Covid-19 Vaccines What You Need To Know
The start of the Covid-19 vaccination programme in the UK was a great moment for everyone in healthcare. We want to make sure all our patients have the best information on the vaccines.
Which vaccines are available?
There are currently 3 vaccines authorised for use in the UK; Pfizer, Astra Zeneca/Oxford and Moderna. The NHS is already offering the first two and expecting to have supplies of the Moderna vaccine in March 2021. There are also further vaccines which are expected to be approved in the coming months.
Pfizer This was the first vaccine authorised in the UK. It was made by a collaboration between the US pharma company Pfizer and German company BioNTech. The vaccine contains particles called mRNA (messenger ribonucleic acid), when it is injected into the body it tells cells to make a spike protein. This spike protein is the same as the spike proteins found on the Covid-19 virus surface. Your immune system will see the spike protein and make immune cells called T and B cells. These T and B cells will then become part of your immune system memory so that if it sees the virus again is it already primed and ready to make a quick response. Two doses of the vaccine are recommended, currently, in the UK these are being offered 12 weeks apart. In trials, it has shown to prevent 95% of symptomatic cases of Covid-19 infection. Common side effects seen after vaccination are headache, tiredness, local reaction at the injection site, and fever. Thankfully serious reactions are very rare. The vaccine requires special storage at -70 Celsius and needs to be used within a short time frame so it is many being given at large-scale vaccination centres.
AstraZeneca/Oxford The vaccine carries DNA (deoxyribonucleic acid) for the Covid-19 spike protein, it is carried within another type of virus called ‘adenovirus’, these viruses can illnesses such as the common cold. When the vaccine is given the adenovirus is able to enter your own body cells and the DNA tells the cells to make the spike protein. Your immune system will then make T and B cells that target the spike protein. These will be part of your immune system memory and ready if you are again exposed to the virus. Two doses are given at least 4 weeks apart. DNA based vaccines are easier to store so it can be stored in a standard medical fridge and is able to be given by some NHS GP surgeries. The vaccine was shown to be over 70% effective at preventing Covid-19 infection. There was some evidence that a lower first dose may be more effective and studies are ongoing to see if there is a way of making the vaccine even more effective.
Moderna The vaccine is manufactured in Boston and works similarly to the Pfizer vaccine using mRNA to provoke an immune response to the spike protein. It is easier to store though requiring only over – 20 Celsius. It is also given in 2 doses at least 4 weeks apart. The UK government has ordered doses but these are not expected until at least March 2021.
Vaccines made by Novavax and Janssen will hopefully gain approval for use soon. Currently, it is not possible to choose which vaccine you are given.
Who is entitled to the vaccine currently?
The UK government has set out its priority list for vaccination, it started in December with people living or working in care homes and people over 80 years of age. Moving downwards through the groups they have also now been vaccinating frontline healthcare workers and through age brackets down to those over 70 years of age. People aged 16 to 74 years of age who are ‘clinically extremely vulnerable’ should also be eligible for vaccination in the current round of vaccinations before 15th February 2021.
The vaccination programme is then expected to continue working down the age brackets. Priority will be given to those under with an underlying health condition, this list will be broader and include those with conditions such as diabetes or heart disease.
Can I have the vaccination privately?
The NHS is currently giving all Covid-19 vaccines in the UK. It is likely at some point that there will be options to have the vaccine privately whilst NHS supply remains protected, in a similar way to how we usually give flu vaccination each winter privately at the clinic. This is not likely to happen until later in the year when there will be many more vaccines available. Please be aware there are sadly already scams asking patients for payments or bank details, these are not requested by the NHS. These should be reported by forwarding suspect emails to report@phishing.gov.uk or text messages to 7726.
We have always encouraged patients to register with the NHS in addition to having a private GP. In the UK you are able to have both options as long as you are entitled to NHS care. If you have not visited your NHS GP surgery for some time it is worthwhile to check that you are still on their register and they have your up to date contact details. As many surgeries are dealing with lots of Covid-19 related queries it is best to do this by contact through your NHS surgery website or email address rather than the telephone. When you are eligible for Covid-19 vaccination then you can book this online but will need your NHS number, so it if you do not know this it is good to request this and keep a record. You can ask your NHS surgery or check online here.
