Turkish specialist explains COVID-19 vaccines

By Duygu Yener

ANKARA (AA) – A Health Ministry’s Coronavirus Science Committee member said Friday the first applications of a vaccine that is to arrive in Turkey next week can be applied Dec. 25-26 because of a 14-day testing period.

Humanity is in a race to find a cure for the deathly virus and important steps have been taken in vaccine studies that are regarded as the hope to end the pandemic.

Turkish scientists continue to also study vaccines. But claims about the vaccine are on the public’s agenda. The qualities and safety of the COVID-19 vaccine developed by China’s SinoVac firm, set to arrive in Turkey around Dec. 11, are also in question.

Dr. Ates Kara from Hacettepe University Medical School in Ankara spoke with Anadolu Agency about the qualities and effects of the vaccine planned to be applied across Turkey as well as questions on other studies.

Anadolu Agency (AA): How many types of vaccines are there?

Ates Kara (AK): There are live and inactive vaccines. We can make some microorganisms lazy and weaken some of them, thus decreasing their capacity to cause illnesses. More precisely, they are completely destroyed or they can survive. Survive where? In a proper environment. When the environment is damaged, they can die. These are live vaccines.

AA: What are the advantages of live vaccines?

AK: As the vaccine tries to multiply itself and moves in the human body even if given only one dose, our defense system recognizes it immediately. The body identifies it as foreign and enemy and responds dramatically. It almost becomes protective for a lifetime. While weakening the microorganisms, we ask them this: What do you want as microorganisms? Their primary purpose is to reproduce. The moment we provide them the food they want, they start reproducing speedily. This way, they lose the things they do not need or regard necessary in time, as they become a burden. What is that? The capacity to cause diseases in us. They lose it and weaken. And we apply them as live vaccines.

AA: What is an inactive vaccine?

AK: We cannot weaken some organisms. Whatever we do, they maintain their capacity to cause diseases. In this case, we inject dead microorganisms, which we call inactive. What we basically want when we inject them dead is that it does not have the capacity to cause diseases but they will be recognized by the defense system of the body, our immunity system will learn and respond to them.

As the microorganism moves when we inject them alive, the immunity system recognizes it very well and responds strongly. Applying the vaccine only once suffices. The problem when we inject it dead is that it does not move, it is dead. The body sees it but sometimes does not recognize it. In that case, it becomes necessary to apply a few doses of the vaccine. That is why we take three doses of the vaccines during our childhood. Killing the microorganism and injecting it into the human body after making sure that it will not harm the human body in any way is a technology that we know and apply widely since Louis Pasteur. The problem here is that you first meet to produce the microorganism, and then kill it. To be able to produce enough doses of the vaccine, it is a problem.

Can you recognize a human if we show you only the head? Yes. In inactive vaccines, we inject only the necessary parts by producing them in an outside environment. In viruses and in us, the whole information is written in a code. What if we give the coded part, and our body produces that code? The immunity of our body recognizes and responds to it. We either kill the whole virus, inject and introduce it or give the information that produces it to the human body. The part that we call as information is mRNA. It is produced and responded to in the human body. In inactive vaccines, we inject the virus in a completely dead state.

Two vaccines are at the forefront in Turkey these days. AstraZeneca's vaccine that they developed with Oxford University places this code in another virus and enables our body to produce it, rather than giving it directly. All three of these are inactive vaccines but in one we inject the whole microorganism, we give the information as mRNA directly in another, and we place the mRNA in another virus, another microorganism and apply it to be produced in the human body in the other.

AA: What is the most important difference between an inactive vaccine and mRNA?

AK: The most important disadvantage of the inactive vaccine is that its production is difficult and expensive. Because it needs to be produced in large quantities. You need to kill it and then make it a vaccine. Creating an environment where you produce large quantities of a virus is difficult and very expensive.

The technology of mRNA vaccine is completed but it is easy to produce. That is the difference. Therefore the mRNA vaccine and the vaccines carrying the virus have the cost-wise advantage.

AA: What are the criteria while evaluating the vaccines?

AK: Our first wish is to obtain the vaccine as early as possible. And our main criterion has to be safety. In a general perspective, an inactive vaccine seems to be the most advantageous as we have been using it for years, we know the technology, and we inject it dead. mRNA vaccine is easy to produce, and we see that it may respond better in terms of technology. It is not a vaccine that we are used to so far. It is a new technology. It is necessary that its data must be crystal clear in terms of safety.

We should not consider vaccines as medicines. Vaccines are examined very much and in great detail. Because they are applied to healthy individuals. We need to be sure that it does not have any effects not only today but in three months, six months or a year either. The number of deaths is increasing in Turkey nowadays and it is probable that it will continue to be high in the coming period, so we need to make the vaccine accessible. Therefore, Turkey is negotiating with all the producers. In the next step, the vaccine must be very safe or you need to stand where you can be sure of its safety in some way. Then you need to look at effectiveness.

AA: In the light of all this information, how safe are the vaccines?

AK: The World Health Organization said a vaccine will be approved if it is even 50% effective. In a period of a pandemic like this, the more success you attain when you apply the vaccine, the better. The data that we have obtained and the information received from researchers show that the effectiveness of these vaccines is around 90%. Our number one criterion must be safety. Our country takes action considering soppy and safety.

AA: How will the reliability of the vaccines that will come be tested?

