Medical Centre

Covid-19 vaccinations will kick off within days but it seems some people need a sharp dose of facts first. In an article published in the Daily Mirror, Matt Roper and I debunk some of the common myths and misconceptions about vaccines.

Scepticism about vaccines has been growing throughout the pandemic and a recent survey found that one in five British adults may refuse to take a coronavirus jab – even though it is probably our only hope of a return to normality.

1. MYTH: A vaccine produced so quickly can’t be safe

Most vaccines take years to develop, test and approve for public use but, says Dr Majeed, a global effort has meant scientists have been able to work at record speed.

He says: “Covid-19 vaccines have to go through the same process of approval as other vaccines. Funding was made available immediately and studies set up rapidly.

“There have been a lot of technological developments that allow vaccines to be developed much more quickly.”

2. MYTH: I might be allergic but won’t know until I get it

Azeem Majeed is professor of primary care and public health at Imperial College London

“Allergies to vaccines are very rare,” says Dr Majeed. “They are given safely to millions of people every year.”

The odds you’ll have a severe reaction to a vaccine is about one in 760,000.

Being struck by lightning next year is higher at one in 700,000.

Most reactions are because of some other component of the vaccine, such as egg protein, if the person is severely allergic.

3, MYTH: There haven’t been enough tests for people with underlying conditions

Dr Majeed says: “There are many vaccine trials taking place and they are being tested in people with different characteristics, such as age, sex, ethnicity and medical history.

“Results show they are safe in all groups they have been tested in.”

4. MYTH: Vaccines can overload your immune system

In 2018 the myth was debunked by American researchers who examined the medical records of more than 900 infants from six hospitals.

 They found no link between vaccines given before the age of two and other infections in the following years.

 “Vaccines do not overload your immune system,” says Dr Majeed. “On the contrary, they generate an immune response that helps reduce the risk of infection, complications and death.”

5. MYTH: The vaccine could actually give me coronavirus

Some vaccines contain the germs that cause the disease they are immunising against but they have been killed or weakened to the point they don’t make you sick.

In the case of a coronavirus vaccine, “none that are in development contain a live coronavirus,” assures Dr Majeed, “and they therefore can’t give you a coronavirus infection”.

6. MYTH: If everyone around me is immune, I don’t need a vaccine

“It’s essential to achieve a high vaccine coverage so we create herd immunity,” says Dr Majeed. “If people refuse to be immunised, we will continue to get outbreaks of Covid-19.

“If you decline to be immunised, you may get infected and also infect the people you come into contact with.”

7. MYTH: It’s better to be immunised by catching Covid

Dr Majeed says: “Vaccines have been shown to be very safe, whereas illnesses such as measles and Covid-19 can lead to serious long-term medical complications.

 “Vaccines have saved many lives and prevented people from being left disabled.”

8. MYTH: Vaccinated children experience more allergic, autoimmune and respiratory diseases

This is another unfounded claim that has led some parents to delay or withhold vaccinations, says Dr Majeed.

 Studies examining many vaccines have failed to find a link with allergies or autoimmune disease.

 “Vaccines protect against many diseases and substantially reduce the risk of illness and death in children,” he says.

9. MYTH: Some of those taking part in trials died

Stories that Dr Elisa Granato, one of the first participants in the human trials of the Oxford vaccine, died shortly after being injected, were shared millions of times.

 The news was false and she gave a BBC interview saying she was feeling “absolutely fine”.

 “Only one death has been reported among people taking part in trials,” says Dr Majeed.

 João Pedro Feitosa, a doctor in Brazil, was given the placebo rather than the vaccine and died of Covid-related complications.

10. MYTH: The swine flu vaccine left people with side effects, so why would this one be safe?

A mass vaccination programme against swine flu in the US in 1976 led to increased chances of people developing Guillain-Barre syndrome, a rare neurological disorder.

 Dr Majeed says: “Covid-19 vaccines have been carefully tested in a large number of volunteers and found to be very safe.

