A Case for Worldwide Mass Immunization with MMR to Limit Deaths from COVID-19

Introduction

It is generally accepted that deaths related to Covid-19 are centred on adults about their 70’s which might be reason for the association with co-morbidities like cardiovascular disease, obesity, diabetes mellitus, chronic kidney disease, chronic lung disease, smoking, cancer especially hematologic malignancies, lung cancer and presence of metastatic disease. The strength of the evidence for these associations is still being investigated. One plausible expla¬nation for all these associations may be their increased risk for micro-thrombotic events in the microvascular circulation of vital organ systems as well as increased risk for thrombo-embolic dis¬ease in general. Male patients appear to have higher death rates in China, Italy, Denmark and the US. Black, Hispanic and South Asian patients have increased mortality in the US and this may be related to the disparities in healthcare indices in these populations as well as their higher representation in the “essential work-forc-es” and associated increased exposure to infection.

An initial concern about these Covid-19 related mortalities in New York and London suggested the effect of high-density populations. This theory has not been sustained in other high-density cities. Another possibility which linked the high mortality of Covid-19 deaths in Lombardo in Italy did not accord with low mortality rates in Florida where there are large populations of elderly in¬dividuals. A plausible explanation was that the factories in Lom¬bardo were heavily staffed by Chinese workers who brought back the infection from China after the Chinese New Year celebrations.

An epidemiological conundrum was that Covid-19 viruses tend-ed to spare children from serious outcomes. Onwude and Sokun-bi (2021) have documented only six childhood mortalities in the worldwide medical literature [1].

We followed new scientific suggestions for the plausible expla-nation of the minimal relationship between Covid-19 deaths and children and young individuals. Firstly, because we were aware of the relationship between Measles, Mumps and Rubella immunisa¬tions and Covid-19 deaths in children, we compared the areas of the world with recent mass immunisations and Covid-19 deaths to determine if there was an associative link between mass Measles, Mumps and Rubella (MMR) immunization strategies in countries with recent outbreaks of Measles who reported Covid-19 relat¬ed deaths. We compared the results with mortality rates related to Covid-19 in countries who have either had Measles outbreaks or not who did not need to mass immunise. One refinement to MMR immunization was adopted by countries like Cambodia, where two doses of a Measles-containing vaccine regime was employed to provide high immunity against Measles and that this protection would last a lifetime.

Methods

We searched the internet literature for reports of countries with recent Measles, Mumps or Rubella outbreaks when mass or partial mass immunization was carried out. We also searched for coun¬tries with recent or just WHO concerns about outbreaks of Mea¬sles, Mumps or Rubella, recording whether it was followed with a mass or partial mass immunization program. We related these against reported Covid-19 deaths rates.

Results

In Table 1, we show some representative countries who have executed recent mass immunisations with MMR vaccinations for Measles outbreaks. Their reported mortality rates related to Covid-19 is also shown. Apart from Hong Kong where the mortal¬ity rates have increased from 5/10 million populations in 2019 to 11.4/million in 2020, the other countries show their mortality rates related to Covid-19 less than 10/million population.

                       Table 1: Recent Mass Immunisations with Measles, Mumps and Rubella*.

The reported Covid-19 mortality rates are between 0/million pop-ulation in Cambodia (mass immunization 2017), 4.7/million pop¬ulation in Singapore (mass immunization in 1997), Madagascar 7.1/million (mass immunization in 2019), Vietnam 4/10 million population (mass immunization in 1997), and 0/million popula¬tion in Cambodia (mass immunization 2017). In Nigeria, there was a partial mass immunization in conflict-affected states of the North Eastern Nigeria to protect more than 4 million children (4,766,214) against a Measles outbreak. Libya underwent a na¬tional mass immunization in 2005 of residents of age 9 months to 20 years but with one dose of immunization. Their Covid-19 mor¬tality rates (40.6/million) are higher than in other countries who mass immunised.

In Table 2, we show that countries which had Measles outbreaks and did not institute mass MMR immunizations like the UK, USA and Italy have at least 10 times more Covid-19 related deaths com¬pared to populations that had either mass immunizations or partial immunizations like Nigeria with a Covi-19 related mortality rate of 5/million (Table 1).

