By Natalie Tannous  

By my count, we are 683 days into the strange reality of the C19 pandemic. Granted, that number may vary depending on where you start counting from. Was the first day of the pandemic when the World Health Organisation declared it official on 11 March 2020? Was it that really weird cough you had after a trip overseas in November 2019? Was the start of the pandemic when your country announced its first lockdown? Whenever the pandemic started for you, I have not met a single person that does not wish it to be over.  

Even if we are privileged enough to be thinking about exiting the pandemic with enhanced digital skills, exciting new careers we had to pivot into, or a renewed appreciation for being able to breathe easily, no one I’ve spoken to over the last 561 has ever said ‘I just wish the pandemic would last a little longer’. I would wager that you’ve not heard anyone say that either: everyone is waiting for the threat to their lives and livelihoods to be over.  

When C19 vaccinations were first announced, some breathed a sigh of relief while others raised a sceptical eyebrow. Like so many other debates that rage within society, whether or not people would take up a C19 vaccine was quickly heating up family mealtimes and workplace Zoom calls around the world. The scene was not so different in our own virtual offices here at the Africa Centre for Evidence (ACE). 

As a centre, we gathered to talk about the issues around what reliable evidence can tell us about getting vaccinated or not, and how people can use evidence synthesis methods to navigate the ocean of information being shared. We invited anonymous questions from our ACE team members ahead of the meeting. Below I capture the discussion an edited transcription of our conversation (we will share the video here soon, and ask that you please excuse the melodious sounds of this writer’s work-from-home situation captured in some parts of the video).  

The choice to be vaccinated remains an individual one, and that’s okay. While the synthesised research evidence is clear about the safety of the C19 vaccines, we recognise and respect that our knowledge and understanding of the pandemic and this disease is constantly growing: we don’t have all the answers to every question. But we do have enough answers to know that taking the C19 vaccine is a good step to protect ourselves against the severe consequences of this disease. The science on the vaccine being safe is the best-researched, most closely monitored, and least likely to change research evidence we have right now. We all feel differently about vaccines and what the best way is to protect ourselves. Irrespective of those differences, we all share something in common: the hope that this pandemic will end soon.  

Transcribed conversation  

Natalie Tannous: [00:00:00] So I’ve heard a lot about vaccine technology and this one vaccine technology mRNA is what the COVID-19 vaccines use. Can you tell us: what is that? How has it been used in humans before now, and what is this technology going to do inside my body? 

Dr Laurenz Langer: [00:01:57] So the mRNA is a really new vaccine technology and it works differently from the vector based one, which is the traditional approach. So basically [in a vector-based vaccine], a mini-me version of the virus is being injected into your immune system, learns how to recognize it. In mRNA vaccine, they’re injecting a messenger – not the entire virus – just a little protein into your body. And so your body then picks up on the messenger RNA and starts to produce responding proteins that train your immune system to recognize the virus and then to produce an immune response. You don’t actually get the virus, as in the vector-based vaccines. You’re getting a messenger of what your immune system would be expecting rather than the actual thing. mRNA vaccines have been around since the 2000s. And there’s other vaccines that use the same approach, for example, for the common flu, for Zika. And it’s also been trialled in humans for cancer. 

Dr Laurenz Langer: [00:03:25] When all of a sudden COVID became a number one health issue, the producers of these vaccines decided, this is such an adaptable technology: can we adapt the approach for this new virus? And that went really quickly. And that’s kind of the advantage of the technology, because it doesn’t need the actual virus. It just uses the messenger RNA. It’s not with COVID that this is the first time that this type of vaccine is in a human – the other trials of the other vaccines for the other diseases had human trials before. And so collectively, we do know from that evidence base that mRNA vaccine technology had reached a stage where it was safe enough to try it in humans.  

Natalie Tannous: [00:04:44] A follow on first question is whether there been any weird side effects reported from using this technology in other in other vaccinations for other diseases? 

