[Q&A] Vaccination Promotion Team: "It Will Be Difficult to Remove Masks This Year Even After Getting Vaccinated"

[Asia Economy Reporter Lee Chun-hee] "I think it will be somewhat difficult to achieve complete herd immunity and return to the pre-COVID-19 situation (such as removing masks) within this year." (Choi Won-seok, Professor of Infectious Diseases, Korea University Ansan Hospital)

The government aims to start the first COVID-19 vaccination on the 26th, vaccinate 70% of the entire population by September, and establish herd immunity by November. However, even if this vaccination plan is properly implemented, there is a forecast that it will be difficult to remove masks within this year.

Professor Choi Won-seok of Korea University Ansan Hospital said at an online COVID-19 vaccination special briefing on the 24th, "As the virus continues to mutate, its transmissibility may have increased, raising the basic reproduction number. Also, among vaccinated individuals, there may be a small number who do not develop immunity, so it will be somewhat difficult to reach a level that completely blocks the epidemic," he said.

Regarding false information circulating that COVID-19 vaccines implant wireless recognition chips in the body, he pointed out, "It is very unfortunate from the perspective of scientists that such concerns arise online," and added, "The spread of misinformation can cause great harm."

At the briefing, Jeong Eun-kyung, Commissioner of the Korea Disease Control and Prevention Agency (KDCA), explained, "Adverse reactions may inevitably occur after vaccination," and "The government operates a compensation system to protect the public and healthcare workers administering vaccinations." In case of death, compensation of 437.4 million KRW and funeral expenses are provided. Additionally, the government plans to expand the scope of compensation, simplify the review process, and remove criteria for medical expense amounts to ensure people can receive vaccinations with confidence.

Below is a Q&A session with Jeong Eun-kyung, Commissioner of KDCA; Choi Won-seok, Professor of Infectious Diseases at Korea University Ansan Hospital; and Kim Joong-gon, Professor of Pediatrics and Adolescents at Seoul Medical Center.

Jung Eun-kyung, Commissioner of the Korea Disease Control and Prevention Agency, is holding a special briefing on COVID-19 vaccination on the afternoon of the 24th at the Disease Control Headquarters in Cheongju, Chungbuk. From left to right: Choi Won-seok, Professor of Infectious Diseases at Korea University Ansan Hospital; Commissioner Jung Eun-kyung; Kim Joong-gon, Professor of Pediatrics at Seoul Medical Center.
[Image source=Yonhap News]

- There has been much controversy about the AstraZeneca vaccine. Is its production method different from other vaccines, and is there any reason for this? Is there really a difference in safety and efficacy compared to other vaccines?

▲(Choi Won-seok) I do not think there are significant problems with the safety and efficacy of the AstraZeneca vaccine. Each vaccine has a different mechanism of action, so their manufacturing methods differ. Also, the reported figures in studies cannot be the same for every vaccine. When clinical trials are conducted, the number of participants, the region, country, timing, and the race and age groups involved all vary, so it is impossible for the figures to be identical.

The important thing is whether the vaccine meets the criteria for efficacy and safety. The AstraZeneca vaccine, like other vaccines, meets these standards. Since it surpasses the criteria for being considered effective and safe, it is judged to be a safe and effective vaccine. In that sense, vaccination is possible and recommended.

- I understand that after receiving a COVID-19 vaccine, antibodies form in the body after some time, protecting us from the virus. Is there a way to check if antibodies have properly formed after vaccination?

▲ (Choi Won-seok) It is not just simple antibodies but neutralizing antibodies that can neutralize the virus that need to be checked. There is a way to confirm whether neutralizing antibodies have formed, but it is difficult to test all vaccine recipients.

Testing for neutralizing antibodies requires laboratory tests involving live viruses. It is physically impossible to test millions or tens of millions of vaccine recipients. This is not a test that can be done at general clinics or hospitals.

What I want to say is that although most vaccines worldwide show different efficacy rates, in terms of antibody production and seroconversion rates, they are at a very high level. We expect that antibodies will form in the vast majority of vaccine recipients.

