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COVID-19 Vaccination in Korea

 

 The spread of COVID-19 started globally in 2020. After that, people’s fatigue has been increasing day by day while the situation is prolonged until now, in 2021. Therefore, interest in COVID-19 Vaccines is also expanding. In Korea, the vaccinations first started on February 26, 2021, and are continuing. In the middle of this, let’s look at the present conditions, issues, internal and external cases of side effects, and reactions to the vaccinations, and the prospects.

 

Introduction of COVID-19 Vaccination in Korea.

 On January 20, 2020, a 35-year-old Chinese woman from Wuhan, China, was diagnosed as a COVID-19 patient for the first time in Korea. After this, the confirmed number of patients was only about 30 for about one month. But, when 909 confirmed cases occurred on February 29, 2020, the first wave of the pandemic had begun. On August 27, 2020, as 441 cases were confirmed, the second wave of the pandemic happened. On September 7, 2021, 1,597 cases were confirmed on that day.

 In Korea, some efforts were being conducted like ‘social distancing’ to prevent the spread of COVID-19 from the early part of the epidemic. With social distancing, the vaccination was being implemented since the first vaccine was introduced on February 26, 2021. However, as of July 5, the present condition of vaccination is still low in that only 29.9% of people in Korea have received the first shot and only 10.4% have been fully vaccinated. According to the disease control authorities, the new confirmed cases were over 1,100 on July 6, 2021 day. This is the first time in six months of there being more than 1,000 patients after the third wave of the pandemic, which has had small-scale diagnoses since December 25, 2020.

 Choi Jae-Wook, the professor of Preventive Medicine at Korea University said that “When looking at statistics or data, (the occurrence of patients) looks like it’s going to the fourth pandemic wave.” at an interview with Yonhap News on July 7, 2021. Because of this, the social distancing step 4 has been implemented in the capital area since July 12. Likewise, in a state in which the end of the COVID-19 pandemic cannot be assured, the attention of nationals for the expansion of vaccination is still on-going.

 Korea took the first step by approving the ‘Special import of COVID-19 Vaccinations’ of the Ministry of Food and Drug Safety on February 3, 2021. On that day, they revealed that “We determined this special approval by considering the opinions from the Joint Expert Advisory Council and overseas vaccination cases in a dimension of nationals’ secure safety through the vaccination.” Through this, the import of vaccines for 10 million people contracted with ‘COVAX facility,’ which is the group vaccine purchase project, had been available. Following this, on February 26, 2021, the first shipment for 58,500 people arrived at Incheon International Airport. These vaccines were used for the vaccination of the medical teams that treat COVID-19 patients.

 In Korea, more than 15 million people completed at least the first shot of the vaccination in the first half of 2021. Regarding the supply and demand of vaccines, part of the contracted doses of vaccines from AstraZeneca (hereafter ‘AZ’), Pfizer, Moderna, and Janssen were introduced. In the second half of the year, it’s expecting that the rest of the contracted volume will arrive. Also, the Novavax vaccines that are already contracted will also be brought in after it is approved.

 On July 7, 2021, 700,000 doses of vaccines that the government got by the Vaccine Swap agreement with Israel, has arrived. Here, the Vaccine Swap means borrowing the vaccines from the country with a sufficient supply and paying back after. Israel contracted the Swap with Korea by having the cold chain vaccine supply network which is the warehouse system storage, wrapping, distributing the refrigeration∙ and freezing products, and having the base to inoculate on short terms. On one side, on July 21, the 81,000 doses of Pfizer vaccines were acquired by the Vaccine Swap with Israel.

 

Side effect cases of COVID-19 vaccine

 The concerned voices got louder while cases of side effect were found in other countries that introduced the vaccines earlier. Let’s look at the kinds of side effects and examples.

