Vaccinating against covid-19 in people who report allergies

Dear Editor

While I give full credit to the authors for handling this issue so skilfully, there are many questions that the World still can’t answer. “Reassurance” is a magic word that most clinicians often use, sometimes successfully. But is that really simple when it comes to convincing patients for Covid-19 vaccination in the current situation? The reality is, only time will tell what Covid vaccine will and can do. This is what the people seem to believe, so there is a need for more and better understanding.

We acknowledge that the world medical community is trying their best and has introduced several Covid vaccines at a rapid speed, so there are likely to be some lapses and misses.

However, general public would expect definitive advice, that science can’t offer now. That is possibly why the public willingness to take the vaccine dropped from 90% to 70% and further to 64%, as reported by the authors. This means nearly 40% of the population may require reassurance and this is not just for the allergy issue.

As of now, there is hardly any official report or information in the media about what proportion of population refusing the vaccination? Instead all we know is that hundreds of thousands of peopleare receiving it regularly. Why there is no real figure of the refusal rate, if any? There is also little data about patients recovery rate and hospital discharge rate, except mortality?

Allergy is a major concern for refusing the vaccination as people are not clear about the vaccination's pros and cons. There is conflicting and confusing information and even the UK government advice website says, “some people may still get Covid-19 despite having a vaccination”. How do you identify those people? There is uncertainty whether the vaccine will fully protect or not, and the official advice site also says “we do not know whether the vaccine can stop you from catching or passing on the virus”. This message leaves many questions about the benefits of vaccine against any unknown future adversities, that the public wants to be reassured.

The scientific benefit of vaccine lies with the induced antibody. With the same logic, any Covid recovered patients will also have naturally induced protective antibody same as vaccine. There is no reliable evidence to show that the naturally induced antibody is less protective than vaccine induced antibody. Furthermore, there will be another population of Covid-19 exposed asymptomatic antibody carriers with herd immunity. This could be a very large population of millions that has not been investigated.

The key question is, whether antibody titers in the Covid infected/Exposed groups would be similar to vaccine antibody titers? If it is so, should they need vaccination? And if they did, how would the benefits of vaccination be measured in the herd immunity groups?

With the above situation every person should have an antibody test prior to vaccination so that the post vaccination differences in antibody titre can be measured to assess the vaccination benefits. It is also not fully known how long the natural antibody and vaccine antibody can provide protection, without the long term vaccine side effects?

Until answers to these issues are available, it won’t be surprising to see variable public interest and reactions to vaccine. People realise vaccines were made in a very limited time.

The allergy concerns are serious, and the previous writer below, provided clear evidence that over 70,000 anxious people weekly hit their enquiry website hub. The allergy is not always known and anyone allergic to anything is likely to have serious anxiety. While “reassurance” may work for some people to accept the vaccine, it cannot stop occurrence of severe allergic manifestations, if not full anaphylaxis. Therefore administering a vaccine to people with a history of allergy will remain a hit and miss risk that the injector will have to undertake. I have seen patients allergic to something, later developed allergy to other things. Also some people have immune sensitivity with persistent high level of serum IgE who can badly react to anything. Such patients to receive Covid vaccine with reassurance may be high risk, as I am yet to see any evidence of vaccination given to people with high IgE.

There is also allergy risks with the added preservative ingredients in covid vaccines like polyethylene glycol (PEG 2000) and Polysorbate 80, and reassurance may not provide full safety. There are numerous other Covid vaccines in the manufacturing process and it is not yet known what preservatives they have and how they will react? With all that in mind making preservative free covid vaccine could be one step safer for allergic patients.

More importantly, there is now emerging evidence of new variants of Covid-19 infections, which may become Covid-21 and so on. With such rapidly changing virus variants there might be a need for broad spectrum Covid vaccine like broad spectrum antibiotics – is the world ready for it?

As it stands, the use of Covid vaccine will continue as planned given the sentiment and emotions attached with it, though there are many questions to answer for full public confidence. At present it is a mixed situation of unknown future. Some people are taking it as told and some are taking it assuming it will work. But no one knows whether the vaccine will fully protect or the Covid-19 will take its natural course and eventually disappear on its own accord – that’s what I hope.