- I understand the goal is to complete vaccinations and achieve herd immunity by November. How will the formation of herd immunity be confirmed?

▲ (Jeong Eun-kyung) We plan to conduct sample population surveys of about 200 vaccine recipients per vaccine type to check whether neutralizing antibodies have formed and how long they last. We will use this data partially. Also, clinical trial data on neutralizing antibody formation rates per vaccine are already available. By reviewing these data and comparing them with vaccination rates, we can estimate herd immunity or neutralizing antibody prevalence. Thus, using clinical trial results and separate survey data, we can estimate herd immunity based on vaccination rates.

The most important indicator will be whether the number of confirmed cases decreases as vaccinations proceed. Therefore, we do not check whether antibodies have formed in the entire population.

▲(Choi Won-seok) To add, everyone wants to return to the pre-COVID-19 world without masks. Many consider that time as the formation of herd immunity and keep asking about it. However, I think it will be difficult to achieve complete herd immunity and return to the pre-COVID-19 situation early, probably not within this year.

There are several reasons. First, the herd immunity threshold has been calculated based on the initially estimated basic reproduction number. However, as the virus mutates, its transmissibility appears to have increased, possibly raising the basic reproduction number.

Second, not everyone vaccinated acquires immunity at a protective level. A small number may not develop immunity, making it difficult to completely block the epidemic.

However, if vaccination proceeds while maintaining some level of social distancing and mask-wearing, we expect a situation where a large outbreak is unlikely. Although masks may not be removed, a considerable level of daily life should become possible. I think this is the government's goal.

- Vaccinations start this week. Can vaccinated people immediately stop wearing masks? When will full daily life be possible?

▲(Choi Won-seok) Even after vaccination, sufficient immune response does not form immediately. It takes at least 1-2 weeks for adequate immunity to develop. Also, the vaccines we plan to use generally require two doses. Even one dose provides some immunity and protection compared to none, but it is not as sufficient as after two doses. To consider immunity sufficient, at least two weeks after full vaccination are needed.

Regarding whether masks can be removed after that, it is still difficult to recommend. Mask removal will only be possible when community transmission is sufficiently suppressed. Although vaccination lowers risk and alleviates concerns, if cases still occur in the community, it is safer to continue infection prevention measures such as mask-wearing, hand hygiene, and basic social distancing.

On the 22nd, medical staff were moving at the COVID-19 Central Vaccination Center set up at the National Medical Center in Jung-gu, Seoul. COVID-19 vaccinations are scheduled to begin on the 26th. Photo by Mun Ho-nam munonam@

- I am taking medication for diabetes and hypertension. Can I continue taking my medication after vaccination?

▲ (Choi Won-seok) You can continue taking medications related to underlying conditions such as hypertension and diabetes before and after vaccination. There is no reason to restrict, stop, or change medications. Many people with diabetes and hypertension were included in clinical trials, and efficacy and safety indicators did not differ significantly. Vaccination is possible, and continuing the same medications is recommended.

- Regarding vaccination, if someone who received a vaccination notice wants to postpone vaccination due to fever or other symptoms, whom should they contact? Will they be able to reschedule vaccination after symptoms improve?

▲(Jeong Eun-kyung) Since vaccinations starting this week are mostly conducted at institutions, it is not appropriate to force vaccination if one has fever or poor health. It is better to reschedule vaccination when in the best condition. In such cases, informing the vaccination institution on the day or the day before to adjust the schedule is necessary.

When individual vaccinations begin, a reservation system will be operated, allowing schedule changes through the system.

- After other vaccinations, swelling or flu-like symptoms occurred. Are these immune responses or adverse reactions? How can we distinguish immune responses from adverse reactions after COVID-19 vaccination?

▲ (Kim Joong-gon) When a new substance enters the body, the body reacts to eliminate it. This is called an immune response. Symptoms such as swelling at the injection site, flu-like symptoms, and fever after vaccination are immune responses to the vaccine.