Dr Laurenz Langer: [00:05:43] It’s a fair point to say that for none of the vaccines do we have long-term data. So I think the way it’s being implemented, we have a really good tracking system in each country to monitor side effects. So just from my own experience, any side effects I actually did have (but from a vector based one), I needed to report those to the German health authorities and they then report it to the European health authorities. So we don’t have long-term data and we need to acknowledge that. But the real-time data we have is being tracked really, really cautiously. So we have good data – I wouldn’t call it evidence yet -but we have good data on the effects as it comes out. There’s been some suggestion that does the vaccine affects your DNA? And from a biological perspective, it doesn’t actually enter your DNA at all. If you want to understand the exact biological difference, I don’t think I’m the right person, but from the efficacy trials and safety trials for the different diseases, we know that your DNA is not is not affected by the vaccination. 

Natalie Tannous: [00:07:30] Another question that I have is if I get the COVID-19 vaccination, how long will it protect me from having a higher risk of getting COVID-19? 

Dr Laurenz Langer: [00:08:30] That’s a multimillion dollar question, and I’m really sad to say that in my reading of the data, we don’t really know. Despite a few data points, we don’t know how long the vaccine protects us, nor do we know how long people who had COVID are immune to getting it again. It’s probably worth watching the real-time data to see how it’s coming out. So, for example, my grandmother got vaccinated in the Jan-February period of this year. And initially there are suggestions that people would get a booster shot in Europe at least in our autumn, which is in October. But currently the health authorities are basically feeding back from the people vaccinated in the first round that the level of immunity seems sufficient that at the moment, at least in Europe. But I think that’s something that can change very quickly.  

Dr Laurenz Langer: [00:09:40] And then I think it’s an interesting question when you ask how long does immunity, if you had COVID, last and what does it mean for vaccines? And again, it’s quite frustrating that we don’t have the good data on it that we like to have. But the advice that I got, having had COVID in September (2020) is that I should be getting only a single shot of any vaccine. 

Natalie Tannous: [00:10:32] So what happens in a case where I’ve never presented with COVID symptoms and so have never gone for a test: should I still get vaccinated? 

Dr Laurenz Langer: [00:10:49] Well, so I don’t like telling anybody what to do. So I won’t answer the should. Right. What I can only tell you is how I would weigh the risk of the vaccine doing me any significant harm with the risk of getting COVID without vaccine protection, then I personally would probably opt to be on the safe side and get the vaccine. Because from what we know, taking a single shot shouldn’t do me any bad but the side effects of covid itself are worse, in my opinion. 

Natalie Tannous: [00:11:47] Another question that I had was, can the C19 vaccine give me COVID-19?  

Dr Laurenz Langer: [00:12:29] The answer for the mRNA one is very clear: no, you can’t because you’re not getting the actual virus. So, in the vector-based vaccine the data is fairly clear that you can’t get the actual disease. But I think that’s important to mention and I have a personal anecdote in a second that you can develop symptoms that are associated with the disease so you should be even more cautious. So I would just say that if you’re told to not do anything that would suppress your immune system (like drinking alcohol), it might be a good idea to follow that advice on my experience. 

Natalie Tannous: [00:13:43] What is the difference between my natural antibodies and the COVID vaccine? If I’ve had COVID-19 recently and my body has built up its natural defences, what’s the difference between that and getting the vaccine? 

Dr Laurenz Langer: [00:14:57] There’s two different ways our immune system functions. There are direct antibodies and then we’ve got these T cells that kind of memorize how to produce the right antibodies. In terms of your own antibodies, depending on how long after COVID, your immune system’s response to produce direct antibodies decreases but your immune system should still be able to remember how to produce those antibodies through the T-cells. So if you’re taking a vector-based vaccine, the antibodies are basically the same as having had COVID-19 in that your body produces direct antibodies. And then with the mRNA vaccine, it’s different in the sense that the vaccine actually doesn’t give you antibodies; it helps your immune system to already know what’s coming and prepare accordingly. Remembering of course that we don’t know exactly how long immunity lasts so the longer ago you had COVID, the fewer antibodies you’ll have.  

Natalie Tannous: [00:16:59] The final question that I have is, does the SARS-COV-2 virus that causes COVID become less lethal as it mutates? 

