"My father's death after contracting the coronavirus was the main reason behind my decision to get vaccinated," Ahmed Salah, a 36-year-old engineer who registered online for a vaccine shot in March and was inoculated in April, told Al-Ahram Weekly. Less than one per cent of the Egyptian population has been vaccinated so far. Nevine, like Salah, is among them. "I went through a period of hesitation," she told the Weekly, "which ended when I realised the vaccine's benefits outweighed living with the anxiety of the possibilities of being infected." "What prompted me to be vaccinated was the current increase in the number of cases being reported daily, and the fact that the symptoms appear to be serious. I'd urge everyone to get vaccinated," said Nevine, whose first jab of AstraZeneca vaccine left her with a high temperature for two days. Nevine said that many people she had spoken to were holding back from being vaccinated because they had read reports that the vaccine can cause blood clots. But for her, she said, it was a simple calculation: the incidence of blood clotting was extremely rare, "a rate of four per million, a far smaller risk than is posed by coronavirus". Following reports linking rare occurrences of blood clotting to the AstraZeneca vaccine, some countries suspended the use of the vaccine altogether while others restricted its use. A report issued on 23 April by the European Medicines Agency (EMA) said the most serious side effects of AstraZeneca are very rare cases of blood clots estimated to occur in one in 100,000 vaccinated people. The EMA stressed, however, that the vaccine is effective in preventing hospitalisations, intensive care unit (ICU) admissions, and deaths as a result of Covid-19. Health Minister Hala Zayed told the public on Saturday that they should not fear taking the vaccine and urged everyone to register. According to Health Ministry figures issued last week, only 660,000 people have been vaccinated. Sameh Mohamed, a 39-year-old father of two, is adamant that he will not be getting vaccinated any time soon. "No one knows the vaccines' side effects in the long run," he said. Instead, he has decided to continue with precautionary measures while simultaneously trying to strengthen his immune system. Denmark and Norway suspended the administration of the AstraZeneca vaccine. Germany has restricted it to people over 60, and on 1 April announced that people under 60 who had received a first AstraZeneca shot would be given a different vaccine for their second dose. The UK is administering alternative vaccines "whenever possible" to people under 30 while Italy, Spain, and the Netherlands have limited the use of AstraZeneca to people over 60. Due to Zayed's statement that people vaccinated are not totally immune from infection, Mohamed decided to strengthen his immune system and adhere to the precautionary measures rather than be inoculated. Like Mohamed, Dina Samak says that, for the time being, she will continue with precautionary measures. "I'm not comfortable with the possible side effects," she says, "and besides, even if I do get vaccinated, I will not have complete protection, and there are no guarantees that any one vaccine will be effective against new variants of the virus." That many people are hesitant about being vaccinated is only to be expected, says clinical research expert Ashraf El-Fiky. "The phenomenon is not confined to Egypt but occurs in most countries, including the US," El-Fiky, a former fellow of the US Food and Drug Administration (FDA), told the Weekly. He urged the Health Ministry to engage in more public awareness and confidence raising campaigns. El-Fiky said the fact that President Abdel-Fattah Al-Sisi and Prime Minister Mustafa Madbouli had both had their first doses of the vaccine may help alleviate some of the public's concerns. Egypt has contracted 100 million doses of various types of vaccines, Zayed said, of which 1.5 million doses of Sinopharm and AstraZeneca have already arrived. According to the cabinet, an additional 900,000 shots of Sinopharm are due to be delivered in late April and two shipments of two million AstraZeneca shots each will be received early May. Negotiations are also underway for 10 million doses of the Russian-made Sputnik V vaccine. "The supply of vaccine shipments is tied to it being allowed to be exported from the country of origin," Zayed said, adding that because more than 80 per cent of the vaccines produced globally are destined for 12 countries only, it was necessary for Egypt to work on manufacturing vaccines locally. To achieve its goal of vaccine self-sufficiency and later on export to African countries, Egypt has an agreement with China's Sinovac Biopharmaceutical Company that will allow VACSERA to domestically produce 40 million doses of the Chinese vaccine this year. The first five million doses of Sinovac vaccine will be locally produced within two months, said Zayed. A second agreement, signed between Egypt's Minapharm pharmaceutical company and the Russian Direct Investment Fund (RDIF), will allow the manufacture of over 40 million doses annually of Russia's Sputnik V vaccine in Egypt. Sputnik V is currently thought to have a 95 per cent efficacy rate. Since early April Egypt has seen a slow but steady increase in the daily number of infections. Health officials warn, however, that the reported number of cases is likely to underestimate the problem since only cases admitted to public hospitals are registered. On Tuesday, for the first time since January, Egypt — which has yet to hit the peak of the third wave — exceeded 1,000 daily cases. "Unlike the first and second wave, the third wave is likely to be selective due to the presence of vaccinated communities which will not be hit hard by this wave due to its now-existing herd immunity," El-Fiky told the Weekly, indicating that the inoculation rate and population number are the two most important factors to keep in mind during the third wave. He also explains that the third wave also comes in the presence of newly-detected mutated strains with different clinical symptoms. "For that reason, the peak of the third wave may take a plateau form — more flat than the first two waves — and take more time to decline," El-Fiky predicted. Countries with low vaccination rates and huge population census may witness a fiercer wave, he said. "India is currently suffering from a devastating wave of Covid-19, and it has a vaccination rate of eight per cent. In Egypt, the vaccination rate is still below one per cent, leaving the country exposed to a potentially catastrophic situation," El-Fiky said. Zayed says the current hike in infection rates had been anticipated during Ramadan, when Muslim families traditionally gather, and during Coptic Holy Week, which began on 25 April. On Saturday, Zayed said an increasingly lax approach to precautionary measures was fuelling the spread. While she urged the public to be more cautious, El-Feki said the time for caution may well have passed. What he would like to see is the immediate imposition of a two- or three-week curfew to circuit-break the spread of the virus. Asked about the possibility of reinstating last year's partial lockdown, Zayed said it was something for the cabinet to decide. Far more likely, she suggested, would be the closure of businesses that do not stick to safety rules. Meanwhile, on Sunday, the Education Ministry decided to end the school year this week except for students due to sit grade 9 and grade 12 exams. *A version of this article appears in print in the 28 April, 2021 edition of Al-Ahram Weekly
