Covid-19 vaccine hesitancy campaigns and rallies are making headlines all around the world, including in South Africa, but is the fear and mistrust justified? Internationally recognised public health expert Dr Ernest Darkoh takes a look at some of the most common concerns about the vaccine and provides answers that are scientific, compassionate and illuminating.
1. Who can and can't get vaccinated for Covid-19 in South Africa?
In South Africa all adults aged 18 and above are eligible for vaccination. In other countries they are vaccinating children as young as 12, but this isn’t currently part of South Africa’s strategy.
2. Does the COVID-19 vaccine have adverse side-effects that people should be aware of and what is the process to report them?
In South Africa the best information about the vaccine and any potential adverse side-effects can be found on the National Institute for Communicable Diseases (NICD) website and its Frequently Asked Questions page: https://www.nicd.ac.za/covid-19-vaccination-reporting-adverse-effects-faq/. Instead of listing side effects here, it is better for people to refer to this website because it presents new data and information all the time as it is discovered. We are learning new things about this disease every day and therefore it is important for people to stay abreast of the very latest developments and guidance from the most credible organisations such as the NICD.
It should be noted, however, that for most people, side effects are minimal and of short duration. The protective effect of the vaccination far outweighs the side effects of receiving it.
3. Why is there such a high level of vaccine hesitancy, why are government communications not always effective & what can be done to address vaccine hesitancy?
As human beings we are wired to respond very powerfully to fear or to negative experiences. Most of us will still vividly remember all the painful experiences we have had even though they occurred decades ago, indeed many of those experiences shaped and continue to shape our current lives. However, we seem to fail to give the positive experiences the same depth of meaning.
It is also extremely difficult to prove that something that is not happening, is actually not happening. This is why fake and negative fear-based messaging works - the more extreme it is and the more the message is repeated, the more it works. Unfortunately, there are some who seek to exploit this vulnerability for their selfish benefit.
These fear tactics have been used by dictators and all the most despicable despots known to humanity and is the reason paradigms like racism, sexism and xenophobia are used rile up populations to commit atrocities. Unfortunately, social media now allows for a single destructive or ill-informed person to reach millions of people with their message and by the time it is proved that the message was fake it is extremely difficult to undo the damage.
This is why it is critical for people to receive the correct messages first through credible sources and channels that can be trusted. If they are infected with the negative messages first, it is extremely difficult to counteract or undo. Sadly, we have seen so many people believe dubious fake messages from social media or the internet resulting in their death.
It truly boggles the mind that someone is willing to risk death and not seeing their children grow up because they believed a random message on the internet that usually has been generated someone who is not qualified to be issuing such a message or worse yet, someone for whom this is a sick game.
Because government communications are not negative, extreme or fake, they have a much bigger hill to conquer - positive messages don’t tend to go viral as much as negative or highly sensational messages. Governments must therefore approach the issue of proper vaccine information and communications as an existential first priority. The messages must be based on the best science and generated by those institutions and professionals who are most qualified. The messaging must also be extremely simple, non-technical and designed to encourage and help people to protect themselves, their families and their communities. Finally, people need to hear the right messages over and over in the language they understand - once is not enough.
4. There have been reports that some of the Covid-19 vaccines cause blood clots. Should people take blood thinners prior to getting vaccinated?
People who are not already on blood thinners for other reasons should absolutely NOT take blood thinners prior to getting vaccinated. The chances of getting blood clots due to the vaccine are extremely low. For example, between March 2 and May 7 of this year the US Centres for Disease Control (CDC) reported that out of 8.7 million people in the USA who had been given J&J’s Janssen Coronavirus vaccine, only 28 people had developed a rare blood clotting syndrome called thrombosis with thrombocytopenia (TTS). In simple terms it means clotting with low platelet count. Of the 28 people with TTS, 25 were treated successfully and only 3 died from the condition. In contrast, according to data from Johns Hopkins University, over the same period of time, a total of 2.2 million Americans were diagnosed with Covid-19 and 43 000 died! It is important to note that in the few cases where people developed the blood clots, we can still not be certain that it was caused by the vaccine or from other factors. It is also very important to remember that Covid-19 is a disease that causes problems with inflammation and clotting to start with. It is also important to note that taking blood thinners for any non-medically indicated use can be extremely dangerous for your health.
Because the cases are so few to date, there is not enough data available yet to definitively say that the blood clots are directly due to the vaccine or to predict ahead of time who may get them. This is why it is important that recipients of the vaccine (and any other medication for that matter) report any adverse events to their medical practitioner immediately.
