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Roadmap out of lockdown an ‘all England’ approach

The much awaited four step roadmap proposed by the government on 29th March 2021 as a four month exit plan from the current restrictions breathed a new lease of hope in people towards a more foreseeable future of returning to some normality.

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The much awaited four step roadmap proposed by the government on 29th March 2021 as a four month exit plan from the current restrictions breathed a new lease of hope in people towards a more foreseeable future of returning to some normality. 

As of 28th April, a total of 33,959,908 people have received one dose of the vaccine, with 13.6m having received both jabs. The public have also complied with staying at home, testing, isolating and, letting in fresh air. All of which plus the “hands, face and space” rhetoric aided towards reducing covid infections significantly. In fact, experts have said that Britain is no longer in a pandemic. New collations of data show symptomatic Covid infections were reduced by up to 90% since deployment of vaccine programme. Furthermore, just one dose of either the AstraZeneca or Pfizer/BioNTech vaccines showed 74% effectiveness against symptomatic infections and a two-thirds drop in cases.

Consequently, with this data, Boris Johnson moved England into step two of the road map – a “major step forward” to “freedom”, and out of lockdown on 12th April. However, the move is said to be ‘guided by data rather than dates’ and comes with a caveat that people must still behave “responsibly”, as there is still a threat present from new variants of Covid-19 and to protect the NHS. Hence, it is a map subject to change should the risk necessitate it.

The 4 tests before the 4 steps

The roadmap is dependent upon four tests which are guided by data and act as a checklist upon which decisions to ease restrictions and/or to move onto the next step shall be determined. The four tests will determine whether: 

  1. The vaccinations programme is to continue in its distribution as planned.  
  2. There is evidence showing that vaccinations are effectively reducing deaths and hospitalisations in those who are vaccinated.
  3. Infection rates do not surge at a rate that the NHS is overwhelmed with hospital admissions.
  4. New corona virus variants’ do not create further unforeseen risk.

The government has proposed a minimum of five weeks between each milestone step to allow four weeks of scientific data collection and analysis. Thereafter a one-week notice is factored in to implement and prepare for further restrictions, if necessary, or conversely relaxations, which will be England-wide. 

So, in view of the above, 21st June sounds somewhat unlikely, especially since new variants keep propping up, there may be the need for localised actions and testing. The uncertainty of their severity, as well as public compliance of the rules, and response to vaccines means there could potentially be yo-yoing between steps and long intervals before we are able to move onto the final and fourth step towards reclaiming our freedom legally.

The four steps…past, present and future

Where are we now?

On 23rd April 2021, Professor of Medical Statistics and Epidemiology at Oxford and Chief Investigator on the Office for National Statistics Covid-19 Infection Survey, Sarah Walker said, “Britain has moved from a pandemic to an endemic situation,” meaning the virus is circulating within the community at low and controllable levels. 

Having said this, it does not deter from the present threat of new strains and further peaks due to complacency. On Tuesday 13th April 2021 at 12:18 pm Josh Layton of Metro News reported police rushed through packed crowds, of hundreds of people in London Soho celebrating their release from restrictions, exhibiting little or no social distancing on the first night of step two measures.

Even if, the events are to be treated as isolated occurrences, it does uncover the risks from large gatherings to ensure social distance is consistently maintained. Such hasty celebrations could come with heavy caveats, leading us back to reverting to the constraints of our homes. Could 21st June 2021 be the date for our freedom out of the shackles of Covid-19? Only time and data can tell. For now we hope the proposed road map leads us to a safe destination from where we can all resume our lives, without the fear of Covid-19. As a nation we continue to demonstrate obedience to the regulations, and have taken individual oneness to act responsibly in order to reduce the spread of the virus. The hopes of many are pinned on that in continuing to do so, the virus is beaten down to the last variant and we return towards normality as we knew it, albeit it is questionable if the parameter of ‘normal’ will ever be the same post pandemic.

All views expressed in this editorial are solely that of the author, and are not expressed on behalf of The Analyst, its affiliates, or staff.

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Health

New study links alcohol consumption with hundreds of thousands of cancer cases

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A recent global study has found an association between alcohol consumption and a substantially higher risk of various types of cancer, such as breast, colon, and oral cancers. 