 In Korea, the interest in the side effects that could happen with the vaccination are increasing. The ‘anaphylaxis’ which is the extreme allergic response shows symptoms such as difficulty breathing, low blood pressure, and vomiting. The Korea Centers for Disease Control and Prevention (hereafter ‘KCDC’) has recommended an increase of the observation time to 30 minutes which is more than 15 minutes for an ordinary person after inoculating someone who showed the anaphylaxis response before.

 Meanwhile, the Food and Drug Administration (hereafter ‘FDA’), European Medicines Agency (hereafter ‘EMA’) including Ministry of Food and Drug Safety are regulating the thrombocytopenia, cerebral venous sinus thrombosis (CVST), and visceral vein thrombosis (SVT) coming with partial bleeding as the side effects of AZ vaccines. After the inoculation, possible side effects include a persistent headache in which painkillers doesn’t work, vomiting, and blurred vision. Those symptoms can happen after the administration of Adenovirus vector-based vaccines such as AZ vaccines. Adenovirus vector-based method is made by injecting the other viruses which are harmless to the body such as Adenovirus.

 Furthermore, specialists said that patients should be careful to the side effects such as myocarditis and pericarditis after inoculations with mRNA vaccines that using the mRNA which uses a specific protein in the body to carry the DNA information. These two side effects are inflammations of the very thin membrane about 1.5 mm thick that surrounds the heart, and the myocardium of the heart muscle. Kim Ki-Nam, the head of the Inoculation Planning Team advised, “According to the guidelines, when having the symptoms such as chest pain, pressure, discomfort, difficulty with breathing, shortness of breath, painful breathing, a faster heart rate and palpitation after getting COVID-19 vaccination, the patient needs to be treated quickly at medical institutions.” Also, he added, “We are telling the medical institution which treated patients with these adverse reactions to report them.” The mRNA vaccines introduced in Korea are Pfizer and Moderna.

 

 From overseas where vaccination started earlier, the data about the stability of vaccines has been generated. On May 19 of this year, the ‘Yellow Card Reporting’ from the Medicines and Healthcare products Regulatory Agency (MHRA) was generated by the government of the United Kingdom. Most of the adverse reactions were slight, at a low level in that the reports of adverse reactions were 3~4 cases among 1,000 injections of AZ vaccines and Pfizer vaccines.

 According to the Centers for Disease Control and Prevention (CDC), as the result of 13,794,904 doses of vaccination of Pfizer or Moderna, from December 14, 2020 to January 13, 2021, there were 6,994 cases reported to the Vaccine Adverse Event Reporting System (VAERS). Among them, 90.8% were a slight illness and only 9.2% were a serious illness. Also, anaphylaxis responses were 4.5 among 1 million cases. There were 113 cases of death after vaccination but there was no evidence there is a cause-and-effect relationship at that time.

 On the contrary, for the AZ vaccine, the thrombosis with thrombocytopenia syndrome (hereafter ‘TTS’) cases were reported since March 2021. For this, the United States is making the reports of TTS cases about AZ vaccines and Janssen vaccines mandatory. Also, myocarditis cases of people in their teens and twenties were announced. On one side, in April 2021, the presentation of a problem about myocarditis adverse reaction was conducted in Israel, the country with the highest number of Pfizer vaccine inoculations. After that in May, EMA raised a problem, On May 26, the WHO received reports of myocarditis cases from Pfizer and Moderna vaccinations.

 On June 24, 2021, the FDA warned that mRNA vaccines such as Pfizer and Moderna can be related to the cardia disorder happening rarely in young people under 30. It was the first time that the FDA admitted a cause-and-effect relationship between a vaccine and an adverse reaction. In the USA, the concerns are coming out that this warning from the FDA can raise the atmosphere of avoiding the vaccination. However, the American Medical Association (AMA) and United States Department of Health and Human Services (HHA) are emphasizing that the Pfizer and Moderna vaccine are still effective, and a cardia disorder is an adverse reaction that is extremely rare.