IMPORTANT NOTE: Most people do not understand statistics and probabilities so let me frame the numbers above in more simple and accessible terms. Assume you have two groups, Group A and Group B, each containing 8.7 million people. You are then told that in some time over the next two months that 3 random members of Group A are going to die and 170,000 random members of Group B are going to die, and that an additional 870,000 people in Group B will be developing serious long term health complications. Which group would you choose to join? For those who need a hint: Group A is the vaccinated group.
5. Is it safe for pregnant women and those who are planning to become pregnant to get vaccinated?
Vaccination is safe for women who are pregnant as well as for those who are planning to become pregnant, as far as we know. Like with any new intervention it is important to carefully track people’s experiences and the data over time and if any concerns are picked up the guidance will change accordingly.
6. What vaccines are available in South Africa and how do they work in your body?
The J&J Janssen and Pfizer vaccines are currently available in South Africa, with other options currently being explored. Both of these vaccines work to provide your immune system with instructions on how to recognise and fight off the Coronavirus. Your immune system works by creating proteins that are able to attack invaders. The vaccines provide the instructions on how to make those proteins, but the two options in South Africa package them slightly differently.
The J&J vaccine (“one and done”) is a single shot vaccine that uses a piece of DNA inside of an inactivated shell. That DNA is then “read” by messenger RNA (mRNA) from your body, which is basically a template that cells use to create proteins. That mRNA is then used by your cells to make the protein that will recognise and attack the virus if it enters a vaccinated person’s body.
The Pfizer vaccine uses mRNA directly inside of a lipid (fatty) coat, rather than DNA. It is more fragile than DNA, but also skips one step of this process by providing the template directly rather than using the mRNA of your body to make the template. It’s important to note that these vaccines only include small pieces of the virus’s overall structure, so it is not possible to contract the virus from the vaccine itself. They only include instructions for recognising the spike proteins of the virus (those red spikes that you see on the images of the virus), so you can’t catch the virus from the vaccine.
7. What technology is used in the current vaccines and how does it differ from that used in other vaccines of the past?
mRNA vaccines are based on new technology. People may wonder if this technology is safe and can it be trusted. While this is the first time that most of the world is learning about mRNA vaccines, this technology has been in development for a long time (10-15 years). This kind of vaccine platform has been studied for flu, rabies, and Zika virus. The use of mRNA vaccines can be thought of like a bakkie. The bakkie carries in the mRNA for fighting COVID-19, and the bakkie has also been proven safe for carrying in mRNA to fight flu, rabies and other viruses.
One of the reasons why these kinds of vaccines seemed to appear out of nowhere for most people is because 1) so many resources were made available to conduct simultaneous clinical trials, 2) there were so many cases of COVID-19 that it took less time than with other viruses to collect data on how effective the vaccines were in preventing it.
8. Can the vaccine give me the live Covid virus?
No. It is important to note that the vaccines do not contain the virus, they only contain tiny bits of information that help the body to recognise the virus’s spike protein. There have been more than 1.7 billion doses of Covid-19 vaccines delivered worldwide. You are much more likely to die of Covid-19 than to have issues associated with the Covid vaccines.
9. Is herd immunity a realistic target considering that vaccines do not prevent the transmission of the virus?
The entire point of herd immunity is to prevent death and suffering, which is precisely what these vaccines do extremely effectively. Our biggest concern should be the development of new variants that our current vaccines fail to combat. This is why it is absolutely critical to continue to actively prevent the spread of the virus through aggressively identifying new outbreaks and strictly adhering to public health measures like wearing proper masks, physical distancing, avoiding poorly ventilated spaces and handwashing on an ongoing basis. We may all be feeling pandemic fatigue, but we have to remind ourselves that these measures are still as important as the vaccine. We will only fully break the infection cycle of this dreadful virus if we all get vaccinated and keep adhering to all the public health measures until it is proved safe to scale back.
A good analogy to think about in tackling COVID-19 is protecting yourself against crime. People will deploy multiple levels of security ranging from street lights, video cameras, armed patrols, boundary walls, electric fences, beams in their yard, panic buttons, dogs, burglar bars and a safe room. Saying that we will only focus on vaccines and stop all the other measures is the equivalent of saying that one security measure, like only having a wall, will keep me and my family safe. We all know how such a one-legged strategy is likely to end up for you.
10. How long will my immunity last when I get vaccinated? Social media is giving me mixed messages.
It is important to note that as time passes, we learn more and more about the duration of immunity. Some countries are already recommending additional booster injections. Therefore, it is critical that we all follow the latest developments closely and adopt an attitude of making the best decisions we can based on the best knowledge and intelligence available. Consult your doctor before believing any social media messages that may be forwarded to you. Most importantly do not forward on any social media messages to your networks. If you are concerned about a message that is circulating, only forward it to your doctor for them to give you an opinion. If you are going to get information online only go to credible authoritative organisations like the WHO, Africa CDC, US CDC and South Africa’s NCID.
