The Vaccine – should you…shouldn’t you??

Preamble

I want to start this post off by declaring I am a doctor, an intensive Care doctor at that, so I have witnessed first hand what this virus can do!

I also want to state that I am NOT anti-vaccine, nor am I a conspiracy theorist! I wanted to post this in order to stimulate intelligent thought processes and debate upon this hot topic that will affect us all. Today marks a point in history – the first vaccination in the UK as part of a 50 hospital roll-out AND vulnerable patient targeted initiation programme.

I am mildly sceptical, as are my ITU colleagues, as to whether we should plough straight into getting the vaccine, or should we stall for a little while? Will it really be of a massive disadvantage to our patients, or us, if we wait and see what happens as others get the jab? Is this bad, should we feel guilty for feeling this way? Are we not setting the right example waiting, as we should be leading from the front-line? We are doctors and are here to minimise harm, help the sick and also to be a part of revolutionary medical management. We are not here to hamper that process, nor its progress. Should we all have it, no questions asked, as its the responsible thing to do for the public and society?

Is there any debate, shouldn’t this be a no brainer?! The fact is, there are lots of doctors are having a wobble! Some have been told they can’t have it (breastfeeding/pregnancy) etc. Many have tried to rationalise the thought processes based on the risk they pose to patients if they themselves contract COVID; and with that comes the risk of them transmitting it to vast numbers of patients they attend. We put our patients first, as ever.

Others balance their personal risk from COVID. If this risk is considered low, how does this meet the uncertain risk from a vaccine only tested on 20,000 people? No one can guarantee no side effects, as even the most benign drugs out there have them, so this would not be realistic, but could there be serious side effects, unmasked when given to a larger population. Are we willing to take that gamble; the risk posed to patients abstaining, vs the risk to ourselves and our families taking it and getting a reaction? Here, we put ourselves and our families first. What if the vaccine causes long-term issues? How will workers be treated by hospitals; they may be on long-term sickness…how will that impact their lives? Then again, what will be said if workers do not get the vaccine, then get COVID and are off on long-term sick? The ‘You were warned’, phenomenon comes in!

My declaration, as it stands, is that I may wait. 2 reasons for this, though relatively minor:

1. I am as yet uncertain, as the world is, what the effects will be of Pfizer’s vaccine.

2. I also react very badly to the standard influenza vaccines – so you could understand why I feel sceptical and mildly apprehensive about this guise for COVID!

It’s a matter of risk. Most of us have a good idea of our COVID risk now? We don’t have a clear picture of how high the risk is with the vaccine and whether that is a higher or lower risk until more people have taken it. The elderly are high risk and therefore from the numbers tested, it is of potential clear benefit to them. For those who are within the lower spectrum age demographic, and are in ‘good health’, things are far less certain. If the 80-year-olds were all vaccinated first and that showed it was safe in a larger population, this might then be fine?? Where are the vociferous politicians who stepped forward saying they would 100% have the vaccine…..

I started a debate, rather by accident!

Reading this fantastic article on the matter from Pete Brindley and Matt Morgan:

Have a read of the reaction to the article here, lots of good debate ensued…

December 8th 2020!

So, today saw the first patient vaccinated against COVID-19. The world watched on with wide eyes as a lady received the jab in Coventry UK.

But, what will happen…..will she develop symptoms post vaccine that could overwhelm her? We are all wondering, and similarly, we wonder what will happen to those higher risk patient groups preferentially receiving the vaccine. After all, they are the chosen ones – those with medical conditions, those of the elderly end of the age spectrum, like our lady above, who is in her 90’s!

So, the vaccine has been VERY heavily and stringently tested right?! Well, yes, of course it has. But the word on the street is that it has been rushed through for financial gain / for cudos / for political bicep flexing and so on. These words may come from the ‘anti-vaxers’, but we may all have thought about it, whether we vocalise it or not.

What of the trials then?

Take a read of this BMJ editorial here:

What are the yes/no arguments proposed to pushing through drugs on the basis of less than ‘robust’ trial evidence then? Is that what we have done here? Have we pushed through this vaccine on the back of fewer patients, less time and lower numbers to spot the amplification effects this brings on side effect profiles? This is a pandemic, so we need to move fast, as the more we delay, the more deaths could result where we could have commenced life-saving therapies. History demonstrates in many circumstances, it took ‘gut feelings’ and experience base over evidence, to push forward many of the revolutionary therapies we see today. Look what happened with H. pylori treatment…it took a self-experimenter to push the message through!

So….is this what we did in the RECOVERY trial then….did we push through various measures, various drugs etc. in order to desperately attempt to make a dent in this horrible pandemic. Well, perhaps. Various aspects of it, via its fluidity, have been kicked into touch. Whereas, dexamethasone therapy, for example, remains strong. Without the ability to somewhat ‘freestyle’, as we did here, on the go on the shop-floor, we would maybe never have discovered what we did…and this WAS out of desperation.

But, perhaps during a pandemic, we should actually be ever cautious of pushing too hard, too fast? What if it all goes terribly wrong as that robustness wasn’t there?! We face deaths that are now ‘iatrogenic’, as well as pandemic! Those are the arguments against, of course. We have had it bred into us that everything MUST be heavily peer-reviewed and scrutinised to the nth degree before anything can become a true and safe practise changer via EBM. Surely this is the only way to go then? More patients, more scrutiny, more years go by as the pandemic spirals out of control?

We have Pfizer in the UK!

So, there are different options, but it just so happens the UK are now the guinea pigs for the Pfizer vaccine. Has this one been pushed through and gained approval faster than the others because of the superior shoving from this pharmaceutical giant? We all know what was said regarding pecuniary interest within this company. But, was this all conspiracy theory creating panic in the pandemic?!

There are other choices, as seen here:

See also this piece from Mike Hansen:

Final video on the big 3 here:

A harrowing reminder

Trials themselves

Download and look at the trials the company’s performed below, with protocols:

So…..

Take care all……will you or won’t you??? It is entirely your decision and it should be yours alone!

JW