Dr Laurenz Langer: [00:17:12] Unfortunately not. It would be nice if it did. But I think at the moment we have three or four variants that are officially variants of concern, with three others that are currently being watched at the moment and may be upgraded to the same level. We can see from global data that variants are more transmissable but to my reading of the data, we don’t see any differences in mortality between variants. And unfortunately, that mean for the question that COVID-19 doesn’t become less lethal as it mutates. 

Dr Laurenz Langer: [00:19:08] What I found really interesting from the experience of being vaccinated is how uncertain I was myself, to be honest. There’s lots of contradictory data and evidence. And I also find it personally very frustrating that oftentimes, you know, there’s ‘certainty’ that’s pushed out where we sometimes don’t have certainty. Going through all the data, the reality is that we don’t have all the answers and we should, I think, just acknowledge that the science changes and we might learn more about them all. It’s important to keep an open mind and just acknowledge that we just don’t know everything, unfortunately, at this stage. And that’s something we need to learn to how live with. 

Professor Ruth Stewart: [00:20:26] How do you judge whether evidence is reliable? This is something that I’ve been working on for over 20 years. And I realize in this conversation that I’m coming to it with a massive privilege, not just that I’ve been working on how to judge whether information is accurate or not for the last two decades. But also because I know probably all of the experts across the globe who are working in this field. When I’ve thought about vaccines and COVID and the current scenario, my view is skewed because I have access to this years of experience, masses of evidence, and those who are interrogating the evidence on a daily basis. So the decision for me to have the vaccine – I’ve had my first shot of the Pfizer vaccine here in Johannesburg – was really easy because those people who I respect for their skills and ability to review the evidence were also being vaccinated. And I realize I am in a huge position of privilege to be able to tap into such an enormous amount of expertise so quickly.  

But there’s also something about the fact that we regularly scan evidence and consider whether or not it’s reliable. And so ever since the pandemic began, I’ve been scanning the COVID evidence, as many of us have, including all sorts of things that have passed through my Facebook and Twitter and WhatsApp, and all sorts of questions and queries that have come to me from across colleagues in Africa and in Europe. And I haven’t yet found yet any or heard or explored any reliable evidence that shows that the risk of the COVID vaccines outweighs the risks of having COVID . And I guess that’s my kind of bottom line in all of this: it’s not just about evidence of vaccines that we’re considering, but it’s how to balance it with the evidence of serious disease, death, and – now we’re learning over time – serious disability for those who survive, particularly who survive experiences like ventilation in hospital. So Laurenz has been talking a little bit about what do we know about the long-term impacts of taking a vaccine, and we don’t have very good data yet. The truth is, we are also just beginning to learn about the long-term impacts of the disease and the virus itself, and I think for me that some of the scarier stuff. 

We’ve also at the Africa Centre for Evidence (ACE) been able to do a project about misinformation and how it’s transmitted. And it’s been really interesting to reflect on that and to reflect on how I approach a piece of evidence and what we learn from that research. And the first thing that stuck with me from that work is that when people share information about COVID, they don’t necessarily know if it’s misinformation or not. But when people share information, they’re doing it because they care about their communities. So they might challenge. Someone sent me this information; I’m going to challenge back and say, “I don’t think that’s true because I’m worried. I don’t want the people I love to follow the wrong path in terms of some of the treatments that are being suggested or some of the prevention activities”. And the other side of that is that people are trying to share positive ways of preventing you from getting sick.  

So I think it’s really important when we think about information about COVID that’s been shared with us and how we respond to bear in mind that people are doing it out of care for their immediate circles. And we need to respond to information about COVID without labelling people as wrong and without pushing people away, because if we do want to share evidence-based responses, we have to do it in a fairly neutral way. So then from there, I thought it was worth sharing some tips of what I do when I get a piece of information.  

Ruth’s seven tips for navigating a piece of information

1) Listen out for cautious language (and be encouraged by it) 

Professor Ruth Stewart: [00:24:35] So one of the first things is I know that scientists tend to be overly cautious. They tend not to overstate that their findings and they tend to use language like ‘the best available evidence’ or ‘the evidence is limited’. But my experience is that people sharing misinformation tend to be the opposite and overly confident. So if somebody comes in with bold statements, ‘the facts’, even using the language of the ‘facts are’ or conspiracies and clear conspiracy language – ‘The Department of Health doesn’t want us to know’ or ‘The pharmaceutical industry doesn’t want us to know’ – that kind of language around secrets and overconfidence makes me wary.  