However, the ultimate goal of vaccination is to develop immunity against the pathogen. If unwanted symptoms occur during vaccination, they are classified as adverse reactions. Thus, swelling, fever, or flu-like symptoms after vaccination are immune responses but are considered adverse reactions as they do not correspond to the vaccination's ultimate goal.

- I heard about anaphylaxis in the news. What are its symptoms? Is there a way to know beforehand?

▲ (Kim Joong-gon) Anaphylaxis is an excessive immune and allergic reaction of the body's immune system to a specific substance. Symptoms may appear several hours later, but mostly within 30 minutes.

Symptoms involve skin, respiratory, digestive, and cardiovascular systems. Skin symptoms include hives, itching, or rash. Respiratory symptoms include difficulty breathing, severe shortness of breath, wheezing, coughing, and hoarseness. Digestive symptoms include abdominal pain, diarrhea, and vomiting.

Importantly, cardiovascular symptoms include rapid pulse and sudden drop in blood pressure causing dizziness and fainting.

If not treated promptly and appropriately, anaphylaxis can be fatal. It is crucial to diagnose and provide emergency treatment quickly.

Fortunately, medical institutions administering vaccinations are fully prepared for anaphylaxis. Anaphylaxis is not limited to COVID-19 vaccines but can occur with any vaccine. Therefore, vaccination sites have all necessary measures in place. Although anaphylaxis is rare and serious, it is not a condition to be overly feared.

There is no way to predict anaphylaxis beforehand. Therefore, people who have experienced anaphylaxis from previous vaccinations or foods should remain at the medical institution for at least 30 minutes after vaccination for monitoring.

On the afternoon of the 9th, at the Comprehensive Cancer Prevention Vaccination Center of the National Medical Center in Jung-gu, Seoul, medical staff moved a participant who showed adverse reactions after vaccination to an ambulance after providing emergency treatment during a vaccine inoculation drill. Photo by Joint Press Corps

- What adverse reactions have been reported in countries that have already administered COVID-19 vaccines? What serious adverse reactions have been causally linked to COVID-19 vaccination?

▲(Kim Joong-gon) The Pfizer, Moderna, and AstraZeneca COVID-19 vaccines have completed clinical trials, and their data are publicly available. Based on clinical trial data, all three vaccines report almost the same adverse reactions.

The most common adverse reactions are pain at the injection site, fatigue, headache, muscle or joint pain, and fever. Other symptoms such as abdominal pain, diarrhea, and vomiting have also been reported.

Most adverse reactions resolve within a few days, usually within three days. These reactions are common to many vaccines, not limited to COVID-19 vaccines.

The only serious adverse reaction causally linked to COVID-19 vaccines is anaphylaxis. Although it is a severe allergic reaction, with early diagnosis and appropriate treatment, recovery is possible. There is no need to be overly fearful of anaphylaxis. No other serious adverse reactions have been causally linked to the vaccines. Therefore, adverse reactions to COVID-19 vaccines are similar to those of other vaccines.

- Some people experience mild fever and chills after vaccination. If a nursing hospital worker experiences such symptoms, are they prohibited from going to work according to COVID-19 guidelines? If a worker needs to take leave due to health reasons after vaccination, is leave legally guaranteed?

▲(Choi Won-seok) Mild fever or chills after vaccination are likely immune responses caused by the vaccine. However, similar symptoms can occur if infected with COVID-19. For workers in nursing hospitals, group facilities, or hospitals, it may be risky to continue working with such symptoms.

Personally, I think they should be treated the same as suspected COVID-19 symptoms. It is better not to go to work or be exposed, and testing is advisable for those working in such facilities.

▲(Jeong Eun-kyung) Nursing hospitals conduct proactive and periodic screening once or twice a week to monitor infection status, so management should be linked with this. We will prepare detailed guidelines accordingly. If leave is needed due to health reasons, sick leave should be recognized.

- I understand the government compensates for vaccination-related damages. What is the exact procedure, and what compensation can be received?