Researchers analysed data from 2010 to 2020, which disclosed a correlation between alcohol use and cancer development. 

In 2020, the study showed that 741,300 cancer cases were linked to alcohol use, where men represented the majority of these cases. As per the study, 77% (568,700) of alcohol-related cancer cases were that of men, while women accounted for 23% of the total cases (172,600). 

The study estimates that, globally, amongst the different types of cancers, oesophagus (189 700 cases), liver (154 700 cases), and breast (98 300 cases) cancers contributed to the most cases overall, followed by colorectal cancers and cancers of the mouth and throat.

The researchers found that heavy drinkers, those who consume an average of 2 to 6 drinks or 20 to 60 grams of ethanol alcohol a day, were seen in 39.4% of the total alcohol-attributed cancer cases. 

Moderate drinking was also found to be unsafe, with estimates that this level of drinking contributed to 14% of the total alcohol-caused cases.

Alcohol consumption severely damages DNA by causing increased production of harmful chemicals in the body. This consequently affects the production of hormones, which can lead to cancer development.

Alcohol equally has the potential to worsen the cancer-causing effects of substances, such as tobacco. 

Alongside raising awareness, researchers are also called for amplified government interventions in order to decrease alcohol use, especially in the worst-affected regions. 

The author of the new study Harriet Rumgay, a doctoral student at WHO’s International Agency for Research on Cancer, stated, “we urgently need to raise awareness about the link between alcohol consumption and cancer risk among policy makers and the general public”

“Public health strategies, such as reduced alcohol availability, labelling alcohol products with a health warning, and marketing bans could reduce rates of alcohol-driven cancer,” states Rumgay.

The Cancer Society of New Zealand has said that it supports the study conducted into the alcohol harm in Māori communities. It also published a position statement, which recommends various policies to specifically address alcohol availability, affordability and marketing to equitably reduce alcohol usage and related cases. 

Such measures being taken around the world to reduce alcohol consumption, demonstrates the severity of the impact of alcohol use on our health, be it moderate drinking or heavy drinking.

With the eye-opening statistics revealed from the study, if global awareness is not raised, more people may be at an elevated risk of cancer than they realise. 

All views expressed in this editorial are solely that of the author, and are not expressed on behalf of The Analyst, its affiliates, or staff.

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Health

A tangled identity: Proteins, prions and perseverance

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Everyone has an early memory. Perhaps, it is the time when you tentatively learnt how to ride a bicycle. Or your first day of school, when you had to introduce yourself to other students and eagerly waited for the soft toy to be passed to you so you could speak, a bit like the conch in William Golding’s ‘Lord of the Flies’. Or perhaps, it is a confusing portfolio of images, almost a distortion of emotional and logical circuits in the brain with no explanations to offer. Whatever it may be, the unique patterns in the neural networks – the epicentre of our identities, have constantly been weaving threads of memory and experiences. But what if they cease to weave? What if the neural networks that interconnect like the constellations of the stars stop connecting?

In fact, as a 17-year-old, one of the realisations I have come to make about the human brain is that it is this mystical realm that is somewhat akin to the ethereal world of the universe and stars – with both known and unknowns.

Over time, we have only ever been able to catch a cursory glimpse of the nuances of the brain’s neural language. Therefore, when the brain reveals its infirm side, it often becomes hard to find a reprieve from the ocean of confusion and bewilderment. When the neural connections that help transmit messages to different muscles and organs of the body start to become obstructed, it leads to a decrease in brain size and the death of nerve cells due to apoptosis, exposing the destructive side of the brain. The ripple effect of these results causes fallibility in the brain, and ultimately renders the person incapable of reasoning, functioning or living independently. And this is the case with Alzheimer’s disease.  

From a clandestine malady, Alzheimer’s disease has evolved into this incurable neurodegenerative disorder imbued with such might that it can metamorphose a person’s entire personality and memory. Since its first medical diagnosis in 1906 by Dr Alois Alzheimer, a German physician, scientists have strived to expound upon its behaviour, endeavouring to discover its mantle of remedy.  

