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COVID-19 Vaccines, Myths and Misinformation

Updated: Sep 30, 2023










6th January 2023


Associate Professor of Viral Oncology in the School of Medicine

University of Leeds

Long Covid Kids Expert and Champion


Consultant Data Analyst, Long Covid Kids






Long Covid Kids expert Dr Stephen Griffin, Associate Professor of Viral Oncology, School of Medicine University of Leeds works with various groups to provide evidence-based vaccine information for mainstream media, social media and webinars. He has provided answers to frequently asked questions to assist families with their decision-making.

Long Covid Kids support freedom of choice and provide information in order that families can make informed decisions. For further information on the COVID-19 vaccines visit your public health authority and consult a qualified, practicing doctor.

Dr Griffin makes an important point. “Vaccine hesitancy is just that, and completely understandable given what has happened since 2020. Vaccine hesitancy requires support and clear messaging from scientists, the media, and governments alike. To actively and deliberately promote anti-vaccine sentiment is, to my mind, inexcusable. This is not the same as accepting both the benefits and the issues associated with vaccines”.




 


Contents





 


1. Where did vaccines come from?


Short Answer

The “father of vaccines” is Edward Jenner, who in 1796 noticed that milkmaids who contracted a mild illness known as cowpox were incredibly unlikely to catch dreaded smallpox. Jenner, somewhat questionably by today’s standards, inoculated the skin of a young boy, James Fipps, with cowpox pus. He then gave him a lethal dose of smallpox pus a few days later, and on multiple occasions afterwards…James never developed smallpox.


As a result, vaccines are so-called after “vache”, which is French for “cow”.








2. What is the principle behind vaccination?


Short Answer

Vaccines programme your immune system to recognise the same targets as seen during infection, but by removing the pathogen in question are much safer. This lays down an “immune memory” – a strong response that confers subsequent immunity.


Long Answer

Before Jenner’s escapades, it was long understood that if you survived smallpox you did not catch it again – this was the first notion that our immunity could be “programmed”. For this reason, the practice of “variolation” was commonplace, where a “measured dose” of variolous material (meaning “of/resembling smallpox” – when the virus was discovered it was called “Variola virus”) was scratched into the skin. This usually led to a milder disease course compared to the normal route of catching the virus through the air. 3-4 weeks later, assuming you survived, you became immune…a somewhat risky public health policy!


Jenner unwittingly became the first molecular viral immunologist. We now know that the cowpox virus (named “vaccinia virus”, imaginatively!) has a strong degree of similarity with smallpox in certain important proteins to which our immune cells respond to (see below). However, it lacks the factors that make smallpox so incredibly virulent. Thus, the response we make to vaccinia is so similar to the one we would make to variola that if we then encounter the latter it is faced with an effective immune response without us ever having to have seen it before…


In essence, the principle of vaccination is to achieve an effective, protective response by programming our immune system with something as far away from the dangerous pathogen as possible. Over the years, we have moved from live organisms to those “attenuated” (weakened) in the laboratory, to killed versions of the pathogen, and most recently to using molecular biology to completely do away with everything other than the bare essentials.






3. What are the advantage of vaccines?


Short Answer

Vaccines allow immunisation without experiencing infection, which is especially important for childhood diseases. They also give responses that are more consistent across populations.


Long Answer

Any infection is a race between the virus (or any other pathogen) and the host. Encountering a virus for the first time, especially one unlike any other puts us at a huge disadvantage for reasons I’ll describe below.


So, the idea of a vaccine is to trick our immune system into thinking it has seen the virus before…assuming we survived! This gives us a head start that we would not otherwise have because of “immune memory”, which produces a much more vigorous response than the first encounter. This is what we call “immunity”.


However, as with any biological system, nothing is ever 100%, mainly because we are an incredibly genetically diverse population.






4. Is the response to a vaccine the same as to a “natural” infection?


Short Answer

Essentially, yes, although we can manipulate the response to generate specific types of immunity and make it a more vigorous and reproducible response.


Long Answer

This is a somewhat complicated issue because often we don’t want to necessarily reproduce “natural” responses (I personally hate this term as it suggests a benefit, or something you buy from a health food store!) as they’re not particularly effective. This is often because invading pathogens play tricks on our immune response so that it is dampened and/or altered in a way that can leave the door open to a return visit. Note, vaccines use the same information, i.e., proteins from the virus, as seen during infection, but we now understand how to alter the ensuing responses.


The stimulus induced by an infection is considerable, so we need to try to achieve a similarly strong response. This usually involves the use of “adjuvants”, which are chemical formulations that invigorate the response to vaccines, allowing us to use comparatively less material. We also know that introducing the vaccine via different routes (e.g., inhaled versus injected), using different forms of vaccines, and giving multiple doses over time can tailor the strength, longevity and nature of the response achieved. This all interlinks, which is why various vaccines can have quite different dosing schedules.







5. I am young, fit and strong so I have a “healthy immune response”. Why do I need a vaccine?


Short Answer

Resilience and fitness are obviously important for general health, but your immune response is NOT a muscle that can be trained. Instead, it is a precision weapon that needs to be properly programmed.


Long Answer

Some people liken the immune response to a muscle, but this is not the case. It is not something that is made “better” by lifestyle choices, or trips to the gym, or invulnerable because you are young. Of course, “resilience” is important as is nutrition and not being vitamin deficient, underlying factors have influence, our responses change as we age, and much older people can also have less vigorous responses.


However, this is NOT the same as having a specific, robust response to a particular pathogen. Most of us survive the majority of encounters with viruses because even our first responses are pretty good – we catch up and eventually win the race. But, as mentioned above this is dependent on genetics – think of a “bell-shaped curve” of our population, most people are in the middle, some at the good or the bad extreme…and this is without extraneous factors. Pee-Wee Herman, to all intents and purposes, would likely have the same immune response as Arnold Schwarzenegger…OK, showing my age now...







6. How do we respond to vaccines?


Short Answer

Vaccines induce specific responses to a foreign signal, known as antigens, which are distinct to our own bodies. These responses comprise protective antibodies that prevent infection, as well as white blood cells that kill virus-infected cells. Once this response has been elicited once, the next time the invading virus is seen a much more vigorous response ensues because your cells retain a “memory”...this is “immunity”, but it’s rarely 100%.


