Getting a Covid-19 vaccine is a personal choice. Nobody can force you to have it. Despite vaccine green cards and travel restrictions in various countries, Covid-19 vaccine remains voluntary. While most doctors in South Africa have scrambled to get themselves and their staff vaccinated, and some determined patients have managed to get early vaccines in the last few days of the Sisonke trial, the level of vaccine hesitancy, distrust and fear of vaccines continues to amaze me. Like the majority of my medical colleagues, I am firmly of the belief that everyone who can (with very few specific exceptions) should be vaccinated against COVID-19 as soon as possible. Preference should be given to:
- those most vulnerable to getting severe disease and dying from Covid-19.
- the elderly (in descending order of age), and those with significant co- morbidities (obesity, diabetes, cardiac disease, hypertension and respiratory diseases).
- teachers, other essential workers and those living or working in communal settings.
Ideally , these citizens should be closer to the front of the queue.
I want to address some of the issues around vaccine hesitancy, through some of the questions that have most commonly been posed to GPs.
1. Why should I get a Covid-19 vaccine & do they even work?
The Covid-19 vaccines work by stimulating your immune system to recognize the virus. Then, when you are exposed to it again, your body’s defense system can fight off the virus more easily.
This means that you are:
- less likely to become infected,
- less likely to transmit the virus and
- far less likely to get severe illness, need hospitalisation or die.
Based on the most recent clinical trial data available and some real world data, the Covid-19 vaccines really DO WORK! Some stats on the vaccines available in SA:
•J & J SINGLE DOSE⁃ 76.7% real world overall efficacy⁃ 52 to 57% efficacy against B1.351 (SA strain)⁃ 85% protection from severe disease (100% after day 49)⁃ 100% protection from hospitalisation in clinical trials⁃ 100% protection from death in clinical trials⁃ 74% reduction in asymptomatic transmission
•PFIZER TWO DOSES⁃ 90% real world overall efficacy⁃ 72 to 75% efficacy against B.1.351 (SA strain)⁃ 90% protection from severe disease⁃ 100% protection from hospitalisation in clinical trials (94% real world)⁃ 100% protection from death in clinical trials (98% real world)⁃ 72 – 95% reduction in asymptomatic transmission
2. Does the Covid-19 vaccine make you feel sick? What are the long term side effects? I’m worried about the risk of clotting.
Both Johnson & Johnson and Pfizer vaccines commonly cause mild side effects that usually last for one to three days. They CANNOT cause Covid infection as they do not contain live SARS-COV-2 virus. Side effects include:
- swelling or pain at the injection site,
- body pains,
- arm pain, and
- swollen glands.
Side effects after the second dose of Pfizer are reportedly worse than those experienced after the first dose. People who have already had Covid-19 may experience slightly worse side effects than those who haven’t.
There is an extremely rare incidence of the J & J vaccine causing an uncommon clotting disorder in women. However, Covid-19 itself is responsible for a far higher incidence of clotting, and the FDA, CDC, SAHPRA and other global health authorities have deemed that the benefits far outweigh the risks.
3. I’m young, healthy and not at risk, why should I get vaccinated?
This is not about you! It’s about protecting the vulnerable in the community – your grandparents, parents, and those who are immunocompromised and vulnerable. It’s an incredibly egocentric view to go with the assumption that you are young and healthy, are unlikely to develop severe Covid infection and therefore vaccines don’t apply to you.
While those most at risk should absolutely be first in line to receive vaccines early, as these will protect them, unless 60% of the population is vaccinated, the virus will continue to spread and mutate, meaning that even those who are vaccinated remain at risk.
4. I’ve already had Covid, I don’t need a vaccine.
For people who have recovered from COVID-19, the vaccine strengthens their immune response (both antibody and T-cell immunity), and lengthens the duration that immunity lasts. Vaccines stimulate the production of NEUTRALISING antibodies more than natural infection, which means that they offer better protection against new variants. Several clinical trials have confirmed that the Covid-19 vaccine works better than natural immunity against variants of concern (including the so-called “South African” and “Indian” strains).
5. Isn’t it better to rather get Covid, which will give me better natural immunity?
See number 4. above for why the vaccine is more effective than natural immunity. Also, the risk of Covid infection is much, much higher than any risk from having the vaccine. You just don’t know how severely you will be affected or who you will spread it to. Vaccines also massively reduce the risk of “long Covid” which can be debilitating and last for months.
6. If I have a Covid-19 vaccine, will I still have to wear a mask, socially distance and sanitise?
The vaccine is only one more layer of protection against Covid-19. Until many more people are vaccinated and there is herd immunity, we need to remain cautious. As it is still possible to transmit the virus and to get infected (albeit much lower risk), infection control measures need to remain in place while the pandemic is still with us. However, amongst other vaccinated adults, in small groups and at outdoor venues, once vaccinated, life can become much more normal. Even once you are vaccinated, healthy lifestyles, good eating, exercise, not smoking, and vitamins should all play their role in keeping you healthy and safe. (This week, the CDC updated their mask policies, stating that vaccinated adults are no longer required to wear masks even indoors in most settings – While the USA are perhaps being a little presumptuous (with only 35% of their population fully vaccinated), this is a great incentive to get a vaccine: masks can finally come off once the majority of people are immune).
