Got a friend who’s got it wrong about vaccination? Here’s how to set them right.

Yesterday New Zealand provisionally approved use of the Pfizer vaccine, sparking a fresh burst of argument about Covid-19 vaccinations online. Many people have concerns about the vaccines and how they will impact people. I worked with Jo Kirman, associate professor of microbiology and immunology at the University of Otago, to put together this simple resource for dealing with fears people may have about the vaccines.

1. The vaccine was developed too fast

The Covid-19 vaccines are a remarkable example of the incredible things we can do with international effort, funding, and a common goal for good. It’s something to be celebrated – and the question around why this vaccine was created so quickly when others take years should be flipped. We should be asking: why isn’t there similar funding and government support for other preventable diseases to have vaccines developed?

Aside from that, these vaccines weren’t created from scratch. They were already under development before Covid-19 because of the SARS and MERS epidemics, which had generated sufficient concern for people to start this research. Many of the vaccines were being developed for other infectious diseases and were “repurposed”. So, this wasn’t completely new stuff – the vaccines were pretty much ready to move into clinical trial within a few months because of that. The trials themselves have been fast-tracked – much of the red tape was streamlined so they could get started quickly. The EMA and FDA already had processes available for prioritising certain types of drugs or vaccines in emergency situations.

So, they removed the bottlenecks so that the testing and evaluation could take place quickly. It has still been evaluated carefully. Rather than being concerned, we should be delighted that this could happen so quickly. It’s been a massive communal effort. As soon as the scientific and medical communities were alerted to Covid-19, people have worked tirelessly to save lives.

2. The vaccine is dangerous [insert anecdote here]

The problem with anecdotes is that they don’t tell the full story. For example, in the Moderna Phase III trial you could say that 30 people developed severe cases of Covid-19. But the reality is quite different. A secondary endpoint analysed severe cases of Covid-19 and included 30 severe cases (as defined in the study protocol) in this analysis. All 30 cases occurred in the placebo group and none in the mRNA-1273 vaccinated group.

The Phase III Moderna trial had over 30,000 participants. Half received the vaccine; half received the placebo. That’s a massive number. The Pfizer trial had over 40,000 participants.

The frequency of grade 3 adverse events in the placebo group (1.3%) was similar to that in the vaccine group (1.5%), as were the frequencies of medically attended adverse events (9.7% vs. 9.0%) and serious adverse events (0.6% in both groups). Simply put, this means there were near-identical numbers of severe adverse events in the placebo group as in the vaccine group. Also, it’s important to note, in this large Phase III trial some people did die. Three people in the placebo group died and two people in the vaccine group. One died of a heart attack and one died by suicide. So, when people say there were deaths, they’re correct, but it’s not the full story.

Anecdotal evidence in a comments section can feel compelling. If you see someone say: “My grandad had the Covid-19 vaccine and two days later he died from a stroke,” it’s tempting to make the vaccine the cause for stroke and conclude that the vaccine is bad. But Grandad was 89 and strokes are quite common in that age group.

Epidemiologists can compare the number of people having strokes in his age group who weren’t vaccinated with those who were, and can see if there are any increases in stroke incidence over the whole population.

At an anecdotal level, you can’t tell much at all. But when a layperson is reading something, an anecdote is much more relatable and has more impact than data and numbers.

3. The vaccine hasn’t been tested on enough people

Around 30,000 people participated in the Moderna vaccine trial. Around 40,000 people participated in the Pfizer vaccine trial. Novavax will conduct its Phase III trial on 30,000 people; AstraZeneca and Oxford University aim to enrol 60,000 participants in their clinical trials.

4. Covid-19 has a survival rate of 99% so you don’t need to get the vaccine 

We are so lucky in New Zealand to have not been hit hard by Covid-19 – but it makes people forget just how many people we have lost worldwide. Here’s just one online memorial featuring 150,000+ lost loved ones to Covid-19 in India alone. We cannot comprehend 2.24 million dead.

In India, one of the world’s largest inoculation campaigns has begun with the Covid-19 vaccination, with 3.9 million healthcare workers having now received their first dose of the coronavirus vaccine. This is our chance to show we care about each other, that we have humanity. If these deaths aren’t enough to sway you – maybe you could consider the other ways Covid-19 can kill. If you are able to but decide not to get vaccinated, you are deciding that you are comfortable that your inaction could result in the death of someone else.

Finally, it’s important to consider that while “only” 1% die, about 5% of infected people become critically unwell with Covid-19. These people all require ICU beds, and we have limited numbers of these. That means that ICU beds being used for people with other illnesses or accidents or post-operative care become unavailable. Additionally, many others with severe Covid-19 (an additional 5-10% of cases) require hospitalisation.