Long Answer

The immune response is complex, but in essence, it splits into two main branches. The first is a series of sensors, alarms, and booby traps, along with the local police. This is termed the “innate response”. Its job is two-fold: first, to slow the new invaders down as best as it can, and second, to call in the big guns!


The big guns are the “adaptive response”. Think of it as an army with access to a vast weapons locker full of precision weapons. It has to be a locker because these powerful weapons need to be stowed safely after use. However, they may need to mobilise again so the keys are always kept handy – this is the “immune memory” mentioned above.


The army comprises two divisions – artillery and foot soldiers. The artillery make and “fire” antibodies, these are the B cells. Antibodies stick to virus particles and, ideally, stop them infecting us or spreading around the body. The foot soldiers are T cells, which can spot cells that harbour viruses and kill them. As viruses are “obligate parasites”, they cannot thrive without a host, so this self-sacrifice is worthwhile as long as they act quickly.


Our soldiers train at birth to recognise short pieces of proteins, known as peptide “antigens”, usually just 8-12 amino acids (twenty unique protein building blocks) in length. Thus, the repertoire of soldiers is vast, 20x20x20x…eight or more times over. Critically, they do NOT recognise proteins from our own bodies, only invaders.


Infected cells display the foreign antigens on their surface, like waving danger flags. Some local police have this as their main job and are able to signal to the army that it is time to open the arms locker (a lymph node, e.g. the “glands” in your neck). Critically, ONLY the soldiers specific to a particular peptide are mobilised – the correct precision weapons. The soldiers multiply (hence swollen glands) and prepare for battle. A matter of days later the artillery begin their barrage and the foot soldiers move out to search for infected cells.


Once the dust settles, the majority of the army is decommissioned, as the weapons are too powerful to leave firing…indeed, misfiring immunity is a damaging phenomenon seen in those suffering from autoimmune diseases. All being well, however, sentinels remain in our tissues and lymph nodes, ready to respond vigorously and on a hair-trigger if the invader returns. This is our immune memory, the incredible elite force that bestows immunity upon us.






7. Why do some people get ill or die, whilst others barely notice infection, sometimes whether they’ve had a vaccine or not?


Short Answer

We are all genetically diverse, which dictates how we respond to vaccines or infections alike. Whilst the overall effectiveness of responses in most people is similar (we win most of the time), there will always be outliers that do much better or indeed, much worse than average. Combined with virus variability and other factors (e.g., medicines, other infections or conditions etc.), disease outcomes are always a spectrum.


Long Answer

Disease is a complex interplay between the inherent properties of a virus, the genetics of the host underpinning the properties of our immune response, and our environment (e.g., medications, other infections or conditions, poor diet, age etc.). We are told sometimes, mistakenly, that viruses become “milder”, but it is the disease that becomes “milder”, due to balance between these factors. Of course, this relationship can remain dynamic, so we must not be complacent…


As above, we can depict the range of different immune responses across a population as a “bell-shaped curve”. This curve is of course different for every disease as it is largely dependent upon which antigens are recognised and how effective the ensuing responses are, again, mainly down to genetics. Most of us are in the middle range and do OK…most of the time. Those at the higher tail might barely notice a given infection, whilst others at the bottom may be inherently incapable of mounting an appropriate and robust response and are unable to achieve protection.


This all effectively places us in different positions when running the race, but most of us eventually win. We can make sure we have the best possible chance using vaccines, or indeed prior infection (with associated risks), to ensure that we mount the more robust memory response, rather than being “naïve” to a particular virus. Nevertheless, there will remain some who do not make an appropriate response (and may be otherwise completely well), or indeed have their response hindered by medication or underlying conditions.


If this last group does not immediately resolve the infection, the battle runs for longer and the more damage done to the battlefield itself - our bodies - by both the virus and host response. This is what happens during severe COVID, which is why drugs like dexamethasone that dampen certain aspects of your immune response are so helpful at this late stage of disease. Sadly, some of us never catch up again.






8. Are the COVID-19 vaccines new, untested technologies?


Short Answer

Incorrect. They simply were not used before on such a scale. AdV are extensively used in gene therapy and cancer, whereas RNA vaccines were already used in human trials for other diseases. Clinical trials confirming vaccines work were robust, large, and they are complete; no corners were cut when applying for emergency approvals.


Long Answer

Not at all. Whilst obviously these sorts of vaccines were yet to be deployed in such vast amounts necessary due to the pandemic, both adenovirus vectored and mRNA vaccines were established platforms prior to the emergence of SARS-CoV2. This is a major reason why the response was scaled up so quickly. There are also traditional killed virus vaccines (e.g., Sinovac, from China), and some based on laboratory-produced spike protein (e.g., Novavax).


However, most concern centres on the mRNA and adenoviruses. Despite what some might have you believe; mRNA is NOT artificial! It is abundant in every cell of your body and is effectively a recipe for a particular protein, which is made by protein factories known as “ribosomes”. Weirdly enough, SARS-CoV2 uses RNA to make spike protein as well when it infects us! These vaccines are essentially a Trojan horse or “vector” that delivers the mRNA message to the cell, rather than originating from our own nucleus. In the case of adenoviruses, these are mini-DNA templates for the mRNA. Thus, our own cells manufacture the protein and generate the antigen peptides as described above. This actually has advantages in terms of the ensuing responses compared to providing protein alone, plus the mRNA also heightens the innate response, making the link to the adaptive response more robust.





9. Were the COVID-19 vaccine trials rushed and are they still ongoing? Is it true that they are not officially approved?


Short Answer

No, the number of participants defines the reliability of these trials, not time. The relevant safety and efficacy data is therefore robust. Other trials are follow-ons for specific patient groups.


Long Answer

This is obviously not the case. Yes, the COVID-19 emergency has led to an unprecedented and rapid rollout of these vaccines, but NO corners were cut!


Four factors traditionally cause the lengthy approval process for vaccines: admin/red tape, the related sequential stop-start progress of trials, money, and, most importantly, recruiting enough patients. Time itself does NOT determine trial outcomes and approvals; patient numbers are key.