A double-prion disorder

The onset of Alzheimer’s disease is most likely associated with a combination of factors such as the accumulation of beta-amyloid (a protein), leading to plaque deposition. The amyloid proteins are highly toxic to the surrounding cells and can result in neuronal cell death. The inception of this incurable disease is further attributed to twisted fibres of a protein called tau, which rapidly spreads after the beta-amyloid reaches a certain level. Prions, which, in essence, are misfolded proteins, spread to adjacent proteins and cause a contagion effect whereby they are also misfolded in a similar fashion. Together, these proteins wreak havoc in the brain by forming tangles and plaques, and therefore, Alzheimer’s disease is characterised as a double-prion disorder.

A question may arise as to why prions cannot just be destroyed. However, it is worth noting that as prions are essentially proteins, any efforts to inhibit them through exposure to extreme pH or temperatures, for instance, would denature the essential proteins required by the body for our survival.

Age and sleep disorders as risk factors

In the 1800s, the average human life expectancy in the UK for a man was 40.2 years and for a woman 42.2 years. Nevertheless, fast forward to the 21st century, and human beings are living longer than ever. According to the data from 2011, the average life expectancy in the UK has increased to 79.0 years for a man and 82.8 years for a woman. However, this timely escalation in our life expectancy has come with its repercussion: the danger of an epidemic for the elderly population. With the increase in our longevity, the threat of being diagnosed with a cerebral neurodegenerative disease has also surged. Furthermore, many studies claim the ‘dementia tsunami’ is heading our way, and Covid-19 seems to have made this a more pronounced reality. Therefore, the fact that the elderly population are beginning to outnumber the young people coupled with the disproportionate effects of Covid-19 creates a heightened sense of urgency to locate the causes and develop cures for the incurable neurodegenerative disorders.

Recent evidence has highlighted that perhaps sleep deprivation can be an early biomarker of Alzheimer’s disease, even a contributor. According to research conducted, many patients diagnosed with Alzheimer’s disease already suffer from a clinical sleep disorder- with insomnia ranking high in the list. Over time, insomnia – the inability to fall asleep – can lead to chronic sleep deprivation. It causes alterations in many parts of the brain, some of which are linked, albeit subtly, to the onset of Alzheimer’s disease. This causal link can be further strengthened by considering how when a person is diagnosed with Alzheimer’s disease; a similar degression can be observed in both the magnitude of sleep deprivation and the severity of the diagnosed condition.

Scientific advancements 

Various promising pathways are beginning to come to light in terms of scientific endeavours to identify a potential cure for Alzheimer’s disease. From using an electron microscope to better comprehend the intricacy of the brain, to Aducanumab being approved for treating Alzheimer’s disease, the understanding and research for Alzheimer’s disease have progressed by milestones. By no means is Aducanumab the ultimate cure, and there remains a vast territory currently unexplored. However, it is the first treatment to be approved for Alzheimer’s since 2003, which addresses how reducing amyloid plaques can reduce cognitive decline. Other current advancements include using modelling methods to predict disease processes, looking for new biomarkers in the cerebrospinal fluid (a clear fluid that surrounds the brain and spinal cord), and developing RNA interference (RNAi) technology to help with silencing genes prevalent in Alzheimer’s disease, amongst many others. 

As the progress continues, hopefully soon, novel therapies will bring a shift, and there will be more than just a fleeting descry of a potential cure as we will enter a new epoch of remedies.

All views expressed in this editorial are solely that of the author, and are not expressed on behalf of The Analyst, its affiliates, or staff.

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Health

The Delta COVID Variant is Overwhelming the U.S. Forcing a Rise in Coronavirus Cases

New Coronavirus cases are up 10% since last week as the Delta variant sweeps the US – with only half of the population fully vaccinated

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Arkansas, Florida, Missouri, and Nevada are currently experiencing a full outbreak and all states have seen an increase to new case numbers. As a result, there has been a 36% increase in hospitalisations and a 26% increase in deaths caused by the virus. With LA recording a significant 1,537 cases, the highest since March, the county is mandating masks in all indoor venues from Saturday night including those who have been vaccinated. 

Vaccine hesitancy, along with many Republican-controlled states prohibiting the enforcement of mask mandates, has led to the highly contagious variant spreading rapidly. Children are also at a risk of contracting the Delta variant of Covid-19 as there is no authorised Covid vaccination for children under 12 years of age.  This comes more than 18 months into the pandemic, a point at which the general public anticipated the virus would be under control. 

