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Covid-19 vaccine: a sudden good break

Various vaccination queries answered, and the secret of the sprint, from Bedminster Pharmacy’s Ade Williams

The contemporary translation of a well-known scripture verse reads: unrelenting disappointment leaves you heartsick, but a sudden good break can turn life around. The development and subsequent rollout of the Covid-19 vaccination programme has created much-needed optimism. However, the past year’s persistent pattern of emotional peaks and troughs has left many of us less trusting, with an increasingly cynical world-view. With unsubstantiated claims of ill intent, pharma-company conspiracies and government deception, what is one to make of the Covid-19 vaccine? Questioning, no matter how unpopular, is part of logical decision-making processes and we have always excelled at finding the right answers this way.

Q: Is the vaccine safe? It was developed and approved so quickly.

A: The secret of the Covid-19 vaccine sprint is the global collaborative working and focus of world-leading scientists, supported by unprecedented levels of funding – £6bn spent by the UK government alone. China sharing details of the fully sequenced virus gene on 10 January 2020 set off a race to develop testing processes and vaccines. It is worth noting that all three UK vaccine candidates – with the Pfizer/BioNTech vaccine now licensed – have multinational working teams and organisations. This sort of openness, coupled with the ongoing sharing and scrutiny of the research process by the regulators, has helped to speed things up. The UK’s Medicines and Healthcare Products Regulatory Agency (MHRA), responsible for approving medicines such as vaccines, is world-renowned and highly regarded. Their proactive adoption of a ‘rolling review’ approach to their Covid-19 vaccines – rather than ‘‘a massive data dump at the end of the research process” with questions only addressed then – has enabled evaluation to be completed in as short a timescale as possible. Approval is by no means the end of the safety process. Continuous monitoring for safety of the vaccines when in use involves all clinicians, and most notably members of the public, directly reporting their experiences. This process is the same that applies to every medicine licensed in the UK. Legally, pharmaceutical companies, regulators and healthcare professionals are liable for the safe and appropriate use of all medicines. Every piece of emerging evidence and experience remains critically important. Research data is also openly published and available for scrutiny.

Q: Is it true that the vaccine will modify my DNA?

A: This is entirely false. The licensed Pfizer/BioNTech vaccine and other vaccine candidates use modified RNA (mRNA) technology. Unlike a standard vaccine, RNA vaccines work by introducing an mRNA sequence (the molecule which tells cells what to build) which is coded for a disease-specific antigen, once produced within the body. The antigen is recognised by the immune system, preparing it to fight the real thing. The part of the SARS-CoV-2 virus (Covid-19) that has been coded to develop the vaccine is the easily recognisable spike proteins covering its surface. These spike proteins do not cause sickness on their own but allow the virus to bind to human cells and begin replication. Scientists reproduce part of the viral mRNA that has instructions to build only the spike proteins and not the whole virus in a lab, then use this product (not a live virus) to develop the vaccine which stimulates the immune system to make antibodies that can remember and destroy the virus – immune response. The mRNA cannot mix with your DNA. It does not alter our genetic code, and it does not cause unusual allergic reactions. As American infectious disease and public health physician Dr Tom Frieden put it; ‘‘Think of this process as an email sent to your immune system that shows what the virus looks like and instructions to kill it and, then, like a Snapchat message, it disappears.’’ Research areas where mRNA vaccines were already being explored before Covid-19 include cancers; blood cancers, melanoma, brain cancer and prostate cancer. Also virus infections such as influenza, ebola, zika, HIV-1 and herpes simplex virus.

Q: Will vaccines work against the new reported variants?

A: Analysis of the new UK mutated variant has identified changes to the spike protein – the building blocks of our vaccines. At the moment, no evidence suggests that any of the three leading vaccines will be made ineffective by this mutation, although this will continue to be monitored. These vaccines develop an immune response against the existing protein spike while also training the immune system to attack several different parts of the virus. The latter, even though part of the protein spike has mutated, ensures the vaccines should still work.

Q: What about those cold storage requirements?

A: There was some anxiety about how usable the first vaccine, with its peculiar cold storage requirement, will be. NHS ingenuity and collaboration has helped mitigate this. Not only hospitals but GP surgeries, and soon designated community pharmacies, will join the vaccination effort.

Q: How long after the vaccination are you protected? Do you need the multiple doses?

A: It typically takes a few weeks for the body to build immunity after vaccination. In the case of the licensed Pfizer/BioNTech vaccine, this is 21 days after the second dose. It is, therefore, possible a person could be infected with the virus just before or after vaccination, and get sick. This is because the vaccine has not had enough time to provide protection. It is not unusual for vaccines to require multiple doses – think of the MMR and Meningitis B vaccines. Developmental research determines the time interval between vaccine doses that will produce a sufficient immune response. It is, however, imperative to remember that not completing a vaccination course or delaying the subsequent follow-on dose/s forfeits the protection offered.

The mass vaccination programme in Bristol is ongoing with the elderly, health workers and carers. I recently spent time in Bristol Children’s Hospital – a useful reminder that the most vulnerable in our society are depending on us to protect them from this virus. Practical steps can make things easier; assuring employees they can take time off to attend vaccinations, calling out/deleting false claims while choosing not to share them. Vaccine hesitancy-driven misinformation is a fraud that can cause us collective harm. Asking questions, seeking answers from reputable sources and having open discussions without boxing anyone into binary choices is the only way we can respect each other’s views. Your vaccination choice directly affects your loved ones and community. Let’s get it right and save lives.

Follow Ade on Twitter: @adewilliamsnhs or @bedminsterpharm