The first three issues were addressed by dramatic improvements in co-operation and cutting red tape, plus the resources made available by governments and pharmaceutical companies were more than ample. However, the main factor was the abundance of patients at risk of infection during a pandemic which, along with a clever combinatorial trial design, meant trials could be rapidly up-scaled after passing efficacy and safety milestones. Indeed, most of the initial phase III trials (those “powered” to determine efficacy and safety on a large scale, required for eventual approval) had many more patients than would otherwise be present in such studies. Thus, if anything, the trials were in fact more robust in many cases than other vaccine studies. Moreover, the number of vaccines given out in “phase 4”, i.e. the continuous monitoring of medicines used in the wider population, numbers in the billions…there is enough data to answer most questions now.


It IS true that the vaccines were initially authorised using an “emergency use authorisation” (EUA). However, this was another time saving strategy addressing the emergency at hand. The EUA still requires the same standard of supporting information. Full approval just takes time, – the Pfizer vaccine was fully FDA approved in autumn 2021.


Yes, there are still ongoing trials, but these are follow-on studies trialling the vaccines in different cohorts, such as different age groups, people with various underlying conditions or on certain medications – this is IN ADDITION to the information required for the EUA and/or approval. More recently, we have seen new bivalent (dual-acting) vaccines trialled in light of the Omicron sub-variants and there may be other vaccine combinations or dosing regimens to follow.







10. Is it true that the COVID-19 vaccines are an experimental gene therapy that can alter your DNA?


Short Answer

Both the mRNA and the AdV vaccines result in RNA being delivered to your cells that programmes the manufacture of spike protein. RNA can only be converted into DNA under extremely rare circumstances specific to either unrelated viruses, or highly specialised cellular processes. Moreover, just becoming DNA is not enough; integrating DNA into the host chromosomes also requires complex and specific processes that again simply would not apply here.


Long Answer

This is an overblown conspiracy theory as you might imagine. As above, they are not experimental, nor is mRNA a foreign entity within your body. They are also not a gene therapy in the sense that they could alter our genetic material, the DNA within the cell nucleus.


The “central dogma” of biology can be abbreviated to “DNA makes RNA makes protein”. The DNA is our vast library of information, mRNA is an individual recipe, and the resultant protein is the building block of our cells. Nevertheless, as with all dogma there are exceptions. The most well-known is again from viruses, namely “retroviruses” such as HIV. Retroviruses, as the name suggests, reverse the central dogma, using an enzyme known as “reverse transcriptase” (RT) to make DNA from an RNA copy. However, HIV still requires another enzyme, “integrase” to insert its DNA copy into our own DNA. Viruses like SARS-CoV2, or the mRNA vaccines, are indeed comprised of RNA but they lack these enzymes and do not pass into the nucleus, making integration impossible.


However, a little-known fact is that a fair proportion (~10-15%) of our own DNA actually contains viral and virus-like sequences resulting from integrations into our germline cells over our distant evolution. Some of these like to move about! We are talking over an evolutionary timescale, so do not worry, but some types of these “transposable elements” make RT as they are distantly related to modern retroviruses (retroelements). Moreover, an important host enzyme known as telomerase also possesses some RT-like activity. It has therefore been proposed that SARS-CoV2 and/or related vaccines, can somehow hijack these processes and insert themselves into the genome.


Whilst a single published peer-reviewed study actually proposed this phenomenon, it used cancer cells, which have unstable DNA integrity, and did not provide definitive sequencing evidence of integration. This is unsurprising as retroelements and telomerase are highly specific to their own RNA, which, unsurprisingly, bears no resemblance to SARS-CoV2. Moreover, this phenomenon was never identified during decades of research on other Coronaviruses. Thus, neither the mRNA corresponding to the spike protein within the vaccine, nor the virus genome can affect our genetic makeup.






11. Is it true that the COVID-19 vaccine was never tested on pregnant women and it is dangerous for them?


Short Answer

You never include pregnant women deliberately in initial trials due to any unforeseen risks to the baby. However, many women did become pregnant during early trials with no adverse consequences. Plus, now we have data on literally millions of pregnancies via the rollout, as well as defined studies designed to assess this precise question. What IS dangerous during pregnancy is COVID, for both mother and child, especially during the third trimester.


Long Answer

This is utter nonsense. What IS true is that COVID is especially dangerous in pregnant women, particularly if not vaccinated and if caught during the 3rd trimester where it can cause premature or stillbirth, maternal clotting issues and other complications, and increased referrals to neonatal ICU. Notably, one major benefit of being vaccinated, either before or during pregnancy, is that maternal antibodies then protect the newborn from infection.


Whilst trials did not intentionally recruit pregnant women (this is understandably best practice), many fell pregnant during the trial period with no increased risk of adverse events compared to non-pregnants. There have since been numerous studies of vaccines in pregnant women since the vaccine rollout, all of which showed no additional risks compared to non-pregnant women. Lastly, literally, millions of women the world over have received a vaccine during pregnancy.


Dr Viki Male (Imperial College, @VikiLovesFACS), is a major proponent of vaccine safety during pregnancy and publishes a plethora of information online on this subject. She is a true champion for this cause and an excellent public communicator.






12. I have heard that the COVID-19 vaccine can cause infertility. Is this true?


Short Answer

This poisonous disinformation has no immunological basis whatsoever. Studies have not found the anti-placental antibodies he proposed might exist and there have been no issues with fertility in vaccinees during multiple studies and reams of real-world data. Again, COVID is the actual issue as it can damage both the testes and ovaries.


Long Answer

This is perhaps the most insidious, poisonous and harmful anti-vaccine rumour known. Its proponent is a notorious COVID minimiser and anti-vaccine campaigner. The poisoning of young families’ minds against vaccination whilst trying to conceive is a genuinely damaging phenomenon.


It was proposed that the spike-based vaccine immunised people against a protein called alpha syncitin, which plays an essential role in the development of the placenta. This was based upon a five amino acid overlap between the two protein sequences. However, reading my introduction above should allow you to challenge this and re-educate others on why this is completely unfounded scaremongering. First, antigens are always a minimum of eight amino acids for this very reason, i.e., to avoid overlapping sequences. Anything shorter just isn’t recognised. Moreover, even if somehow this was visible to immune cells, the soldiers programmed to recognise it would not exist due to their decommissioning around birth. Lastly, studies have searched for anti-syncytial immune responses in vaccinees, and found nothing. Hence, the world has not suffered a fertility crisis following the vaccine rollout.


