Chapter

1 INTRODUCTION

Background of the study

Purpose of the study

Research Questions

Theoretical Lens

Scope and Limitations of the Study

Importance of the Study

Definition of Terms

2 REVIEW OF RELATED LITERATURE

Sample 1

AN EVALUATION ON THE ADVERSE EFFECTS OF ASTRAZENECA VACCINE AMONG THE

SELECTED FRONTLINE HEALTH WORKERS
IN DAVAO CITY: A CASE STUDY

Chapter 1

INTRODUCTION

Coronavirus disease 2019 created a global health crisis and left a huge impact on human

lives. It is a disease that came from the virus called Severe Acute Respiratory Syndrome

Coronavirus 2 (SARS-CoV-2; formerly known as nCoV-2019). It was first detected in Wuhan City,

Hubei Province, China, last December 2019 (Trilla et al., 2020). Johns Hopkins University of

Medicine (2021) has been at the forefront in response to COVID-19. The university recorded

around 129,465,881 confirmed cases and a total of 2,825,940 deaths globally due to disease.

The COVID-19 pandemic is much more than a medical issue. It also affected the overall

global economy― communities, businesses, and financial markets. Malls, enterprises,

amusement parks and other recreational establishments are facing an existential threat. The rate

of unemployment has been gradually increasing. Almost half of the 3.3 world’s global workforce

are at risk of losing their sustenance (World Health Organization, 2020). One of the most affected

sectors is travel and tourism. Traveling is one way to build social relationships, connect with

strangers, and an opportunity to learn and grow as an individual. It helps us develop and discover

new skills and cultures. International and local travel have temporarily ceased in operation.

Countries around the globe are taking action to prevent the spread of the coronavirus from

national quarantines to school closures (Kaplan et al., 2020).

 The Coronavirus pandemic is a challenge to mankind that requests a global, unified

reaction, from established researchers as well as from industry, associations, governments and

everyone all throughout the globe. Millions of lives are saved every year through vaccines.

Vaccines function by preparing and training the body’s immune system to acknowledge and fight

off the viruses and bacteria they aim to target. The body, if exposed to those disease-causing

bacteria or viruses after the vaccination, will immediately get ready to destroy it, preventing

illness. At least seven (7) various vaccines have been rolled out in countries and one of these is

the Oxford-AstraZeneca vaccine, also known as AstraZeneca vaccine (WHO, 2021).

Estimated of 1.6 million COVID-19 vaccine doses have been administered worldwide.

Figure 1 shows that over 40 million vaccine doses had been administered in France. The chart

below shows the total number of doses given per vaccine manufacturer. About 5.72 million

Oxford/AstraZeneca vaccine doses are available in the country. The country also received 3.91

million Moderna vaccine doses. Recently, they also obtained 422,701 vaccine doses from

Johnson&Johnson. Moreover, France received an estimated 33.15 million doses from

Pfizer/BioNTech which was the greatest number of vaccine doses they had received. This is only

possible for a limited number of nations that provide the necessary data (Ritchie et al., 2021).

AstraZeneca, with the University of Oxford, is committed to help beat COVID-19 by

sharing the scientific knowledge and expertise to accelerate the development of a potential

vaccine to prevent the virus. The vaccine is made up of another virus of the adenovirus family

that has been altered to contain the gene for creating a protein from SARS-CoV-2 (European

Medicines Agency, 2021). With its cheap pricing and simple storage requirements, AstraZeneca's
vaccine option has experienced a series of obstacles in 2021, including worries about efficacy,

probable side effects, and long-running supply issues. AstraZeneca's most recent problem is also

the company's most serious to date. Its vaccination has been associated with thrombosis and

cerebral venous sinus thrombosis (CVST), an uncommon form of blood clot in the brain that has

occurred in a handful of younger women (Wise, 2021). Following the advice of the Philippine

Food and Drug Administration (FDA) and the DOH All Experts Group on Vaccines, the Department

of Health (DOH) announced the formal commencement of the Oxford AstraZeneca vaccine for all

eligible populations. It was determined that there are presently no known risk factors for VITT

and that the advantages of taking the COVID-19 vaccination still outweigh the risks. Specific

standards and actions will, however, continue to be applied in order to limit the dangers (DOH

2021).