The NHS IT system will identify adults with an underlying condition which puts them at higher risk in “group 6” who are due to be vaccinated after the over 65 years plus age group, hopefully, this group will be offered the vaccine in the coming months. This includes a wide variety of conditions such as diabetes, coeliac disease, previous ischaemic heart disease and epilepsy. If you have had private treatment and are not sure if your NHS GP is aware of your condition then again it is sensible to contact them by their website or email to ensure your conditions are correctly coded. The full list is available at the bottom of this post for reference. If you need advice or copies of correspondence to help with this then do please get in touch.
Should I have the vaccine if I am pregnant or planning for pregnancy?
There is no evidence that Covid-19 vaccination is dangerous in pregancy but there have also not yet been any trials studying its effect in pregnant women. For most women the current advice is to delay vaccination until after pregnancy. If you have the vaccination and then find you are pregnant unexpectedly then there is no reason to panic. Vaccines using similar adenovirus methods as the AstraZeneca/Oxford vaccine have been used in pregnancy for other infections very safely. To help gather data if this happens please let your doctor know as the government keep a register of cases. Women who are a high risk for exposure to Covid-19 for example because of their work or high risk of complications due to an underlying health issue should discuss vaccination with their doctor as it may be sensible for them to have the vaccine.
Should I have the vaccine if I am breastfeeding?
Despite no trials in vaccination during breastfeeding based on how the vaccine works in the body the World Health Organisation and the UK Joint Committee of Vaccination and Immunisation both agree it is safe to have the vaccine whilst breastfeeding.
Should children or teenagers have the vaccine?
Thankfully serious illness in children due to Covid-19 infection remains rare. There is some data on the use of the Pfizer vaccine in children over 12 years of age. Children over 12 years who are at high risk of complications of Covid-19 may be considered for vaccination outside of it’s licensed use. Given the high rates of Covid-19 in teenagers I suspect that they may become a group offered vaccination later in the year once more studies are completed.
Should I have the vaccine if I have already had Covid-19?
If you have recently had Covid-19 it is advised to wait 4 weeks from the start of symptoms or a positive swab test before having the vaccine. This is because some people can have symptoms of Covid-19 which get worse again after 1 to 2 weeks and it would be difficult to know if this was due to the vaccine or the original Covid-19 infection if they were vaccinated during that time. People with long term symptoms following Covid-19 can be safely vaccinated. But if their symptoms are not stable or still being investigated it would be sensible to wait for a short period so that any change is not attributed to the vaccine incorrectly.
Once I have been vaccinated can I stop social distancing?
There has been some very encouraging recent evidence that there is good protection from 3 weeks after only the first dose, and that it may reduce the chance of you transmitting the virus to others by about two thirds or 67%. This is all good news for the prospect of easing lockdown in the coming weeks and months. But given that protection and reduction of transmission is well below 100% we will all need to continue to be careful, especially whilst there is still a large number of people with the virus in the community. Remember the very tricky aspect of Covid-19 is that you can spread the virus either before you start to feel symptoms or without ever having symptoms.
Should I have the vaccine if I have an allergy or carry an adrenaline autoinjector pen such as an EpiPen?
In the early phases of the vaccination programme there were some cases of serious allergic reactions, especially to the Pfizer vaccine. Subsequent tests have shown that it is safe to have the vaccine if you have a food or drug allergy as long as you are not allergic to any of the vaccine components. If you have a history of anaphylaxis to multiple drugs or unexplained anaphylaxis then you should receive the AstraZeneca/Oxford vaccine rather than the Pfizer vaccine. If you experience a reaction after the first dose then check with your doctor where or when you should have the second dose.
Will I get a ‘vaccine passport’?
The UK government have not yet issued details of a vaccination or immunity passport scheme. But it has been widely reported this is being developed by several countries. In the short term when you attend for your vaccination you will receive a vaccination card which you should keep safely. The vaccination will also be recorded in the national database. If you want to read more about antibody testing after vaccination then read our blog here.
Should I take the vaccine?
We would strongly advise those who are offered and suitable for the Covid-19 vaccine to go ahead and take the vaccine. We know that there has naturally been some anxiety that the vaccine has been made and approved quickly but none of the usual steps have been missed in its approval and we are confident it is safe. Indeed when our team was lucky enough to get our first doses of the vaccine it really felt like something to celebrate and we were delighted to be able to protect ourselves and our patients. Trials of the vaccines have shown they are very effective at preventing serious illness and hospital admissions due to Covid-19. A single dose of the AstraZeneca/Oxford vaccine was shown to prevent 76% of symptomatic infections in the 3 months following the first dose. The Pfizer vaccine was over 94% effective at preventing symptomatic Covid-19 infection. There are concerns about how effective the vaccine wil be at preventing cases caused by new variants, especially the new variant first found in South Africa. It is unlikely a new variant will make the vaccines completely ineffective but they may not work as well. We anticipate that booster doses of vaccine will be needed in the autumn and vaccine manufacturers are already working to make these more effective on new variants.
