I want to write a post about a human factors observation from when I got jabbed recently, but realise I can’t without rationalising why I got jabbed. This is why you (almost certainly) should too, as soon as you possibly can.
As with everything on this site - and the web in general - this is not medical advice, just here for information. If you have any questions aboute vaccination go speak to your doctor (and don’t read crackpot conspiracy theories from people trying to sell you clicks)
Basic immunology: Why COVID fucks you up
I am very much not an immunologist (as my tutor for 2nd year pathology will attest to), but I do use a working knowledge of immunology in my day-to-day work life, so I’m going trying to try and make a complex topic relatively simple for the non-medic. In essence, you have two key immune systems:
- Innate immunity: This is the Army of your immune system. It does one thing over and over again - massive deployment of resources aiming to kill all the things - and on the whole it does it relatively well. Biologically this is passive things (like skin) and cells that are always do the same thing (macrophages and other inflammatory cells)
- Adaptive immunity: This is the Special Forces of your immune system. Recognising known threats and discretely bumping them off without much fuss. This is where all the obsession with antibodies comes from.
Let’s think about what happens when you catch an infection. As an adult (which I presume most of you reading this are) your immune system has seen most things. By this stage in our life it’s all about adaptive immunity - spotting the bug which we’ve met before, and zapping it with antibodies before it has a chance to do anything wrong. Taking our military analogy from above, this is the same as Border Control stopping a known bad guy on the way into the country, or MI6 acting on intelligence and quietly taking them out before you even know they’re on the streets (I’ve watched too many BBC police dramas). Minimal interruption, and the world keeps turning.
What about if you’ve never seen a bug before? Well that’s a very different story for us, but it’s one that kids live every single day. As a toddler you’re constantly being exposed to new and exciting bacteria, viruses, and fungii, which is why they’re constantly snotty, have a sore throat, always have a temperature, and spend most of their life grumpy. It’s like the army is on the streets every day, constantly fighting off new invaders, and the only way it knows how to cope is to throw wave after wave of soldiers at the problem (a massive immune response, the cardinal sign of which is a temperature) until it goes away. But it does mean that the slowly developing special forces now know that bad guy exists, and will be ready next time, for the rest of their life.
What do small children and bats have in common? They’re really good at coping with this overwhelming immune response. They get grumpy, but live to fight another day. This is why a lot of the horrid viruses (like SARS-Cov-2, the bug causing the disease COVID-19) come from bats, because the bats can cope with the extreme immune response required to kill the virus, so in turn the viruses have to get harder and harder to kill.
Children are therefore more like a developing country - that used to having the army on the streets that the population just go about their everyday lives and everything keeps happening the way it’s supposed to. As grown ups, we’re far, far less adept at coping. Imagine the army being deployed on the streets of the UK? We can barely cope with rain, let alone the disruption that would cause. Things would grind to a halt and all the systems of government would fail. This is what happens when we get infected by a bug that we “should” have seen as a child (for example chickenpox in a kid causes an itchy rash, in an adult serious pneumonitis and death; I got glandular fever as an adult, which in kids causes a sore throat, but in adults - as I discovered - it causes liver failure). Border Control fail to recognise it as a threat, MI6 lack the intelligence needed to execute a hit, so by the time the body realises it has an intruder everywhere the only option is to deploy the Army across the entire region which does the only thing it knows how, which is bomb the shit out of everything.
We’re just not equipped to cope with this overwhelming immune response to new infections, and this is a major part of the underlying reason why people die of sepsis - the body’s own responses to infection become dysfunctional, and we fall in a heap because we just can’t cope.
And what’s the newest infection on the block? Which none of us until this year (probably) had seen? SARS-CoV-2…
How COVID fucks you up
COVID-19 is very much a spectrum of disease, from mild infections through to respiratory failure and a sepsis-like picture that we still don’t entirely understand, where this overwhelming inflammatory response knackers your lungs, kidneys, heart, and brain, and causes your blood to become prone to clotting as well as making it impossible to breath. Trust me, you really don’t want it.
Kids, on the whole, fair well with COVID. Adults do not, and the older we get, the less well we cope. This is all pretty much down to our innate immune system’s response. “I’m just doing my job” it says, but kids are well made for the body’s army to be going flinging biological missiles everywhere, and we’re just not.