 

 On May 31, 2021, TTS which is a side effect of COVID-19 vaccination was first found in Korea. The inoculated person with the symptom is the 30-year-old male who got an AZ vaccine. On June 16, 2021, the second TTS patient died so the first death case due to side effects of the COVID-19 vaccine occurred. This is the first case in which causality has been admitted for death after the vaccination. That patient was a man in his early 30’s, although he had taken medication for a strong headache and vomiting, were appeared 9 days after he has inoculated with the AZ vaccine, but the symptom did not improve. After that, he felt his symptoms worsen and he lost consciousness. In turn, he visited a tertiary hospital 12 days after the vaccination, was diagnosed with TTS, and eventually passed away. The COVID-19 Vaccination Response Promotion Team responded: “(We’re) planning to improve the parts that needed to be a supplement, after reviewing the progress from an appearance of an abnormal reaction to the death, with experts.”

 The cases that were reported as doubtful adverse reactions after the vaccination were 100,833 cases as of midnight on July 10, 2021. Among them, most of the cases, 95,745 (95.0%), such as muscular pain, headache, fever, chills, and nausea after inoculation involved symptoms that commonly occur. There were also, 443 cases suspected to be anaphylaxis, 4,244 main adverse reaction cases as nervous system abnormal responses, and 401 cases of death were declared. Among the death cases, as of July 10, 2021, there was only one causality verified case. According to the Immunization Damage Investigation Team, if the causality due to vaccine is not admitted, the causes of death are mainly old age and underlying problems such as sudden cardiac death, high blood pressure, acute myocardial infarction, and diabetes.

 

Issues about COVID-19 vaccine

 While the COVID-19 vaccination is progressing in order and the interest in it is increasing, the issues of discarded vaccine accidents, breakthrough infection, and shortage of vaccines are also getting attention.

 

 On June 30, 2021, at the Gwangju Buk-gu vaccination center, 1,000 doses of the Pfizer vaccine were discarded because of negligent management. It is told that the community health worker who manages the vaccines didn’t put them in the refrigerator to defrost the ones that would be used that day. This way, they were neglected at room temperature for 14 hours. Pfizer vaccine needs to be used after no more than 30 minutes at room temperature although it can be kept in a refrigerator up to five days.

 In this way, vaccine discarding accidents happen frequently. Specifically, it was found that vaccines for 8,300 people had to be discarded during the first four months of inoculation. This was followed by the data, ‘Discarded vaccine quantity and cause’ that the People Power Party’s Cho Myung-hee Office received through the Vaccination Response Promotion Team on July 2, 2021. Most of the doses were scrapped because of carelessness, in 192 cases. These were cases where vaccines storage was not managed at the proper temperature such as not closing the door of a refrigerator, forgetting, or unplugging by mistake.

 Cho Myung-hee, a member of the National Assembly said that “There should be no situation of discarding the vaccine by management mistakes so that even one bottle of vaccine is lacking.” Also, she mentioned that “The health authorities and local governments have to prepare alternatives to avoid discarding vaccines by rechecking the storage of vaccines and inoculation administration.

 

 Originally, Jung Se-Gyun said that “The government decided to introduce vaccines for 79 million people.” on February 16, 2021. However, the supply bottleneck of vaccines occurred several times. One synthesis-level medical institution had trouble due to the lack of AZ vaccines. The people who were inoculated by the first shot of AZ vaccine during March and April 2021, should have been getting the second shot during June and July. The official from that hospital said that “It was supplied with a shortage of 50 shots compared to the number of people who need to get the second AZ shot.” In addition, talk exploded in anger that “We called the public health center and KCDC to ask what to do with the rest of the people, but there was no answer.”

 Finally, on June 17, 2021, the disease control authorities brought out the cross inoculation of Pfizer for the 76 million people who got the first AZ shot as a solution.” About this, some criticized by saying that it was the reversal of the original position of government which was to hold to the stance that there be no failure with the quantities.”