Dr Rochelle Walensky, the director of the Centers for Disease Control and Prevention (CDC), stated “I think now is our moment to really double down on our vaccination efforts and our other prevention interventions” as “this is now becoming a pandemic of the unvaccinated”. Further, unvaccinated Americans “account for virtually all recent Covid-19 hospitalizations and deaths” stated Jeff Zients, Counselor to the President of the United States and a Coordinator of the Coronavirus team within the White House. 

The pandemic has affected our lives for the last year and a half. In the beginning, the talk of the town was the urgency at which a vaccine was needed. Now, we have several vaccines and a confusing hesitancy from many people to take the vaccine. With the virus being a crucial matter of public health, shouldn’t we be jumping the gun to save the world? 

References:

As delta variant spreads, medical experts warn of risk to young children (nbcnews.com)

US seeing ‘pandemic of the unvaccinated’ as cases rise in every state | Coronavirus | The Guardian

All views expressed in this editorial are solely that of the author, and are not expressed on behalf of The Analyst, its affiliates, or staff.

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Third wave of Covid-19 overwhelms healthcare systems in Africa

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Covid-19 cases in Africa have seen a recent sharp rise, which in turn has caused up to a 43% increase in Covid-19 related deaths. This sudden surge has led to a shortage of oxygen and intensive care beds in hospitals. This is a big problem right now, as the number of cases will soon reach the peak that was recorded in January 2021. “Deaths have climbed steeply for the past five weeks. This is a clear warning sign that hospitals in the most impacted countries are reaching a breaking point”, as was stated by Dr Matshidiso Moeti, a World Health Organisation (WHO) regional director. The case fatality rate in Africa has also increased to 2.6% which is 2.2% on average for the rest of the world, mainly due to the new Delta strain that has spread all over the continent.

This devastating increase has been fatal for the severely ill people as there is a shortage of healthcare workers, poor infrastructure, and an overall lack of resources. Most deaths have been occurring in Namibia, South Africa, Tunisia, Zambia, and Uganda according to the WHO. On Tuesday, the cases reached the highest amount recorded with 6 million cases in the continent. Until now, 47 African countries have been affected by the recent surge of Covid-19. This third wave of Covid-19 is the highest and fastest surge that Africa has seen since the start of this pandemic.

The main problem is the lack of oxygen – as without the oxygen critically ill people don’t even have a fighting chance. The WHO is working to eliminate this oxygen shortage but until now there is still only 27% of the medical oxygen being provided. Moreover, the vaccination rate in the continent is extremely low as well. Only 18 million people across Africa are fully vaccinated out of the 3.5 billion people that have been vaccinated worldwide, this makes up only 1.5% of the population of the continent, according to the data provided by WHO. There is still a chance of reducing the wave as additional vaccine supplies are expected to reach Africa in the coming weeks and months.

Lastly, due to the latest riots that have been taking place across Africa, according to the Wall Street Journal after Jacob Zuma’s arrest, who was a formal leader, the precautionary measures that are taken to prevent Covid-19 have been largely ignored; this has been exacerbated by a blockage of supplies, like oxygen and vaccination destined for the continent, as stated by the Wall Street Journal. If Africa doesn’t immediately tackle these issues it could lead to great devastation as the continent is already suffering from recent political unrest. 

All views expressed in this editorial are solely that of the author, and are not expressed on behalf of The Analyst, its affiliates, or staff.

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Covid medical advisers – the toughest job in the world?

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Chris Whitty, the chief medical adviser for the UK government, was recently assaulted by Lewis Hughes, who is due in court for the offence on 30th July. So, what drove the ex-estate agent to behave in this way, and why target Mr. Whitty?

The Scientific Advisory Group for Emergencies (SAGE) was established after mad cow disease (BSE) became prevalent in parts of the UK in the 80s and 90s. It has since advised the UK government on the 2009 flu pandemic, 2014 Ebola outbreak and the 2015-2016 Zika virus epidemic, to name a few. Since the Covid pandemic took speed in March 2020, the SAGE committee has been advising ministers and the Prime Minister alike, but, as we all know, the virus is fast evolving and today’s best-assessed advice could change tomorrow. Is this why being a SAGE adviser is the toughest job in the world and those at the forefront of the group, the faces that we saw televised in the daily briefings, have been targets for the public? Those who cannot understand the degree of uncertainty that lies between the research established on any one day and how it can be strikingly different from the next, need to be better informed, perhaps. 