If just 1% of people in New Zealand became infected with Covid-19 simultaneously, that’s up to 5,000 people requiring a hospital bed and 2,500 others requiring ICU care. In April 2020, we had 358 ICU beds available in all of New Zealand, so you can see that existing infrastructure gets overwhelmed quickly. Others with non-Covid-19-related illnesses such as cancer or even a burst appendix may not get the level of care they would usually receive. That is why prevention by vaccination is so important. Young people die from Covid-19 too – not as often as the elderly, but they do die, even apparently otherwise well young people. Also, if you decide not to get vaccinated, and you get very ill, you will rely on doctors and nurses and other health care workers to place themselves at risk to help you. Vaccination is a way of showing that you care about health workers, about others, as well as yourself.

5. It’s not safe for children and I won’t get my child vaccinated

Children under 16 are not being vaccinated. Pfizer is studying its vaccine in children over age 12. But that effort began only a few months ago. Moderna will start testing its vaccine on kids early this year. The delay in testing kids means it could be many months before vaccinations are approved for anyone under 16.

6. It’s not a vaccine – it changes the DNA in your body / It’s new, untested technology

There’s a lot of confusion out there about what mRNA is. So, here’s a great explainer: Think of our bodies as being built up from tiny Lego pieces (called cells). Each cell is a living thing and it has a function. For example, to make a hair, or to absorb food from your gut, or in the case of some immune cells, to make antibodies. Each cell has the same genetic blueprint (your genes) and this is called DNA. To do their different jobs, each cell has to turn specific genes from the DNA into proteins that help the cell do their job. To make a gene into a protein you need a transient intermediary and that is what mRNA is. It never lasts long, but it provides the ‘script’ based on your DNA for the protein.

So, with mRNA vaccines we are giving our cells a little bit of the coronavirus spike protein ‘script’ so our cells can manufacture it by themselves. The mRNA doesn’t last long in your cells and it also doesn’t change your own genetic blueprint because it is not DNA. It’s just a temporary script that allows your cells to make a bit of spike protein. Then your immune cells take notice – they recognise the spike protein as ‘non-self’ and start to make an immune response against it. Your B cells will make antibodies, and these antibodies can inactivate the virus if you get infected, so this makes you immune. The very cool thing about the immune system is that it can remember for years, decades even. So, your B cells that make antibodies can still react and make antibodies several years down the track.

7. We don’t know what the long-term side effects will be

First of all, most known side effects of vaccines manifest very quickly: allergic reaction, injection site inflammation, fever, or muscle aches. It’s true that the clinical studies so far have performed follow-up over months, rather than years. But, based on what we know about all other vaccines, and the very short-lived nature of mRNA, there isn’t any need for concern about serious long-term side effects.

This is because mRNA is very transient. It breaks down very fast at body temperature (that’s why those vaccines need to be in such cold storage). So, it’s not something that is going to hang around for long at all. Also, we have lots of our own mRNA in every cell in our body. So, it’s not something to be afraid of – you are literally teeming with mRNA all the time.

Secondly, as we speak, people are being vaccinated worldwide. In Israel, five million doses of the vaccine have been given to a population of about nine million – and about one million people have received two doses.

The current seven-day average for Covid 19 vaccinations in the UK is just over 389,000. More than 9.2 million people have now received a first dose of a vaccine, and more than 490,000 people have had a second. Since vaccine distribution began in the U.S. on December 14, more than 26 million doses have been administered, reaching 6.5% of the total U.S. population, according to federal data collected by the Centers for Disease Control and Prevention.

By the time the vaccine comes to New Zealand – billions of people will have safely had the vaccine.

8. We don’t need to get vaccinated in New Zealand because we don’t have Covid-19 here

Our borders will not remain closed forever and as soon as we open them Covid-19 will come into New Zealand.

Since no vaccine is 100% perfect and no test is 100%, even if we restrict entry into New Zealand to vaccinated and recently tested people, it will definitely get here. We have seen in nearly every other country in the world what happens when the virus enters a community of unvaccinated individuals without strict public health measures put into place and it’s not pretty.

9. If you’re confident in the vaccine then you shouldn’t worry about other people not getting it because the vaccine will protect you

No vaccine is 100% effective. No scientist or health professional will claim that it is. But, the two most effective Covid-19 vaccines – produced by Moderna and Pfizer – are up to 95% effective, which means five in every 100 exposed vaccinated people will display symptoms of Covid-19 if they get infected.

These five people could develop productive infection that might transmit the disease to their little cousin with immune-deficiency, or their brother recovering from a heart attack.

Vaccines don’t stop disease transmission when taken in isolation, we need to vaccinate a high percentage of the population (70-80%) to achieve herd immunity.

Just because vaccines are not 100% effective it doesn’t mean they’re not great. No contraception is 100% effective, but most people who use it will agree contraception is quite useful!

10. It’s my body and my choice 

It is. And you’re not being forced to take the vaccine. But you do need to look at what the evidence says – and thankfully, there’s plenty of evidence we can share with each other.

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