Flu and Covid Vaccinations - a good idea

After commenting about vaccines and the way that different germs vary, requiring a different strategy of vaccination schedules this created considerable interest with lots of people speaking to me as I'm out and about or giving vaccinations in the pharmacy.

I thought that it would be good to look at the vaccination schedules and plans in three ways. An historic overview of medicine changes, an explanation of how the decisions are made about which vaccinations to give, and an explanation of why some vaccines provide lifelong immunity whereas other vaccines need to be repeated at different frequencies.

Medicine has changed dramatically in the 50+ years since I started training. The previous generations had the advent of antibiotics and I remember my first partner in Pailton  telling me that when he was a medical student during the war their contribution to the war effort was to meet the troop ships coming into Liverpool and ask military personnel who had been treated with this new penicillin stuff to urinate into a milk churn as recycling from urine was the quickest and most efficient way to get more penicillin.

When I began new medicine breakthroughs often took a long time to spread through the whole of the NHS service, and this denied certain procedures to some people but also this slow communication meant that some things that were less successful would not be recognised for significant periods.

We were a Medical Research Council practice, and I can remember going to the medical research annual training conference and being told that the human genome was on its way but that it would take a long time perhaps 10 to 15 years. The 286 chip became the 386 and the 486 and by the following year they were talking about it being ready in a few months.

Computers allow a huge amount of processing data, not least of which monitoring the effects of medication and vaccinations in a way that wasn't possible 50 years ago. The National Institute for health and Care Excellence (NICE) came into being to collate and analyse the data and share best practice, progress or problems in a way that hadn't been possible before the modern communication systems arrived.

If one looks at the vaccinations there have been vaccination scares, and the recent ones have reduced the uptake of vaccines quite dramatically.

My professional and personal experience in the early 1980s was as a new parent and as a paediatric doctor who was escorting small children to the regional ventilation centre because they could not breathe and survive without help because of whooping cough. Many subsequently had long term health issues, and some did not come back. Even though I saw this and I knew that statistically whooping cough was  a 100 times bigger risk for long term health issues or death than the worst case scenario of the alleged vaccine problems. When my daughter was due to have the whooping cough nonetheless it caused great anxiety. Speaking as a parent I am glad I listened to the experts. It took a long time in those days to collect and analyse the data. The evidence showed that the vaccine was safe.

During my time doing paediatrics I saw numerous children who were left with ongoing problems after admission with measles. Measles worldwide still kills, 140000 children in 2018. Although this sounds a lot it was 2.5 million in 1968 before modern vaccines.

In the aftermath of Dr Andrew Wakefield (who was struck off by the GMC – “guilty of serious professional misconduct”) propagating the risk of autism linked to the MMR has decimated childhood vaccination uptake. We are now seeing measles outbreaks. Something I haven’t seen since arriving here 40 years ago.

This leads onto how information is analysed and presented as well as how policy decisions are made. A GP or for that matter any doctor cannot know everything. NICE provide guidelines that are constantly updated by independent experts with the best knowledge available. We rely on the British national formulary (BNF) which is constantly updated for the best available information on all aspects of the medication we prescribe. Both NICE and the BNF have a substantial body of experts who weigh all the information before putting it together. There is a separate committee on the safety of medicines, and all medicines have to be approved before being available on the NHS. It is possible with modern computers to monitor all the events that follow the use of medications and vaccines in a way that was not feasible previously. Once the only reporting mechanism was a form at the back of the BNF which a doctor would fill in if they thought there had been an adverse reaction. The committee on safety of medicines can withdraw a drug overnight if sufficient concerns arise.

The Joint Committee on Vaccination and Immunisation (JCVI). Is an independent body with numerous experts. They review all vaccinations and have a range of expertise from their own work, collating the available research as well as international connections. Many are international experts. Changes to the vaccination programme are based on the expert guidance of this group.

This group represents the best gold standard advice that is available and as a GP I am dependent on the full vaccination guide that they provide as well as updates. I could not compete in terms of expertise with any of the experts let alone the experts as a group. Life is not without risk. And all doctors and certainly as a GP you're constantly weighing up the benefits versus the risks of various actions procedures and treatments. The idea being that the benefits should always significantly outweigh the risks. There is always that small element of risk and there is always a tiny risk that knowledge developments in the future will prove that there were better therapeutic interventions. In my personal professional opinion, the GP can only follow the guidance on what is gold standard treatment at that point in time.

Remember smallpox has been eradicated. Look at diphtheria, tetanus, and polio. I saw rare cases of the first two in my early career but none for 40 years.  These were major killers 80 years ago. All by the development of vaccines. On a personal note, 2 friends from my days in cubs had callipers and sticks having recovered from polio. My children did not see this let alone my grandkids. Polio is now reduced by over 99% and eradicated in many parts of the world.