 On last July 12, 2021, an advance reservation of vaccines for people between 55 to 59, started but the service was shut down, in just one day, because of the lack of quantity. For this, Jung Eun-Kyung, director of KCDC said that “(We) closed because of a short fall for the advance reservation period, because we were taking reservations for a quantity lower than the supply schedule had determined”, and apologized for the inconvenience incurred by the failure of the expected demand forecast.

 Recently, the ‘breakthrough infection’ cases, which are infections after getting shots, occurred. On June 28, 2021, according to the Central Disease Control Headquarters, as of June 24th, the breakthrough infections were recorded at 44 cases.

 About the breakthrough infection, Park Young-Jun, the epidemiological investigation team leader said, at the briefing on June 18, “The case confirmed the diagnosis 14 days after completing the second shot, is defined as the breakthrough infection, but strictly, it’s considered as the estimated case.” Also, he added as “That’s because it’s proper to judge as the infected case before the valid inoculation (antibody formation) rather than breakthrough infection, since the point in time that people are exposed to the virus, was 14 days before (after the inoculation).” That is, it can be the infection before the formation of antibodies after the inoculation, not breakthrough case. In addition, it’s the statement of disease control authorities that the probability of breakthrough infection is slight, so it still encourages people to be vaccinated.

 However, Yu Seung-Min IOC Committee member who had already been vaccinated and arrived in Japan for the Tokyo Olympics, was diagnosed with COVID-19 in a test conducted after entering the country. He said on his SNS as “I’ve got examined twice at the date of 13 and 15, before the departure, and got a negative result, also got the vaccine twice.” Likewise, cases considered breakthrough infection are still occurring, and confusion continues.

 

Reactions about the COVID-19 Vaccination

 While the inoculations were being developed, experts in the country are giving an opinion about the introduction and administration of the vaccine. Between some of the nationals, anxiety about the vaccine arose. Mr. Kang, while being interviewed by news1 said that “Although the government will announce with basis, it’s inevitable about the formation of anxiety.”

 About this, the opinions of experts are mostly that getting a vaccine is beneficial. Choi Won-Seok, the professor from the Department of Infectious Diseases in Korea University College of Medicine defined as “I don’t think there is any psychological insecurity at all, based on the risk that the COVID-19 is having, the information and material that vaccine is securing, I want to recommend that people be inoculated.”

 But some of the experts emphasized that the government should explain the various adverse reactions that can happen after vaccination to nationals. Jeong Jae-Hoon, the professor of Preventive Medicine in Gachon University College of Medicine, who was interviewed by KBS News, mentioned “The most important thing is to deliver the information before something happens.”

 Also, in February 2021, on one side, some medical personnel started to get participation signatures on a statement: ‘Opposing the legislative bill of compulsory vaccination of COVID-19 vaccine’ for the bill that Hong Jun-Pyo, a member of the National Assembly has suggested. It was known that more than one million people participated in one day after the opposing signature campaign began. They claimed that “COVID-19 vaccines are developed in less than one year. Each phase of the clinical trial could not be performed normally.” And they added as “It needs to explain the effect and side effect of vaccine exactly, to ask for the assent of the infected person.”

 Meanwhile, experts have emphasized that there is a need to speed up the inoculation because of the recent spread of the Delta variant. On June 21, 2021, medical professions emphasized that “If the Delta variant which has a higher infectivity and fatality rate than the existing COVID-19, is spread, it will act as an unfavorable factor in the country.” They said that “The government needs to gather speed of vaccinations of the second half of the year, and review the introduction of booster shots (extension of herd effect, extra inoculation for the reinforcement) that build-up to prevent additional infections.” Therefore, there is a need to speed up the vaccination and to make preparations that are effective on additional variants.

