I have been vaccinating my patients against COVID-19 for the best part of three months now.
Some have questions about the vaccine, which I am, of course, more than happy to answer, but ultimately the vast majority say they feel lucky to be offered it.
But, now, there seems to be a slightly more sinister pattern emerging; when we call patients to book them in, some are saying they do not want to be vaccinated because they know someone who suffered side effects.
In an Australian study examining concerns about the COVID vaccine, 10 percent of people surveyed cited “potential side effects” as a reason not to have it.
It is not the first time I have heard this – when we book people in for their flu vaccines each year, there is a cohort of folk who won’t have it because they believe it gave them mild flu-like symptoms the last time.
The first thing to say is that minor side effects after having any vaccine are common and the same is true for the new coronavirus vaccines. A study of 40,000 mainly health workers who had received the Pfizer vaccine found that one in three reported minor side effects. None was serious; all were short lived. The most common side effects that have been reported are soreness at the site of the injection, mild fever, chills, headaches, fatigue and muscle aches.
These do not tend to last long and are a sign that your immune system is reacting well to the vaccine. The symptoms are not indicative of a coronavirus infection as the vaccines do not contain the virus itself, so you cannot catch COVID-19 from having one. Instead, they contain tiny pieces of genetic material that teach your body how to fight the coronavirus, should you come into contact with it.
When you are injected with a vaccine, you want your immune system to recognise that what you have been injected with is “foreign” and try to fight it. In order for it to do this, messengers in your blood called cytokines respond to the vaccine and signal to your immune system to spring into action.
As the cytokine levels rise in your body, they also have a mild inflammatory effect on blood vessels and tissues, causing responses such as a temperature, muscle aches and chills. It is hypothesised that younger people are more likely to report side effects from vaccines when compared with older people due to them having a more robust immune system.
Having said all that, if you do not have side effects, that does not mean your immune system is not working. Our immune systems are so variable, it is impossible to correlate the severity of side effects with the efficiency of immune response. You could have a perfectly good immune response to the vaccine and suffer no side effects at all.
Another study has also found that you are more likely to suffer side effects from the vaccine if you have already had coronavirus. One third (33 percent) of people in this group reported “mild whole-body” side effects such as fatigue, headache and shivers after their first dose, compared with one fifth (19 percent) of patients who had not had COVID. Researchers suggest this may be the effect of a favourable immune response among the group who have already had COVID, but they stress more research needs to be done on this.
After seeing the devastation COVID-19 has inflicted on my patients, this doctor believes that minor side effects are a small price to pay when it comes to protecting yourself and your loved ones against this deadly disease.
Progress Report: Learning disabilities, COVID and vaccines
People with learning disabilities are six times as likely as others to die from COVID-19, new research has shown. Younger people with learning disabilities (those aged 18 to 34) are most vulnerable. They are 30 times more likely to die of COVID than others of the same age.
Understandably, this statistic has shocked many people and has led to campaign groups demanding that the government prioritise everyone with a learning disability in the vaccination roll-out. Currently, only those who are classed as having “severe” learning disabilities are being prioritised in the UK, for instance.
Campaigners say the definition between mild, moderate and severe learning disabilities is too vague, leaving many people exposed.
Even more alarming, a Guardian article published in the UK this week exposed a worrying number of “do not resuscitate” (DNR) orders that have been issued during the pandemic for those with learning disabilities.
A learning disability is a significantly reduced ability to understand new or complex information and learn new skills, as well as a reduced ability to cope independently which started before adulthood, with a lasting effect on development. That means that people with learning disabilities often may find it harder to manage basic everyday skills and rely on support from others for many tasks, including communicating, managing money or looking after themselves.
People with learning disabilities have entered this pandemic already disadvantaged from a health point of view. In the UK, for example, those with learning disabilities on average die 20 years earlier than those without, and many of these are avoidable deaths if they had been given appropriate access to healthcare.
Problems include: negative attitudes from healthcare staff; fragmented services and poor communication between agencies; failures by healthcare providers to make reasonable adjustments for the individual’s disability so that they are not at a disadvantage when they access healthcare; a lack of understanding of the needs of those with learning disabilities; and not enough involvement allowed from carers.
So why are people with learning disabilities being issued with DNR forms? DNR forms are usually completed for patients who are not likely to benefit from cardio-pulmonary resuscitation if they, for example, are in the end stages of a terminal illness or are elderly and frail.