One confounding factor when debunking this claim is that there CAN be changes to the menstrual cycle in some women following vaccination. However, this can happen for any vaccine, is usually short-lived and has no longer term consequences. Moreover, infections can cause much more pronounced perturbation of menstrual cycles, and SARS-CoV2 can cause damage to ovaries, testes and other reproductive tissues.






13. Do healthy people need to have a COVID-19 vaccination? I have been told that the severe adverse reactions to the vaccine are far worse than COVID-19


Short Answer

All medicines have side effects, including vaccines. Some rare events can be severe, and some people have indeed died as a result. However, this is exquisitely rare, and in no way anywhere near the ridiculous numbers proposed by anti-vax campaigns. Fifty people have had the vaccine listed as their underlying cause of death in England since rollout began, with over 140 million doses given. This is the same number of people with COVID on their death certificate as occurring on a single day during late August 2022, well after the summer BA.5 wave had subsided. Vaccines are estimated to have prevented more than twenty million deaths across the world since they were first made available.

Long Answer

It is important to remind ourselves sometimes that vaccines, as with all medicines, exhibit a range of side effects and adverse reactions within a population. When you give billions of doses, you are naturally going to see these happening more and more. We must remember that vaccines are potent medicines designed to stimulate your immune response, but in a “controlled” way. This is almost always safer than infection, but much like infections, the vaccine is only one half of the equation because people respond differently to the immune stimulus – this comes down to bell-shaped curves once again, because of genetic diversity.


To give an idea of rarity, there have been 58 deaths where COVID vaccines were involved in England up until November 2022, 50 of which were directly due to the vaccine and one was sadly in the under-20 age group. However, this is following over 143 million vaccine doses, but this does NOT mean that these are in any way trivial. More research is needed to understand why these occur.


All vaccines have a range of moderate side effects, which can range from nothing to soreness at the injection site, or feeling generally unwell, body aches and fevers etc. This is due mainly to these sorts of symptoms being caused by elements of your immune response, and this applies similarly when we’re infected by a virus. It is difficult to predict who might respond in this way, and it may be different for different vaccines. Nevertheless, whilst this can be very unpleasant, it is important to remember that being infected would likely be a lot more so, and standard over-the-counter medications can usually provide relief.


However, as the vaccine rollout progressed and vaccinees started to number in the millions, sufficient incidence of more severe reactions occurred to confidently attribute these to the vaccine rather than randomly occurring in the population; obviously, even the largest trials were not big enough to see these events.


The most serious adverse events were atypical blood clots in the blood vessels draining blood from the brain in a small proportion of especially younger women receiving the AZ vaccine. This has since led to women under 40 not receiving this type of vaccine in the UK and elsewhere.


Another more severe reaction to vaccination is inflammation of the heart muscle, or the sack that surrounds it, so myo- or pericarditis. This is usually seen in younger and adolescent males in response to the mRNA vaccines, but can occur in other circumstances, not least following virus infections. Whilst obviously this is a cause for concern, the vast majority of those encountering this issue experienced a short-lived problem, resolved by bedrest and anti-inflammatory drugs. By contrast, myocarditis is a common feature of SARS-CoV2, whereupon it is commonly more serious and longer lasting. Importantly, the reduced levels of RNA in the paediatric vaccines (given to under 12s) have reduced this risk to essentially zero. One study has estimated the incidence of vaccine associated myo/pericarditis as one per 30 000 vaccinations the world over. Of 8.7 million vaccine doses given to US 5-11 year olds, only twelve verified cases of myocarditis occurred (eight boys, four girls). At the time of reporting, eight had recovered and four were recovering after being discharged home.


However, there are a plethora of other adverse reactions associated with vaccination including cardiovascular, neurological, fatigue and rashes. Accordingly, some sufferers equate their post-vaccine reactions to long COVID, and the symptoms can certainly overlap considerably. There is also a line of reasoning hypothesising that the spike protein generated during vaccination may itself cause some of these issues. However, other studies refute this and it remains unclear what the relative contribution of this may be in relation to immune stimulation per se.


There are multiple studies online stating overblown accounts of severe vaccine reactions based upon unvalidated analysis of patient reporting systems, such as the UK yellow card and US VAERS. It is important to remember that association is not causation, and subsequent investigations almost universally find causation in only the minority of cases.


Finally, whether you choose to receive a vaccine is a personal choice, but please ensure it’s an informed one. In the absence of media attention during the latter part of 2022, this can be challenging, to say the least. However, one study estimated that ~19.8 million deaths had been averted by the vaccine during 2021, the first year it was rolled out.







14. I have been told that natural infection gives better immunity; COVID-19 is "endemic"; we are all going to get infected anyway; COVID-19 is just a cold. Is it worth getting the COVID-19 vaccine?


Short Answer

It is clear that a course of vaccines (ideally at least three) give superior immunity compared with infection alone. However, the diversity generated by the ever expanding list of new variants means that vaccine-derived antibodies can lose their ability to prevent infection when based upon the original virus; reinfections are becoming increasingly common. For Omicron, this is also true for those infected with one of the earlier variants, without prior vaccination. Ideally, this would be addressed by vaccines that could keep pace with viral evolution, but we are already lagging behind in many ways. Hybrid immunity, ideally vaccine first before infection, does give good protection, but so does boosting with/without additional variant spike proteins, and this carries far lower risk.


Long Answer

This is…complicated. The picture in the UK is a mosaic of prior vaccination and infections, with some people having multiple instances of both. However, there remains a considerable number of people that may have only had it once or have managed to avoid it altogether – these may be some of those top responders from the bell-shaped curves or people that have taken stringent precautions either out of choice, or necessity, to avoid infection due to clinical vulnerability.


It is important to discriminate what people mean by immunity a lot of the time. Vaccines are assessed in trials for their ability to prevent severe disease, symptomatic (usually moderate or mild) disease, or infection per se. The latter is the hardest thing to measure in a population due to asymptomatic infections, but we can also test how well blood-borne antibodies work in the laboratory as a proxy for this. A lot of the time when people mention waning immunity, or evasive variants, they are referring to the capabilities of our antibodies to prevent infection; antibodies always wane over time, otherwise our blood would become an increasingly thick gloop as we aged and experienced multiple infections/vaccines. The protection versus severe disease and/or death is also partly dependent on pre-existing antibodies, but is considered to be mediated mainly by tissue-resident T cells, as well as memory B/T cell responses.


