Assessing potential Covid-19 vaccines

I am a Consultant in Blood Borne Viruses (BBV) and also a regional lead for the National Institute of Healthcare Research for Infectious Diseases and Microbiology. I am lucky enough to be involved with two Covid-19 research trials here at my hospital in Milton Keynes, one of which is the well-known ‘recovery’ trial that is looking at potential effective treatments for Covid-19. We are also in the process of enrolling in a Covid-19 vaccine trial, as well as a study looking at the behaviour of healthcare staff and keyworkers during lockdown, including assessing their mental health and alcohol intake.

Ironically, my 2017 Churchill Fellowship looked at some of the risk behaviours associated with the spread of BBV in Vancouver, and this provides many valuable insights and lessons in the spread of the airborne Covid-19 virus. My Fellowship also involved analysing the educational and healthcare skills of healthcare providers and those living with a BBV, so this has placed me in a position to deliver remote webinars, lectures and seminars on Covid-19 to colleagues, patients and under- and post-graduate students.

Although there are groups who are clearly most at risk from Covid-19, it has affected all populations in some form or another. Currently the only thing we have to combat the virus is being mindful of 'hands, face, space', as well as a test and trace system which most governments have released in some form or another, with varying degrees of success. The use of IT has greatly helped with this in many respects, but further work is needed to ensure potent effectiveness.

As a Black & Minority Ethnic (BAME) healthcare worker, on the frontline in a place that was considered a 'hotspot' for Covid-19, this has been a very frightening and anxious time. There were uncertainties about type and quality of personal protective equipment (PPE) and, when I was subsequently deployed onto Covid-19 duties covering the wards, this anxiety was heightened over personal safety and relevant competencies needed to deliver effective healthcare. As our workforce numbers diminished due to those self-isolating, shielding and infections, we had to find better and leaner ways of delivering healthcare and prioritise those who needed a hospital admission. Being redeployed to the Covid-19 wards to help fellow colleagues was a massive lesson in not just the knowledge and training received and given, but also in how my fellow nurses and doctors showed valiant efforts and courage in dealing with some very sick patients.

With respect to the potential vaccines, including the recently approved Pfizer mRNA vaccine, we need to see the data published in a peer review journal rather than vague, sensationalist headlines. However, data released by Pfizer demonstrates almost a 95% potency, which is a clear breakthrough, especially when a 50-60% protectiveness was expected. Using a unique technology of mRNA is clearly a game-changer and hopefully will be utilised for other RNA viruses such as hepatitis C and HIV. My concern, however, apart from the current lack of a detailed, expert reviewed article, is that this has been driven through after such a short period of time, when it usually takes years for a vaccine to go through. With respect to the AstraZeneca 'adjuvant' vaccine, which acts in a different way to the one proposed by Pfizer, the 90% potency is also potentially very exciting, but recent media articles suggest that more scrutiny is needed on the data and a publication is awaited here too.

My specific recommendation, particularly as someone who will be up taking the vaccine myself as a frontline worker, is that we need to have full confidence in the safety and efficacy of the vaccine. I will need to make an informed choice about any future vaccine available and to express confidence to colleagues, patients and even my family to follow the same route. An urgent, early release of the data collated by the relevant stakeholders is needed, while investment and funding of continuing research in other Covid-19 vaccines is crucial.

Research and development of potential therapeutics and vaccines should continue and, if this is carried out, I am optimistic that some normality can return to society by Easter 2021. Indeed, studies suggest that if 60% of the population are immune or vaccinated against Covid-19, some element of widespread herd immunity may be obtained.

This will require a concerted effort in uptake and confidence of a vaccine that is potent and effective. I do feel that the current, second wave of Covid-19 will be more long-lasting and severe, as 'winter' viruses can exacerbate and, indeed, confuse a potential diagnosis of Covid-19. Even when the vaccine is rolled out, continued PPE provisions along with track, trace and isolate protocols should follow. We are seeing a rise in non-Covid-19 conditions, such as mental health issues, and measures will be needed to address these health concerns as part of long-term recovery plans.