Commentary

COMMENTARY Vaccination is the most beneficial treatment a physician can provide because it can elicit protection from potentially lethal microbial disease even if it does not prevent infection. The study titled “Evaluating the Role of COVID-19 Vaccines in Patient Outcomes: Evidence from the Eighth Wave in Kerman, Iran” submitted by Raisi Sarbijan et al1 statistically supports this premise. They performed a retrospective cross-sectional study on 161 COVID-19 patients, all of whom were hospitalized at Afzalipour Hospital in Kerman, Iran, during the eighth wave of the pandemic (January 21 to May 21, 2023). Most of the patients had received at least 1 vaccination with 1 of 5 different vaccines. The patient population was admitted to hospital with severe shortness of breath, rapid breathing, low blood oxygen levels (≤90%), and clinical signs of pneumonia with laboratory confirmation of SARS-CoV-2 infection. The authors note that the course of disease for vaccinated individuals was milder and less lethal than for those who were unvaccinated with some differences in efficacy of the different vaccines. Disease in these individuals may have occurred despite vaccination for many reasons including exposure to a different strain of SARS-CoV-2 than addressed by their vaccine. The relatively small number of patients, with diverse histories (potential risk factors) and receiving different numbers and formats of vaccines and potentially to different strains of the virus, limits the strength of the findings for this study, but the take home message is still valid—vaccination is beneficial. COVID-19 disease can range from being asymptomatic, a common cold, or to serious respiratory (pneumonia) and multisystem inflammatory disease with the potential for long-term sequelae, as long COVID.2 The virus structure, broad tissue distribution of its cell surface receptor, and ability to escape the initial innate protections make SARS-CoV-2 very contagious. The predilection of the virus to mutate and then be selected to escape antibody control hinders the efficacy of vaccine programs and establishment of herd immunity. Even so, vaccination with the most current version of the COVID vaccines remains the best means of protection against the disease.1,3 There are several different formats for the COVID-19 vaccines.4–8 In the United States, the available vaccines include the lipid particle containing mRNA vaccines of Pfizer and Moderna and the adjuvanted nanoparticle vaccine of Novovax. These vaccines elicit or utilize a structurally modified glycoprotein spike protein (S) of the virus that retains its optimal immunological conformation. The FDA judged these vaccines as safest and most effective. These formats also lend themselves to be updated to accommodate the strain changes that have occurred with the evolution of the virus. Other vaccines, available elsewhere and in Iran, include the following: inactivated whole viral vaccines (Sinopharm; COVIran Barekat), adenovirus fusion vaccines (Oxford/AstraZeeneca [ChAOx1 nCoV]; Sputnik V) containing the gene to promote the expression of the S glycoprotein, and subunit vaccines (PastoCovac). The patient population in the Raisi Sarbijan et al1 study received one or another of these alternative vaccines, most receiving the Sinopharm vaccine. No mention was made as to whether they received the latest, updated vaccine to the most current virus strains. Despite the different uncontrolled variables regarding the nature of the patient population and the types of vaccines that were administered, the study reaffirms that prior immunization can lessen the symptomatology and severity of disease.8 Another study showed that vaccination can also reduce the potential for long COVID.9