The majority of people will have received a vaccine based upon the original Wuhan strain, as well as boosters. There are now bivalent mRNA boosters with Omicron spike encoded along with the original (BA.1 in the UK, BA.5 in the US and other countries).


There are two general questions implicit in the above statement that often overlap in this context. The first is people that decline vaccines (or have not had the opportunity due to limited access, or infection during 2020) and become infected without prior vaccination. As discussed above, this carries far greater personal risk compared to vaccines, but as long as you survive then you will indeed have a degree of immunity. The T cell foot soldiers in this scenario are certainly present, but it is clear from many studies that two, but especially three vaccines induce much stronger and better-targeted antibody artillery from our B cells. This is because not only do successive vaccines increase the overall levels and longevity of antibodies, they refine their ability to neutralise (i.e., bind to, and prevent from entering host cells) virus particles through a process called “affinity maturation”.


Variants of concern also dictate the patterns of immunity for those without vaccines. If you consider the original virus to be at the centre hub of a large spoked wheel of different variants evolving away from it, then its central position has meant that infection/vaccine induced immunity served us well against newer variants such as alpha. However, whilst VoCs such as beta and gamma had antibody evasive properties, it was Delta that really began to change things. Not only was this able to evade some of the key antibody responses induced by vaccines/infection with the Wuhan virus, it was also more transmissible and pathogenic than most others before it. This meant that, for the first time, appreciable numbers of breakthrough and/or reinfections began to appear in 2021 as this variant quickly rose to prominence.


If Delta was at one end of the wheel, Omicron was a spoke pointing the opposite way, and was so long that it distorts its otherwise circular form. This means that Wuhan-based antibodies struggle to neutralise Omicron as the number of mutations it has accumulated (the length of the spoke) are so great so as to make it an entirely different target. Moreover, the main spike was actually two (BA.1 and BA.2; BA.3 never left South Africa in significant numbers), and BA.2 has given rise to spokes and wheels of its own!


This is not to say that prior immunity from vaccines or infection does nothing to prevent Omicron. We know this as recently boosted people were better-protected during the first two waves. This is because having high levels of albeit less effective antibodies can compensate for the important ones that Omicron evades. However, this means that protection from infection reduces more rapidly than vs previous strains. Furthermore, each successive version of Omicron that arises (currently all from the BA.2 “spoke”) shows further changes to its evasiveness and transmission advantage such that even recent Omicron infection on top of vaccines does not guarantee protection.


Why is all this important in relation to the question above? Well, our immune response establishes itself based upon how it is initially programmed to recognise a virus, followed by refinement as it sees subtly different versions. This essentially causes your immunity to behave a bit like the wheel and spokes itself as it evolves following each exposure. Mapping this on top of the SARS-CoV2 wheel therefore loosely defines strains against which you’re better protected.


Why is this important? Well, if you start in the middle (Wuhan) and start moving out in a similar pattern to the viruses you experience, then you’ll be better off unless things change dramatically. As such, non-vaccinated people seeing a delta infection had virtually no protection whatsoever from Omicron strains. Conversely, if your first infection is an Omicron subvariant and you are not previously vaccinated, your protection is focused out on an extraneous spoke and you really only ensure protection from that particular strain due to the distance between them.


The flip side to this is that a viral variant may be different enough to evade your immunity, but isn’t recognised by your immune cell repertoire as a distinct target – you don’t have a specialised weapon in the arms locker. This is known as “original antigenic sin”, and the way in which our immunity establishes and then changes, defined by the nature of subsequent exposures, is termed immune “imprinting”.


For this reason, as well as conferring additional T cell immunity, people often refer to “hybrid immunity” as the best possible protective immunity from SARS-CoV2. Ideally, this means vaccine followed by infection to reduce risk, but of course this is not the same as no risk. Thus, again the ideal would be to track evolution of the virus with your vaccine programme as we do for influenza, but the rate at which SARS-CoV2 is continuing to evolve makes this incredibly difficult. Some researchers have developed computer-based tools that predict where mutations may next arise in the virus and these are surprisingly accurate, only possibly not quite enough to base a global vaccine policy on.


Ultimately, the safest and most consistent form of immunity will be achieved via vaccination, but there are some benefits to infection-induced responses…the question is whether these remain worth the risk of becoming infected as the virus continues to evolve.






15. Is there any point in getting the COVID-19 vaccine - Omicron is "mild"?


Short Answer

Omicron is less likely to cause severe disease than delta, as measured within highly vaccinated populations like the UK, but is similar to the original Wuhan virus. This does not apply to children and young people, and is almost completely dependent upon prior immunity. Nevertheless, the reduced risk is countered by unprecedented prevalence, leading still to mass hospitalisations during waves. Moreover, BA5 and derivatives appear capable of infecting the lower airway once more, increasing risk of severe disease. Populations where immunity is poor, especially in elderly or vulnerable populations have been devastated by Omicron waves; this happened in the spring of 2022 in Hong Kong.


Long Answer

It is true that in vaccinated adults, Omicron is less likely to cause severe disease than Delta in highly vaccinated populations. Less severe in this instance means approximately comparable to the original Wuhan virus, so by no means trivial. This differential disappears for under 19s, however, so this combined with the dramatic increase in prevalence has led to considerably higher numbers of juvenile hospitalisations since Omicron arrived. One major issue is that UK children lag dreadfully behind other countries in terms of their vaccine coverage, instead being exposed to multiple waves of infection (see below).


The original BA1 and BA2 Omicron viruses also showed a preference to infect the upper, rather than the lower airway due to a change in the way it gains entry into the cell; this means it is less likely to cause pneumonia or ARDS. Many newer forms appear to follow suit, but there is also evidence that the BA2 derived BA5 lineage may have reverted to a more dangerous form. Again though, this reduced incidence/risk is counterbalanced by unchecked and overwhelming prevalence, meaning that the clinical impact remains considerable and deaths continue. Omicron is also just as likely as the original virus to cause long COVID, slightly reduced again compared to Delta.


The complacency generated by the “mild” narrative is profound, and most people don’t realise that a major determinant of this is our high level of protection from severe disease resulting from our complex mosaic immunity. This became abundantly clear following the outbreak of BA2 in Hong Kong during spring 2022. Here, the elderly population had not adopted vaccines in sufficient numbers and had erstwhile been protected by stringent protections from the virus entering the country. Sadly, relaxation of restrictions and the high transmissibility of BA2 led to an horrendous outbreak, overwhelming hospitals and causing thousands of deaths over a matter of weeks. Underestimating SARS-CoV2 and taking our immunity for granted is therefore a dangerous strategy, yet one seemingly embraced by a worrying number of governments.