Colin Angus has put together some terrifying visualisations of how COVID is affecting the population by age groups, and this is excactly the picture we’re seeing, with increasing excess mortality (i.e. more deaths than we’d expect in an average year) with age:
Hopefully by now you’ll see that catching COVID would be a Bad Thing. Even if you’ve won the genetic lottery and can cope with an inflammatory response, that person you coughed on in the supermarket might not be so lucky, and your gran is in for a real struggle when her metaphorical army put in their first appearance for decades. So we all have a responsibility to try to stop catching this virus, both for our own sake, but also to stop spreading it around (and then we can all go back to doing the things we enjoy, like going to restaurants and engaging in hobbies outside of the garden).
Why the vaccine (almost certainly) won’t fuck you up
Vaccines aim to work like that childhood phase, showing the body the potential bad guys at the door, and teaching the Special Forces to spot them. Almost all vaccines following this approach:
- Introduce a bit of dead bug, or an altered version of the bug that causes less harm
- Introduce some other things (called adjuvants) to irritate the immune system into responding
- Innate immunity gets excited (so you feel a bit generally unwell)
- Adaptive immunity makes some antibodies, and it all goes away
Next time you see that bit of bug it will be attached to the bad version, but the adaptive immune response knows it, and kills it with antibodies before the army are even aware it exists, keeping you safe and happy (and before you can spread it around).
Much is made of the “risks” of vaccines, and yes, like any medical intervention (and anything at all) there is a risk, but it is entirely overplayed. As such we need to be clear about what we mean by risk, and why saying thing with 100% certainty in medicine is just about impossible.
Vaccine risks can be considered as plausible risks (things we’d expect), and implausible risks (things that shouldn’t happen).
Most of the plausible risk is because you are playing with the immune system with things that look like, or are a downgraded form of, infection. For example, one of the most feared complications of measles is encephalitis (brain inflammation) due to the immune response. This occurs in about 1-3 in 1000 infections, so there is a very, very, very small risk of it happening with vaccines, because they’re going for the same immune response with very similar triggering molecules. It’s happened three times in the entire history of measles vaccinations, and in only one of them has the vaccine been solidly causally linked. Similarly anti-vax websites rant about transverse myelitis being caused by vaccines, but the rate of it is vanishingly small compared to the rate of transvere myelitis being caused by actual viruses.
Other plausible risks are things like allergic reactions to the vaccine, which again isn’t surprising. Allergic reactions to drugs happen all the time (NAP6 suggests this happens in 1:10,000 anaesthetics, so much more frequently than during vaccinations) and is a predictable part of using drugs. The key is to be aware that it’s a risk, observe people and treat them (as has happened in all cases so far in reactions to the vaccine). These risks are around 1:100,000 to 1:1,000,000, or close to 1 in a million; but there’s 66 million people in the UK so even one in a million events will happen 66 times if we vaccinate everyone.
Then we can consider the implausible risks of vaccines. The current conspiracy theory is regarding the COVID vaccine impacting on fertility, simply because the patient information leaflet in the US says that there is no evidence regarding this. I’d love to say that there is no risk to fertility, but I can’t, because all it would take is one counter example to disprove it. But I can no more guarntee that a baked potato won’t impact on fertility, for the same reason. In neither case is there a biolgically plausible way for it to occur.
Do we know exact risks when we set out on a vaccine program? It’s a tricky “yes and no” answer. Long-term risks are impossible to guarantee, but if we are disproportionately worried about these we’d never vaccinate everyone. For example you can’t know for sure the long term risks for a ’flu vaccine when it’s by necessity a new one every year to cope with the evolution of ’flu, but we also know the “biologically plausible” risks of the things in the vaccine and of the bug we’re injecting in to you, and so base our risk:benefits decision on that. We can’t guarantee that you won’t grow a second head, but it’s very, very biologically implausible as there’s nothing in there known to cause it.
What we do know is that catching COVID essentially doubles your risk of dying this year. So if you’re young fit and healthy, with a small risk of dying in a year, 2x a small amount is still a small amount. But if you’re in your 90s, with a life expectency of years, doubling this is a massive risk. This explains why we’re rolling out the vaccine to high risk groups first, but still, two times a small amount is double what it was, and significantly higher than the risks associated with vaccination which is much less than one in a million chance of serious reaction, so I’d encourage everyone to get vaccinated as the risk:benefit ratio is definitely in your favour.
“But this is a new vaccine!” the media shout hysterically. Lets see what the Pfizer vaccine does differently?