 “Once they are more widely used, there will be monitoring of people who have received the vaccines to identify any future problems.”

11. MYTH: Vaccines cause autism

 The idea that vaccines cause autism has long been disproved but the claims have recently been doing the rounds again.

 Last year a massive study from Denmark found no association between being vaccinated against measles, mumps and rubella, and developing autism.

 It is the latest of at least 12 other studies that have tried and failed to find a link.

 Dr Majeed says: “No evidence has ever been found that vaccines cause autism in children.”

12. MYTH: The Spanish Flu vaccine led to 50 million deaths

During the 1918 pandemic it was the fact there was no vaccine that caused it to infect a third of the world’s population.

 In the 1930s scientists found it was caused by a virus, with the first vaccine developed a decade later.

Read Covid-19 vaccination – separating fact from fiction in full

The global Covid-19 pandemic has led to over 50,000 deaths in the United Kingdom, disrupted health services for many other conditions, and has had enormous economic impacts that have led to massive increases in unemployment and government debt.[1,2,3] With the United Kingdom’s failure to implement an effective test, trace and isolate programme as we have seen in countries such as South Korea and New Zealand, a vaccination programme offers us the best way to finally bring this pandemic under control[4]. It is therefore essential that the Covid-19 vaccination programme is implemented well and that we do not repeat the many mistakes we have seen in the government’s response to Covid-19, such as in the Test and Trace programme.[5]

Primary care should be at the heart of the delivery of the UK’s vaccine programme. With around 7,000 general practices in England, for example, they are easy for patients to access and their staff are generally well-trusted by the public.  Unfortunately, a decade of under-investment in primary care has led to a shortage of general practitioners, very overstretched primary care teams, and reduced the ability of primary care to respond to new challenges.[6] These problems cannot be addressed quickly but the government can take some immediate actions to reduce pressures on primary care. This could include, for example, cutting the administrative burden on general practices by suspending appraisals, revalidation and CQC inspections for the foreseeable future.

To ensure smooth implementation of the vaccine programme, funding is required to pay for new vaccination centres, provide current general practice clinics with the facilities they need such as equipment for transporting and storing vaccines, and meeting the costs of administering a complex vaccination regime to patients who are housebound or living in care homes. Other required measures include funding to rapidly recruit additional staff such as general practitioners, nurses, healthcare assistants to administer vaccines; and staff to provide administrative and management support. It is also essential that primary care services for the management of acute and long-term problems, and preventive programmes such as children’s immunisations, continue to operate normally. This means that additional capacity rapidly needs to be created in primary care so that the vaccination programme does displace or delay other essential clinical work, particularly as Covid-19 vaccines are likely to take longer to administer than the other vaccines currently offered by the NHS, resulting in considerable extra work for primary care teams.

Moving on to the logistics of vaccine delivery, there are currently two types vaccines that are close to approval in the UK. Adenoviral vector vaccines such as ChAdOx1 nCoV-19 are logistically easier to deliver as they can be stored long-term in standard vaccines fridges and so could be administered by primary care teams working in the patient’s usual general practice.[7] In Contrast, mRNA vaccines have to be stored at very low temperatures (minus 70 degrees Celsius for the Pfizer / BioNTech mRNA vaccine) and have to be used within a short period of time after defrosting.[8] Hence, mRNA vaccines are more suitable for large vaccination centres with a high throughput of patients rather than the typical general practice. In the longer term, as more data on safety and efficacy becomes available, it would be appropriate to focus on a smaller number of vaccines, rather than continue with the government’s current approach of having many different vaccine options. As well as simplifying the vaccination programme, this would also cut its costs and reduce the likelihood or patients missing out on their second dose of vaccine because of its unavailability or receiving the wrong vaccine at their second appointment.

