Q and A

Question

Q&As on COVID vaccines: safety, effective, dosing, ethnicity, chemsex, Halal?

Answer

The following questions were for a community UK-CAB workshop on COVID vaccines. Answers by Angelina Namiba and Simon Collins. This page will be regularly updated with new questions and information. It was last updated on 21 January 2021 from an initial post on 22 December 2020.

Selected Q’s translated into Czech and into Russian.

Are vaccines against COVID-19 effective?

Yes, any approved vaccine has been very carefully studied in  a wide range of people.

These first vaccines are highly effective. Both the Pfizer and Moderna vaccines prevent COVID-19 symptoms in about 95% of people. They also prevent severe COVID-19 and might help stop transmission.

The Oxford vaccine is expected to be at least 70% effective.

All these vaccines are much better than first thought possible. At the start of the pandemic  the target for an effective vaccine was set at 50%. All the current vaccines are much better than this.

Which vaccines are being used in the UK?

The first vaccine that was approved in the UK is called BNT162b2 (tozinameran). The trade name is Comirnaty.

BNT162b2 is made by Pfizer/BioNTech. It was approved in the UK on 2 December, in the US on 12 December and in the EU on 21 December 2020.

On 8 January 2021, a second similar vaccine, developed by Moderna/NIH was approved in the UK. However, this is unlikely to be widely available until March/April 2021. The Moderna was approved in the US on 18 December 2020. The code name for this vaccine is mRNA-1273. It was approved in Europe on 6 January.

On 30 December 2020, the UK approved the vaccine from Oxford University and AstraZeneca. This is called ChAdOx1 (from Chimp Adenovirus Oxford). It also has the code name AZD1222.

Other vaccines are being used in UK studies (see later below). These include a vaccine from Janssen that might only need one dose (JNJ-78436725), and a self-amplifying ribonucleic acid (saRNA) vaccine at UCL. As new vaccines are approved we will add them to this page.

The PROVENT and STORM CHASER studies are looking at using a monoclonal antibody (AZD7442) for people who might not benefit from vaccines. GSK is also studying a monoclonal antibody (VIR-7831) in early infection.

Why should I get a vaccine?

The main reason to get the vaccine is to protect yourself against COVID-19.

COVID-19 can be deadly – it is much better to be protected. Even people who recover from COVID-19 often have symptoms that last for many months. This is called long COVID and is still being studied.

If you have been offered the vaccine it is because of your personal level of risk. The vaccine may also protect your friends, family and contacts at work.

Is my risk high enough to need the vaccine?

There is only a limited supply of these vaccines. 

In the UK, for at least the next few months, you will only be offered the vaccine if your personal risk is high.

This will be because of your age and your health or because you work in a high risk job.

Do I have to get the COVID-19 vaccine?

If the vaccine is for your own health, then this is always still your choice. You do not have to have the vaccine.

Please talk to your doctor if you have any worries or concerns. Or if you are not sure about having the vaccine.

If you are offered the vaccine because of your job, not having the vaccine might affect the work you can do.

In the future, some countries might want travellers to be vaccinated.

Are COVID-19 vaccines free in the UK?

Yes. The NHS will not charge anyone for these vaccines.

ALL COVID vaccines are free in the UK. This includes whether linked to your health risk or to your job.

Never give out personal details linked to payment for a vaccine. This is a good sign of a scam.

Are vaccines against COVID-19 safe?

Yes, based on the results from large studies, any approved vaccine will also be very safe.

For example, the Pfizer vaccine was studied in more than 44,000 people with no safety concerns.

With vaccines, most side effects occur in the first six weeks. All approved vaccines will have studied thousands of people for at least this long. Often, the symptoms reported are similar in both the vaccine and the control or placebo group.

But within a few weeks of approval the Pfizer vaccine had been used by hundreds of thousands more. This is when reactions that are more rare can sometimes be reported.

In the UK this included two people who had a history of allergy reactions. This history was serious enough for them to always carry an adrenaline syringe. Both people were managed in hospital similar to other allergic reactions and they are both now well.

This led to a recommendation that mRNA vaccines (Pfizer and Moderna) should only be given where there is medical support to treat allergic reactions.

