With the news that the UK is the first Western society to approve the Pfizer vaccine, so many people still have big concerns about a vaccine they feel has been rushed through. Are they right to be concerned? Tannice Hemming finds out…
Coronavirus has affected us all. Even if we haven’t experienced loss ourselves, it’s getting closer to affecting every one of us. Our death toll in the UK surpassed 75,000 people yesterday, not long after late October saw us hit 60,000 lives lost. We’ve seen an acceleration of deaths since September after the lull of the summer most likely meant some of us relaxed a little too much.
Kent residents’ tears as tier system comes into force
Today, as we leave a national lockdown in England, many of us enter a stricter tier system. I live in Kent, one of the few places in the South where the strictest tier, tier 3 is in force. Kent residents will today find themselves able to go shopping in non-essential shops and visit leisure facilities, but pubs and restaurants will remain deserted unless they can provide takeaway services. Whilst the shops will be bustling once again, we cannot meet up with our friends and family as others in lower tiers can.
Yesterday, a counsellor for Kent County Council told Nick Ferrari on LBC’s breakfast show that Kent is facing two emergencies and is struggling. The county needs extra support to continue preparations for Brexit as well as supporting the 4 local hospital trusts in Kent and Medway to continue helping those people afflicted with Coronavirus.
News that the Pfizer/BioTech jab has been approved by the MHRA will fill most of us with relief but there are many who have concerns. Some of the people with worries about accepting the offer of a vaccine aren’t even people who would usually identify as “anti-vaccination”, but they are unsure about a vaccine that has seemingly taken so little time to develop in comparison with the usual development time. So what’s the truth about the vaccine and where can one get good information to help decide whether you should accept that shot in the arm? Many are very unhappy with the idea that refusing it (for personal or medical reasons) would limit freedoms in comparison with those who have accepted a vaccine. Others still are worried what the long-term health implications of the vaccine would be, too.
A vaccine passport?
Matt Hancock has, this morning, appeared on Sky News refuting the idea that having the vaccine would mean you could have the widely discussed (and derided) “Vaccine passport”, allowing you greater freedoms than those who remain un-vaccinated. He said “we don’t yet know how much it stops you transmitting Covid” and that “we will vaccinate according to protecting the people who need the protection most”.
Sir Simon Stevens, the chief executive of the NHS has said “this is an important next step in our response to the […] pandemic and hospitals will shortly kick off the first phase of the largest-scale vaccination campaign in our country’s history.”
An interview with a doctor
On the weekend, I spoke in depth with Dr Frank Han, a US physician with an interest in helping the “vaccine-curious” come to an informed decision about accepting vaccinations. He works in Pediatric Cardiology in Illinois but spends a great deal of time talking to parents about vaccinations for their children. All his views are of course representative of his opinion and do not necessarily reflect the views of his employer.
He is a member of Vaccine Talk: A Forum for Both Pro and Anti Vaxxers on Facebook with over 42,000 members. It’s a place for vaccine debate and discussion and he’s keen to help anyone with queries by showing them the science behind each one they’re concerned about. You can get there by visiting vaccinetalk.org
When it comes to discussing worries about vaccinations, he’s very clear on how he feels and the responsibility of scientists and health care providers to provide good information.
“People like to read about vaccine misinformation because it is generally more attention grabbing than vaccine science, which can harken back to the days when we had boring teachers. Establishing the difference between correlation and causation is a challenging task for non-science trained people, and I sympathise that people sometimes get the connections mixed up. There are also physicians who haven’t done the greatest job at Public Relations, which I totally understand. I just hope that mums around the country who are on the fence, reach out to medical professionals for their questions – because we would all love to tell you everything you want about vaccine science, we just don’t have the means to give every patient the opportunity to answer every single question in a single appointment.”
Having crowd-sourced a list of questions from a group of savvy and smart mums I am proud to be amongst, I set about getting their concerns answered.
Speed and haste – was the vaccine developed too quickly to be safe?
Q: Some people are concerned about how quickly the vaccine has been created. How founded are those fears, especially with respect to any long-term health implications of a new vaccine?
A: The fears are founded in the sense that the vaccine industry does have its failures, when it previously tried to release vaccines quickly. The fears I hear though, I think can be adequately addressed when you see that the modern COVID vaccines have the benefit of decades of research behind them. The speed that you observe is because in previous years, grant funding was hard to come by, and international cooperation was hard to come by. When you have international cooperation, vaccine trials doing multiple steps in parallel, and multiple governments and large companies pledging all available financial resources, the modern COVID vaccine story is actually one of the medical world’s strongest accomplishments.
Q: How long are the vaccines expected to last for? Has there been enough testing?