                      Table 2: No Recent Mass Immunisations with Measles, Mumps and Rubella (www.wordometer.com)

Conclusion

These observations of reported data show that countries that have had recent episodes of Measles outbreaks and either mass immu¬nized or partially immunized their population with MMR have seen benefits in lower Covid-19 related deaths, in most cases less than one-tenth the mortality rates from Covid-19 deaths compared to the best countries that did not mass immunize, like Germany. Not all the countries that have not mass immunized had outbreaks to Measles but there were WHO concerns about Measles outbreaks in the UK, USA, Italy and Spain.

The best comparative example is Italy which had a large-scale Measles outbreak in 2017 affecting over 4,000 individuals, caused by a much lower than typical MMR rate in that country. The lack of sufficient MMR is a possible explanation why there has been a higher death rate in Italy from COVID-19 when compared to most other similarly affected countries. The Measles immunization rate in Italy in 2005 was just 85%, one of the lowest in Europe [2-4].

There has been an accumulation of different evidence types for our proposal for mass MMR immunization. Firstly, there is a scientific link between MMR and Covid-19. Kodzius et al pro-posed that MMR vaccination may be able to protect children from Covid-19 because of their discovery of a sequence similarity of the 30 amino acid residues between glycoproteins of SARS-COV-2, Measles and Rubella viruses [5]. They followed this hypothesis along the lines that the antibodies produced in children due to the MMR vaccine could recognize some protein parts (epitopes) on the SARS-CoV-2 spike proteins”. They theorised that these anti¬bodies, particularly in the epithelial layer of respiratory airways, block binding and entry of the virus into the cells”.

Kodzius et al were inspired by the immunological principle based on the antibody cross-reaction recognizing antigens in two dif-ferent microbes. They wanted to look for homology sequence in SARS-CoV-2 and the viruses that commonly are prevented by vaccination during childhood. It was discovered that 30 amino acid residues share similarities between the Spike (S) glycoprotein of the SARS-CoV-2 virus and the fusion glycoprotein of Measles virus as well as with the envelope glycoprotein of the Rubella vi¬rus. These initial findings have been supported by other epidemio¬logical studies, including proposals for a plausible explanation in cross-immunity protection [6, 7].

There is other corroborating epidemiological evidence. Belgium has one of the highest rates of Covid-19 deaths worldwide. This has now been linked to the absence of Measles, Mumps, and Rubella (MMR) immunization in Belgium in the 1980 and 1990 [8]. Sim¬ilar to countries like Nigeria with massive attacks of Measles and widespread adoption of the MMR vaccine since 1971 and which now show very low level relative rates of Covid-19 mortality rates (5/million population), the other group of countries with the lowest rates of Covid-19 deaths are those that have been involved with mass immunizations with MMR because of recent epidemics of Measles, example in Samoa 0/million population, Singapore 4.7/ million population, Madagascar 6.8/million population and Hong Kong 11.4/million population as of early 2020. This theory of the potential protection of MMR can be criticised because of new cases in places like Hong Kong. This can hang on the possibility that full protection of MMR is based on two vac¬cinations or new cases from visitors who did not take part in the mass immunisation program.

An anomalous result of Covid-19 deaths in mass immunised popu¬lations occurred in Libya. A plausible explanation is that one dose of MMR immunization, instead of two doses was employed. It is generally accepted that two doses of MMR are best protective. The evidence is strong that childhood deaths worldwide from Covid-19 is extremely rare, with only 6 reported cases in the med¬ical literature.

The evidence points to a strong determination that MMR vaccination in children and world mass MMR vaccination could have had a protective effect on Covid-19 deaths.

World Health maintains that evidence continues to add up demon¬strating that the commonly available MMR vaccine could be the key to stopping the COVID-19 pandemic quickly, allowing much of the world to get back to business as usual within months [8]. There is no doubt that the MMR vaccine is safe and that mass immunization with the MMR vaccine is feasible even as progress continues on developing a specific SARS-Cov-2 vaccine.

There is a potential benefit that in countries which cannot afford Covid-19 immunization, then there is a choice for MMR as a vi-able alternative, especially if the practice worldwide is to give re-peated top-ups [9-17].

References

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