1 hour 39 minutes

The Portrait Conversation, Episode 16, welcomes back special guest Dr. Stacey Efstathiou, who was previously featured in The Portrait Conversation, Episodes 4 and 12.

Stacey is a well-respected virologist, a world expert on herpesvirus, who was Head of Viral Vaccines at the National Institute of Biological Standards and Control from 2015 to 2018; and was Head Of Division (Virology) at the Department of Pathology, University of Cambridge, UK, from 2003 to 2010. He has published almost 100 scientific papers; is author of three patents; has been a keynote speaker at numerous international conferences; was Editor in Chief of the Journal of General Virology; and was a member of the Medical Research Council (MRC) Infection and Immunity Board.

In this conversation we get a global overview of how vaccinations are going world-wide and how that’s impacting the slowing down of the pandemic, the differences between different vaccines, the roadmap for returning to post-pandemic normalcy and how that may differ from pre-pandemic normalcy, and address questions, concerns and fears about vaccines, including these:

COVID-19 Vaccine Q&A with Dr. Efstathiou

Addressing concerns about the COVID-19 vaccines

These answers (below) are quoted from a email correspondence between myself and eminent virologist Dr. Stacey Efstathiou (referred to as SE below), former Head of Viral Vaccines at the National Institute of Biological Standards, UK, and former Head of Division (Virology), Department of Pathology, University of Cambridge, that followed The Portrait Conversation interview. If you’d like to learn more in-depth about the different types of vaccines etc, then please watch The Portrait Conversation with Dr. Efstathiou on this page. The questions and concerns quoted below have all been heard first hand from friends and acquaintances who are vaccine hesitant. The answers are shared with the intent to provide science-based information to those who are still hesitant to be vaccinated due to lingering concerns, confusion and misinformation. In summary, the vaccines are overwhelmingly safe, and the benefits of vaccination far outweigh any risk. Everyone who is eligible for vaccination is encouraged to get vaccinated. For those who still decide not to, please wear masks to protect the immunocompromised and elderly, especially when in close contact such as dancing.

• “I’ve already had covid and have natural immunity. Therefore I don’t need to be vaccinated.”
  SE: Natural infection generates low level of immunity. The vaccines induce a very strong immune response ie much higher antibody and cellular immune responses than are generated by natural infection. For this reason vaccination is much more effective than natural infection at producing longterm protective immune responses.

• “I’m waiting for a better vaccine (like Novavax) to be approved.”
  SE: I don’t think there is any data indicating that the Novavax vaccine is any better than what we have already. The RNA and Adenovirus based vaccines are very effective and will be hard to better. The Novavax vaccine is different as it is protein based so you are not dealing with nuclei acid based vaccines. in many ways it’s a more conventional protein based vaccine that is combined with an adjuvant ( a substance that enhances the immune response). Is waiting for different vaccines to be licensed a good idea in the middle of a pandemic when we have good data showing the impressive efficacy of existing vaccines? I wouldn’t take the risk. The existing vaccines are safe and work.

• “I live fairly isolated, am healthy, careful and at low risk so I don’t need to be vaccinated.”
  SE: Fairly isolated is not going to protect you in the long term. At some point you will get exposed with the virus and develop Covid disease symptoms. Unless you live a totally isolated life, which is almost impossible, vaccination is recommended.

• “Vaccines were rushed through, only FDA emergency approved therefore not fully tested and the long term side effects are unknown. It’s a mass experiment and I don’t want to be a lab rat. I’m going to wait and see. I’m waiting for FDA approval to go from emergency to regular.”

  [JS: FDA UPDATE – On August 23, 2021, the FDA approved the first COVID-19 vaccine. The vaccine has been known as the Pfizer-BioNTech COVID-19 Vaccine, and will now be marketed as Comirnaty, for the prevention of COVID-19 disease in individuals 16 years of age and older. The vaccine also continues to be available under emergency use authorization (EUA), including for individuals 12 through 15 years of age and for the administration of a third dose in certain immunocompromised individuals. https://www.fda.gov/coronavirus-disease-2019-covid-19/comirnaty-and-pfizer-biontech-covid-19-vaccine]