A: That has several aspects – one specific research question is, do we have strong, sustained immunity in the same way that older, more established vaccines have prolonged immunity? That is a “maybe” at this point, and the exact purpose of clinical trials. Th other part of that question is, do COVID vaccines decrease the rate of transmission in the population? That is a reasonable research question as well , and this requires specific testing to figure it out. I would say though, based on the data so far, things point towards a “Yes” on reducing transmission, and for the duration of immunity, the vaccines haven’t been around long enough to know the precise duration – but the longevity of immunity has been found in some studies to stretch to 6-7 months (with potential to be longer, as antibodies aren’t the only way you stay immune).
At this point, he linked me to a fascinating study done in October 2020, Seroprevalence of anti‐SARS‐CoV‐2 antibodies in COVID‐19 patients and healthy volunteers up to 6 months post disease onset. This study, published in the European Journal of Immunology, concluded:
“Although titres reduce subsequently, the ability to detect anti‐SARS‐CoV‐2 IgG antibodies remained robust with confirmed neutralization activity for up to 6 months in a large proportion of previously virus‐positive screened subjects”
This study was however about immunity after getting Covid through natural transmission rather than a vaccine.
A common reason that people have an aversion to taking a vaccination is the widely quoted notion “why are we vaccinating all (including a healthy population) for a virus where the recovery rate is around 99%?”
Dr Han is clear that death is not the only concern about Coronavirus. I have previously written about the terrible ravages that the illness now commonly known as “Long Covid” wreaks on a significant proportion of the infected, with detailed descriptions of how it affects various people, so I’m only too aware of the devastation involved.
He explains: “The virus is especially nasty in that it can cause strokes, long term debilitation and needing to be in a care home, getting the more frail members of our society sick, liver damage, lung blood clots, heart attacks, changing your lung into scar tissue, skin damage, kidney damage – and these things occur to a substantially bigger percentage of the population than 1%. Doctors hope that members of public can appreciate the importance of this vaccine because we don’t want any of those other nasty things to happen [to them] To put that number in perspective, the mortality rate of COVID has now exceeded the rate of Americans dying from heart attacks in the same period COVID has been around. So 1% looks small, but there are so many other bad things that COVID can cause.”
Dr Han’s reference for his stats: the widely-disseminated idea that Covid is “just another flu” is smashed to pieces by the data in that piece, which concludes “across the EU28, 0.025 people per day die of flu, compared to 0.75 per day on the most recent COVID-19 figures. That makes the pandemic around 30 times more lethal than flu – and that’s at its current levels: using the peak figures cited above, COVID-19 killed more than 515 times as many people per day as influenza.” The data is provided by Eurostat – the European Union’s statistical office collating data from across the continent.
Rapid manufacturing, bases and the immune response
Most fears about the vaccine stem from the idea that it’s been developed just so quickly. However, many of these fears most likely result from a general lack of knowledge about vaccinations. No wonder, since it’s barely touched upon during schooling. We’re just expected to reveal our fleshy bits and welcome the needle with ingredients that most of us can’t pronounce, let alone understand. This ignorance is usually capitalised on in debates about vaccines as pro-vaccination people tend to ask anti-vaccination people which part of a list of long names of chemicals they object to being in their body. When the anti-vaxxer, predictably, says “all of them”, it is then revealed they are the chemical components of a fruit.
Q: The technology in the Oxford vaccine is not new, however this type of vaccine (viral vector) has only once been licensed for human use. Is that a concern?
A: The rationale for using the Adenovirus vector is that you need some container to deliver the SARS-COV2 protein to the patient; otherwise you run the risk of the immune system just temporarily seeing the foreign protein and then not generating a durable immune response. Previous researchers invented the replication deficient adenovirus for this reason, to make an effective container to deliver the protein. The phrase “replication deficient” means that the virus was specifically edited in the lab to not have its own ability to copy itself, and be cleaned out by the body after the job is done. I think that the Oxford-Astra Zeneca team is doing all they can to test if their new vaccine is safe in people, and if I were an NHS consultant, I would have no concerns about taking the ChAdOx1 vaccine, and would do my utmost to practice detailed informed consent with any family I recommend it to.
Covid vaccine: the next medical scandal?
Q: The thalidomide scandal is mentioned a lot as a reason why people won’t have it. Do you think it’s a fair comparison?