Looking forwards, we do not yet know how long the immunity and protection from infection generated by vaccination will last.[9] People may therefore require booster doses of vaccine at regular intervals and the NHS should also plan for this. This requires good call-recall systems, something which general practices can provide because of their computerised medical records and experience of delivering other vaccine programmes. We also need observational studies to assess how frequently “vaccine failures” occur (i.e. how many people contract Covid-19 despite being immunised and what their characteristics are), as well as data on adverse events and safety. The UK, with its system of computerised primary care records, is well placed to generate this data, particularly if linkages can be made to other data such as hospital episode statistics and mortality records. To do this, the problems that afflicted the Test and Trace programme in its early days, such as the failure to record test results in primary care records, must be avoided.[10] This is could be successfully achieved by integrating vaccination recording at the time of vaccination administration in the patient’s primary care record and not creating a separate information technology infrastructure as was done with Test and Trace.[11]

We need to ensure the NHS, and in particular primary care, is well-prepared for the programme and that unrealistic expectations of the timescale are not created amongst the public. The Covid-19 vaccination programme is too important to the health, wellbeing and economic security of the UK to delay its implementation or to get wrong.[12] The government has invested considerable funding into other areas of the Covid-19 response, including funding the private sector to deliver services such as Track and Trace. The funding that has been allocated to the NHS for the vaccination programme is currently small in comparison. Whatever investment is needed for the successful and timely delivery of the vaccination programme should be promptly provided by the government so the programme can begin at scale, rapidly vaccinate the at-risk population of the UK, and finally allow life in the UK to start to return to normal.

This article is based on an editorial published in the British Medical Journal

DOI: https://doi.org/10.1136/bmj.m4654

References

1. 50,000 COVID-19 deaths and rising. How Britain failed to stop the second wave. https://uk.reuters.com/article/health-coronavirus-britain-newwave/special-report-50000-covid-19-deaths-and-rising-how-britain-failed-to-stop-the-second-wave-idUSL8N2I94SG

2. Maringe C, Spicer J, Morris M, Purushotham A, Nolte E, Sullivan R, Rachet B, Aggarwal A. The impact of the COVID-19 pandemic on cancer deaths due to delays in diagnosis in England, UK: a national, population-based, modelling study. The Lancet Oncology. 2020 Aug 1;21(8):1023-34.

3. Office for Budget Responsibility. Economic and fiscal outlook – November 2020. https://obr.uk/efo/economic-and-fiscal-outlook-november-2020/

4. Majeed A, Seo Y, Heo K, Lee D. Can the UK emulate the South Korean approach to covid-19? BMJ 2020; 369 :m2084.

5. Scally G, Jacobson B, Abbasi K. The UK’s public health response to covid-19 BMJ 2020; 369 :m1932

6. Majeed A. Shortage of general practitioners in the NHS BMJ 2017; 358 :j3191

7. Ramasamy MN, Minassian AM, Ewer KJ, Flaxman AL, Folegatti PM, Owens DR, Voysey M, Aley PK, Angus B, Babbage G, Belij-Rammerstorfer S et al. Safety and immunogenicity of ChAdOx1 nCoV-19 vaccine administered in a prime-boost regimen in young and old adults (COV002): a single-blind, randomised, controlled, phase 2/3 trial. The Lancet. 2020 Nov 19.

8. Bower E. Which COVID-19 vaccines are lined up for roll-out on the NHS? https://www.gponline.com/covid-19-vaccines-lined-roll-out-nhs/article/1700217

9. Centers for Disease Control and Prevention. Frequently Asked Questions about COVID-19 Vaccination. https://www.cdc.gov/coronavirus/2019-ncov/vaccines/faq.html

10. Carrell S, Garside J. Coronavirus testing hit by struggle to match results with NHS records  https://www.theguardian.com/world/2020/may/28/coronavirus-testing-hit-struggle-match-results-with-nhs-records.

11. Lind S. GPs may need to record Covid vaccinations on separate IT system, says NHS England. https://www.pulsetoday.co.uk/news/technology/gps-may-need-to-record-covid-vaccinations-on-separate-it-system-says-nhs-england/

12. Iacobucci G. Covid vaccine: GPs need more clarity on logistics and planning, say leaders BMJ 2020; 371 :m4555.

Read Vaccinating the UK against Covid-19 in full