Shopping for the Best Vaccine

Several years ago I (Dr. Ramzi Banda) needed to buy a new car. Not being a smart shopper or one with much knowledge in cars, I enlisted the help of a friend well known for his technical prowess and shopping acumen. 

In just the previous two years, he had bought and sold more cars than I have done in my entire life. So when we went car shopping, he asked me to stay quiet and let him do the talking. All he wanted to know from me was my budget and the size of car in which I was interested. 

Armed with this information, he assured me that I would get the best car for my money. And sure enough, within a day or two, he made the choice which I blessed, and I drove out of a particular car dealership with a brand new car that lived up to my expectations. 

When I eventually asked him about his shopping “tricks,” he told me there were none. Instead, his approach was that when you buy anything, be it a car or a cell phone, you need to decide what you want it to do for you and what your tolerance level is for its potential shortcomings. 

A car's purpose is transportation, and you expect it to perform glitch-free for several years. 

Everything else is extra. 

Whether it is a famous brand and has luxurious leather seats or any other amenities doesn't matter. The car should get you around and do it without causing you any hassle - that's what is essential. Of course, if you want to spend more money, you can add the options. But that is why they are called options. 

A few days ago, I thought of that incident again when one of my patients asked about the best vaccine against COVID-19. His approach was like that of a car shopper, but with a lot fewer available choices. 

He wanted to know which vaccine gives the highest immunity and has the least side effects. After all, a vaccine is supposed to provide immunity with minimal side effects. My answer was simply, “whatever is available to you.” However, he was not satisfied; he wanted the Bentley of vaccines! 

So far, most countries have offered a limited choice of vaccines. While there are over a dozen out in the market, only two or three are approved in any one country. So shopping for the best vaccine is easy. You need to visit only two or three “dealerships.” 

Yet, it is much harder than shopping for a car, especially because of all the hype and publicity surrounding what has become unnecessarily a contentious topic. 

Remember the two shopping conditions set out by my friend: utility and tolerance of failure? Let us apply them here. 

Vaccines are supposed to provide immunity from infection. So far, all the vaccines out there do that. And while the efficacy figures vary, it is important to note that we do not have a single head-to-head trial to pass a verdict about the superiority of one over the others. 

Each one of them is tested against a placebo, but more importantly, they were tested in different populations and at varying times. Efficacy now entails immunizing against one or more of the variants, whereas efficacy circa 2020 was simply against the “parent” virus. 

Similarly, when it comes to side effects, the balance is not tilted one way or another. Each one of them has been associated with rare but potentially severe side effects. But association is not causation, and when the numbers are spread out and analyzed, the odds of these side effects for any one of the vaccines are no higher than they are in the general unvaccinated population. 

So which one is the Bentley? All of them or none of them, depending on your perspective. 

But does it matter? Whichever vaccine one selects is as good as any. All of them are pretty effective and safe. 

Are any one of the vaccines 100% safe or 100% effective? Unfortunately, the answer is no. Because in medicine, as in life, there are very few things that reach that level of perfection. 

There is, however, an overarching critical consideration. Failure to get vaccinated is a guaranteed risk, if not for the individual, then for their family, colleagues, and society as a whole. And the faster we get people vaccinated, the less likely it is that the virus will linger around and acquire more mutations, which may render the available vaccines less effective. Therefore, it is mandatory that we all get that jab and not fret over which one it is. 

Vaccination against COVID-19 is a choice, and no one should be forced to receive it against their will. But I submit to you that it is also a duty - to oneself, one’s family, one’s community, and humankind in general. We need to rid ourselves of this predicament, this nightmare that has hounded our daily lives for over a year. One that does not look to be going away soon. 

We owe it to ourselves first - even if one feels young and healthy. After all, COVID-19 has claimed many young and healthy lives. 

We owe it to our families. So many families have suffered the loss of a loved one because another member brought the virus home to someone who meticulously followed the rules about masking and social distancing. 

We owe it to our community. Businesses have gone belly up, people have lost their jobs, and children have lost a year of schooling. 

And we owe it to humankind. We live in a highly interconnected world, and one can only feel safe and immune if all of us are safe and immune. 

Therefore, for all the naysayers and the doubters, I say - please shed your doubts away, and for all those holding out for the Bentley of vaccines, I like to tell them that it is parked at their door or will soon be. While vaccines may not be the panacea to defeat the virus, which will require a multipronged approach, vaccination is the most effective step available to us. 

So roll up those sleeves!