they raised

1. The necessity of the vaccine: 

The petitioners suggest that the COVID19 vaccine is unnecessary because the case fatality rate is low. They further introduced the issue of Hydroxychloroquine and Ivermectin as alternatives to the vaccine. 

      My response: The case fatality ratio (CFR) measures the likelihood of death from a particular disease. It is highly dependent on the number of confirmed cases and confirmed mortality from COVID-19. In the case of COVID-19, the case fatality ratio may not reflect the risk of death because it may likely overestimate or underestimate the probability of death. Not everyone who needs a test gets tested, and not all Covid-19 mortalities are recorded, especially in our setting. So, it will be erroneous to recommend the stoppage of a therapeutic intervention based on the CFR. Another consideration is that in an ongoing outbreak, those who are currently sick and are counted as cases may eventually die from the disease. So, in the early stages of an outbreak, CFR will likely be underestimated but increases as the disease take its course.

Another erroneous impression is that the petitioners suggest that the burden of COVI-19 infection is depicted by case fatalities/death alone. However, the impact of covid-19 goes beyond disease mortality. Increased hospitalizations, ICU bed exhaustion, loss of productivity, and long-term consequences from covid-19 infection are among the reasons why the covid-19 vaccine is necessary. The Korle-bu Teaching Hospital and other hospitals in the country had to close their doors to the public because of COVID-19. Additionally, the impact of nation-wide stay at home orders, effects on children education, and the mental health problems created by COVID-19 has been documented in a recent report by UNICEF. The collateral damage caused by covid-19 makes it imperative to utilize all the scientific measures in tackling COVID-19. 

Hydroxychloroquine and Ivermectin: I sincerely hoped we had gone past this, especially among health professionals who are supposed to know better. The petitioners went back to the argument common among conspiracy theorists and anti-vaxxers about using unproven therapies in the treatment against COVID-19. However, their write-up failed to provide a single reference that claims these medications offer therapeutic benefits.

Many systematic reviews and randomized controlled trials which are the pre-requisites in making therapeutic recommendations, has shown that Hydroxychloroquine showed no clinical benefit as pre or post-exposure prophylaxis or treatment. Similarly, high-level evidence studies have shown that Ivermectin did not significantly improve COVID-19 symptoms.

Additionally, a randomized, double-blind placebo-controlled trial showed that patients who received Ivermectin required mechanical ventilatory support earlier in their treatment

2. Efficacy

In a bid to justify their stance against the covid-19 vaccine, the petitioners stated that the vaccine had not achieved its intended purpose of preventing transmission and spread. Also mentioned is that it is false that the vaccine reduces hospitalizations and death. They buttressed these assertions by misinterpreting data reported by known anti-vaxxers. 

My response:  As a reminder, no vaccine is 100% effective. This means that even if you are fully vaccinated, you can still get infected. A breakthrough infection does not mean that vaccines are not effective. The primary endpoint of the COVID-19 vaccine trial was never to prevent infection transmission or spread. Instead, it was meant to mainly reduce the incidence of symptomatic disease, hospitalization, and death. see mRNA, AstraZeneca, J & J. Multiple results from real-world evidence have shown that the Covid-19 vaccine is highly effective against the development of severe disease, hospitalizations, and death

The petitioners further reference an article vermonchronicles indicating that 76% of the 33 patients who died from COVID-19 were vaccinated.  However, they failed to put this number into the specific context of the populations and their vaccination rate. They deliberately ignored the fact that the majority of those that died (19/33) were elderly and among the first vaccinated (waning immunity).  

Additionally, 88% of the population were fully vaccinated, so infections will likely include those vaccinated.  The health department spokesperson stressed that the findings indicate that the vaccines are highly effective. Boosters have become necessary over time due to declining immunity and the emergence of different variants.  Boosters have equally been shown to be effective against variants. 

3. Safety 

Finally, the petitioners indicated that because of some vaccine adverse effects.  The harm of vaccination outweighs the potential benefits. 

My response: - The bottom line is that the covid-19 vaccine has been demonstrated to be safe. Every therapeutic intervention has side effects, including paracetamol. Because everyone is built differently, it is expected that our body’s reaction to the vaccine or any medication for that matter will be different. While some people never develop any reaction after the vaccine, some may develop severe adverse events. Common side effects like headaches, tiredness, and muscle pains are expected.   

Serious adverse events are rare. The petitioners consistently misrepresent the Vaccine Adverse Events Reporting System (VAERS) data. However, there are clear limitations on how that information can be used to make scientific arguments because reporting is voluntary and subject to biases. Additionally, Individual reports to the VAERS may be merely coincidental and not necessarily causal. This is a typical case of "association is not causation". 

 Serious adverse events like anaphylaxis, blood clots, Myocarditis are infrequent. Fifty-seven people out of more than 17.7 million doses of J & J were confirmed to have gotten blood clots.

Three cases of blood clots have been reported to VAERS after nearly 496 million doses of the mRNA vaccine were administered. The rest of the rare adverse events show similar trends in terms of incidence/occurrence. Considerable evidence has shown that the vaccines are safe, contrary to what the petitioners are reporting. 

Conclusion:

 I tried to stay away from the issue of vaccine mandates and instead stick to the unscientific component of their petition. No one ever said that vaccination alone is the way out of this pandemic.  

The emergence of variants and the subsequent waning of immunity emphasizes the need for measures like masking, social distancing, and personal hygiene to fight against this pandemic.  

The recommendation made by the petitioners to the president to quit the vaccination roll-out is not based on any high-quality evidence, but rather it's based on personal beliefs. 

*****

Dr. Banda A, Khalifa is a doctor and public health researcher. He is an MPH and MBA holder from the Johns Hopkins Bloomberg School of Public Health. He is also a Public Health Physician and an FAA Certified Aviation Medical Examiner.