News update: COVID-19 vaccination

11 March 2021 Newsletter

A lot has already been said and written about the COVID-19 vaccination. Despite this, through
our own conversations with companies and customers, we are very aware of how much remains
unclear. For some questions there simply is no straightforward answer. We can however offer
some clarity and advice on a number of aspects which are not only of general interest, but also of
specific interest to business travellers and expats.

Q. How necessary is vaccination in the fight against COVID-19, compared to all the
measures that have already been implemented?
A. Very necessary! In addition to measures which actively discourage people from moving around
too much and instead encourage them to reduce contact with others (working from home,
travelling only in case of emergency, curfews), measures have also been taken encouraging
enhanced personal hygiene and protection, and the current testing policy has been developed. Yet
despite all of this, we are not in control of the virus; it is still with us. Vaccination, which is
intended to build up protection against the virus by a provoked immune response, is therefore a
hugely welcome weapon in the fight against COVID-19 and hopefully a step towards ‘getting back
to normal’;.
For more background information on this, please visit sites such as https://www.rivm.nl/covid-19-vaccinatie or https://www.rijksoverheid.nl/onderwerpen/coronavirus-vaccinatie.

Q. Is vaccination 100% protective, does the protection last and can we be sure that
those persons who are vaccinated cannot spread the virus if they do come into
contact with it?
A. These are legitimate questions, about which there is plenty to say (or to speculate) and about
which there is additional information to be found on the websites mentioned above. Very briefly,
vaccination is a very effective way of stimulating the buildup of antibodies in those vaccinated.
However, as every immunologist knows, this does not tell the whole story. How long the
protection lasts for is unclear at the moment. But even if in the coming months research shows
that the protection provided by the vaccine diminishes after a certain period of time, you can
always offer people a periodic booster vaccination.
Whether the spread of the virus to others also occurs less effectively after someone has been
vaccinated but comes into contact with the virus, is the subject of research. It does appear to be
the case according to the still somewhat limited data, which is very positive.

Q. Is vaccination sufficiently safe?
A. Fear and sometimes suspicion often play a role in this discussion. Vaccinations which are
included as standard in the National Vaccination Programme occasionally cause side effects as
well; sometimes only locally (a sore arm), but sometimes leading to a more general feeling of
being unwell. These are temporary effects. The vaccines currently being used have been tested
and assessed for safety and efficacy in tens of thousands of people. Tens of thousands of people is
not everything on a global scale, but the likelihood of as yet unknown but relevant side effects
becoming apparent seems quite small. Low is not the same as zero, but in the light of a pandemic
that has gripped the world and so severely curtailed people's freedoms, it is questionable whether
fear of rare, as yet undiscovered side effects, should be a decisive argument against vaccination.

Q. Can I stop taking all the precautions again if I have been vaccinated once or
twice?
A. Over the coming period, the current precautionary measures should definitely not be toned
down. However, as soon as the vaccination level in the general population rises and if it turns out
that the number of COVID-19 infections is indeed decreasing significantly, then this question will
immediately become part of follow-up research. After all, it seems logical that if the number of
infections and the spread of the virus decreases, the current measures can be relaxed. For the
time being, however, unpleasant as all these measures may be, it would at least be a relief if the
lock-downs and curfews could be lifted and health services could be resumed to operate as
normal. And hopefully, soon thereafter, travel restrictions can be lifted. Of course, it is crucial that
as many of the population as possible gets vaccinated!

Q. What travel-related (testing) obligations still apply if I have been vaccinated?
A. Let’s start by saying that vaccination is primarily meant for one’s own protection! Everything
else that is compulsory for the time being in the form of annoying tests or whatever else is, if we
are honest, bearable. It is not yet known whether there will be additional provisions for
occupational travel, for instance to show proof of the antibody yield in the blood as measured
after vaccination, and whether or not this has to be recorded in a vaccination passport.
But it remains to be seen whether merely such a vaccination passport will suffice or whether a
negative result of a recent PCR or rapid test will still be required for international travel. Again,
these regulations will continue to be assessed as more clarity is gained about the exact level of
protection offered by the vaccine or the extent to which a vaccinated person can still infect others
after coming into contact with SARS-CoV-2 (the virus which causes COVID-19).

Q. If I can be vaccinated abroad with a vaccine not yet registered in the Netherlands,
should I do so?
A. Data on the effectiveness and safety of the various vaccines, as well as information on the
number of people in whom this has been studied, will become increasingly available in the coming
period. In the Netherlands, the vaccines currently used are those of Moderna and
Pfizer/BioNTech, both approved by the EMA. There are also (advanced) agreements with other
vaccine developers (CureVac, Janssen, Sanofi). Vaccination with the AstraZeneca vaccine is
currently put on hold.
Other vaccines are being developed around the world. The Russian Sputnik vaccine has very
recently had its first data published on a larger scale, and these seem to be fairly favourable. It has
not received EMA approval as yet. However, results from some other vaccines are disappointing.
And for some vaccines information about the production process is missing or it is unclear how
carefully safety testing has been carried out. It is therefore very difficult to give an overall answer
to this question.

Q. If someone has been vaccinated, is a rapid test still useful/reliable?
A. Vaccination (if successful) causes the body to produce antibodies against the coronavirus.
These vaccine antibodies, which can be detected in the blood, cannot at present be distinguished
from the antibodies produced by someone who has actually experienced COVID-19.
However, an antibody blood test/serology is hardly ever used to detect the disease. A PCR or an
antigen rapid test, taken from a throat/ nasal swab, both use a different technique and are
specifically able to detect (parts of) the virus itself. These tests are both still suitable to
demonstrate infection; the result is not influenced by the fact that someone has been vaccinated.

Q. Are there any differences between the vaccines currently used?
A. Yes. The sites of action of the vaccines on the virus may differ and, depending on the type of
vaccine (mRNA vaccine/protein vaccine) so may the underlying mechanism. See also this link. The
studies available to date show that the effectiveness of the various vaccines does not differ greatly,
although the degree of protection provided by the expected Jansen/Johnson&Johnson single-
prick vaccine appears to be slightly lower. But it does seem to be sufficient to prevent death and
hospitalisation. However, until research becomes available showing that this is not always
necessary, it is important to complete a vaccination series with the same vaccine as the one with
which you started. If, for some reason, this is not possible, then the safest course of action is to
start a full series with a different vaccine.

Q. If everyone on a project or on board of a ship has been vaccinated, does testing
still need to be done or do protective measures need to be taken?
A. The answer stands or falls with the question of how (long-term) effective the vaccine is in
protecting and also to what extent a vaccine ensures that further spread of the virus to other
people is prevented. If all of that turns out to be OK and antibodies have been shown to be present
in everyone on board or participating in a project, then testing and precautionary measures may
be relaxed over time. But for now, this is still too early.
Apart from that, a vaccinated person who develops symptoms that are consistent with COVID-19
will still have to be tested to rule out COVID-19. This is partly to reassure people around him or
her in case of a reassuring result, but also because the vaccine does not provide 100% protection.

Q. What if someone has had a complete round of vaccinations with a vaccine that is
not available in the Netherlands/has not received EMA approval?
A. A tricky question! You then have to decide whether to accept this or to advise someone to be
vaccinated again with a vaccine that has been approved in the Netherlands. An intermediate
solution would be to measure the level of antibodies in the person’s blood and act accordingly.

The e-mail address where we can be reached for further questions is
world@travelclinic.com. We can also be reached by telephone during opening
hours. You can also fill in a contact form on our updated website.

We would like to draw your attention to the following:
You can contact us for all COVID-19 tests. We are also open on weekends by
appointment.