While the government battles with the economic fallout of lockdowns, the pressure on the NHS, and the mental health of the nation, SAGE is working tirelessly and collectively with other agencies and scientists, including NERVTAG, SPI-M and WHO to eradicate or, at the very least, live with the virus with some degree of immunity, so that the world can go back to the normal we all once knew. 

Mr. Whitty was confronted in February and accused of lying to the public about the virus. He was also accosted by a man in Westminster and has even had people chanting and shouting outside his London home. Sir Patrick Vallance (Government Chief Scientific Adviser (GCSA)) and Mr. Whitty were dubbed “glum and glummer” by critics as they informed the nation of the government’s steps to curb the pandemic and its relentless acquisition of lives. Influential trade lawyer, Shankir Singham, warned the government that “scientists shouldn’t be giving press conferences publicly without any filtering, as other scientists warned that Vallance and Whitty’s predictions were almost “designed to scare us. 

The government has relied on scientists throughout the pandemic. They are the ‘technical experts’ and have always been upfront about the potential socio-economic damage from lockdown, and surely their presence has helped public confidence? However, the ‘impression’ that the British public gets with the conflicting and ever-changing views of different influential individuals could result in frustrations and misgivings. They clearly rely on the evidence and the policies, which are made to alleviate the problems faced due to the pandemic. 

Another factor contributing to these frustrations is the actions of individuals such as Dominic Cummings and former health secretary, Matt Hancock’s recent behaviour, which strongly undermines the very policies that the scientists are trying to advise and the government implements. In a letter to the West Suffolk Conservative Association, Mr. Houlder (a local councillor) said that He has let every member of the public down, pontificating that they should all make huge sacrifices on the altar of the pandemic, whilst doing the complete opposite himself.” The day before Hancock was shown in a compromising position with a work colleague, Keir Starmer announced the death of 27-year-old Ollie Bibby, who died with only one person at his hospital bedside, to ministers at Parliament.. 

The scientists are simply trying to save lives. To think of an alternative scenario, where no lockdown was imposed and people were to go about their normal business, is unthinkable. The number of deaths is unimaginable. The scientific community, the government, and the general public need to work together to achieve the best possible outcome and the only way to achieve this, is for public figures to behave in a way that conforms to the policies they have implemented. There simply is no other way of achieving this; hypocrisy is not an option. 

Furthermore, the media should be responsible in the way it presents and interprets the vital information that is relayed to the public, quoting ‘glum and glummer’ is not going to persuade the public to follow the rules. If anything, the public will associate a sense of gloom and mistrust with the advice given.

However, it was evident from the start of this pandemic that things would not be easy. The public’s frustrations cannot in any way justify the actions and attitudes of the few who are attacking the very face of the scientific advice, assaulting and abusing the advisers should be openly condemned, and the attackers brought to justice. There is no excuse for criminality or injustice in this situation. The job of the government medical advisers should be respected and valued by the UK public.

All views expressed in this editorial are solely that of the author, and are not expressed on behalf of The Analyst, its affiliates, or staff.

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Covid-19 Vaccination and pregnancy – is it safe?

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The Covid-19 vaccinations have been the subject of public scrutiny ever since their initial rollout in January 2021. With both pharmaceutical companies and country governments pushing for their rapid distribution, questions have arisen regarding their safety and efficacy in various proportions. There was particular apprehension regarding the effects on fertility and pregnancy. While rumors about the vaccines affecting fertility have been largely dismissed by healthcare professionals, the skepticism around their effects on pregnancy and lactation still remains widespread. A major reason of that being the exclusion of pregnant women from the clinical trials for the vaccines. The paradoxical nature of this decision comes to light as several healthcare organizations have since then classified pregnant women as a high-risk group. 