11. I have a strong immune system and never get sick. Can I get away with not getting the vaccine?
Your body may be strong and you may have faith in your ability to fight off the virus, but so did many of the other millions of people who have now died from it. While most people survive Covid-19, the outcomes can be unpredictable. We have all heard the stories now of people leaving behind their young children, and there are far too many people in ICUs asking for the vaccine when it is already too late to help them. There are also unfortunately many people who survive Covid-19 but are left with serious long term debilitating side effects of the disease including lung damage, kidney damage, brain damage, amputated limbs and more. Rather get the vaccine and increase your chances of survival and avoid potential serious complications of Covid-19.
12. Could the mass vaccination of the world’s population be a sinister plot to harm us?
The vaccines are too small to carry any kind of microchip, as some people have reported. The vaccines cannot change your body’s DNA because they do not enter the nucleus of your cells and only contain very limited instructions for making certain proteins in your body. The vaccines do not carry the “Mark of the Beast”, they are just a kind of medicine similar to many other medicines that can help your body to fight off a foreign invader. Getting vaccinated is a way of living the values of loving thy neighbour, because the more people who get vaccinated, the more we protect those who cannot receive the vaccination (such as children).
13. What do you think of alternative Covid treatments?
Large research studies have shown no benefit of Ivermectin or Hydroxychloroquine and they are therefore not recommended for use. In the US, the FDA is currently warning the public against the use of Ivermectin, a horse deworming medicine. The largest Ivermectin study to date, touting Ivermectin as a Coronavirus treatment, was withdrawn because its data had been manipulated.
14. What do you say to people who are overwhelmed by Covid fatigue?
We are all tired of Covid-19. But this should not cause us to stop or give up. There is hope. The fact that we were able to find multiple effective vaccines within one year of the start of the pandemic is quite miraculous. The best option for getting us out of perpetual lockdowns is to stop the spread of the virus through public health measures and speed up people’s ability to fight the virus through vaccination. Waiting for natural immunity to build by letting everyone get infected will take more time, lead to tremendous loss of life and suffering, necessitate continuous lockdowns and give the virus more time to mutate into even more devastating variants.
15. Why are so many people swayed by viral social media messages about the pandemic and what makes these messages so much more persuasive to some people than official information sources?
I am dismayed at how people simply trust random messages from the internet and social media. Sadly, there have been a few notable cases where people with seemingly top professional credentials have been putting out dangerous fake news. The public must understand that very few people are truly qualified to speak authoritatively on these matters. Just because someone is a doctor does not mean they understand the latest in the field of immunology. I have three undergraduate degrees with honours in chemistry, biochemistry and molecular biology. I went to Harvard Medical School. I also have a Masters Degree in Public Health from Harvard and have worked in medicine and public health for the last 25 years delivering large scale health programmes on the ground, including vaccine programmes. Despite all my experience, even I consult the real experts and the most trusted scientific sources before issuing any opinion.
I do this because, firstly, I am not an immunologist - in the same way I have specialised in public health for decades, there are professionals who have spent their lives specialising in immunology and vaccines and are up to date on the very latest knowledge and developments.
Secondly, Covid-19 is new and every day we are learning new things about the virus, the disease, and how to manage it. This is an extremely high specialty area where you have to trust the very best experts and institutions, and no one else. And even expert immunologists will have differing opinions, however when 99% of experts agree on something and you decide to trust the 1% who does not agree, then you are probably taking the wrong gamble with your life.
My advice to the public regarding social media:
* Consult your doctor before believing any social media messages that may be forwarded to you. Most importantly do not forward on any social media messages to your networks.
* Most of the messages forwarded around are highly sensational and have high “shock” value. This makes it very tempting and easy to forward on. If a message evokes a strong reaction from you, this should be a big warning sign that you need to exercise the highest levels of caution and not believe it at face value.
* If you are concerned about a message that is circulating and want to check on its veracity, only forward it to your doctor so that they can give you an opinion. If you are going to get information online only go to credible authoritative organisations like the WHO, Africa CDC, US CDC and the South African NCID.
Dr Darkoh is the co-founder of BroadReach Group, an organisation that is tackling Covid-19 and other public health crises on the frontlines with human and technological interventions in partnership with governments and others to assist millions of patients and thousands of health workers and facilities.