 The Korea Society Opinion Institute (KSOI) asked for 1,015 people who are over 18 years old, for two days since February 26, 2021, which is the first day of vaccination in Korea, about ‘You can get a vaccine after November if you reserve the inoculation, and what do you do when your vaccination order comes?’ It has appeared that the response, “I will get vaccinated as soon as the order comes” was 61.7%, the response, “Even if I can get it after November, I will reserve the vaccination” was 28.1%”, and the response, “I don’t know” was 10.2%.

 KBS is conducting an opinion poll with professor Yu Myung-Soon Team of the Graduate School of Public Health at Seoul National University since March 2021. By the result of asking the intention to be inoculated every month until June 2021, the will for the vaccination was recorded at its maximum in June. It seems by the belief that the vaccine is safe, is getting bigger, the will to receive vaccination also has grown. The respondents were only 59.2% in May 2021, but increased to 75.5% in June, one month after.

 

The prospect of COVID-19 Vaccine

 On June 24, 2021, Jung Eun-Kyung, the director of KCDC said at a briefing that “The (vaccine) quantity expecting to be introduced the second half of the year, is very sufficient.” She disclosed that “The vaccines for the third quarter are 80 million doses, for the fourth quarter are 90 million doses.” Accordingly, it’s expecting that the inoculation will be conducted more actively. About the schedule for vaccination of the third quarter, she said, “Rather than sorting the chronic patient or object of vaccination, we are planning to expand the people by ages and inoculate intensively until September.” Also, she added, “It will progress by planning individually for the disadvantaged groups which are difficult to bring to the inoculation site and the people who need protection.”

 The vaccines that the government reserved by July 2021 was 193 million servings (for 100 million people) of the five types of COVID-19 vaccines: Pfizer, Moderna, Novavax, AZ, and Janssen. The official of KCDC explained the point that some of the vaccinations are delayed, “It’s because there were some temporary mismatches between the kind of vaccine and quantity needed for the second shot.”

 Moreover, the government delivered that they are reviewing the Vaccine Swap with other countries besides Israel. Jung Eun-Kyung, the director of KCDC, at the briefing on July 6, 2021, said, “It can be reviewed positively, to exchange the vaccine with other countries, as the method that can share vaccines with each other when there’s some problem of No-show vaccine and expiration date.” The experts are considering the USA as the country for a Swap following Israel. Jung Ki-Seok, the professor of the division of pulmonology in Hallym University Sacred Heart Hospital emphasized that “The USA can afford vaccines but the inoculation rate is in a stagnant state”, “It’s the principle that the government should make an effort in somehow such as negotiation, and reduce the time without the vaccine.” According to this, it seems that vaccine diplomacy will expand.

 From May 27, 2021, the inquiry of No-show vaccines and vaccination of that day by consignment medical centers, became available through the Naver and Kakao applications. The vaccination of that day application is done if someone clicks the ‘reservation’ after selecting the consignment medical center having No-show vaccines. Also, taking notifications is available by registering a maximum of five specific consignment medical centers for each application. Accordingly, the consignment medical centers can inoculate people with the vaccines that occurred unavoidably from the vial opened lastly every day, by finding some people who want to be vaccinated. This is for the minimization of discarding the No-show vaccines.

 The medical team responded positively about this. The nurse from Seodaemun-gu consignment medical center who was interviewed by YTN news said that “The inoculation rate will increase. It will be good because there are no discarded vaccines.” The nationals showed the responses that the competition is very intense. Specifically, as the reservation of Pfizer vaccine became available from July 5, 2021, the reactions are heated. One netizen said on the community board as “The notifications of NO-show Pfizer vaccines are keep coming, but it’s saying exhaustion though get on right away.”

 

 In an unexpected epidemic, the vaccine is considered as the main method for the end of COVID-19. However, by conducting the introduction of vaccines step by step, the anxiety and expectation of nationals are in flux. Through management and supervision should be carried out through continuous monitoring of anxiety about side effects of the vaccines.

유정연  wjddus0918@naver.com

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