People with a history of serious allergies should discuss the risks from an mRNA vaccine with their doctor. This includes to any of the listed ingredients in the vaccine, for example to polyethylene glycol. It is easy for even severe allergic reactions to be safely managed.

Other common allergies, including to medications, foods, inhalants, insects and latex, are not thought to increase allergic reactions to the mRNA vaccines. Please discuss the benefits vs risks with your doctor who knows your history.

In a similar way, shortly after the Moderna vaccine was approved in the US, there were several reports of reactions in people who had used facial fillers. This was in two people who had used facial cheek fillers within six months and one person who used lip filler two days after the vaccine.

All the reactions resolved after treatment with steroids and antihistamines. Responses to both Pfizer and Moderna vaccines in people who have used facial fillers should be prospectively tracked to understand how often similar reactions occur.

As facial fillers are commonly used to correct HIV-associated lipoatrophy, this might be a caution. In practice though, very few treatments are likely to have been available during 2020 because of COVID. Also, the main filler used in the UK for lipoatrophy (New-Fill) isn’t a permanent filler, but just regenerates collagen growth.

Other very rare reactions might still be reported. This is because even very large studies cannot include every type of medical history. Also, the studies mainly included people who were generally well and at low risk of COVID-19.

The seriousness of COVID-19 makes it much safer to have an effective vaccine even if rare reactions might happen. This includes for people with a history of allergies or past use of fillers.

It is probably not a good idea to use facial fillers immediately after a vaccine. Guidelines are likely to recommend this. 

How do we know the vaccine is safe?

These vaccine are safe because studies showed there is a very low risk of serious side effects.

Compared to the very real risks from COVID-19, using the vaccine is much safer than not using it. This is known from research studies in tens of thousands of people. The studies recorded every side effect or any potential side effect.

Additional safety data comes after the vaccines are used outside of studies. This will include from people who were not included in the main studies. This led to a caution in people with history of serious allergic reactions (see next Q).

What is the best/ideal interval between vaccine doses?

In the UK, NHS guidelines recommendations are slightly different for each vaccine. 

  • The second dose of the Pfizer/BioNTech vaccine can be given from 3 to 12 weeks after the first dose.
  • The second dose of the AstraZeneca/Oxford vaccine can be given from 4 to 12 weeks after the first dose.

In practice, both vaccines are now being given with 12 weeks between doses. There is no choice for which vaccine you get or the timing of doses.

However, these recommendations have been made based on limited evidence, some of which is not publicly available. Pfizer, for example, only supports a three week dosing interval based on lack of evidence for anything longer, even though the NHS has extended this to 12 weeks. The limited information about the longer dosing of the Oxford vaccine came from the UK study using the half-dose (which is not being given).

Individual protection will be better when the second dose is given earlier – i.e. after either 3 or 4 weeks. This is because full protection will be reached more quickly.

On a population level, government policy is to try to give the first dose to as many people as possible. This is looking at reducing risk for the UK as a whole given limited access to vaccines. The policy also recommends that the same vaccine should be used for both doses.

The first dose of either vaccine will give a good level of protection. Other vaccines have shown that giving the second dose later can be better than giving it too early.

The real answer is that there is not enough evidence to answer this question.

For more information please see:
https://www.england.nhs.uk/coronavirus/wp-content/uploads/sites/52/2020/12/C0994-System-letter-COVID-19-vaccination-deployment-planning-30-December-2020.pdf

Am I protected after the first dose of a COVID-19 vaccine?

All the current vaccines need to be given in two doses.

In the UK, the second dose is now being given after 12 weeks. This means that full protection doesn’t develop until a few weeks after the second dose.

Please continue to limit your risk of catching or transmitting  COVID-19 before this. Please continue to wear a mask in shared indoor spaces, to limit social distancing and to use hand hygiene until you have the full protection from the vaccine.

Some guidelines still recommend being careful after this time.

Will the COVID-19 vaccines work against the new variant viruses?

Most researchers think the vaccines will still be effective against new variants.

This includes the two recent variations in the UK and South Africa. This will need to be checked in practice though.

Many viruses make small changes over time. This is just part of how viruses evolve. Although most changes are not important, they can sometimes make the virus easier to transmit.

This recent study also says that mRNA vaccines should be easy to modify if more difficult strains develop.