This graph illustrates the significant impact of the Omicron variant on child COVID-19 hospital admissions





16. I have heard stories about COVID-19 vaccines and graphene oxide; 5G; magnetism; Bill Gates; great resets etc. Are any of them true?


Short Answer

They are complete rubbish


Long Answer

I am not commenting on politics, but I am fairly sure that Mr Gates did/does not own or design the vaccines or the WHO. Graphene oxide I can comment on, however. The accusations state that graphene oxide, a form of carbon able to conduct electricity, comprises up to 95% of the vaccine. This is somehow responsible for receiving “signals” sent via the new 5G networks…to what end I am unsure. I believe it may also be implicated in the magnetic “phenomena” observed around certain vaccination sites on selected people’s arms (so magnetic, some are able to attract non-ferrous material!).


Thankfully, there is no need to conduct chromatography or mass spectrometry on vaccine samples. Graphene Oxide is barely miscible in water at very low concentrations – it will not dissolve, but it can form a suspension of fine particles. However, at 95% weight/volume, it would form a thick black sludge or slurry that almost certainly would not travel down a hypodermic needle…and would also be relatively conspicuous!


I’ll leave it there.







17. I have heard that COVID-19 vaccines are not “proper vaccines” because they do not prevent transmission. Is this true?


Short Answer

The SARS-CoV2 vaccines DO prevent infection, but the longevity and specificity of protection varies, especially with new highly evasive variants. Onward transmission is also reduced by your strong memory T cell response, reducing the levels of virus in the airway. Again, this is not absolute and inhaled vaccines may well fare better…especially when matched to variants.


Long Answer

Of course they do, especially if recently vaccinated/boosted. The rate of antibody waning varies per individual, but also depends which set of your antibodies is abundant and/or important for preventing infection by the viral variant in question. As above, imprinting and antigenic sin combined with your genetics dictates the patterns of immunity you adopt, so this is getting harder to measure in diverse populations.


In addition, whilst we are limited in the types of vaccines we have available at present in relation to the evolution of SARS-CoV2 variants, short-term protection can still be achieved by recent boosters. This is because escape is not always 100% from the virus perspective and so high titres can overcome it to a degree, but also an abundance of less effective neutralising antibodies can compensate for the loss of certain key weapons from our arsenal. As such, blaming the Wuhan based vaccines for not being highly effective at preventing Omicron infection is like blaming a Phillips screwdriver for not being able to tighten a flat-headed screw!


Lastly, the majority of vaccines prevent disease better than they protect versus transmission. One exception is e.g., measles vaccine, mainly because measles does not tolerate significant changes to its surface “spike” proteins in the way other viruses can.







18. Is it true that vaccines do not prevent Long COVID?


Short Answer

Again, not 100%, but yes, they do reduce risk by about half, or slightly more/less depending on the study in question. Also, preventing the short version generally stops the long one!


Long Answer

Several studies have shown this to be true. Firstly, to prevent the long version it is a good idea to prevent the short one. Secondly, several studies show that breakthrough infections in vaccinees are ~40-50% less likely to lead to long COVID. The mechanisms underlying this are unclear.


It is also the case that vaccination during long COVID has been observed to alleviate symptoms in certain patients, around a 1/3-1/2 improve, ~1/3, stay the same, but symptoms can also be exacerbated. This may be linked to the fact that long COVID likely comprises multiple conditions with different aetiologies under one umbrella, which is something requiring much more research to unravel.






19. I have Long COVID. Should I have the COVID-19 vaccine?


Research is currently in its infancy with some people reporting improvements, some no change and others worsening symptoms. Research can be found here including results from surveys undertaken by Long Covid support services.






20. I am taking vitamins and other medicines prophylactically, so I don't think I need a COVID-19 vaccine


Short Answer

Correcting a vitamin deficiency is not the same as a therapy. There are no prophylactic treatments for SARS-CoV2 infection aside from the Evusheld antibody cocktail. Supporters of certain miracle cures tend to combine quackery with anti-vaccine and/or anti-“big pharma” narratives. We are not horses, or in need of worming, for the most part.


Long Answer

First, COVID is NOT a cold. Colds do not kill millions of people in a matter of years or lead to mass chronic disability. If you are lucky enough to have a very mild or asymptomatic infection, then you have your genetics and, unless you’re anti-, your vaccines to thank. Even mild acute episodes can predispose to post-acute sequelae (cardiovascular, neurological and more) and Long Covid.


Throughout the pandemic, we have heard an ongoing narrative of what amounts to quackery in terms of alternative therapies, medical protocols, or preventative measures that can stave off infection, or limit the impact of COVID. Much as overdosing on vitamin C will not cure a cold, frankly, this delusion is just wrong and ultimately causes more harm than good. As someone that researches antivirals, I can’t tell you how angry some of the nonsense online makes me.


OK, so it has been known for a long time that vitamin D is important in the response to infection within the lungs. However, this is NOT the same as it being a therapy. High doses in individuals known to not be deficient at the start of the study have no therapeutic benefits over placebo. So yes, deficiency in this important cofactor is commonplace in many countries, but that does not make it a therapeutic! Vitamin D has been combined with high amounts of mineral zinc, antibiotics and other medicines in “COVID recovery/treatment packs” that have been peddled across the world to hapless people, often in countries where vaccines have not been widely available. My view is that this is exploitative and outright harmful to those amongst the least able to cope.


Leaving bleach injections and subdermal UV light aside for a moment, the emphasis at the beginning of the pandemic was to “repurpose” existing medicines to accelerate their availability to hapless COVID patients. Whilst this was understandable and acceptable during the very early stages, more robust trials like RECOVERY proved conclusively whether repurposed medicines were effective. However, it quickly became clear that certain medicines supported by limited in vitro/preclinical evidence and underpowered patient trials were becoming talismanic in the eyes of certain groups, also providing a convenient alternative to vaccination.