In latter years there have been no extreme examples of what was considered gold standard treatment being shown to be detrimental.

If you look back in time there are numerous examples of really quite horrendous treatments. Arsphenamine (Salvarsan): Developed in 1910 by Paul Ehrlich, this was the first effective treatment for syphilis and also used for other diseases like relapsing fever and African trypanosomiasis. This was basically an arsenic compound, but gold standard in 1910, it worked to a degree. It would not even get to first stage investigations nowadays.

So, the programme for vaccinations is based on the JCVI guidance.

The body kills and removes germs from its system by virtue of the immune response. A key part of the system is the production of antibodies (immunoglobulins) these are chemicals which stick to the outside of germs and help the body to damage and kill the germs to prevent  their replication.

An individual who recovers from an infection will develop an immunity and this may last for the rest of their lives or for shorter periods with some germs. Chicken pox is a classic example where an individual who suffers chickenpox will have lifelong immunity in about 95% of cases. The lifelong immunity is because the body develops memory cells which can stimulate rapid production of immunoglobulins if the body meets the germ again.

The idea of a vaccination is that it stimulates an immune response that causes the body to develop an immunoglobulin memory that will respond if the body meets the actual germ. Many of the original vaccines involved using weakened or dead versions of a germ. Nowadays more and more vaccines use only part of the germ that allows the immune system to develop immunoglobulins which will help kill the germ.

Some germs do not change their appearance and once the body has produced immunoglobulins these will deal with the germ, like chicken pox.

The question of why some germs require repeated vaccinations relates to the behaviour of the germ and its appearance. The immunoglobulins will recognise certain chemicals or structures on the germ and attach to the germ to start the process of killing the germ.

In some germs it is possible to develop a vaccine that recognises something that is common to all strains so one vaccination will suffice. Using an analogy the virus material that goes into the host is “Housed” in a coating that protects it. Imagine a chemical that could selectively damage and break a specific type of brick. It could crumble every house that was built with the  exact same bricks and so expose the inside to the elements. As long as the bricks do not change these houses will not succeed. So, it is with some viruses the Protein “bricks” that make up its protective “housing shell” never change and so once the body has a memory to produce the immunoglobulin it can recognise and kill that germ. Chicken pox as an example.

Other viruses will change their protein bricks shell and so that the body cannot recognise them..

Influenza and COVID have different strains, and the method of attack is by attacking the shell around the RNA core. In the analogy, houses built with different bricks are immune and cannot be demolished. The problem with these viruses is that they constantly change their protein brick shell. So that the body cannot recognise them in the same way. The body has to start from scratch and go through the process of trying to manufacture new immunoglobulins against the new bricks in the virus shell

There are constant subtle changes in influenza which is called antigenic drift and previous illnesses or vaccinations might give some level of immunity to similar strains. However, there can be major changes in influenza, this is called antigenic shift where the changes are so great that it is virtually like a new germ and the body does not recognise it at all. In 1919 Spanish flu killed more people than the First World War.  Asiatic flu (1889–1890) · Spanish flu (1918–1920) · Asian flu (1957–1958) · Hong Kong flu (1968–1970) · Russian flu (1977–1979) · H1N1/09 flu pandemic (2009–2010).

These epidemics occur when the virus changes make it appear “new”, antigenic shift. The difference being that the systems were in place in 2009-10 to put out a vaccination programme and control the epidemic. Similarly, the covid vaccination programme significantly contributed to reducing severe illnesses and deaths.

The world health organisation monitors the spread of viruses and both vaccines give the best cover for what is predicted to be the most likely dominant strains to cause problems in the UK each year. The dominant strains in the UK change every year.

Based on 50 years of medicine in my opinion we are better protected than ever. My attitude is listening to the expert groups who have a wide range of massive relevant expertise.

Andrew Wakefield was not an immunologist, virologist or infectious disease expert, no training in autism. I wonder how so many people so simply followed him rather than the true experts? Then I look at Donald Tumps medical pronouncements. No system is infallible but there have been disasters based on listening to single so called experts promoting their own subsequently unproven theories.

I know which system I will follow for myself and my family and loved ones.

We will continue to provide Flu and Covid NHS vaccinations for those who are eligible.

ring 01788 834848 to make an appointment.

We are already providing Private flu vaccinations. We have just signed a direct contract with the manufacturer for COVID and we will confirm the price as soon as everything has been completed. We expect it to around £75, hopefully less and are hoping for our first delivery in the next few days.