Pfizer COVID-19 vaccine might still overcome UK and SA variants.
https://i-base.info/htb/39652

Can I mix doses with different COVID-19 vaccines?

This is a good question that might change in the future, based on new data.

Currently, UK recommendations are to use both the same vaccine for both doses.

However, there are rare times when different vaccines can be used. These include:

  • When protection from the second vaccine is urgent if same vaccine is not available.
  • If there is no record of the make of the first vaccine.
  • In these cases, any second vaccine would be better than missing the second dose.
  • This is NOT a recommendation to routinely mix vaccines.

This is based on guidance in the UK Green Book, chapter 14a.
https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/948757/Greenbook_chapter_14a_v4.pdf (PDF)

What is in the COVID-19 vaccines?

Maybe it is better to start by saying that none of the COVID vaccines in the UK contain any live viruses. There is no risk of catching coronavirus from the vaccine.

mRNA vaccines (Pfizer and Moderna) don’t contain anything from the virus. Instead they tell your body how to make these proteins so your immune system can respond. Other vaccines (Oxford/AstraZeneca) only use a protein (not the whole virus).

This will not cause an infection though.

Vaccines also include other ingredients that help the vaccine work. For example the Pfizer vaccine contains traces of sodium and potassium. This is sufficiently low to still be called sodium-free and potassium-free.

It also contains sucrose and this, together with all other ingredients, is listed on the patient leaflet that you get before the injection. This is also online now if you want to check first (see further information in the final question).

Are animal products in the vaccines? Are they Halal and Kosher?

  • There are no animal products in the Pfizer, Moderna or Oxford vaccines.
  • There are also no traces of pig products or egg products.
  • These vaccines are all Halal safe and Kosher.

This link to a two-minute clip from Imam Yunus having the vaccine at Newham Hospital in East London.

As chaplain of St Barts, Imam Yunus talks about how the vaccine is safe, effective and Halal
Imam Yunus on how the vaccines are safe if you are Muslim.

Please note this video is included as an information resource. It is not directly liked to HIV and i-Base was not involved in producing it.

What if I have a history of allergy reactions?

As in the question above, even people with a history of serious reactions can still use the vaccine. This includes people who have reactions to vaccines, medicines or foods.

However, if you currently need to carry an anti-allergy syringe, you need to be vaccinated in a clinic in case a reaction occurs.

Two health workers in the UK with a history of severe reactions did react to the Pfizer vaccine. Both people have now recovered. More information will be collected on cases like this.

Can I develop an allergic reaction to the vaccine?

Yes, although the risk is small and relates to your history of allergies.

Both the mRNA vaccines from Pfizer and Moderna should only be given in a setting with medical support to be able to handle allergic reactions.

Anyone with a history of severe allergy reactions can still use these vaccines. But they should discuss the risk/benefits with their doctor.

However, anyone who has a severe reaction to the first dose of these vaccines, should not take the second dose.

See guidance from the US on risk of allergic reactions to mRNA COVID-19 vaccines:
https://acaai.org/news/american-college-allergy-asthma-and-immunology-updates-guidance-risk-allergic-reactions-mrna

What about if I have immune suppression from HIV or cancer treatment?

Yes, the vaccine is still recommended if you are HIV positive or if you have cancer. This is because of the high risk from COVID-19.

Although the leaflet that comes with the Pfizer vaccine includes talking to your doctor first if you have a reduced immune system, this is not related to a safety concern with the vaccine. It is only because the protection from the vaccine might not be as strong.

This means that even after both doses of the vaccine, it might still be important to be careful. For example, if the pandemic is still at a high level, by wearing a mask and social distancing. But this is similar to advice to the general population.

As more people are vaccinated, researchers will look at responses in people who were not widely included in studies. It is worth being cautious until we have these results. They might also find that responses are just as strong in people living with HIV or cancer.

What if I have other inflammatory or autoimmune conditions?

As above, the vaccine is still recommended for people living with inflammatory or autoimmune conditions. This includes people using immune suppressing drugs.

In this, it is very similar to getting a flu vaccine. Anyone who can use the flu vaccine can use a vaccine against COVID-19.

