As the world turns its attention to Qatar for the World Cup, the small Middle Eastern country moving toward the Persian Gulf is most identified in the medical studies network for offering some of the earliest data on vaccine efficacy, declining immunity and COVID-19 reinfection. 19 pandemic.
With a national fitness formula and a focus on collecting the right data, the researchers were able to answer some of the most critical questions about COVID as they emerged, publishing in leading journals including the New England Journal of Medicine, JAMA, Natural Medicine and others. .
Leading the team are Laith Abu-Raddad, PhD, and Hiam Chemaitelly, PhD, anyone from Weill Cornell Medicine-Qatar, who have been dedicated to infectious disease epidemiology for more than 15 years and have long-standing relationships with the country’s public fitness sector. that made his paintings possible.
When the pandemic hit in early 2020, Abu-Raddad and Chemaitelly worked intensively with Qatar’s Ministry of Public Health to make sure the country’s medical databases collected the right data in the first place so they could help meet the country’s immediate desires for healthcare capacity. And then, later, do some research. This included tracking each and every COVID screening conducted in the country, collecting detailed evidence on the severity of infection according to WHO criteria, and capturing all vaccination data.
Abu-Raddad said there were two must-haves in the country before the COVID pandemic that enabled his work: the complex virtual fitness platforms that led to Cerner’s national use for all medical records, and the structure of Education City, a conglomerate of American universities that opened branches in Qatar.
Being a small country of around 3 million people also helped: “A lot can be done through a phone call,” Abu-Raddad said.
At the same time, having a complete knowledge of millions of other people has allowed for really extensive analysis.
Ruanne Barnabas, MD, an infectious disease leader at Massachusetts General Hospital in Boston, has followed Abu-Raddad’s paintings since they were colleagues early in their careers. He said that Abu-Raddad is the right user with the right equipment in the right position at the right time, given the high-quality knowledge he possesses and his experience in the science of knowledge and dynamics of infectious diseases.
“The research was conducted through very rigorous clinical strategies that have been refined over many years,” Barnabas told MedPage Today. and test hypotheses. “
Another asset Abu-Raddad’s strong team assembled: “He invested many years in mentoring and building a culture of clinical interest and evidence-based work,” he said.
“They were in such a smart position to do that, given their expertise in infectious diseases,” he added. “They’ve influenced how we’ve dealt with the COVID pandemic and how we’re moving forward. “
Learn more about COVID immunity
The team’s early studies explored the severity of the infection and who is most exposed to the threat of hospitalization and death. Then his focus shifted to herbal immunity and the threat of reinfection. They conducted the first reinfection study after an herbal infection, which was published in Clinical Infectious Diseases in December 2020.
But overall, those early articles didn’t get much attention, Abu-Raddad said. “We’ve tried to publish in high-impact magazines, but we didn’t succeed,” he told MedPage Today in a Zoom interview. new team in the picture, so we published but didn’t succeed in the New England Journal or The Lancet or Nature Medicine. “
But over time, the team’s paintings began to get noticed, with Abu-Raddad saying the “tipping point” was their first letter to the editor published in the New England Journal of Medicine in May 2021 about the effectiveness of the Pfizer vaccine against Alpha and Beta variants.
After that, the team’s work took off. His original New England Journal of Medicine article from October 2021, one of the first to show that coverage against infection with the Pfizer vaccine declined, but hospitalization and death coverage persisted for 6 months. They originally published the exam in medRxiv.
The following month, the team published an original study in JAMA showing that infection before vaccination was associated with a lower risk of infection progression, as well as an article in Nature Medicine comparing the efficacy of the two mRNA vaccines against the delta variant.
Over the next year, the team published dozens of papers informing doctors about immunity, drawing knowledge from millions of patient records. They found, for example, that reinforcements still protected the Omicron wave from hospitalization and death.
“At the time, it was very important to combat vaccine hesitancy with a third dose,” Chemaitelly told MedPage Today via Zoom.
They also found that various types of immunity, whether they came from a vaccination, a previous infection, or a combination of both, were resistant to Omicron.
Abu-Raddad said his studies in general have shown that herbal immunity has been underestimated. A paired retrospective study they published in the Lancet Microbe, for example, showed that plant-based immunity was linked to a lower incidence of infection than two doses of an mRNA vaccine.