Where possible, a full and frank discussion with either the patient or a family member before the form is signed is had and the form is only signed after their thoughts and feelings have been taken into account.
This does not seem to have happened in many cases of people with learning disabilities. Disability charity Mencap has queried whether these DNR forms were put in place simply because the person had a learning disability.
At the time of writing this update, the healthcare regulator, the Care Quality Commission, is looking into these incidents and is due to publish findings shortly.
But if it is true, then it may have led to yet more potentially avoidable deaths during the early stages of the pandemic and action must be taken to prevent this from ever happening again.
In the Doctor’s Surgery: Which vaccine is best for me?
Answering questions about coronavirus and the current vaccines have now become second nature to me. Whether it is confirming that they do not contain any animal products or repeatedly explaining that there is no evidence that any of the approved vaccines can affect fertility, it is now part of my daily routine.
As I was about to vaccinate one gentleman in his 70s with the Oxford-AstraZeneca vaccine last week, he said to me: “Doctor Khan, I don’t want that one, I want the Pfizer vaccine.”
It caught me by surprise because, by and large, people who come to the vaccination clinics are there because they want the vaccine and will take whichever one is on offer.
“Why?” I asked him.
“Well, I’ve heard it’s better,” he said matter-of-factly.
The truth of the matter was, we only had the Oxford-AstraZeneca vaccine in stock. We have no control over which is delivered to us and, in truth, we are just happy to be giving out the vaccine.
“What do you mean it’s better?” I asked.
“Well, a friend told me he had the Pfizer one as it’s the best one.”
My next patient was already waiting for their vaccine but I wanted to give this man the correct information.
I explained to him that all the vaccines that had been approved by the regulator had gone through robust trials and were effective against the variants that were currently causing the majority of infections in the UK. After much explaining, he accepted the vaccine and went on his way.
If I am being honest, the reason I was surprised at the question is because all of the people I had vaccinated so far were grateful to receive the vaccine. Although our death toll from coronavirus has been tragically high in the UK, we are lucky that we are ahead of the game when it comes to our vaccination programme. Many countries still have supply issues and many developing nations have yet to start vaccinating and are relying on organisations such as the World Health Organization (WHO) for their vaccines.
I am of the opinion that you should take whichever vaccine you are offered. If they have been approved by your medicines regulator, they will offer you protection against serious symptoms of the coronavirus.
The authorities will be rolling out vaccines in your area that are effective against your local circulating strains. It has been previously stated that if any new variants start to become dominant, manufacturers can tweak vaccines in a relatively short space of time to make them effective against those strains as well.
So yes, booster vaccines may be needed in the future but in the meantime count yourself as being fortunate if you are offered the vaccine. Many people across the world will be waiting a long time to get theirs.
Good News: Oxford-AstraZeneca vaccine begins trials in children
One of the biggest tragedies of lockdowns has been the closure of schools across the world. Children are missing out on vital education as well as important social interactions. As is usually the case with these things, children who were at the biggest disadvantages before the pandemic, because of social deprivation and other socioeconomic reasons, are being hit hardest by lockdowns. There is real pressure to open schools safely in order to avoid a generation of children who will be disadvantaged by missed education for the rest of their lives.
Much of this will rely on driving the number of community infections down through lockdown measures and reducing the burden on hospitals through preventing illness. But vaccination is also key and, although children are unlikely to become very sick from coronavirus, there is some evidence that older children, in particular, can spread it.
The National Institution for Health Research (NIHR) has funded a study which will be run by Oxford University, trialling the Oxford-AstraZeneca vaccine in young people aged 6 to 17. They are building on what is already known about the vaccine in adults, that it is safe and effective and will be studying its effects on 240 young volunteers.
Half of the children will be given the Oxford-AstraZeneca vaccine and half a placebo vaccine. They will then be monitored for their immune responses and any side effects. The trial will give us a better understanding of the control of the coronavirus in children and young people and, with preliminary data coming out of Israel suggesting vaccines can help reduce transmission of the virus as well as sickness from it, this may get us that one step further to ending lockdown measures and getting our children back to school.
Reader’s Question: Who should not get the COVID vaccine?
The vaccines are safe for the vast majority of people but the health authorities in the UK have stated that anyone with severe allergies to the ingredients of the vaccines should not take the vaccine. It has also been advised that if you have been involved in a coronavirus vaccine trial, then you should speak with the team conducting the trial before taking the vaccine as you may well have had a vaccine already as part of the trial. The vaccine has not yet been approved for use in children, either.