These include:

  • Inflammatory rheumatic diseases (rheumatoid arthritis, axial spondyloarthritis, lupus).
  • Inflammatory bowel disease (Crohn’s disease and ulcerative colitis).
  • Psoriasis.
  • Multiple sclerosis.
  • Organ transplant recipients.
  • People on chemotherapy.

This is because of the high risks from COVID-19.

Although only a subset of people with these and other complications are so far included in vaccine studies, there is no safety concern. As above, the caution is that the vaccine might not be quite as effective.

Ongoing research though will be looking at this but this article is also helpful.

Ongoing research though will be looking at this but this article is also helpful.
Why vaccines are recommended for people with immune suppression and autoimmune conditions.

https://www.medscape.com/viewarticle/942853

Can people with haemophilia and HIV have COVID-19 vaccines? Are there special cautions?

Yes, the COVID-19 vaccines are recommended for people with HIV and haemophilia. However, many people will need clotting factor treatment immediately before they have the injection. This is because, although rare, people with haemophilia can develop serious bleeding after an intramuscular injection.

There are no problems with the vaccine, just a caution over a potential problem linked to an injection.

The COVID-19 vaccine must be given as an injection into the muscle in your arm. This is even though some vaccines like the flu vaccine can be given either into the muscle or under the skin.

People with haemophilia should only be given the vaccine “if their haemophilia doctor thinks it can be done safely”. This is likely to be true for probably everyone with haemophilia and HIV in the UK. As stated above, some will need factor treatment before having the vaccine.

What extra precautions should people with haemophilia and HIV take for the COVID-19 vaccine?

The following suggestions include:

  • Use a small size needle for the vaccine injection (23 or 25 gauge is recommended in the UK).
  • People with haemophilia and HIV who regularly take clotting factor treatment will need to have treatment to prevent any bleeding just before the vaccine injections.
  • Firm pressure should be applied to the injection site for two minutes afterwards.
  • Some people with moderate haemophilia will not need any treatment.
  • People with haemophilia and HIV who are taking emicizumab should not need any extra treatment before being vaccinated.

What if I have haemophilia and inhibitors to a clotting factor?

If you have been on emicizumab for some time, you should be able to have the COVID vaccination injection without problems and no need of extra treatment.

Please check with your haemophilia centre if you are in this situation.

If you are still in the loading phase of emicizumab, your haemophilia doctor will need to decide what is needed to allow you to be vaccinated without causing any bleeding problems. The loading phase is usually the first 4-6 weeks.

If you are on another treatment, it is also important to check with your haemophilia doctor.

Where can I get more information about haemophilia and COVID-19 vaccines

The following resources include more information.

COVID-19 vaccination programme Information for healthcare practitioners (see page 16).

https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/949063/COVID-19_vaccination_programme_guidance_for_healthcare_workers_December_2020_V3.pdf (PDF)

COVID-19 vaccination guidance for people with bleeding disorders from the World Federation of Haemophilia

Available at https://news.wfh.org/wp-content/uploads/Joint-Guidance-on-COVID-19-Vaccination-Dec-22-Final-1.pdf (PDF)

Green Book chapter 14a (page 7).

https://www.gov.uk/government/publications/covid-19-the-green-book-chapter-14a

Does the vaccine interact with other medicines?

No. There are no medicines that currently can not be used with the Pfizer and Moderna vaccines. 

If you are taking other treatment, there is no need to stop this to have a vaccine.

Although it is good to ask about interactions with current medicines, there are no interactions with the vaccines. If you are worried, it is easy to double-check this with your doctor.

Your doctor will also know your medical history and whether one type of vaccine might be better for you than another.

Do I need to say I am HIV positive before getting a vaccine?

No. Injecting procedures are the same whether you are HIV positive or negative.

However, in the UK, your GP needs to know you are HIV positive in order to get earlier access.

Although one of the vaccine leaflets (for the Pfizer vaccine) does ask about HIV, you can ignore this if you want to. The leaflet is an old leaflet that is now out-of-date.
If you are asked to fill in a form about other medical conditions, you can also ignore HIV if you are on effective ART.

If you do include info on HIV, you might also be surprised. The person giving the vaccine might say “me too” or “yeah, my Mum is also positive”.

Why do some vaccine leaflets mention HIV?

Two of the vaccines includes information that refer to “immune suppression”. The Pfizer leaflet also includes HIV with this reference.