Hydroxychloroquine, used to treat Lupus and other conditions for many years, was combined with a class of antibiotic known as a macrolide (e.g. azithromycin, erythromycin), which have some anti-inflammatory properties (and the vitamin/zinc concoctions described above). Hydroxychloroquine was shown to display antiviral effects in SARS-CoV2 culture at very early stages, but it was realised shortly afterwards that the systems used were not physiologically relevant. Moreover, the drug could not approach appropriate doses in lung tissue, and the RECOVERY trial proved a complete lack of therapeutic benefit, in fact highlighting a trend towards increased harm.


Nevertheless, fringe groups continued to promote hydroxychloroquine, and it was later endorsed in the US by then-president Trump, who allegedly pushed the drug through an emergency FDA approval. Nowadays, in light of actual bona fide evidence, the WHO advise against the use of hydroxychloroquine for COVID treatment.


Ivermectin is the other supposed “wonder drug” capable of both treating and protecting users from SARS-CoV2 infection. It is on the WHO list of essential medicines, and its inventor was awarded the Nobel Prize. It is an anti-parasitic drug, used to treat diseases caused by mites and nematodes, including scabies, onchocerciasis (river blindness) and Strongyloidiasis. It also has multiple uses in veterinary medicine. It has a very good safety record, which proponents cite as a good reason to use versus SARS-CoV2.


Ivermectin has a well-defined mode of action against helminths, and its potency allows for short treatment duration at low doses, which are well tolerated. By contrast, since an Australian research team first demonstrated antiviral effects in culture versus SARS-CoV2, a plethora of mechanisms have been proposed to explain this. Antiviral effects were observed only at much higher concentrations compared to the anti-parasitic dose, which has led to people ingesting it at dangerous levels and developing liver damage.


Whilst multiple smaller trials have reported beneficial effects of Ivermectin therapy for SARS-CoV2 and meta-analyses have supported this, sadly some quite serious data discrepancies were discovered in key studies reporting positive effects. Moreover, one study published in JAMA showed that trials reporting positive effects were conducted in countries with high endemic rates of Strongyloides, making this the likely source of health benefit. Ivermectin is being assessed in the randomised controlled PRINCIPLE trial in the UK; results are pending.






21. I've been told that children aren’t at risk from COVID-19, so they do not need to take an “experimental vaccine”


Short Answer

Sadly, children are indeed at risk from acute and long COVID – this risk should be considered against other childhood infections, NOT adult disease. In addition, recent estimates state that somewhere between 2-14% of those infected will endure long-lasting symptoms consistent with post-COVID syndrome. The impact on a young life is profound. Whilst adolescent males have a slightly increased risk of side effects such as myocarditis (mild and self-limiting in the main), medical regulators the world over have approved mRNA vaccines for use in children, with a reduced dose for under 12s. This includes under 5s in many countries. The reduced dose virtually eliminates the risk of myocarditis, which in turn is more likely to occur, and to be serious/life threatening, as a result of COVID.






This graph shows the number of children living with lingering symptoms since their COVID-19 infection. Some children have now been living with symptoms for two years and some almost three. These children are not reflected in ONS data. As infection levels rise, so does reporting Long Covid by children and adults alike.




Long Answer

It is absolutely the case that children and young people are far less likely to develop severe COVID upon SARS-CoV2 infection when compared to adults, especially older adults. However, it is thankfully the case that children simply do not become severely unwell, and/or die at rates comparable to adults, plus some specific diseases are exclusive to children rather than adulthood. To accurately gauge the risks of COVID to children, it is therefore imperative to compare with other childhood illnesses, specifically in this case, other vaccine-preventable diseases. However, many, sometimes including paediatric doctors, continue to use adult comparisons as a means to placate parents and children alike about the risks associated with COVID. This is a constant frustration for those working to support families where children have indeed suffered, including Long COVID Kids.


Whilst not extensively reported in the media, acute COVID in children can be both serious and life threatening, plus a rare hyper-inflammatory syndrome resembling Kawasaki disease is also a serious concern (multi-system inflammatory syndrome of childhood, “MIS-C”). However, one common narrative amongst certain groups is that children are less likely to catch, transmit, or suffer severe disease than adults, plus schools were not considered hubs of transmission. Incredibly, these assertions based primarily upon 2020 data persist even now, despite the fact that most children were not in school and so mixing was minimal. The picture has understandably changed dramatically during 2021 and 2022 following the return of schools and subsequent relaxation of protections.


The difference between 2020 and 2021 is stark. Schools returned in the summer of 2020, when prevalence in the UK was at an all-time low. Mitigations were in place during the autumn, and schools closed again in January 2021 due to the Alpha wave, after farcically returning for a single day after Christmas. However, later that spring schools returned and thereafter what little mitigations were in place to protect children were removed, in no small part it seems due to undue influence from certain pressure groups. Children and younger people were a major factor in the transmission of the Delta variant in autumn 2021, as well as the first and ensuing Omicron waves since BA.1 replaced delta in Nov/Dec 2021. This is because classes generally spend protracted time periods mingling at close quarters in poorly ventilated spaces, particularly in colder weather, plus asymptomatic infections are more common at these ages, leading, unwittingly, to spread of infection.


Despite having three summers and other significant downtime, the Government has done little to improve air handling in schools or provide HEPA filters, yet still saw fit to remove masks and halt random testing. Indeed, it was shown by random (rather than symptomatic) testing, that prevalence tracks with school openings and closures. Moreover, households with children were more likely to experience infections than those without, during waves. Government policy has finally started to recognise focus upon clean air, although little support has been provided to implement this.


Accordingly, ONS-certificated COVID deaths in UK under 19s went from just over 20 in 2020, to 106 in 2021. NHS England reported 9206 hospital admissions for under 17s with COVID-19 between October 1, 2020, and November 1, 2021 (England alone), and according to ISARIC only 42% had underlying conditions and BAME children were considerably over-represented. Critically, unlike the rhetoric from certain quarters, ISARIC found only 20% of hospitalisations over this period to be incidental, or “with” COVID. Thus, the narrative that children aren’t affected by COVID is clearly flawed and the situation has worsened in 2022 due to successive Omicron waves.









This graph shows the number of children who have died due to COVID-19 since the pandemic began. Child COVID-19 deaths, if reported, are usually framed as being few and with pre-existing conditions. Of note is that previously healthy children have died and children have developed new health conditions since COVID-19 infection. This means that children who were previously healthy are now living with pre-existing conditions which could predispose them to increased infection severity from other viruses.