▲(Jeong Eun-kyung) Adverse reactions may inevitably occur after vaccination. To protect the public and healthcare workers, the government operates a compensation system.

When the vaccinated person or their guardian applies for compensation, we conduct an epidemiological investigation and a causality assessment by the adverse event investigation team to determine if the adverse reaction is related to vaccination. The results are reviewed by the Vaccination Damage Compensation Expert Committee, which decides on compensation within 120 days at the latest. The committee operates regularly.

Compensation covers out-of-pocket medical expenses, nursing care costs, disability lump-sum payments, and in case of death, death lump-sum payments and funeral expenses. The death lump-sum payment is approximately 437.4 million KRW.

▲(Kim Joong-gon) There are also procedural changes. First, the scope of compensation has been expanded to encourage rapid vaccination uptake. The compensation scope is being broadened, and the review process, previously strict with multiple steps, is being simplified.

▲(Jeong Eun-kyung) Previously, compensation was provided only if out-of-pocket medical expenses exceeded 300,000 KRW. For the temporary COVID-19 vaccination, no upper limit on medical expenses will be set, and all cases will be reviewed, with expedited review for minor cases. Administrative procedures will be improved accordingly.

On the afternoon of the 9th, medical staff administered vaccines to training participants during a mock vaccination drill held at the Comprehensive Cancer Prevention Vaccination Center of the National Medical Center in Jung-gu, Seoul. Photo by Joint Press Corps

- I understand that a vaccination certificate can be issued after vaccination. Can having this certificate exempt one from quarantine or gathering bans?

▲(Jeong Eun-kyung) Currently, vaccination certificates are issued for all vaccinations, not just COVID-19. The vaccination information system allows individuals to obtain certificates, and a system to issue certificates in Korean and English for COVID-19 vaccination is being established.

However, having a vaccination certificate does not exempt one from facility access restrictions or gathering bans. However, the government is reviewing whether vaccinated close contacts or exposed individuals can be exempted from quarantine and instead undergo testing or active monitoring, whether quarantine periods for overseas entrants with certificates can be adjusted, and whether testing frequency for workers in nursing facilities can be changed after vaccination. We will announce details once finalized.

- There are claims that chips are implanted in the body through vaccination for government surveillance, and some medical personnel refuse vaccination citing severe side effects seen abroad. What is your explanation for these claims?

▲(Choi Won-seok) It is very unfortunate from a scientific perspective that such concerns and stories arise. The idea that chips are implanted for surveillance is not scientifically plausible. The claim that "healthy people experience severe adverse reactions" refers to anaphylaxis, which can occur even if the person was healthy at vaccination.

The issue is the incidence rate of anaphylaxis. As we know, most vaccines or drugs have an incidence of about 1 per 100,000 to 1,000,000 people, and with proper management, most cases improve without serious problems. I hope this does not become a reason to avoid or fear vaccination.

Historically, misinformation about vaccines has caused many problems. When Jenner first developed the smallpox vaccine, newspapers depicted people turning into cows at the injection site, spreading false information that vaccination would turn people into cows. In some parts of Africa, vaccines were rejected because they were believed to be Western tools for domination.

The harm caused by misinformation is significant. I sincerely hope people are not misled by false information and make wrong decisions.

- According to today's materials, it states "Pfizer vaccine will be administered to those aged 16 and older." Is this just a statement of Pfizer's application, or is the health authority preparing plans based on vaccination for those aged 16 and older?

▲ Currently, various vaccines have different approved age ranges based on clinical trial data. Pfizer is the only vaccine with clinical trial data including ages 16 to 18, and this age group is included in the approval scope. The Ministry of Food and Drug Safety is still reviewing approval, and if approved, the Vaccination Expert Committee will review and decide on vaccination for ages 16 to 18. Additionally, clinical trials for children, adolescents, and pregnant women are ongoing for other vaccines. As vaccine usage expands, vaccination plans will be revised and supplemented accordingly.