Thanks to Ben Johnson again for giving his time to be interviewed. The purpose of this interview is to help people from a non-scientific background understand COVID. I have a scientific background; however, I don’t have much experience of explaining science to the lay public. This last year or so has been an education (Not only have I been doing this blog, but I also spent some time on Facebook talking to people about COVID), this last year has been a massive learning curve for me!

I’ve encountered many people who are anti taking the vaccine as they feel it has taken too short time to be developed. However, I’ve heard that differences in terms of development mean that it was made more quickly.

The key things they need in testing a vaccine, whether in normal times or in pandemic times; you give a certain number of people the vaccine. Then, you wait for people to naturally become infected with the virus to which the vaccine is directed. You would give the vaccine to people in areas with a high number of cases of the targetted virus. So, if you were vaccinating against the flu, you’ve given the vaccine to people in the Northern hemisphere; then you would look to see who caught the flu. That takes quite a lot of time because you usually need 100-200 people to naturally become infected during the course of the clinic trial, so one of the reasons that the COVID vaccine has been developed so quickly is that there are huge epidemics of the virus, so you reach that number very, very quickly. It’s one reason the vaccines have been trialled in the USA in Brazil and earlier on in the UK, as these are the regions with very high numbers of COVID cases. The Astra Zeneca-Oxford University vaccine had many participants from the UK, which was not much use because as we exited our first lockdown, case numbers were very low here, so we got some of the data from Brazil, which had a larger outbreak. So, what you then do is that you unblind the study and you look to see who the people who’ve been infected are and the vast majority of them received the placebo, so actually of the people who received the vaccine, very few caught COVID. It has moved phenomenally quickly; usually, vaccine development takes eight years plus to come to the market. One of the critical reasons for the accelerated speed is regulatory approval. So typically, a vaccine manufacturer (e.g., a university etc) will do the clinical trials, and it will take several years to gather the necessary data.

In contrast, it was done in several months this time around. The genetic sequencing; identification of the strain happened very quickly. The number of cases they needed for the statistical power and the regulatory approval occurred very quickly. If you consider that the total number of participants for the vaccine study for COVID was around 100,000, that’s just the three approved in the UK. This means that this study is better powered with more people than most vaccine clinical trials. So, the data is more solid, not less solid for these vaccines. 

So, I heard one of the reasons that the genetic sequencing stage happened very quickly was because they had a lot of improvement in that area over the last few years. 

Yes, that’s the first stage, and it happened very quickly. There are a couple of reasons for that one is the increased speed in modern years. There are other reasons that it is done routinely as part of surveillance in some countries. Pretty much the point at which the outbreak in Wuhan was identified as a coronavirus, the genome was published there was no real delay. Where as ordinarily such as in SARs there was more of a gap between discovering the presence in the population of a viral pneumonia and identifying it under the microscope as a coronavirus then it being sequenced. Whereas for COVID, the whole thing pretty much happened simultaneously due to advances in genomics. Then, of course, the sequence was made public immediately. 

The other change in technology is the use mRNA and adenovirus vector in vaccine development. All that is needed is the genetic sequence and then they can turn it into a vaccine; soon after they got the sequence, the researchers at biointech in Germany and Oxford University. 

So, this explains why even with a short time to development the vaccine is safe. Also, I’ve heard that an mRNA vaccine is supposed to be safer than other kinds of vaccines.

Every medication has side effects, so if you think of something like paracetamol, a type of plaster, or a COVID vaccine, a small minority will react. Where they’ve vaccinated 100,000 people, they will have identified any uncommon safety issues. Even though it’s a shorter time period that’s irrelevant, what’s more, important are the number of people enrolled in the study and the number of people you’ve to whom you’ve given the vaccine. As the numbers are higher here than you’d generally have for vaccines, this has undergone more stringent safety testing due to the number of people involved. The mRNA vaccines are a totally new technology. mRNA technology is being used in cancer treatments, and they’ve published a study of mRNA technology used in an animal model of multiple sclerosis. So, it’s a really exciting technology. 

It looks like in terms of short-term side effects with the mRNA vaccine, you get a lot of inflammation at the point of injection, but that is a sign that the vaccine is working. Also, its you feel a bit feverish and a bit unwell, but that’s quite normal and shows that the vaccine in working. 

You have to do a cost-benefit analysis for a population; we are all much safer if we get the vaccine than if we don’t.

There are people out there that are talking about being exposed to the virus to become immune; however, I would think that having the virus is a lot more dangerous than having the vaccine also, that they wouldn’t be much of a benefit to ‘natural immunity’ compared to vaccine immunity.

There are two routes to immunity; catching the virus and mounting an immune response to subsequent response. The vaccine is not the virus it’s a dead version of the virus, its genetic material from the virus; it’s been inactivated somehow. Its too soon to say how natural immunity compared to being vaccinated. However, there’s a study in healthcare workers in the UK showing that of people who were naturally infected early on in the pandemic, only around 1% of them have any evidence that they’ve caught it again, the study was done over 6–8-month time period. If you have caught the virus, then you are immune, at least in most people. With the vaccine, it looks like the immune response is considerably stronger. It looks like the Pfizer-biointech mRNA vaccine is the most effective; it looks like it is around eight times stronger. This study was published in Nature recently. 