All these leaflets are out-of-date in this aspect of the information.

All vaccines are recommended for HIV positive people – just as the flu vaccine.

If the NHS leaflet asks about other health conditions, you do not have to mention HIV if you don’t want to.

Could the vaccine interact with my HIV meds?

There are no interactions between the COVID-19 vaccines and HIV meds.

Will my HIV viral load blip when I have the vaccine?

There is not enough results from HIV positive people in the first vaccine studies to report this yet, though this will be reported later.

Based on other vaccines, low-level blips might occur in a small percentage of people just after the vaccine.

These will not affect your HIV treatment or your risk to partners.

As with the answer to other questions here, it is okay to approach the COVID vaccination as if it was the annual flu vaccine – which is widely recommended for people living with HIV.

If your viral load is generally undetectable any increase is likely to be very small. For example, with the flu vaccine, it might increase from less than 50 to maybe 80 or 100 copies/mL – and only for a few days or a week. This is too low to affect the risk of transmission.

Can the vaccine interact with oestrogen and/or testosterone treatment?

There are no interactions between the COVID-19 vaccines and oestrogen and testosterone.

Are the vaccines safe in pregnancy?

Great question. So far there is little data because pregnancy was an exclusion for the main studies. But if you are pregnant, the vaccine is still recommended.

Also, women will still have become pregnant during these studies – and certainly afterwards. These data will all be collected during the study.

When these data are available they will be widely publicised.

Other studies are looking at vaccine responses during pregnancy.

Are the vaccines safe in children?

The first vaccine studies were in people who are aged 16 and over.

Studies in younger children are currently ongoing.

How is the vaccine given?

The Pfizer vaccine being used in the UK is given as an injection into your upper arm. 

A second booster dose is given again, three weeks later. Although protection starts after the first dose, the best protection is from seven days after the second dose.

The second dose of the Oxford vaccine will be given after approximately 12 weeks.

Do I still need to social distance after the vaccine?

This advice is going to change based on local risks and also as more data is collected.

During the first months of 2021, even after the vaccine, it might still be good to reduce the risk of catching coronavirus.

A few people might not be protected by the vaccine. We also don’t know how long protection will last – although it will hopefully be at least a year. If you still become infected without symptoms, you could then pass this to other people.

Please continue recommendations for wearing a mask and social distancing that is relevant for your area.

Can I get COVID-19 from the vaccine?

No. This is easy to answer.

There is zero risk of getting COVID-19 from the vaccine.

The vaccines do not contain live coronavirus that causes COVID-19.

If I get ill with COVID-19 will the vaccine help my recovery?

If you had the vaccine more than two weeks before COVID-19, then the vaccine will already be reducing your symptoms.

There is no data to know whether having the vaccine after getting COVID-19 will have any benefit.

What are the side effects from the vaccine?

Most side effects to the vaccines were mild or moderate.

The details below are from the Pfizer vaccine.

Very common side effects were similar to getting the flu vaccine. They generally got better within a few days. These were reported by more than 1 in 10 people.

  • Mild pain at injection site (common).
  • Tiredness.
  • Headache.
  • Muscle pain.
  • Chills.
  • Joint pain (uncommon).
  • Fever (uncommon).

Common side effects included injection site swelling, redness at injection site, and nausea. These were reported in less than 1 in 10 people.

Uncommon side effects, in less than 1 in 100 people included enlarged lymph glands or just generally feeling unwell.

Swollen lymph glands in the arm and neck have been reported 2 to 4 days after the injection. These also only last a few days and will not affect your health.

Will I get sick with the COVID-19 vaccine like the flu jab?

No, not necessarily, but maybe. So far the COVID-19 vaccines are similar to getting a flu vaccine. And just like the flu vaccine, the response will vary for different people.

The question above shows that side effects are similar to the flu vaccine and are nearly always mild.

Can I still have the flu vaccine and how do I time this?

Yes. If you normally have the annual flu vaccine, you can still have this.

Getting the flu vaccine first might be easier if you are waiting for the COVID vaccine.

If you get offered the COVID vaccine first, then take up this offer and have the flu vaccine later. This should ideally be at least a week after the first dose. The order of these vaccines is not important.