Discovering a vaccine against COVID-19 is important in order to stop the spread of the

coronavirus. Developing a vaccine includes numerous and complex procedures which differs

from developing a standard or normal vaccine. A vaccine’s aim is to activate the human immune

system to combat the foreign agents that invaded the body. Vaccines are the new instrument

that could help us in the battle against COVID-19, putting an end to the pandemic (Calina et al.,

2020).

AstraZeneca vaccine, compared to other vaccines, has also benefits and risks (European

Medicines Agency, 2021). The blood clotting issue, that is said to be one of the side effects, is

concerning the public. Out of 222 blood clotting cases in Europe, more than 30 (13.51%) of them

died (Kupferschmidt & Vogel, 2021). This study aims to investigate the adverse effects of
AstraZeneca vaccine against COVID-19. This is to be utilized by the society to help inform the

public.

Purpose of the Study

The objective of this research is to investigate the issue of blood clotting as one of the

adverse effects of AstraZeneca vaccine. Further, this research focuses on evaluating the adverse

effects of AstraZeneca vaccine. The importance of studying the effects of this vaccine is to be

more educated and learn the different possible reactions to one's self.

Research Questions

This study focuses on the lived experiences of people injected with AstraZeneca vaccine,

including the observation and perception of the AstraZeneca vaccine's adverse effects on the

human body and life. The following questions help establish the purpose of the research and

guide the investigation further:

1. What are the adverse effects of AstraZeneca vaccine into the bodies of those who were

vaccinated?

2. How did the people deal with the adverse effects of the AstraZeneca vaccine?

3. How did AstraZeneca vaccine improve the health condition of the people who were

vaccinated?

Theoretical Lens

The study is primarily anchored on the following theories associated with our study.
Health Behavior Theory— Health Belief Model.

Health Behavior Theories have been formulated at various levels in the study of health

behaviors, including the human, interpersonal, collective, organizational, and society levels.

Furthermore, hypotheses differ in their focus on person versus environmental determinants of

behavior, and cognitive versus affective determinants of behavior (Glanz et al., 1997; Crosby et

al., 2002). This theory is relevant to our research and is linked to it.

The Functionalist Theory

The functionalist view, as described by Talcott Parsons (1951), stresses the importance of

good health and appropriate medical treatment for a society's ability to work. Our capacity to

play our functions in society is harmed by poor health, and because too many individuals are sick,

society's functioning and wellbeing suffer. Poor medical treatment is also harmful to society

because people who are sick have a harder time being better, and healthy people are more likely

to get sick (University of Minnesota Libraries Publishing, 2010).

Self-efficacy Theory

Self-efficacy Theory was first defined by the psychologist Albert Bandura as the belief of

a person’s capabilities to face the challenges and attain a specific goal in life (Ackerman, 2020).

The theory tells us how we give our effort to achieve the effects and results we desire. Self-

efficacy is not just about personal factors. Although personal factors are emphasized, behavioral
and environmental factors also have a huge impact on outcomes (Gallagher, 2012). This study is

connected to the theory. It shows how the respondents took action when they experienced

adverse reactions after the vaccination. It could also support the reason why the respondents

chose to have themselves vaccinated.

Importance of the Study

Recent reports of blood clots linked to the vaccine, however, have raised concerns about

its safety. The researchers want to investigate the vaccine's efficacy, reliability, and effects against

the virus. First, this study would help Filipino citizens in their understanding of the AstraZeneca

vaccine. Second, this research will benefit the healthcare workers and frontliners that will provide

them with information about the possible side effects of AstraZeneca vaccine. The information

could help them prepare and improve their treatment system. The research will also be beneficial

to the Department of Health for them to be more aware and knowledgeable about the side

effects. Third, the government will also be more knowledgeable about the vaccine and be in

utmost caution in purchasing and providing vaccines to the public. Finally, the result of the study

will serve as reference material and a guide for future researchers who wish to conduct the same

study or any study related to this topic.