7. Are Covid-19 vaccines safe? They were developed so quickly – how do I know they won’t cause long term side effects?
Although Covid-19 vaccines were developed with unprecedented speed, all stages of vaccine trial and testing were still adhered to before approval. The science built on processes that were already in place from testing against other viruses from decades before. Scientists around the world have collaborated and massive international funding has gone into the development and stringent testing of vaccines. This has ensured rapid development of vaccines, while still progressing through all the trial stages, rigorous safety checks and ongoing monitoring. And while some people will insist on seeing the conspiracy theory side of big pharmaceutical companies having a financial agenda for producing vaccines, just as with other global threats like smallpox, polio and influenza, vaccines are crucial in bringing an end to this pandemic. Many people ask how we can be sure that vaccines don’t have long term side effects as they are so new – while it’s true that we only have one year of safety data, millions of doses have already been administered worldwide, and vaccines historically do not cause long term side effects (vaccine side effects are generally seen within days to weeks).
8. If I have allergies can I have the vaccine?
Allergic reactions from the COVID-19 vaccine are extremely rare. A person is much more likely to die from contracting the virus or to become a “Covid long hauler” than to have an allergic reaction to the vaccine. The few anaphylactic reactions that have been reported (more commonly after Pfizer than J & J) have been in patients with a history of severe allergy. Allergic reactions usually occur in the first 15 minutes after the vaccine, and are treatable. For this reason, everyone receiving a vaccine is observed for 15 minutes before they are allowed to leave. Beware of PEG – One of the ingredients to be aware of that can cause allergy is PEG (polyethylene glycol) – present in many vaccines, including Pfizer and J & J. It is thus important to disclose before you have a vaccine if you have ever experienced severe allergic reactions, so that you can be closely monitored afterwards. Please remember:
- People with a history of food, bee, penicillin or other medication, environmental or latex allergies CAN still get a vaccine.
- Anyone with a history of anaphylaxis to other vaccines should consult with their doctor, receive the vaccine in an equipped health facility and undergo a 30 minute observation period after receiving it.
- Anyone who is allergic to PEG (polyethylene glycol) or polysorbate, or any other component of the vaccine, or anyone who experiences anaphylaxis after the first dose of vaccine, should NOT be vaccinated.
9. If I have a clotting disorder, or if I am on anticoagulants, can I have the vaccine?
Currently, having a history of clotting disorders and being on anticoagulants is NOT a contra-indication to having a vaccine. Although some vaccines have been associated with a very rare risk of VITT (vaccine induced thrombotic thrombocytopenia), there have been very few cases reported following millions of vaccines worldwide. Any side effects after the vaccine should be reported to your doctor.
10. If I am pregnant or breastfeeding, can I have the Covid-19 vaccine?
The Sisonke Johnson & Johnson trial specifically excluded pregnant and breastfeeding women in South Africa. However, it is likely that this stipulation will be removed in the national rollout of J & J. Pfizer vaccines have successfully and safely been given to pregnant women in the USA and Israel. The risk of contracting Covid-19 during pregnancy in both mom and foetus outweighs the risk of vaccination. However, pregnant and breastfeeding women are encouraged to make a decision about vaccination together with their obstetrician and/or family doctor, taking personal circumstances and risk factors into account. The vaccines do not have any effect on fertility.
With new variants being described around the world in several countries, some of these being more transmissible and causing more severe illness, getting more people vaccinated as soon as possible is crucial. The longer the virus is allowed to spread unchecked, the more chance it has of mutating to cause further, more harmful variants. Social media hype that having the vaccine dampens immunity and causes the emergence of variants has no scientific basis. The more people who are vaccinated and the fewer people left who are susceptible to the virus, will mean that it is unable to continue spreading and thus unable to continue mutating.
12. Ok – you’ve convinced me to get a Covid-19 vaccine – which one should I get?
The first vaccines available in South Africa are Pfizer (two doses, three weeks apart) and Johnson & Johnson (single dose). These are both excellent vaccines with good safety and efficacy profiles, and I encourage you to get WHICHEVER IS AVAILABLE TO YOU FIRST. (Other vaccines will be discussed should they become available).
Conclusions on the Covid-19 vaccine
- The Covid vaccine can only help to shorten the pandemic if communities pull together to ensure access by as many citizens as possible.
- Getting a vaccine, in conjunction with ongoing infection control measures (masks, distancing and sanitising) are the keys to us returning to our normal lives.
- As SA enters the third wave and the Sisonke trial comes to an end, I remain optimistic that vaccination for the elderly will start to become a reality in the next few weeks.
- I encourage everyone to help over 60s to register for vaccines both on EVDS and with their medical aids and will continue to provide updated information as it becomes available.
- At the same time as encouraging everyone to get a vaccine, I also urge patience, ethics and morality so that the most vulnerable and at risk are at the front of the queue to get vaccines ahead of those at lesser risk.