- Introduce a bit of code to make a bit of the virus
- Your cells make the bit of dead bug
- Everything above
Ok, bit of code, that sounds scary. But it’s not. You and I have DNA, the genetic code for making all the things our body needs to function (proteins). So do bugs (mostly). The way we turn DNA into proteins is by an intermediary, called RNA, which takes a short-lasting carbon copy of the DNA to little protein factories called ribosomes.
In the case of the vaccine, instead of trying to convince yeast or bacteria cells in a tank to make bit of the virus which we can then purify and inject, or trying to engineer less harmful versions of SARS-CoV-2 to inject, we’re skipping the middle man and injecting this RNA. Your own ribosomes will make this into an exact copy of the virus’ protein - which on it’s own can’t do anything remotely harmful - which your adaptive immunity will then recognise for next time it sees it attached to a virus.
If anything, this approach is safer. There’s nothing biologically active being injected, unlike in traditional vaccines, and the RNA is broken down after a short while by the same mechanism that our cells use all the time to break down our own RNA. It can’t go backwards into DNA, so you’re not being genetically altered in any way, and there’s no bugs in there to cause an infection.
(There’s also no microchips.)
Finally, there’s all this concern that the vaccine is “rushed”. It isn’t.
SARS-CoV-2 might sound familiar. That’s because it’s a close relative to the OG SARS virus, so attempts to vaccinate against the “spike protein” (the bit that allows it to attach to our cells) have been going on for a while. The thing that holds up vaccine developments are 1) lack of political and financial will meaning paperwork and funding takes ages and 2) lack of the disease being around, so it takes years to get enough people exposed to say it works. None of these were a problem in this case. Governments around the world were prepared to cut red tape and throw money at the problem, you can catch the virus by going to the shops or catching the bus, and the underlying technology was already being developed and just needed tweaking.
The usual phase 3 trial (assessing how well a vaccine works) recruits a few hundred to a couple of thousand patients, and takes a few years, simply because it’s really hard to ethically expose enough people to the illness to be sure it works. For example Ebola recruited a few thousand people which was thought to be groundbreaking. The Pfizer vaccine trial, which was only one of several for COVID-19, recruited 43,661.
So in summary, no, this isn’t rushed (in a bad way). It’s a combination of off-the-shelf technology and excellent science being performed in a time of almost limitless resources and political will, and to a bug that is freely available wherever you go. No one gets upset when technology and innovation is used to make your car safer and more effective, but for some reason when it makes a vaccine safer and more effective the tin-hat brigade get outraged.
But what about the indeminity thing?
As every “fact” about the vaccine is disproved, the anti-vaxers find another to be outraged about. The current biggy is that manufacturers of COVID-19 vaccines have been indeminified by the EU against claims regarding the jabs.
This is actually a Good Thing. By taking the heat for these one in a million adverse events, the EU countries will pay out instead of the manufacturers. This improves the time taken for payouts (if needed) and decreases the overall cost of the program to citizens, as the governments are not having to also pay the manufacturers to fight legal claims. This has long been the case in America for all vaccines, as it was felt that a central government insurance scheme for vaccines was preferable because it actually made vaccinations more affordable, and therefore more likely to be widely taken up, with all the public health benefits involved.
The indemnity makes the vaccines, and you, safer.
Why you should get the vaccine as soon as you can
Hopefully this is helping you understand should get the vaccine (unless you absolutely can’t, and if you can’t, speak to your doctor). It will not only protect you, but it will also protect those around you.
- It isn’t rushed
- It can’t track you (and let’s be honest, you’re probably reading this on your mobile phone, and have at least one of a Google, Twitter, or Facebook account. Nobody needs to implant a microchip to track you because we all freely give our data anyway)
- It can’t give you COVID (even less so than normal vaccines giving you diseases)
- It can’t alter your DNA
- It can’t make you infertile (within the limits of our scientific knowledge, nor can it make you grow a second head)
- The indemnity thing is a non-issue
- The vaccine isn’t just about you (but it does protect you)
- And COVID is a genuine problem for the entire population
We’ll return to Colin’s plots for that last two points: Regardless of what idiots on Twitter post (and that then gets published by the Daily Fail) all cause mortality is much higher this year than in recent history. Not only is COVID (red) killing more people than we’d like, the ramifications of this on the NHS is killing people from other things too (orange). We can’t look after you if you get cancer, or crash your car, if we have no beds because they’re all full of COVID, and we can’t have an NHS to look after you if we have no economy because we’re still locked down because people refuse to be vaccinated.
So stay safe, keep everyone around you safe by staying home this Christmas, and see you on the other side after we’ve all been vaccinated.