Leaving at least one week between the two vaccines will help you know whether either of these gives you side effects.

Should I wait to see how people similar to me react first?

This is a good question – and sounds very reasonable. But within a week or two another 500,000 people will have used the vaccine in the UK.

Any serious concerns will be reported long before you are likely to be offered the vaccine.

If you want to interact with people, then waiting will be more risky than having the vaccine now. However, if you are okay leading a very isolated life, then waiting is a choice.

How long will protection from the COVID-19 vaccine last?

This will only be known with more time.

Protection should last for at least a year and hopefully a lot longer. Some vaccines, for example hepatitis B and tetanus only need a boost every ten years.

Which COVID vaccine is best?

So far, all the leading vaccines look very good. Getting access to any vaccine now is more important than which vaccine you use.

Once several vaccines are available, independent researchers will hopefully compare them with each other.

What if I already had COVID-19? Does it matter where this was severe or mild?

People who already had COVID-19 are still recommended to use the vaccine. It doesn’t matter how severe or mild this was.

The vaccine will already be used by many people who didn’t even know they have caught coronavirus before. And many people who had similar symptoms were not able to get tested.

Will my GP or HIV doctor give me the vaccine? Can I choose?

Who gives you the vaccine might depend on which vaccine is being used. It might be your GP or a hospital doctor. In the UK it is unlikely to be your HIV doctor.

The Pfizer vaccine will generally be given at health centres or hospitals. This is so any allergy can be easily managed. Also because of limits in how it can be stored.

The Oxford vaccines might be given by your GP because it is easier to transport and store. This is early stage for the vaccines but it is unlikely to be your HIV doctor.

However, if you get a letter from both a vaccine centre and your GP, you can chose which of these to use.

Please remember that all the current vaccines need to be given as two doses.

Why should I get the vaccine if the person giving me the vaccines hasn’t had it yet?

The decision on who gets the vaccine first is made by an expert advisory group. It is based on the risk of infection and the risk of severe disease.

If this group recommends you get the vaccine, then this is because your individual risk makes this important.

It is good that you are concerned about the health worker but they are also likely to get the vaccine soon.

Will the vaccine stop me catching COVID-19? Or just from getting ill? Or maybe both?

The vaccine will definitely reduce risk of getting ill, but the answer is “probably both”.

The vaccine are approved because they reduce symptoms of COVID-19.

The first studies didn’t measure whether people caught coronavirus, just whether they had symptoms of COVID-19. However, there is some evidence that the vaccines also protect against infection.

With the mRNA vaccines, most mild symptoms later confirmed as COVID-19 were in people who didn’t get the vaccine. Importantly, nearly all the most serious cases of COVID-19 were also in people who got the placebo (inactive) injections.

Technically, some people might still catch coronavirus and be infectious but without symptoms. This is still an ongoing research question.

Studies with the Moderna and Oxford vaccines include some results showing that the risk of catching coronavirus is also reduced.

Is the vaccine safe if I have other health problems as well as HIV?

Yes, vaccines are recommended in people living with HIV and other health problems.

The more serious your other health problems, the more important it will be to be protected from COVID-19.

Can I get the vaccine if I have or have had hepatitis C?

Yes, vaccines are recommended in people living with hepatitis C or who previously had hepC.

Is the vaccine safe if I use chems like crystal meth, GHB or mephedrone?

Yes, the vaccines do not interact with drugs used for chemsex.

However, taking a break from the chems for the week of the vaccine will make it easier to know whether you get any side effects.

If the social context for using chems means you are having more partners, the protection from the vaccine will be especially important.

Is the vaccine affected by ethnicity? Will it affect me differently because I’m black/brown?

No, vaccines studies include people of different ethnicities. They are created for everyone.

Ethnicity does not affect immune responses or risk of side effects with mRNA vaccines.

Are black and brown people more at risk of getting side effects?

No, as with the question above, ethnicity has not been linked to any better or worse outcomes.

Have vaccine trials included black and brown men and women living with HIV? Or do the findings just relate to the experiences of HIV positive white gay men?

Unfortunately, most vaccine studies only included very small numbers of people living with HIV. So far, the ethnicity breakdown of the HIV positive group has not been presented. All the HIV positive participants might be black and brown women.