  SE: It is correct to say that the long-term side effects of the Covid vaccines are not known and all we can say is that only rare adverse reactions have been observed so far (around 6 months since vaccinations started). So in addition to data showing that the vaccines are safe during clinical trials the real world use of vaccinating millions of people has shown that the benefits of taking the vaccine ie preventing serious disease/death far outweigh the very rare risks of the vaccines. It is however true that the longterm side effects of vaccination (if any) can only be assessed after years of analyses of the health of people vaccinated. Given that this is a pandemic situation we didn’t have the luxury of longterm follow up of people vaccinated. Historically we also have introduced the use of vaccines without waiting years for long-term clinical trial data. If the disease is serious enough we take the risk and monitor people. Good examples are vaccines for Polio, Smallpox, TB (there are many others). My personal view is that the likely long-term adverse effects of the RNA vaccines is minimal. The RNA dose is rapidly degraded in the body so there is only a short time for the RNA to exist in cells ie long enough to make the spike protein but it is then eliminated from the body. The only protein made is the coronavirus spike protein and so the immune response is highly targeted to this protein alone. This massively reduces the chance of adverse immune responses. The Adenovirus based vaccines are more complicated in that you develop an immune response to the adenovirus vector in addition to the spike protein. As it is a DNA based vaccine it is more stable than RNA so may hang around in the body for longer. On this basis  I would argues that the RNA based vaccines will have fewer potential long term adverse effects than the Adenovirus vaccines so if I would advise anyone concerned with potential on term harms to get the RNA vaccine if given the choice. If there is no choice then the benefits of the Adenovirus based vaccine outweigh the risks of catching Covid..

• “I’ve heard the vaccine will effect fertility.”
  SE: The issue of COVID vaccines  having an impact on fertility has been a concern voiced by many groups suspicious of vaccines in general. This concern has led to many problems in distributing conventional vaccines such as Polio yet can anyone point to any vaccine that has led to issues with fertility? I cannot think of any examples ….I do not think there are any examples…. So where does this leave us? It is unlikely that triggering an immune response somehow impacts on fertility as our immune systems are continually challenged with pathogens and vaccines with no known effect on fertility. If it’s not the immune system that has any bad effect then presumably concerned individuals must believe that the vaccine itself has a direct effect. If you believe this then you really need to argue some kind of mechanism otherwise you are saying that because something is new and entering our bodies it could impact fertility.  If that is your position then logic would say that for you to take any potentially new and life saving medicine you would wait a few decades first to see if anything bad happens to people taking the medicine over many years. Of course you run the risk of serious harm by not taking the medicine but you are prepared to do that in case of some theoretical risk that lacks a proposed mechanism . I don’t think thats a reasonable position to take. Perhaps the only thing I would advise is that if you have a choice between an RNA vaccine and an Adenovirus based vaccine I would go for the RNA vaccine as its simpler and has a much shorter half life in the body. This has to reduce any longterm risks (if there are any…).

• “I’ve heard of people dying from the reaction to the vaccine. I don’t want to take the risk.”
  SE: When you vaccinate millions of people there will always be deaths within a short time after vaccination. This doesn’t mean that the vaccine has caused a death. Millions of people start the day with a cup of coffee . Some will die on that day but we don’t really believe that the coffee was responsible for the death. At the end of the day the risk of getting serious disease or dying from  from Covid far outweighs any risks associated with the vaccine.

• “We don’t know what’s in the vaccine and it may permanently alter our DNA.”
  SE: The vaccines are made in a very stringent way by manufacturers and all the ingredients are listed and checked. In the USA the FDA checks each batch of vaccine to make sure the manufacturers are making the vaccine to an agreed standard. In the UK the regulatory body (MHRA) also performs its own checks on each batch of vaccine and the European Medicines agency does the same job for the EU.  The regulatory agencies also inspect manufacturing facilities to make sure that the production process is of a high standard and all correct safety procedures are being followed. There is no evidence that the vaccines permanently alter our DNA. If one accepts that the vaccines are based on nucleic acids (RNA or DNA) that encode the spike protein then they have to be safer that the RNA or DNA that makes up the many infectious agents that invade our bodies all the time and have the capacity to replicate and spread in the body eg. Human adenoviruses, Rhino Viruses, Influenza etc etc.

• “I hear there’ll be boosters. It’s endless.”
  SE: It may be necessary to use ‘booster’ vaccinations if new antigenic variants of Covid -19 emerge. This is what we do for Flu each year. The situation is not clear cut as the Covid vaccines are much better than the flu vaccines and stimulate a broader immune response so it maybe that the use of booster updated Covid vaccines occurs much less frequently than for Flu.

• “The fear-mongering around Covid-19 is over-blown, exaggerated and being used by the government to control us. Covid-19 is no worse than the flu.”
  SE: Covid 19 is much worse than flu. It spreads much more efficiently, causes greater hospitalizations and kills more people than seasonal flu.

• “If we just boost our immune systems through good diet, exercise, sufficient sleep, and reducing stress (like not worrying about Covid), then we’ll all be able to fight off Covid naturally, without need to put foreign substances in our bodies like vaccines.”
  SE: Being healthy and maintaining a healthy weight will help you mount a strong immune response to Covid infection and give you some protection against serious disease. Nonetheless the protection afforded by vaccination is many fold greater than just being healthy. Many healthy people have developed serious disease and have died. These people would have been protected by the vaccine. It is clear that obesity and diabetes is linked with greater susceptibility to infection so I would agree that there is a link between health status and severity of infection. People with co-morbidities therefore benefit more from the vaccines than ‘healthy’ people.