Pregnant individuals are at a significantly higher risk of serious illness from Covid-19 in comparison to non-pregnant individuals, which can result in the need of hospitalization, intensive care or artificial ventilation. There are also higher chances of adverse outcomes such as spontaneous abortion or preterm birth for pregnant Covid-19 patients. These dangers have brought developments in the global vaccination advice. The most recent guidelines from the Center for Disease Control (CDC), the World Health Organization (WHO)  and the Joint Committee on Vaccination and Immunization (JCVI) have strongly recommended vaccination for pregnant women and have also endorsed it for lactating women. Doctors, healthcare professionals and experts worldwide advocate for the same, as they believe the benefits of getting vaccinated outweigh the risks. These claims are backed by studies carried out on pregnant animal models and their offspring, which haven’t raised any evident red flags when it comes to concerns about safety, in both the mother and child. There are, however, reservations regarding the extrapolation of these results to humans. 

The nature of vaccines make it difficult to predict the side effects it may have on different individuals or groups of individuals. As the initial data is so limited, the CDC has invited pregnant women who have received the Covid-19 vaccination to participate in their in v-safe Covid-19 Vaccine Pregnancy Registry. The purpose of this initiative is to collect health information from people who have received the vaccine in either periconception (within 30 days prior to their last menstrual period) or pregnancy period. This allows them to monitor progress and outcome of pregnancy and report any adverse side effects that may have potential links to the vaccine. 

Although participation is voluntary, the CDC encourages women to enroll in the v-safe registry for improved record of data that would help anticipate future directives. Unfortunately, the numbers of enrolled participants in the registry is low, as many of the women who self-identified as pregnant during the time of vaccination either could not be traced or refused to participate. An overwhelmingly large number of women who have enrolled are healthcare professionals, which leads to possible biases in results. Interestingly, this also highlights the lack of awareness amongst non-healthcare professionals about the prospective benefits of Covid-19 vaccination and its studies. In an online survey conducted by researchers at the Harvard T.H. Chan School of Public Health, only 52% of pregnant women across 16 countries (around 18,000 participants) said they were likely to get the vaccine.

The New England Journal of Medicine (NEJM) published an article by a team of American researchers, titled, ‘Preliminary Findings mRNA Covid-19 Vaccine Safety in Pregnant Persons’ based on data from the CDC’s the v-safe registry, the v-safe after vaccination health checker and the Vaccine Adverse Event Reporting System (VAERS). While not exactly alike, the report states that the adverse pregnancy and neonatal outcomes were “similar to incidences reported in studies involving pregnant women that were conducted before the Covid-19 pandemic”, thus deducing that no clear associations could be made between the vaccine and the outcomes. While there aren’t any obvious safety concerns regarding the approved vaccines for pregnant women, further follow up studies are highly suggested. 

On the flip side, reassuring progress has been made in understanding the benefits of the vaccines for pregnant and lactating women. Results for several studies show that the levels of antibodies against Covid-19 in the bloodstream of pregnant or lactating women who received the vaccine are comparable to their non-pregnant peers. Evidence reveals that these are passed on to the newborns as well, particularly if the mother had been inoculated during the third trimester or while lactating, proving that it gives them a certain degree of protection against the disease. More studies are underway to determine the exact mechanisms of antibody transference to the neonates.

When it comes to determining vaccine safety, the most vital tool is clinical trials. Despite being excluded originally, the National Institutes of Health (NIH) is commencing a clinical trial in the United States to evaluate the immune responses generated by Covid-19 vaccines in pregnant or postpartum women. This trial will allow the participants to be studied in a more controlled environment, in the hopes to yield results that are more reliable. It is likely that with the success of this trial, more are to come with further enhancements including populations from other countries as well. 

The general consensus is that vaccination is safe, and more so is encouraged for pregnant and lactating women. So far, the Pfizer-BioNTech, Moderna, Johnson&Johnson/Janssen and Oxford-AstraZeneca vaccines have been approved. Even though there are limited data about safety for the Sinovac and Sinopharm vaccines during pregnancy, the WHO in the interim recommends their use as well. The only exceptions are the Covishield and Covaxin vaccines that have been authorized in India, which have not yet received approval for pregnant women

Despite the green light from healthcare organizations, it is always best to contact and discuss your obstetrician/gynecologist or primary healthcare provider before taking the vaccine. The effect of vaccines is always a multifactorial event and can vary widely depending upon individual conditions. Thus, is it necessary to consider your health status and seek advice from your doctor before taking the Covid-19 vaccination when pregnant. 

All views expressed in this editorial are solely that of the author, and are not expressed on behalf of The Analyst, its affiliates, or staff.

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