For example, the Pfizer study with more than 44,000 people only included about 120 people living with HIV. The results did not show that HIV as any impact on how the vaccines work. Data though are currently limited.

However, there is more data about ethnicity – and more will come from the wider vaccine programmes.

About 10% of the people in the US sites for the Pfizer vaccine were black or African American. There were no differences in how well the vaccine worked or in side effects compared to the rest of the study population.

In the Oxford vaccine studies about 90% and 65% of participants were white in the UK and Brazil sites respectively. Although there were very few black participants in the UK sites this was around 10% in Brazil.

Who approved these vaccines? Were the interests of my community represented?

Vaccines are approved by the same organisations that approve medicines. They were approved for all people.

  • This is the Medicines and Healthcare products Regulatory Agency (MHRA) in the UK.
  • In Europe it is  the European Medicines Agency (EMA)
  • In the US it is the Food and Drug Administration (FDA).
  • Other countries and regions have similar organisations.

Each of these groups is made up of expert advisors who are mainly scientists and doctors. Sometime they include community voices.

The panels are responsible for representing interests of all people who are going to be using these products.

The FDA publishes the detailed study results online for everyone to read. If also webcasts the meeting that decide if a vaccine or medicine will be approved.

How do I know I’m being treated equally? How do I know this isn’t experimentation in black people?

These concerns about equality are very real.

Nearly all countries still have structures that are not equal. Many have a history where people were treated differently.

In the UK, this still affects access to important services that include education and medical care. This is even when there are policies to make access fair.

However, ethnicity has been linked to higher risk of COVID-19 in black, Asian and minority ethnic (BAME) communities. This actually makes access to the vaccines even more important.

As all the studies included people from all ethnicities. There is good data to show they are at least as safe and effective.

COVID vaccines will be offered to people of all ethnicities. As has been seen in the news all ethnicities have the choice to use the vaccine.

If the government didn’t protect me from the COVID-19 coronavirus, why should I trust them with the vaccine?

Perhaps luckily, the government are not directly involved in producing the vaccines. It is not directly running the studies that look at how well they work.

The government is also not directly involved in deciding which vaccines are approved. They have decided which ones are going to be used though – and we need to see if they have picked well.

Whether or not you use any medicine or vaccine is a decision that you make with your doctor as an individual.

I’ve experienced racism in the health system and receiving HIV care. How can you tell me this won’t be the same?

I am sorry for any previous experiences in your care. I am also sorry if you have not been treated fairly in the past.

Although I can not guarantee this will not happen again, there is a lot of information about how to deal with this.

I can however provide information on COVID-19 and the vaccines. This shows that the benefits of the vaccine so far are much greater than the risks from not getting the vaccine.

I hope that you reported previous incidents. There are support groups that can help make a complaint. You can also do this anonymously if your prefer.

Why did we get a COVID-19 vaccine so quickly, but there is still no vaccine for HIV?

There are several answers to this question – which is being asked by many people.

The practical answer is that the threat from COVID-19 were so serious that existing resources were all focused on COVID-19. Plus many more resources became available. The urgency of COVID-19 led to a larger budget – and luckily, this has been more effective than anyone first hoped.

There was also a highly concentrated collaboration between researchers, drug companies, health authorities and governments. Together of course with many thousands of people who volunteered to be part of the studies around the world.

A more technical scientific answer is that the COVID-19 virus is in many ways much simpler than HIV. For example, it does not attack the bodies immune cells that are needed to fight the infection. It also does not hide away inside the cell DNA like HIV. The COVID-19 virus also changes less rapidly than HIV.

HIV does have at least 30 approved treatments. These mean we can now lead long and healthy lives.

There are many other infections where we also need new vaccines. Hopefully the scientific advances made with COVID-19 will help other vaccines including HIV. In fact, Moderna, the company behind one of the mRNA COVID-19 vaccines, plans to use the same advances for HIV. See this press release from 11 January 2021.

As COVID vaccines are now becoming available, should I still join a study?

This is an important question because other vaccines are still being studied. 

These include a vaccine from Janssen currently in phase 3 studies that should finish in January, and other studies that will continue for longer.

UCL is researching a self-amplifying ribonucleic acid (saRNA) vaccine.

Other research groups are looking at COVID-19 monoclonal antibodies instead of a vaccine.