• “It’s all about the money! Big pharma wants to make big bucks on the vaccines, hospitals want to make bucks on covid, government funded scientists want to make money promoting covid fear.”
  SE: There is no doubt that Pharma companies and other organizations/people will make money out of Covid . Any medicine that saves lives and prevents illness will be in demand. This gives an opportunity to make money. There is no evidence that diseases are manufactured to create demand and wealth.

• “If people around me are fully vaccinated, my unvaccinated status is of no risk to them.”
  SE: I think we should all be concerned about the risk of unvaccinated people leading to the spread of Covid -19 in vulnerable people and that includes ‘at risk’ fully vaccinated individuals. The “at risk” fully vaccinated people include the elderly. In a very informative article written by David Spiegelhalter (chair of the Winton Centre for Risk and Evidence Communication at Cambridge)
  https://www.theguardian.com/theobserver/commentisfree/2021/jun/27/why-most-people-who-now-die-with-covid-have-been-vaccinated
  the point is illustrated by the fact that a fully vaccinated 80 year old has the same risk of contracting covid as an unvaccinated 50 year old. This is because the risk of getting serious disease increases as you get older so a vaccinated 8- year old has a reduced risk of getting disease but its not eliminated. In one study in  the UK 29% of people dying of Covid who been fully vaccinated which is a concern. Of course its not just the elderly who are at risk despite having been fully vaccinated. Other groups include those people who are immunosuppressed  ie people with transplants and people with certain cancers that affect the immune system (leukaemia). So if you are unvaccinated you are not only at risk of developing clinical disease yourself but you are also more likely to be an asymptomatic carrier of infection and therefore spread the disease on to other people. Fully vaccinated individuals can also get infected but the duration of virus shedding from such people is massively reduced so you pose a reduced risk of spreading infection. The advice I would give is (1) Get vaccinated (2) Even if you have been vaccinated, if you are in an ‘at risk’ group ie elderly (say over 70) or have a suboptimal immune system due to cancer or immunosuppressive therapy, be cautious and avoid crowded indoor venues if you can and always wear a face mask (FFP2 type masks are probably the most effective and over better protection than fabric re-useable masks).

  The situation with the generation of variants is more complex as this is a global problem. So long as we have highly populated areas of the world with a large unvaccinated  population variants will arise and how ever hard you try to stop people traveling around the world they will eventually get into your country. At the moment the vaccines are coping well with variants so it’s likely that the vaccines are generating such strong immunity (both antibody and T cell immunity) that it will be very difficult for a variant to completely escape vaccine induced protection. The critical next step is for vaccine manufacturing to be ramped up and to get the vaccines rolled out globally.  This is the only way to reduce the emergence of problematic variants. To end on a more positive note we must remember that the virus is adapting to live with us and eventually it will evolve to cause little in the way of serious disease ie. it will evolve to transmit readily and exist in an immune population in order to do this it will probably attenuate itself into a virus that only causes relatively mild disease. Why do I think this is the most likely scenario? Because its happened in the past so all human coronaviruses that we have been living with for centuries started off as zoonotic infections including jumps from Bats and although they probably caused terrible disease when they first jumped, with time they evolved to live with us in harmony. 

  The highly recommend everyone get vaccinated. For those that choose not to I would strongly advise that they do two things. (1) take a daily lateral flow test and isolate them if they test positive (2) wear masks in any crowded indoor venue/public transport irrespective of a negative lateral flow test result ( the tests are just not sensitive enough).  Because compliance will always be an issue I still think that people in ‘at risk’ groups should try and avoid crowded indoor venues and where masks whenever possible. N95 masks are fine.

• “I have a strong natural immunity. I will let my immune system take care of me.”
  SE: They may well have a good immune system that will prevent them getting serious disease but what about those people less fortunate who have a weakened immune response (the elderly, transplant patients/cancer patients and who do not mount an effective immune response after vaccination)? The only way we can prevent such people getting infected is to restrict virus circulating in the population. You can only achieve this safely by vaccinating the majority of the population. 80% coverage for the vaccine (or more !) is a good target.

“It’s just my personal choice whether I choose to get vaccinated or not. It’s nobody else’s business if I do or don’t.”
SE: If people decide that they are not getting vaccinated out of personal choice I would make sure they understand that their ‘choice’ may be a death sentence for people they pass the virus onto. As no one can be sure of their clinical outcome following infection (even if they are fit, young and healthy), getting vaccinated could also save their own life as well as others. Think of this in the context that in a civilised society we expect individuals to follow certain rules to prevent harm being inflicted on others. If someone decided to drink two bottles of whisky and then got in their car, drove at 100 mph and killed someone, would their choice to endanger someone else be “just a personal choice”? This analogy may sound over-dramatic but people really die from catching COVID-19 from someone not vaccinated.