“Ultimately, [natural immunity] can be the same as vaccine immunity,” he said.
Unfortunately, he noted, “not all the bureaucracy of immunity to this virus lasts long. In the short term it works very well, but in the long term we want to remain stronger. “
Focus on immune fingerprinting
However, repeated handling of vaccines has raised questions about immune fingerprinting, known as original antigenic sin.
Abu-Raddad said his team now aims to read whether other immune backgrounds can pass on other types of coverage. So far, they have conducted two studies showing that some profiles “improve coverage against long-term infections, while others compromise coverage. “
For example, the first study showed that those who gained a booster had reduced coverage against infection after finishing the booster to those who gained only two doses of the vaccine.
“Those who won the reminder benefited greatly,” Abu-Raddad said. “But after 6 months, when coverage against infection decreased, that’s when we saw an immune fingerprint. “
The maximum likely explanation for this finding, he added, is that “by administering 3 doses of the same vaccine, we are telling the immune formula to prepare for a challenge similar to that of the original virus. The immune reaction believes that this is where The challenge is, however, the real challenge, of course, is something absolutely different. It is a BA. 4/5 immunoevasive variant of Omicron.
However, Abu-Raddad is quick to acknowledge that while the effects are interesting from an educational perspective, “at the end of the day, I’m not sure how important they are, honestly, because it probably wouldn’t replace how I deal with the virus. “
The most productive solution to avoid infection and the damage that waves of disease can cause is to give boosters, he said, even if it’s a short-term solution.
“Thank God for the reminder,” Chemaitelly said. We had a big wave of Omicron here, and we’ve moved away from the overwhelming hospitals with the retirement. “
Abu-Raddad said there is evidence of immune fingerprints with other viral infections, including influenza. But annual vaccinations regularly offer enough coverage compared to peak infection season to negate any adverse effects of fingerprinting. And there is no evidence that impregnation affects the opposite coverage. to serious illnesses at this stage, he added.
“I rule it out completely, but it seems like years because coverage for serious illness lasts much longer than coverage for infections,” he said.
Abu-Raddad concluded that updated recalls to accommodate circulating strains “will be essential, especially in vulnerable people. “
Long-term funding of randomized controlled trials
The researchers made it a priority for investment because of its conflict-free knowledge, they said. This has not been difficult to do in a resource-rich country like Qatar. Its public fitness infrastructure was well-funded before COVID, thanks to revenue from the country’s massive reserves of herbal fuel, as well as corporate taxes (the country has no source of income taxes for its citizens).
Let no pharmaceutical company budget for any of its data, the researchers said.
Another merit of building knowledge-gathering criteria early in the pandemic is that they can come with strict criteria to define the disease, meaning they had no trouble distinguishing deaths “with” rather than “from” COVID, Abu-Raddad said.
In addition to the Ministry of Public Health and Weill Cornell Medicine-Qatar, other key players in the knowledge team included Hamad Medical Corporation, the country’s hospital formula, “the backbone of the fitness formula here,” Abu-Raddad noted, and Primary Health Care Corporation, a national network of number one care clinics. Qatar University and Sidra Medicine, either in Doha, have been running sequencing and genotyping of the variants, he said.
Both Abu-Raddad and Chemaitelly strongly advocate the perspective of great knowledge to answer vital questions about fitness. As clinical trial price caps have risen further, knowledge bases have become more complicated and complex, Abu-Raddad said.
“We can use great insights to answer questions that clinical trials can’t answer,” he added. “What are the maximum effective combinations of diabetes medications?It would be tricky to do that in a clinical trial. But [with great knowledge], look at millions of people, not just 30,000 in a clinical trial. “
He refers to those analyses as “retrospective randomized controlled trials” and noted that they are much less than randomized controlled trials.
Barnabas said Abu-Raddad and his team are one step ahead of COVID and are confident of its long-term success. While COVID studies have come out of the U. S. In the U. S. , he said, its knowledge systems may need an update. And even then, there is still much to be done globally.
“We thought about how we can do this more broadly and have knowledge for more than one country,” Barnabas said. “All knowledge bases communicate with each other. We provide knowledge in percentages and we do it globally. “
Kristina Fiore leads MedPage’s research and reporting team. She has been a medical journalist for over a decade and her paintings have been identified through Barlett.