It is also clear that children and the school environment play major roles during the transmission of infection, both internally and to family members. Schools are major mixing pots and, especially since e.g., masking and protective bubbles (which were usually too big to be effective due to staffing issues, anyway) they have driven spread of both Delta and Omicron, the latter on no less than three, but likely a forthcoming fourth this winter.


On the global scale, the WHO and UNICEF estimate that ~0.4% of all COVID deaths occur in children and adolescents. This would mean, based on an estimated ~15M excess deaths, that ~ 60000 children and young people have died so far; half are thought to be under 10. This is on a par with other vaccine-preventable diseases, like Haemophilus B and measles, which are major blights on children’s health. In the US, with excellent reporting systems, more than 1200 children have lost their lives to COVID since the pandemic began, equivalent or higher than the number of deaths from all other vaccine-preventable diseases.


Whilst less common during the Omicron era, MIS-C remains a concern amongst particularly younger children, who develop this dreadful condition 3-6 weeks post infection with SARS-CoV2 and again there appears no correlate with initial disease severity. MISC is characterised by fever, inflammation, involvement of at least two organ systems, and requiring hospital care. Thankfully, recent management using steroids and immunoglobulin is usually successful, yet complications can include severe issues such as coronary artery aneurysms and coagulopathies. Immunity driven by prior infection and/or vaccines is attributed to the lesser incidence of MISC resulting from Omicron infection. In agreement, vaccination significantly reduces the risk of this troubling post-acute sequela of SARS-CoV2.

Naturally, given where I am posting this piece, long COVID in kids is a major issue, and yet another reason to NOT allow unchecked transmission of SARS-CoV2. As with adults, the severity of acute disease in children is not generally predictive of long COVID symptoms. Some children have suffered in effective isolation since 2020, unable to attend school or even venture outside much of the time. As with the adult condition, there is a spectrum of symptoms and severity, but it is estimated that ~68K children are living with Long COVID in the UK, with 63K for more than 3 months, and a staggering 41K for at least a year. ONS no longer reports activity limitation data for children with Long COVID, but in a prior report (to July 31 2022) they estimated 13K have their activity “limited a lot”, or worse


Why then is there such a dismissive attitude towards COVID in children amongst many in the UK? In turn, this also generates a disinterest in the need for vaccines as well as a strong reaction from the anti-vaccine movement, enabled by certain pressure groups, which actively seek to blame governments, scientists and clinicians for inflicting “experimental drugs” upon children as if it were some form of abuse. However, it is well documented that childhood vaccines confer ~90% reduced risk of severe disease and hospitalisations as well as a similar effect upon MIS-C; during the US delta wave, only ~8% of hospitalised children were fully (2x) vaccinated.


Whilst antibody protection wanes more quickly than in adults, children have yet to receive the important third (or in some cases even first or second!) dose, let alone any boosters, making it impossible to judge how they might be better protected in the future. One thing is certain though, that vaccines give more reproducible responses than infection alone, where a considerable number of children don’t actually seroconvert. A recent study in NEJM extolled the virtues of boosting children following vaccination, infection, or both, to provide much improved protection from currently circulating viruses.


The UK has seen a delayed, laborious and confusing series of assessments by JCVI in approving vaccines for children. The UK remains an outlier compared to many countries across Europe, Asia, the US and Canada, where vaccines are approved for children from 3 months and up. Despite roll out in numerous other countries months previously, JCVI felt unable to recommend vaccines for 12-15 year-olds in 2021, requiring intervention from the CMOs, yet it was given a brief that excluded long COVID and other societal impacts from their analysis. Furthermore, even where JCVI found clear benefit in 5-11 year olds receiving the reduced dose paediatric vaccines, the messaging around this in spring 2022 was ambiguous and entirely non-urgent. It is little surprise then that less than 10% of UK 5-11 year olds are vaccinated, along with nearly half of 12-15 year olds not having received even a single dose. Worryingly, much lower rates are seen in more deprived areas across the country, as well as within some BAME communities and, depressingly, nearly all children in families where parents refuse their vaccines remain unprotected.


The major element counting against the vaccination of children is peri/myocarditis, as discussed above. There is indeed an increased risk in particular for adolescent males compared to the background population. However, there is a considerable difference between the perceived and the actual risk amongst the population. For context, at the point in 2021 when the US had administered 18.7 million doses of vaccine to adolescents aged 12-16, there were around 10,000 reports on VAERS (the self-reporting system) of which 8% (846) were self-classified as “serious”. However, when explored further there were only 265 verified cases of myocarditis (90% in males). The lower paediatric dose for 5-11 year olds has virtually eliminated myocarditis risk, as discussed above. Compared to the much more serious risks associated with SARS-CoV2 infection, which include a much more severe and longer-lasting form of myocarditis, it is immensely frustrating and upsetting to see such low uptake in a country that, prior to 2010, prided itself on public health.


The low UK childhood vaccination rates combined with unchecked prevalence and a total lack of mitigations in schools is already leading to multiple reinfections in children.






This graph illustrates that school-aged children were on average the most reinfected of all age groups as of 15th September 2022





In addition to Long COVID, it is established in adults that this predisposes towards additional health issues later in life, something that we simply cannot currently predict in younger children. Germany has recently taken action to mitigate this unknown risk, it is hoped that the UK might soon learn from its European neighbour.




Written by


Associate Professor of Viral Oncology in the School of Medicine

University of Leeds




 


Find out more about our visit to No 10 Downing Street on 1st April 2022 to launch the new Long Covid Kids' Support Guide.








 


About

In 2021 Long Covid Kids became the first UK-based, international registered charity advocating for families, children and young people living with Long Covid.

The charity focuses on recognition, support and recovery and has already received recognition from the NHS and the Centre for Disease Control in the USA, as well as being a recommended resource in the NICE Long Covid guidelines.



Our Mission


Purpose
  • We believe all children should be able to thrive and look forward to a positive future. That is why we represent and support children and young people living with Long Covid and related illnesses and the parents and caregivers that look after them.


Our Vision
  • To achieve recognition, support and recovery for Long Covid and related illnesses in children and young people



Support Our Work


While children are living with life-changing symptoms and families struggle to seek support, we need to be here. Your donation will be used directly to support families living with Long Covid. Find out more about our Impact.







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