Scope and Limitation of the Study

This study primarily focuses on the adverse effects of the AstraZeneca vaccine on the

selected frontliners in Davao City. Furthermore, the study investigates, determines, and explores

the experiences of the participants after injecting the AstraZeneca vaccine into their bodies. The
research sample is composed of four (4) frontliners in Davao City which will be selected through

convenient sampling.

Convenience sampling (also known as Haphazard Sampling or Accidental Sampling) is a

type of nonprobability or non-random sampling in which members of the target population who

meet certain practical criteria, such as easy accessibility, geographical proximity, availability at a

specific time, or willingness to participate, are included in the study (Dörnyei & Griffee, 2010).

The major focus of convenience sampling methods is generalizability (ensuring that the

information gathered is typical of the community from which the sample was selected). Subjects

are chosen for sampling based on the research's aim, with the idea that each participant will give

unique and rich information of value to the study (Suen et al., 2014). Commented [TO1]: Transfer to methodology

Definition of Terms

The section will enable us to learn more information and gain enlightenment before going
deeper to the study. The following basic terms of this study have been contextually and
operationally defined:

Vaccine- As defined by Cambridge Dictionary, vaccine is a non-harmful virus/bacteria-

containing substance that is given to a person or animals to prevent them acquiring the disease
or virus. In this study, it means exactly as conceptually defined.
 Inoculate- the term came from the word “inoculaten” which means attaching a plant to

another plant. In microbiology definition, which is used in this study, it means to introduce
microorganisms to a medium. Inoculation is done to boost the immunity of the body. However,
inoculation and vaccination is different. Since inoculation is done to immunize our body, one way
to do it is through vaccination (DifferenceBetween, 2013).

Vaccination- it uses a vaccine to treat a person or animal using immunogens to make the
immune system produce more antibodies to fight infections. Vaccination is a method being used
to inoculate a person or an animal (DifferenceBetween, 2013).

Pandemic- As defined by the World Health Organization, pandemic is a global spread of

a new disease. This causes a sudden, rapid spread of a disease among people (Lockett, 2020). In
this study, it means at is conceptually defined.

Antibody- is also called immunoglobulin. It is produced by the immune system in

response to the presence of an antigen or a forgein substance in our body (Britannica, 2020).

Virus- the term came from a Latin word which means “poison”. It is an infectious agent
that multiplies inside the living cells of bacteria, animals, or plants (Wagner & Krug, 2020).
 Chapter 2

REVIEW OF RELATED LITERATURE

This chapter presents the review of related literature both locally and globally that are

relevant to this study. This chapter provides understanding that will help in the development of

this study.

COVID-19 is the second-worst disaster since World War II, affecting 7.7 billion

people in 211 countries and resulting in an estimated 250,000 deaths before it ended. In

December 2019, an open-air live animal market in Wuhan (Hubei Province), China, was linked to

a cluster of pneumonia cases (Li, R. et al., 2020). The agent of COVID-19, SARS-CoV-2, was named

after the genetically similar SARS-CoV (now known as SARS-CoV-1) virus that caused a deadly

near-pandemic in 2002–2003 (Morens et al., 2020). The illness was later given the name COVID-

19 by the World Health Organization. Even so, 2019-nCoV has been renamed SARS-CoV-2 by the

International Committee on Virus Taxonomy (Yuen et al., 2020).

COVID-19 has killed 71,429 people around the world. The disease began in China and has

spread rapidly to other countries. The World Health Organization (WHO) declared the COVID-19

outbreak a public health emergency. The clinical symptoms of COVID-19 patients include fever,

cough, weakness, and gastrointestinal infection symptoms in a small group of patients. The

elderly and people with underlying conditions are more vulnerable to infection and have a higher

risk of severe outcomes, which could be related to ARDS and cytokine storms (Ali et al., 2020).
 Amidst the quarantine protocols, month long and extended lockdown, COVID-19 cases

continue to rise in the Philippines. The country reported an estimated of almost 5,000 positive

cases and was said to be the highest number of COVID-19 cases recorded since the start of the

pandemic (Biana & Joaquin, 2020).