Joining one of these studies might let you get vaccine or antibody protection before you are offered a COVID-19 vaccines by the NHS.

Talk though what this will involve if you are interested in a study. Some studies might limit how you use vaccines in the future. (See below).

Can I have a COVID-19 vaccine if I was already in a vaccine study?

Whether or not you can still benefit from the NHS vaccine programme will depend on the research study. It will also depend on whether you were in the active or control (placebo) group.

If the study tells you that you already received two doses of one of the currently approved vaccines, then you don’t need any further protection. This means that somebody else who still needs protection can use your NHS vaccine.

If you were in the control (placebo) group, then you can use the NHS vaccine. You might also have the chance to get the active vaccine used in the study.

If you only received one vaccine dose so far, then the study team can tell you now whether or not you got the active or placebo injection. You can then decide if you want the NHS vaccine now.

You might even produce important data from getting both types of vaccine. In practice, new studies will hopefully look at switching between different vaccines.

If the study was using monoclonal antibodies to COVID-19, and you received the active treatment, current advice is to wait at least 90 days before having a vaccine.

This early guidance is currently being reviewed so it is an important situation to discuss with your doctor.

If the vaccine is lifesaving, why is not available to everyone in the world?

You are right, for a vaccine to be really effective, everyone will need to use it. This includes in all countries.

Many organisations, including the World Health Organization (WHO), have been working all year to also make access fair.

For example, the international COVAX programme is aiming to vaccinate two billion people during 2021. This includes more than 100 low and middle income countries including across Africa, Asia and South America.

So optimistically, at some point, everyone will have access.

In practice, high income countries that could afford the first commercial vaccines have bought most of the first stock.

But some of the next stock during 2021 – and more importantly newer vaccines, will be available for the COVAX programme. This might not be until later in 2021 and 2022 though.

Where can I get more information?

The following links are to different sources for more information.

i-Base run an information service if you have individual questions that you would like answered.
https://i-base.info/qa

i-Base report news about COVID-19 treatment and vaccines in a monthly bulletin.
https://i-base.info/htb

British HIV Association (for information about HIV and COVID-19).
https://www.bhiva.org/Coronavirus-COVID-19

Q&A for doctors: similar Q with more technical answers
https://www.nejm.org/covid-vaccine/faq#Clinicians
About 30 questions on COVID-19 vaccines from Paul Sax fro New England Journal of Medicine.

UK patient information leaflet for the Pfizer/BioNTech vaccine
https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/943249/Information_for_UK_recipients.pdf (PDF)

FDA 50-page document with detailed results on Pfizer vaccine.
https://www.fda.gov/media/144245/download

YouTube website to watch the US CDC hearings for COVID vaccines
https://www.youtube.com/playlist?list=PLvrp9iOILTQYiZunwmtiIRt52poVP8D02

A guide to vaccinology: from basic principles to new developments
https://www.nature.com/articles/s41577-020-00479-7
Comprehensive scientific review of safety and efficacy of vaccines published in Nature in December 2020.

Article on why vaccine is recommended for people with immune suppression and autoimmune conditions.
https://www.medscape.com/viewarticle/942853

Guidance from the US on risk of allergic reactions to mRNA COVID-19 vaccines
https://acaai.org/news/american-college-allergy-asthma-and-immunology-updates-guidance-risk-allergic-reactions-mrna

Website for WHO COVAX programme for global access.
https://www.who.int/initiatives/act-accelerator/covax

The People’s Vaccine – a collaboration of large charities including Oxfam.
https://www.oxfam.org/en/tags/peoples-vaccine

4 comments

  1. Lisa Thorley

    Hi Jason,

    Are these people doctors?

  2. Jason

    Hi Simon, some people I work with are stating that the Pfizer/Moderna approach interferes with a person’s DNA.
    What would be the best response to this?

  3. Mogamalie

    What ingredients are used for developing this virus. Is DNA cloning part of this

  4. Simon Collins

    Hi Mogamalie, the ingredients of each vaccine are listed in the patient leaflet that you should be given. Different vaccines use different technologies. The recently approved vaccines though are either mRNA (Pfizer and Moderna) or use an inactivated adenovirus to deliver a coronavirus protein (Oxford/AstraZeneca).

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