Dr Lucy Hooper, Private GP and Co-Founder, 8th February 2021
Joint Committee of Vaccination and Immunisation (JCVI) Clinical risk groups 16 years of age and over who should receive COVID-19 immunisation
Chronic respiratory disease: Individuals with a severe lung condition, including those with asthma that requires continuous or repeated use of systemic steroids or with previous exacerbations requiring hospital admission, and chronic obstructive pulmonary disease (COPD) including chronic bronchitis and emphysema; bronchiectasis, cystic fibrosis, interstitial lung fibrosis, pneumoconiosis and bronchopulmonary dysplasia (BPD).
Chronic heart disease and vascular disease: Congenital heart disease, hypertension with cardiac complications, chronic heart failure, individuals requiring regular medication and/or follow-up for ischaemic heart disease. This includes individuals with atrial fibrillation, peripheral vascular disease or a history of venous thromboembolism.
Chronic kidney disease: Chronic kidney disease at stage 3, 4 or 5, chronic kidney failure, nephrotic syndrome, kidney transplantation.
Chronic liver disease: Cirrhosis, biliary atresia, chronic hepatitis.
Chronic neurological disease: Stroke, transient ischaemic attack (TIA). Conditions in which respiratory function may be compromised due to neurological disease (e.g. polio syndrome sufferers). This includes individuals with cerebral palsy, severe or profound learning disabilities, Down’s Syndrome, multiple sclerosis, epilepsy, dementia, Parkinson’s disease, motor neurone disease and related or similar conditions; or hereditary and degenerative disease of the nervous system or muscles; or severe neurological disability.
Diabetes mellitus: Any diabetes, including diet-controlled diabetes.
Immunosuppression: Immunosuppression due to disease or treatment, including patients undergoing chemotherapy leading to immunosuppression, patients undergoing radical radiotherapy, solid organ transplant recipients, bone marrow or stem cell transplant recipients, HIV infection at all stages, multiple myeloma or genetic disorders affecting the immune system (e.g. IRAK-4, NEMO, complement disorder, SCID). Individuals who are receiving immunosuppressive or immunomodulating biological therapy including, but not limited to, anti-TNF, alemtuzumab, ofatumumab, rituximab, patients receiving protein kinase inhibitors or PARP inhibitors, and individuals treated with steroid sparing agents such as cyclophosphamide and mycophenolate mofetil. Individuals treated with or likely to be treated with systemic steroids for more than a month at a dose equivalent to prednisolone at 20mg or more per day for adults.
Anyone with a history of haematological malignancy, including leukaemia, lymphoma, and myeloma and those with systemic lupus erythematosus and rheumatoid arthritis, and psoriasis who may require long term immunosuppressive treatments. Most of the more severely immunosuppressed individuals in this group should already be flagged as CEV. Individuals who are not yet on the CEV list but who are about to receive highly immunosuppressive interventions or those whose level of immunosuppression is about to increase may be therefore be offered vaccine alongside the CEV group, if therapy can be safely delayed or there is sufficient time (ideally two weeks) before therapy commences. Some immunosuppressed patients may have a suboptimal immunological response to the vaccine (see Immunosuppression and HIV).
Asplenia or dysfunction of the spleen: This also includes conditions that may lead to splenic dysfunction, such as homozygous sickle cell disease, thalassemia major and coeliac syndrome.
Morbid obesity: Adults with a Body Mass Index ≥40 kg/m².
Severe mental illness: Individuals with schizophrenia or bipolar disorder, or any mental illness that causes severe functional impairment.
Adult carers: Those who are in receipt of a carer’s allowance, or those who are the main carer of an elderly or disabled person whose welfare may be at risk if the carer falls ill.
Younger adults in long-stay nursing and residential care settings: Many younger adults in residential care settings will be eligible for vaccination because they fall into one of the clinical risk groups above (for example learning disabilities). Given the likely high risk of exposure in these settings, where a high proportion of the population would be considered eligible, vaccination of the whole resident population is recommended. Younger residents in care homes for the elderly will be at high risk of exposure, and although they may be at lower risk of mortality than older residents should not be excluded from vaccination programmes (see priority 1 above).
References
What do we know about the new Covid-19 variants? Public Health England, 5 February 2021.