A: It’s a different medication all together – part of the problem of drug testing in general is that the human body is so complicated, that a “Star Trek” like scanner to detect all possible eventualities is not yet in existence. If we had such a tool, I would be more than happy to dig for the rare side effect – but human clinical trials have to use the next best tool, which is to test a drug on many people before we can find that rare side effect. The physicians who lived in the era when thalidomide was a new drug, were doing the best they could with a new drug and limited data, and we know now with hindsight, that they were wrong. To put it in perspective, its like looking for a few fireflies (rare side effect) inside a massive forest. It’s just difficult to find those rare side effects. So, the medical community has come out and admitted their shortcomings with prescribing that drug, and a comparison with COVID vaccines is a little unfair because we now have so much more knowledge under our collective belts. Clinical trials for thalidomide weren’t done with the same guardrails and safety protocols we have today – and that drug is in fact one of the reasons why clinical trials are so convoluted and complicated today; this is a source for more extended reading https://embryo.asu.edu/pages/us-regulatory-response-thalidomide-1950-2000
Do you remember the times before the virus, Mummy?
One of my fears is that my children might grow up never knowing what life was like before Coronavirus. My youngest, Ares, was born on 11 September and has never really seen anyone except family without a mask on. My middle child, born in March 2018, entered his second year in lockdown. That prompted me to ask Dr Han about the future.
Q: Will the vaccines, in your opinion, allow us to eventually return to life as it was pre-Covid?
A: I see it like several layers of Swiss cheese; medicine has several layers of protection for the general public but none are perfect. We will gradually come back to normal once the vaccine is in place and we can demonstrate that infections are no longer passed around as rapidly. It’s the linking of several layers of protection that will let us get back to normal.
Finally, I asked Dr Han about the need for as much uptake as possible of the vaccination. Which naturally lead us onto the idea of the “Vaccine Passport” as well as the idea of mandatory vaccinations.
Q: Do you believe in mandatory vaccination, for those where it isn’t medically contraindicated? Under which circumstances? What about if there is vaccine injury, who would be liable?
A: So in England there is a “Vaccine Damage Payment”, and in the United States, there is a “National Vaccine Injury Compensation Program”, which addresses the liability. The complexity of vaccine injury is that it is preferably established by a medical professional – because any reaction that occurs after a vaccine, at least in the United States, can be reported to the national registry of vaccine reactions. This by consequence, makes an analysis of the database rather challenging, because there are things like automobile accidents in the vaccine registry as well.
As far as mandatory vaccination, I believe that it is a consultant’s duty to provide informed consent detailed enough to allow the family a comfortable decision in approving the vaccination in their family members. Why? I think that it is less well known, that some vaccine-preventable diseases have symptoms that aren’t obvious, and can spread quickly in a school. I would not be very happy if I was the parent of a child who started a measles infection, or the parent of a child who caught measles at school. In short, I believe in required vaccinations paired with informed consent. I would believe in enforcement only in the rare circumstance that a family member is also causing demonstrable harm to the child (which is why we have an established Department of Children and Families in the US, and initiation of taking a child into care in the UK)
The conversation then, finally, turned to discussion of the many concerns that parents have about vaccines, most famously sparked by Andrew Wakefield, the disgraced former doctor who now resides in America. I joked with Dr Han that he could keep Wakefield in the US and we talked about what should be done about those who deliberately spread misinformation for gain (like Wakefield has and continues to do).
A: Physicians are busy so – they don’t have the ability to use social media quite as tactfully as Wakefield does, or have quite as much free money standing around to fund large information campaigns. The best thing to do right now is for our medical community to reach as many families as possible that are on the fence, and express that we are on their side. Many physicians have seen vaccine preventable diseases, and know how bad they can be, but since a few, vocal minorities can state their opinions on vaccine injury louder than we can, the recent Nature article illustrates that the Antivax community has a far larger penetrance into the “neutral social media” sites that physicians do. It is the social media world where the battle must continue, and we must do it in ways that resonate with people (which currently appears to be mostly personal anecdotes mixed in with a little seasoning of science for those interested). There are also many misconceptions that are easily expressed – antivax communities can say anything they want, but doctors are by default on the offensive because we have to prove them wrong with unassailable science. So to make a long story short – it will be through better use of Social media, that the battle must be fought.
The future might be brighter – and more educated – than ever before
The truth is that we have been manufacturing vaccines for a very long time and that’s why this vaccine has been able to be created so quickly after an injection of cash and a huge amount of collaboration between public and private organisations across the globe. We know how to make a vaccine and the only thing that was required to be worked out was how to make it effective, rather than the safety. The science behind vaccine manufacture and application is pretty sound at this point, but so many of us do not know really anything about it. If you’d like to rectify that lack of knowledge, I can wholeheartedly recommend looking at the Children’s Hospital of Philadelphia’s Vaccine Information Centre which has detailed info on vaccine science, history and the human immune system as well as information on safety, ingredients and how to safely evaluate scientific information.
It may be a vain hope, but given the amount of new “experts” in vaccine science on social media, I hope that this might inspire the next generation to get interested in science, in vaccinations and in medicine. My own daughter, approaching 5 years old, has mooted the idea that she would like to be a scientist. Maybe the next generation of STEM geniuses, born into the “Covid generation” are just a few years away,