There are two commonly used vaccines – the pneumococcal vaccine and the Hib vaccine – that protect against bacterial pneumonia. These bacteria complicate both influenza and COVID-19 and are often fatal. My study of disease trends and vaccination rates leads me to believe that wider use of the pneumococcal and Hib vaccines could protect against the worst effects of COVID-19 disease.
I am an immunologist and physiologist interested in the effects of combined infections on immunity. I achieved my insight by juxtaposing two seemingly unrelated puzzles: infants and children get SARS-CoV-2, the virus that causes COVID-19 but is very rarely hospitalized or dies; COVID-19 case numbers and death rates varied greatly from country to country and city to city, even before the lockdown began. I wondered why.
One night I woke up with a possible answer: vaccination rates. Most children who start at two months of age are vaccinated against numerous diseases; Adults less. Immunization rates for infants and adults vary widely around the world. Could differences in vaccination rates for one or more diseases be responsible for differences in COVID-19 risk? As someone who had previously studied and worked with other pandemics like the 1918-19 Great Pandemic Flu and AIDS, I had a strong background to uncover the relevant data and test my hypothesis.
Pneumococcal vaccination rates correlate with lower COVID-19 cases and deaths
I have collected national and some local data on vaccination rates for influenza, polio, measles-mumps-rubella (MMR), diphtheria-tetanus-pertussis (DTP), tuberculosis (BCG), pneumococci, and Haemophilus influenzae type B (Hib). I correlated them to COVID-19 case rates and death rates for 24 nations that had experienced their COVID-19 outbreaks at around the same time. I controlled factors like the percentage of the population that were obese, diabetic, or older.
I found that only pneumococcal vaccines offer statistically significant protection against COVID-19. Nations like Spain, Italy, Belgium, Brazil, Peru and Chile with the highest COVID-19 rates per million have the lowest pneumococcal vaccination rates in both infants and adults. Nations with the lowest COVID-19 rates – Japan, Korea, Denmark, Australia, and New Zealand – have the highest pneumococcal vaccination rates in both infants and adults.
A recent (not yet peer-reviewed) preprint study by researchers at the Mayo Clinic also reported very strong associations between vaccination against pneumococci and protection against COVID-19. This is especially true for minority patients who are bearing the brunt of the coronavirus pandemic. The report also suggests that other vaccines or combinations of vaccines like Hib and MMR could also provide protection.
These results are important because in the US vaccination of children against pneumococci – which protects against it Streptococcus pneumoniae Bacteria – varies between 74% and 92% depending on the condition. Although the CDC recommends that all adults between 18 and 64 years of age in high-risk groups for COVID-19 and all adults over 65 receive a pneumococcal vaccine, only 23% of high-risk adults and 64% of those over 65 years of age get it.
Likewise, although the CDC recommends that all infants and some high-risk adults get vaccinated against them Haemophilus influenzae Type B (Hib) were only 80.7% of children in the United States and a handful of immunologically compromised adults. Vaccination rates for pneumococci and Hib are significantly lower in minorities in the United States and in countries more affected by COVID-19 than in the United States
Based on these data, I advocate universal pneumococcal and Hib vaccination in children, at-risk adults, and all adults over 65 to prevent serious COVID-19 disease.
How a pneumococcal vaccination protects against COVID-19
Protecting against severe COVID-19 disease with pneumococcal and Hib vaccines makes sense for several reasons. First, recent studies show that the majority of hospitalized COVID-19 patients, and in some studies almost all of them, are infected with strep, which causes pneumococcal pneumonia, Hib, or other pneumonia-causing bacteria. Pneumococcal and Hib vaccinations should protect coronavirus patients from these infections and thus significantly reduce the risk of severe pneumonia.
I also found that pneumococcal, Hib, and possibly rubella vaccines can provide specific protection against the SARS-CoV-2 virus that causes COVID-19 through “molecular mimicry.”
Molecular mimicry occurs when the immune system thinks one microbe looks like another. In this case, proteins found in pneumococcal vaccines, and to a lesser extent in Hib and rubella vaccines, look like several proteins produced by the SARS-CoV-2 virus.
Two of these proteins, found in pneumococcal vaccines, mimick the spike and membrane proteins that allow the virus to infect cells. This suggests that pneumococcal vaccination can prevent SARS-CoV-2 infection. Two other mimetics are the nucleoprotein and the replicase, which control virus replication. These proteins are made after a virus infection. In this case, the pneumococcal vaccination can control the SARS-CoV-2 replication, but not prevent it.
In either case, these vaccines may offer proxy protection against SARS-CoV-2 infections that we can currently implement even before we have a particular viral vaccine. Such protection may not be complete. People may still suffer from a debilitated version of COVID-19, but like most infants and children, they are protected from the worst of the effects of infection.
Although the specific protection that these other vaccines offer against COVID-19 has not yet been tested in a clinical trial, I advocate wider implementation of pneumococcal and Hib vaccination for another, well-validated reason.
Pneumococcal and Hib pneumonia – both caused by bacteria – are the leading causes of death after viral influenza. The influenza virus rarely leads directly to death. Most of the time, the virus makes the lungs more prone to deadly bacterial pneumonia. Dozens of studies around the world have shown that increasing vaccination rates against pneumococci and Hib dramatically lower pneumonia-related influenza-related pneumonia.
Similar studies show that the cost of using these vaccines is offset by savings from lower rates of hospitalization related to influenza, intensive care units, and deaths. In the context of COVID-19, reducing the rate of influenza-related hospitalizations and ICU admissions would free resources to fight the coronavirus, regardless of the impact these vaccines might have on SARS-CoV-2 itself. In my opinion this is a winning scenario.
In short, we don’t have to wait for a SARS-CoV-2 vaccine to slow down COVID-19.
I believe we can and should act now by fighting the coronavirus with all tools at our disposal, including influenza, hib, pneumococcal and maybe rubella vaccinations.
Preventing pneumococcal and Hib complications from influenza and COVID-19, and possibly proxy vaccination against SARS-CoV-2 itself, will help everyone. By giving these already available and well-tested pneumococcal and Hib vaccines to people, you save money by freeing up hospital beds and intensive care units. It will also improve public health by reducing the spread of multiple infections and stimulating the economy by promoting a healthier population.
ABOUT THE AUTHOR
Robert Root-Bernstein is Professor of Physiology at Michigan State University. His AB and PhD are from Princeton University. After completing his doctorate, he conducted research with Dr. Jonas Salk at the Salk Institute for Biological Studies. In 1981 he received a MacArthur Fellowship, commonly known as the “Genius Fellowship”. His research focuses on autoimmune diseases, drug development, the origins of cellular control systems, and scientific-artistic interactions. For more than fifteen years he has also been researching and advising on creativity. Among other things, he wrote Sparks of Genius: The Thirteen Thinking Tools of the Most Creative People in the World; Honey, mud, maggots, and other medicinal wonders; Discovering: Inventing and Solving Problems at the Boundaries of Scientific Knowledge and Rethinking AIDS: The Tragic Cost of Premature Consensus.
This article was kindly provided by The Conversation.
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