I am pleased to report that my wife and I received our first dose of the Oxford/AstraZeneca vaccine last week from the local general practice in a very well-conducted operation. Clearly, lessons have been learned from the less well-organised administration of the influenza vaccine earlier in the year and we are very grateful.
However, we recognise that this makes absolutely no difference to our lives for at least three weeks since it takes that time for sufficient immunity to build up. Even after that we shall not achieve the full immunity benefit until after the second dose, which we hope to receive in about three months' time. While not forgetting what an extraordinary achievement this production of at least four effective vaccines in the space of less than a year has been, it is important to bear in mind the pinches of salt I referred to in a previous article (
18 November): media hype and the problems of distribution.
Most people very reasonably look on vaccines as personal protective treatment and, of course, that is why we so readily accept them. But doctors and epidemiologists in particular look on them also as protection of populations, and this is something that justifies the enormous expense and difficulty of mass vaccination. Mass vaccination has the aim of eradicating the microbiological threat by reducing the germs' ability to find people to infect, either locally or even worldwide. This aspect makes accepting a vaccine not only of immediate benefit to you and me but also an act of altruism by preventing the disease in others often less fortunate than ourselves.
I make this point because some people may feel the vaccine is unnecessary or even positively risky and therefore decline to have it. In order to achieve the famous 'herd immunity', it is necessary for a high proportion of the population, perhaps 80%, to be vaccinated. Very occasional allergic reactions to vaccines can occur but the current ones have passed intensive scrutiny in trials, and side effects are still being actively looked for without to-date any significant reports after millions of doses have been administered. Rumours are spreading on the internet, seeded by people of ill will or utter stupidity, for example of implantation of microchips or of serious interaction of vaccines with alcohol. Rank this nonsense against the benefits personally and to all of us, as being the only way in which we can get out of the epidemic, and I'm sure even if you are young and robust you will see that having the vaccine is the right thing to do.
Which vaccine?
It is natural to wonder about the differences between the vaccines now becoming available, but it is far too early to compare their efficacies. All that are approved will afford significant protection against the current viral strains and will have a very low risk of significant side effects. If, like me, you are fortunate enough to be offered one, accept it with gratitude. As predicted, claims are already being made for marginal advantages of one or another, but the fact so far is all are working well. I also drew attention to the likelihood of distribution problems, and these have come to a head in Europe owing to the Commission's inexplicable delays and a bad-tempered contractual dispute.
We must remember that until the world is vaccinated, the virus and its mutants will continue to threaten us in the UK, so international coordination of vaccination is essential. These vaccines are all the result of international collaborations – the UK's role with most has been in our facility for organising huge trials, thanks to the NHS.
It is frankly amazing that within a year we have four innovative vaccines available and credit must be given to the UK Government for facilitating this in supporting basic research and trials, and for simply ordering the likely successful ones at an early stage. You may remember that early in the epidemic I noted that the chief scientist, Sir Patrick Vallance, came from a pharmaceutical background and that this was likely to be important; so it has turned out. He would have understood the subtleties of the methods of vaccine development and the trials.
Interestingly, the four vaccines most talked about currently in UK demonstrate three entirely different methods. The Oxford/AstraZeneca one uses an attenuated adenoviral vector to transport the DNA gene for the spike protein. Johnson & Johnson use a similar process. The Pfizer/BioNTech and Moderna vaccines contains synthetic RNA encased in a fatty nanoparticle but no actual virus. The recently announced Novavax vaccine also contains no actual virus but comprises bits of viral spike protein with a fatty adjuvant (a chemical that tees up the body's defence cells and increases the immune response). All different, all effective and without serious problems so far.
Vaccination multinationalism
It was to be expected that the UK's success in getting mass vaccination off the ground so quickly would provoke the government and its supporters in the media to proclaim a great British triumph. They certainly need one after the repeated failures of both our governments that have led us to top the world in mortality statistics. But let us remember that all these vaccines are the result of collaboration between governments, industries and universities in the molecular biological revolution that started in Cambridge in the 1950s with the multinational coming together of Sanger, Watson, Crick, and Brenner, and has changed the world (as a Cambridge graduate of that era, that's my feeble attempt to put the Oxford vaccine success into perspective).
All the vaccines now in use are also multinational in concept and manufacture, and must be used multinationally. We shall not escape this virus if there is seriously uneven worldwide vaccine distribution, since more dangerous mutants will arise elsewhere and eventually reach our shores. So, let's encourage worldwide vaccination of the most vulnerable (mainly 65+) before our least vulnerable are vaccinated. European funding and collaborations have contributed to the success of these vaccines and it is in our interest to see fellow Europeans vaccinated as soon as possible. It is good to note that the UK Government is contributing to wider distribution in the poorer world through the WHO.
What next?
A retired colleague of mine and his wife in England had one friend round to celebrate Christmas; the friend developed symptoms the next day, but both my colleague and his wife died of COVID-19 within a fortnight. Despite several weeks of lockdown, in Scotland there are still around 2,000 COVID-19 patients seriously ill in hospital and 140 on ventilators; over 1,000 catch the disease every day. Across the UK, about 1,500 die each day. Total mortality in the UK so far has been over 110,000 and in Scotland over 8,000, not a record to be proud of.
The success of the vaccination programme should not blind us to the fact that as a population we are still very vulnerable and that further viral mutations will occur. There is now international surveillance, and these are likely to be picked up quickly; the vaccine manufacturers are able to adapt their products to defend against resistant mutants, but inevitably this will take time and cost lives. We must continue to take strict measures to protect ourselves and we must urge governments not to repeat the serious mistakes they have made so far, which were obviously going to lead to second and third waves. We need to be patient about re-opening the economy and must continue to regard other people as carriers, or we shall go back to square one. Forget foreign holidays or return to life as we knew it.
The economy; an anecdote
For much of the past year, my house has been considerably quieter. I live directly under the flight path into Edinburgh Airport and the peace has been very welcome. Wondering what the occasional aeroplane was doing, I put an app on my mobile phone which allows me to track any flight that I hear, and I noticed some increase in activity in the late evening as I went to bed. Flights from Aberdeen, Inverness and Edinburgh were heading to East Midlands Airport. Then I saw that flights from other places in England and Ireland, and even the USA, were also heading there.
In my earlier life, a branch of my institute was situated in the middle of England and I could only reach it easily by flying to East Midlands, an airport which always seems half-deserted. Now, my app told me, the flights were all large cargo planes, and the web told me that the airport is the busiest cargo hub in Britain.
The next morning, an epidemiologist coincidentally announced that the R number was coming down very slowly in England but that the East Midlands remained a hot spot for infection, and it struck me; we are living in an online ordering society and much that we buy is flown from somewhere to us, much through East Midlands where a large workforce must be labouring through the night to get it to us. I suspect but do not know that many will be vulnerable and doing the work because they have to, commuting from the many towns around the airport. As I have pointed out before, COVID-19 is an occupational disease; I hope Public Health England and the Health and Safety Executive are looking into this nocturnal activity to ensure such workers are well-protected. I shall return to this next time.
Anthony Seaton is Emeritus Professor of Environmental and Occupational Medicine at Aberdeen University and Senior Consultant to the Edinburgh Institute of Occupational Medicine. The views expressed are his own
