How to decide on whether or not to Vaccinate

 When I started writing my blog it was mainly to document my journey through medicine from a patient’s perspective.  As it developed it became somewhat of a commentary on medicine from my perspective, trying to keep it sensible, intelligent and thought provoking.  Never did I think it would have to become political, yet thanks to COVID19, medicine and politics have never been more intertwined.

 

Sadly, the reason that it is a political is because our decision makers have decided to play politics rather than make decisions in the best interest of their country.  But today, I’m going to talk about vaccines.

 

To start I want to just clear up exactly what my personal opinion is on vaccines is:-

 

1.     I am pro-vaccine.

2.     I am pro COVID19 vaccine.

3.     I am anti mandatory vaccination.

 

So what am I trying to achieve in this blog?  Even though I believe everyone that can be vaccinated should be vaccinated I don’t want to try and convince you of that.  What I want to do is try to get you to think critically about the information in front of you and available to you and then make an informed opinion.  So I won’t be giving you a link to check out or asking you to read a certain article.  If you truly want to be informed you have to find the information yourself, not simply what someone gives you.  It is also perfectly okay not to inform yourself.  Just know that your opinion is uninformed and you should just keep it to yourself.

 

What should you do to inform yourself?  First, it is important to find the primary data sources.  If you are listening to someone that said they read on the internet that…..  You are at least three degrees separated from the original data.  First degree, the journalist interpreting the data (which you’re not sure whether it is the primary research or not), second, your mate reading the article and third, your friend telling you.  Three points where the information could be distorted or manipulated.

 

When it comes to the vaccine the primary data is what the biotech companies publish, so make sure that what you read is also in a reputable journal and it has been peer reviewed.  Unfortunately, there is always going to be an element of trust that the company has conducted their research ethically and truthfully but that is why it is important to make sure that the data is extensively peer reviewed.

 

When you review the data, the hardest thing is to divorce yourself from any preconceived opinions you might have had.  You need to try and be as rational and impartial as possible and once you start developing an opinion you need to thoroughly scrutinise it because nobody can objectively and forcefully argue that they are right until they have seriously considered that they might be wrong.

 

Once that process is finished, you may wish to discuss this with family and friends and provided you can do so in an amicable and cordial manner with people that may disagree with you.  If you cannot find anyone to discuss this with you can always go and see your GP.  They are more than willing to discuss this with you in a safe and rational environment.

 

Lastly it is okay to change your mind.  Information is changing and being updated all the time and this is normal.  As time goes by, more data is added, and this changes what we know.  As this natural process happens we have to adapt with our knowledge.  If our firm belief based on what we knew is no longer viable given the introduction of new evidence we have to change our mind.  This is not a sign of weakness or failure.  This is actually a sign of strength.  To admit you were wrong and be able to move past it is a sign of great intelligence.  And this is why we have to keep scrutinising our beliefs no matter how intrenched and firm our beliefs are.  

 

Next time I’ll be a little more opinionated and take you through my thought process when it came to the COVID19 vaccinations.  

 

Until then, Stay well

Vaccine (Part 3)

The fact is that no matter what happens a workable vaccine is not going to eradicate COVID from the world it will merely be another weapon in the battle against the disease.  What is more important is we don’t become complacent about the disease.  As individuals it will still be extremely important to wear a mask, social distance and maintain proper hygiene.

 

Our leaders will also have a big part to play.  Not only will they need to get society moving again it is still really important to that they keep working on other methods to control the disease.  They need to make sure that international travellers are not spreading the virus into or out of the country, public areas are cleaned and maintained to a COVID safe level, all public servants (especially health and aged care workers) are afforded every opportunity to work in the safest possible environment, testing and contact tracing is maintained to the highest standards and other medical research opportunities are explored.

 

I’ll even give you a couple of research avenues that should be explored.  First, a treatment that is given to people suffering from COVID to ease their symptoms which would also hopefully decrease the mortality rate.  There is anecdotal evidence to show that inhaled corticosteroids reduce the severity of symptoms of COVID-19. These drugs are widely available for treatment of a wide variety of diseases including emphysema and asthma.  This is being explored overseas:

 

https://www.cebm.net/covid-19/inhaled-corticosteroids-a-rapid-review-of-the-evidence-for-treatment-or-prevention-of-covid-19/

 

We need to explore it here in Australia.  I just want to add that so far the evidence is anecdotal based on observations of people who should be badly effected by COVID skirting through the disease relatively unscathed and the most obvious reason is corticosteroids.  It does not prove the correlation and proper studies need to be conducted in order to find out if it is ae effective treatment or not.