AK: Turkey is negotiating with all vaccine producers. In the first place, there is an inactive vaccine whose supply is guaranteed. There is also an mRNA vaccine. The date and time of arrival of the inactive vaccine are certain. The negotiations for the mRNA vaccine are currently ongoing. We are trying to provide them as much as possible, too. The security side is as important as quick supply. Turkey has not said clearly stated any decision as to which vaccine it will purchase. Turkey is looking at the data. It is conducting phase 3 studies as well. Very competent scientists are working on them.

Turkey will evaluate the data from the phase 3 study. If they prove to be positive, and if the data in the world in the coming days are also positive, only then will Turkey make a certain decision. Turkey has made its preliminary negotiations and set the preconditions. The first vaccine to come is the inactive vaccine. If everything is positive in the first evaluation, Turkey will demand them the following week.

The vaccines will not be applied as soon as they arrive. Every country definitely does its own tests and applications regardless of the vaccine. All the tests will be done one more time although all of them had been done before. The vaccine can be used after these standards are met. The application period for these tests is not less than seven days. Some of them take two to three days. Therefore, it is not possible for the period to be under 14 days. The first vaccine seems to be coming to Turkey on Dec. 11. The tests will take at least 14 days after their arrival. This period can be 15 days or 20 days. If there is a problem in one of the tests in between, it should be done and evaluated again. If there is any hesitation during the operation of the test, that test will be performed again. When our vaccine arrives on Dec. 11, the earliest date to apply it can be around Dec. 25 to 26.

AA: What will the roadmap be like after the vaccine arrives?

AK: Turkey has made all preparations, signed contracts, determined the terms and conditions. If any problem occurs, the contract will be terminated. A vaccine will come Dec. 11 and another Dec. 20. If there is a problem with their own data or a sign comes up, then we can cancel the contract.

If all goes well, the vaccine that is scheduled to arrive on Dec. 11, is the inactive vaccine that will come from China. It will be distributed immediately to all parts of Turkey once it arrives. The tests will be completed. If everything is OK, the vaccines will be applied. If anything wrong comes up in the tests, all vaccines will be withdrawn and sent back to China or Moderna.

AA: Have any side effects been observed in vaccinations on volunteers?

AK: This was preliminary data. Its detailed data are not yet fully formed. If all is well in the coming days, if there is no problem, then we will demand the vaccine. The results are expected to come out around Dec. 7 to 9. We act based on our own safety data. The same assessment is applied for the BioNTech Pfizer vaccine, too. If its security data is appropriate, too, vaccines will be demanded from them as well. The amount of inactive vaccine will be a little higher, and the other will be a little lower.

AA: How will the vaccines be preserved?

AK: Since the inactive vaccine is a dead vaccine, it can be stored in normal refrigerator conditions. Its distribution is easier. It can be stored at 2 - 8 Celsius degrees (36 -47 F). That definitely is an advantage. Since the mRNA vaccine carries information that breaks down very easily, it must be stored below minus 70 Celsius degrees (minus 94 F). This may be a bit restrictive in terms of logistics. Creating the infrastructure for it will not be very difficult for Turkey.

AA: Why will Turkey use the Chinese vaccine?

AK: Turkey has a large population. The vaccine will be applied to a large group. mRNA technology is not a common application. There are data and when we look at the data that we have, they are all positive.

When it comes to inactive vaccine technology, it has been applied for many years. We know the unwanted side effects that may emerge. Since there is a dead microorganism, some pain and redness in the arm occur. We do not expect a significant side effect apart from these. There may be rare exceptions. They stated that they are similar in terms of effectiveness.

AA: How much do the vaccines cost?

AK: The cost of the Chinese vaccine, the inactive vaccine, is a little higher than the mRNA vaccine. A vaccine should not be called "expensive." It is an application done to a healthy person. We do it for protection. Safety should be the priority, followed by efficiency. If you are very confident in its safety and if it is good in terms of effectiveness, you can prefer it. It can be very effective, it can be very protective, but if there is a problem on the safety side, if the unwanted effects are many, you can tend to prefer the less effective one. We can compare the long-term data of both vaccines in March and April.

AA: What are the criteria for determining the priority for vaccination?

AK: The coronavirus has a wide spectrum. Some can recover almost without symptoms while others suffer severely. Health care professionals need to be vaccinated in the first place to ensure that they can serve both sides. There will not be vaccines enough to vaccinate the whole world. We need to proceed step by step.

The worst period of the pandemic for us will be the coming months. The sooner we get the vaccine, the better. If we will receive a certain number of vaccines, the most critical group can benefit the most from this limited amount.

Since the beginning of the pandemic, we have been trying to protect especially our elders because they are likely to be hospitalized if they catch the virus. We have always asked for dedication from those over the age of 65. Then, when the vaccine arrives, we need to vaccinate the group with the highest risk, whom we need to protect first.

Turkey is trying to obtain the vaccine in as large quantities as possible. We do this to be able to vaccinate the health care professionals along with the people over the age of 65.

In the second stage, security officers should have priority. People over the age of 65 are at risk, but then we should include those who are young but have underlying diseases.

In my opinion, our teachers should come right after them. They are the most important people for all of us, for our children. We need to get their lives back to normal conditions as soon as possible.

The list will proceed with those who work in agriculture and the food industry for the sustainability of life.

* Writing by Dilan Pamuk in Ankara