 2) Search for any declarations about conflicts of interest  

I tend to look immediately for any kind of statements about conflict of interest because I want to know where people are coming from. I have a look and see who’s produced this statement or this evidence, and who’s funded them or who supported them? And what I’m trying to think of is, why? Why is somebody sending me this information and what’s it based on?  

 3) More than a single study  

And then I’m always interested in what the body of evidence says. And I’ve had medical friends share, ‘But isn’t this drug promising?’ And I understand that we’re all looking for drugs that are promising. But if it’s a single study, I’m still not completely convinced. I want to look at the body of evidence.  

 4) Date indicating a publishing date or when this information was last updated 

I am cautious when there’s no date attached or no information about when this was last updated. We know COVID is changing quickly and a lot of evidence that first came out in March or April last year we now know isn’t necessarily the case any more. I want to know what the date was and I want to be able to think about how recent it is, and what else might have changed in that time frame. 

 5) Look for authors’ statements about the quality of this research 

 I want to think about whether or not they are transparent about how, in sharing the evidence with me, they’ve judged its quality. So we call it critical appraisal in the world of systematic reviews. And if I’m looking at online results of reliable evidence, they should say something about how they critiqued the evidence before they shared it with me.  

 6) Information is shared in an accessible way  

And are they making an effort to share this information in a straightforward way with the public? So is it open access? Are they making clear evidence statements that I can make sense of?  

 7) Knowing where to find reliable bodies of evidence helps  

We have the privilege of being part of an amazing consortium hosted by McMaster Health Forum in Canada called COVID-END where some of the evidence experts in COVID research are synthesizing and sharing information. And I think if there’s one source that I will always look to with great confidence, it’s the Cochrane Library. It’s the one place I encourage people to go. If somebody shares something with me, I often go to the Cochrane Library to see if it’s based on the best of available evidence. And the methodology behind the Cochrane Library is the methodology that informs all of our healthcare decision-making when we go for all sorts of clinical care: when we go to the doctor, it’s the same archive of evidence that the healthcare professionals regularly look at. So this is not specific to vaccines or COVID. If I see something, if I see a video of a scientist saying, well, let me tell you, blah, blah, blah I’m wary straight away. I go to the Cochrane Library and check it.  

 Professor Ruth Stewart: [00:28:18] A closing note, and one of the queries that I know has come through has been about, ‘is this something bigger’? Is there a conspiracy that I’m buying into somehow by taking this vaccine? Is there a bigger picture of kind of some global biological warfare process that’s going on? And honestly, I think when it comes to vaccines, first of all, there’s a personal decision. Am I going to take this vaccine? And what’s the evidence for me? And I haven’t found any evidence that suggests that the risks of vaccines outweigh the risks of COVID. So for me, the personal decision is an easy one. Yes, please vaccinate me and vaccinate my family as soon as possible.  

In terms of a wider community, we’ve all been vaccinated for years. Vaccination programs have been around since the fifties. So if we are part of a bigger story where there’s a concern around vaccines, we bought into it a long time ago. And those bigger debates may be something for a different discussion. For me, the immediate query and the immediate argument is that the evidence for the vaccines working, and any evidence of concerns around the vaccines, are fully supportive of having a vaccine. Whereas quite clearly and sadly, we all increasingly know people who’ve suffered from COVID and also died from it. 

 About the author 

Natalie Tannous works as the strategic marketing and communications manager at the Africa Centre for Evidence, and also coordinates the centre’s employee wellbeing and engagement work.  

Disclaimer  

The views expressed in published blog posts, as well as any errors or omissions, are the sole responsibility of the author/s and do not represent the views of the Africa Centre for Evidence, the Africa Evidence Network, either sets of advisory or reference groups, or its funders; nor does it imply endorsement by the aforementioned parties. This blog post does not constitute medical advice; guidance for your healthcare practitioner should also be sought when determining whether or not to vaccinate against C19.