There are also some indications that natural immunity potentially does wane, its quite hard to interpret. In the Brazilian city of Manaus in the Amazon, essentially, there were no control measures in place in Manaus. The estimate was that ¾ were infected; this was serology with a bit of modeling. They now have another outbreak; there a few possible explanations for this:

  1. That there was a miscalculation and only half the people were infected.
  2. It’s a new strain.
  3. Immunity has waned.

Perhaps after eight months or so, immunity towards COVID is less. I think though; however, you look at natural immunity is no substitute for the vaccines. 

Where you rely on natural immunity, you’re relying on infection, then you’re looking at 1000s if not 100,000 of deaths, pressure on hospitals. One of the key things the UK government is looking at is the pressure on intensive care beds; when those all full, people aren’t just dying of COVID. If all the intensive care beds are full, then there are fewer spaces for other people to be treated. 

I suppose the other thing about rely on natural immunity is that you might be one of the unlucky people who develops long COVID or has a component of their immune system which is different to other people and put them at great risk of death. I’ve heard that there is some genetic variation among those who are more likely to die, but I can’t remember what it is.

There have been many studies on this but its quite hard to pin down why some people have worse disease than others. It looks like its something called the interferon response, which is part of what is called the innate immune response. In people who have severe disease, the response is very weak, so the initial immune response is very weak, leading to a large amount of pro-inflammatory cytokines; its what you see in bird flu and some other respiratory diseases. Although it indeed remains the case that you’re more likely to have a severe outcome if you are older, so over 70, or if you have a metabolic condition such as diabetes or severe obesity. 

I think many random things are going around about the vaccine, such as impacting infertility, although there is no evidence that I can see that it does this. 

There’s a lot of research into things like this; so, this is an example of a conspiracy theory there’s been quite a lot of research into the psychology of conspiracy theories. I think social media is very effective at amplifying what are very niche views. As I understand it its quite hard to tackle conspiracy theories with facts, they need to hear stories from people they relate to, people who look like them, whatever way you interpret that. They need to be listened to and have a conversation about the benefits for the wider community. Some people will come round; some people will not. People who are very anti-vaccine are very influential on social media; they sit at the center of social networks. Due to their place in the centre of social networks, their voices are amplified. Take time to listen to people who hold these views and tell them what you are going to do. The best thing you can do is lead by example, as old people are getting the vaccine first, this will hopefully reassure people, e.g., its safe enough for granny; why wouldn’t it be safe enough for me to have. There is a lot of vaccine hesitancy amongst black and ethnic minority groups that’s understandable; there are a lot of health inequalities and a lack of black doctors. There has been a lot of activity among black healthcare professionals and black politicians to build up support for the vaccine. Vaccine hesitancy and the stronger anti-vaccine positions are something we generally need to look at in society. 

I’ve also heard people say that due to political situation and people not properly explaining the pandemic situation, that led to a general reduction in trust. 

I suppose it’s that old saying trust is build up slowly and lost quickly. I think that there has been a loss of trust to some extent in experts. One of the most significant factors in belief in conspiracy theories is not following mainstream media and getting your news from social media. Possibly another big factor is the loss of local news; local newspapers are dying because they can’t get advertising because of social media. Also, the politicians don’t help; you can find quotes from those in power about certain measures’ effectiveness at the start of the outbreak. 

One of the things that we can do to change people’s minds about the vaccine is to talk about having the vaccine. 

They have those badges don’t they talking about the fact they’ve been vaccinated. 

We need regular vox pops of people who’ve been vaccinated, starting with granny and working downwards. I think it will have an impact, as they want to get their lives back. 1 in 5 people, over 80 died if they catch this. 

So, you don’t think explaining the science and facts works at all.

It’s hard to build trust with facts, and most people aren’t interested in science. This is why its so dangerous with people on social media saying I am not saying its not safe but…and inserting something as fact when its based on something that’s happened but delivered out of context. Another thing that can help is to comment on someone’s post; if they are saying things about COVID and taking information out of context, you can comment on their post and say that’s not what I’ve read, just basically questioning them. If someone is posting on facebook they are probably very set in their ways. However, their friends might read what you read and maybe be persuaded by it. 

Any thought on the new strain of COVID?

So, viruses mutate that’s what they do. COVID mutates a lot less than influenza and a lot less than HIV does. People are watching out for mutations in the spike protein, so that’s a component of several of the vaccine and how it enters our cells. They want to know if the mutation causes the virus to spread more quickly, is more deadly, and changed in a way that impacts immunity. There must be surveillance to check for mutations. It looks like South African has some impact on vaccine efficacy. 

Even in the presence of a new variant, you still have the same approach, continuing vaccination and continuation of social distancing. Even with emergent new variants, the vaccine should have some effect.  

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