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For many, the global COVID vaccine roll-out represents a beacon of hope for the future. Huge leaps have been made this year in the biomedical research and development field, with the production, distribution, and administration of new mRNA vaccine technologies being used for COVID vaccines. That being said, Andrew Pollard - chief investigator of the Oxford/AstraZeneca vaccine trial - has recently reinforced the view that many experts around the world hold: whilst vaccines are essential, particularly in reducing the burden on health services, their production and usage does not signal the end of the COVID-19 pandemic. This statement is all the more true with the growing risks posed by vaccine hesitancy.
The Covid Vaccine
By the 8th of February this year, almost 13 million people in the UK had received their first dose of the Coronavirus vaccine, and 516,000 their second. Huge progress is being made in the roll-out, and it is possible that we are already seeing the effects in the form of declining death rates and reduced ICU admissions. Many see this as the way forward - a return to normal life. However, despite the efficacy of these new vaccine technologies in clinical trials, many unknowns remain, including the duration of immunity and the effect of the vaccine in reducing transmission, as opposed to disease.
The advent of COVID vaccinations should also not detract from the concerning appearance of new variants, which have already crossed borders.
These variants, particularly prevalent in regions with previous high infection rates (such as South Africa and Brazil), arise through mutations in the genes of the virus. If a mutation causes the virus to produce a particular protein— which enables it to stick better to the airway and lung tissue, or to better avoid the antibodies produced by the immune system— it is more likely to survive, proliferate and cause disease. This well-known and well-understood concept of the ‘Survival of the Fittest’ is the basis for varying the annual Influenza (flu) jab on the basis of the infectious strains anticipated to be most prevalent in any given year. Researchers remain of the opinion that vaccination efforts are unlikely to be impeded by the appearance of these variants, but are still beginning to put resources into redesigning the vaccines. There is also talk of periodic updates for the vaccine; researchers have not yet understood the long-term consequences of these variants and the forces that are driving their existence. Thus, like the flu, we may still see annual epidemics, with individuals with the weakest immune systems potentially suffering the most. In this case, vaccinating in a similar way to the flu jab may be necessary.
With new and adaptable vaccine technologies and much reduced numbers of admissions, healthcare systems will be much better placed to deal with these cases as and when they come in.
Vaccine Hesitancy
That said, the existence of the vaccine itself is insignificant if people do not accept it. Vaccine hesitancy —the refusal or reluctance to have a vaccine because of fears that it is unsafe or ineffective— came to the forefront in 1998, with a study by Andrew Wakefield that was published in The Lancet claiming the existence of a link between the MMR (Measles, Mumps, Rubella) vaccine and autism spectrum disorders. The paper, though retracted in 2010, did significant damage; it became the fuel for the ‘anti-Vaxxer’ movement to promulgate the mistrust of vaccines (and the healthcare systems providing them). MMR uptake consequently saw a drop in the UK from 92% of children vaccinated before age 2 in 1996 to 84% in 2002. Unsurprisingly, what followed was a 13- and 37-fold increase in Measles and Mumps cases. In 2008, the UK declared its first Measles death and the disease as endemic, for the first time in 14 years. On the World Health Organisation’s top 10 global health threats of 2019, alongside other significant public health concerns such as ebola, influenza, and antimicrobial resistance, vaccine hesitancy was a stand-out feature - an easily avoidable public health threat which undermines the huge developments made to overcome and tackle infectious diseases which have burdened humanity over centuries.
The current COVID-19 pandemic has seen a resurgence of anti-vaccination sentiments for a number of reasons, including the necessary speed at which vaccine developments have been carried out, the variation in symptom presentation between positive cases leading people to see the virus as merely a glorified flu, and the increased availability of misinformation and conspiracy theories on the Internet.
However, hesitancy is not just a question of ignorance or conspiracies.
In some cases, particularly in individuals from Black, Asian and minority ethnic communities (many of whom are integral members of the healthcare community), hesitancy is a justifiable consequence of their mistrust following poor treatment and exploitation over decades and centuries by the medical community.
More must be done to respect and address these concerns so that communities can safely reopen and so that people can be sure that they are doing their best to protect themselves and their loved ones.
Hope for Normality?
Life may not go back to normal anytime soon, but we will hopefully err on the side of caution when returning to public events and activities, which will provide health services with an essential and much needed buffer, and give time for the whole country to be vaccinated and essential immune responses to develop. The vaccine thus represents a highly essential means of reaching that normality. It is not yet known what proportion of the population needs to be vaccinated for herd immunity to be achieved, but it is likely close to 80%. This means that we must respect our duty to be vaccinated whenever possible and vaccine providers must continue to supply accurate and accessible information about its efficacy and duration of protection, as well as any potential associated risks.
We cannot underestimate the persistence of SARS-CoV-2. In the words of Harvard University epidemiologist William Hanage: “Viruses are not as smart as humans, but they are much more patient.” Thus, we may not ever completely eradicate the virus, but instead, will come to live with it in the same way that we have with many others.