COVID-19 affects people in different ways. It is new to humans and has become a global

pandemic crisis which makes researchers, scientists, and the governments around the globe

working in high speed to produce vaccines that can stop the spread of COVID-19 (Jeyanathan et

al., 2020).

Janssen COVID-19 vaccine is manufactured by the Janssen BioTech, Inc. at New

Brunswick, New Jersey. It is an adenoviral vaccine that also works by inserting a cold virus that

has been genetically created into the cell and then produces protein spikes. The vaccine was

discovered to be 66% effective at fighting against moderate to severe COVID-19, however, it will

produce higher protection to people having the need of hospital treatment according to trial

outcomes. The vaccine did not cause any severe allergic reaction and the side effects included

fever which were experienced by 9% of the volunteers (Livingston et al., 2021).

Moderna's vaccine, also known as mRNA-1273, undertakes through a novel mechanism

that currently other vaccines do not use. The messenger RNA (mRNA) can cause production of

proteins when injected to cells. The body develops an immune reaction to these peptides

(proteins) when they leave the cell (Livingston, 2021). In the phase III Coronavirus Efficacy trials,

228 out of 15,185 participants (1.5%) reported adverse effects of hypersensitivity, rash at the
injected part and urticaria (Wei et al., 2021). The interim analysis of mRNA-1273 of its phase III

trial demonstrated that it was 94% effective (Mahase, 2020).

The NovaVax vaccine or NVX-CoV2373 was engineered from the genetic sequence of

SARS-CoV-2. It contains a proprietary Matrix-M adjuvant and recombinant that enhances the

immune response and stimulates high levels of neutralizing antibodies (Hui Tian et al., 2021). The

vaccine is said to be 95.6% effective against the original version of coronavirus based on the

clinical trials conducted in the UK. Furthermore, it has also an efficacy of 85.6% against the new

variant B.1.1.7 and 60% effective against B.1.351 or the South African variant (Mahase, 2021).

Gamaleya Sputnik V COVID-19 vaccine, also known as Gam-COVID-vac that has been

developed by Russia-based Gamaleya Institute, contains two different types of adenovirus

vectors for the first and second vaccination━ adenovirus 26 (Ad26) and adenovirus 5 (Ad5)

respectively. It boosts the effect of the vaccine and helps the immune system to produce

antibodies that protects us from the infection. The efficacy rate of Sputnik V against the original

COVID-19 was reported at 91.6% based on the result and analysis of data on more than 20,000

volunteers ages 18 years and older who received both doses of Sputnik V vaccine (Jones, 2021).

BioNTech, a German company, has partnered with Pfizer to develop and assess a

coronavirus vaccine tozinameran, known as BNT162b2. The Pfizer-BioNTech vaccine, like the

Moderna vaccine, was based on the virus’ genetic instruction. It uses a messenger RNA that our

cells read to make proteins. A clinical trial showed that BNT162b2 provides 95% protections

against the coronavirus (Polack et al., 2020).

 The ChAdOx1 nCoV-19 vaccine (AZD1222), also known as Oxford-AstraZeneca vaccine,

was manufactured at Oxford University. It contains another form of adenovirus that has been

altered to contain the gene in order to create a spike protein from SARS-CoV-2 and consists of

adenoviral vector ChAdOx1 (Voysey et al., 2020). Based on the findings, the overall vaccine

efficacy rate is 70.4% and a longer dose interval may result in higher efficacy rate (Hung & Poland,

2021). AstraZeneca's most recent problem is also the company's most serious to date. Its

vaccination has been associated with thrombosis and cerebral venous sinus thrombosis (CVST),

an uncommon form of blood clot in the brain that has occurred in a handful of younger women.

The majority of instances, but not all, occurred in women under the age of 55, and the illness

usually manifested 4 to 16 days after getting the vaccination. The death rate among patients who

had such clots has been as high as 40% (Wise, 2021).