 

The second piece of research is something I have touched on before and that is the development of a one hour COVID-19 test and guess what, this is something that we can rush as there is no safety concerns as the test requires nothing more than spitting in a cup and the research is being developed right here in Australia at the Hunter Medical Research Institute.  Can you imagine how much more effective our contact tracers would be if we could actively start contact tracing in positive cases after an hour as opposed to the 5 days some people have had to wait?

 

Don’t get me wrong, a vaccine will be a powerful tool in the arsenal of weapons against COVID but it is just one battle that will be won in a long and protracted war.  It is extremely unlikely that a vaccine will eliminate the disease from a country or region completely, let alone have global eradication.  Even with highly effective vaccines, eradication of any disease has been extremely difficult.  In fact, in human diseases we have only managed it once.  Smallpox, and it took almost 200 years from the development of the first vaccine in 1796.  Polio is also on the chopping block but a yearly low of 22 wild cases in 2017 to an increase of 125 cases in 2019 shows that the disease is infuriatingly stubborn.  We can expect nothing less from COVID-19.

 

Until next time,

 

Stay well :) 

Vaccines (Part 2)

 In my last post I went through the clinical trial process and why it is a stretch for are pollies to be promising to answer all our prayers, defeat the virus and return our lives to normality with a vaccine.  Here I will expand on that.

 

As they get closer and closer to the releasing a vaccine, you’ll hear two words more and more.  They are safety and efficacy.  The problem is that those words are not absolutes.  In regards to safety, there is not a medical treatment that is 100% safe. Even putting on a band aid could have risk (you might be allergic to the adhesive).  Essentially, it comes down risk versus benefit and both these change depending on the ailment being treated.  For example, if you’re treating cancer, you would be prepared to endure a much higher risk treatment than if you had a cold.  With a vaccine, you are treating a disease that the patient does not have.  Therefore you could argue that there is no benefit to the patient so the risk has to be zero.  But there is a benefit in preventing the disease if the patient is exposed and the public benefit of herd immunity is massive.  Essentially, it is complicated.

 

The way that our society sees it is that vaccines do need to have very low risk and with a very short development and clinical trial length can that safety be guaranteed?  The answer is both yes and no.  We can comfortably prove short term safety, but can we guarantee long term safety.  For example, the Dengue fever vaccination, where even after exhaustive trials and signing off from the WHO, it was found that vaccinated people were suffering from severe bouts of the disease.  Essentially, they had vaccine enhanced disease.  You can read more about it here:

 

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)32525-5/fulltext

 

It is also important to note that even with the cases of vaccine enhanced disease, the benefits to the community as a whole were extremely high as there was a marked decrease in deaths and hospitalisations.  The other thing we have to be very concerned about is the fact that the Oxford vaccine is a live vaccine meaning that vaccine is actually a living virus.  Now, we don’t need to stress too much, live vaccines have been used for ages.  The first vaccines were live viruses including the smallpox vaccine which used the cowpox virus to give you immunity.

 

In any case, live vaccines need to be carefully monitored and scrutinised during the trial process as there is a small chance that the vaccine could cause disease.  Live vaccines also provide an extra hurdle as people who are immunocompromised are advised against having live vaccines.  This includes people with certain diseases (such as HIV), cancer patients, bone marrow transplant recipients, people who take steroids or other immune suppression or modulating drugs and the elderly.  That’s a real problem as the people most vulnerable and liable to suffer from serious complications or death from COVID cannot be vaccinated.  Yes, they will have to rely on herd immunity and realistically that all relies on at least 90% of the country being vaccinated.  Approximately 22 million doses to everyone, including people that don’t want to get vaccinated.  See the problem?

 

And then there’s efficacy.  Some vaccines can be amazing.  The smallpox vaccine offered life long immunity and was the main reason that smallpox was eradicated from the planet.  However, other vaccines can only be partially effective or have a limited lifespan like the flu virus that only lasts six months.  We simply don’t know how effective this vaccine is going to be.  Even if the phase 3 trials prove efficacy, we will only know that it remains effective for a maximum of six months because that is how long the trial will have been active for.

In my next post, I'll wrap up my thoughts on vaccinations

Until next time,

Stay well:)