Structure Polish Academy of Sciences

COVID-19 has been devastating the health of millions of people around the globe and causing untold damage to the economy for many months. Teams of researchers have been working tirelessly on developing an effective vaccine since the outbreak of the pandemic, and we are on the threshold of a breakthrough. However, a large proportion of our society has been expressing concerns about the vaccine. In this statement, we discuss the possible risks and explain why vaccination is the only rational choice which will help us emerge from the pandemic, save the lives and health of countless people and limit the damage already inflicted on the economy.

A year of the COVID-19 pandemic without effective treatment or vaccines

So far this year, over 72 million people around the globe have been infected with the coronavirus, with over a million cases in Poland. According to official data, the virus has taken over 1.6 million lives so far, with over 23,000 deaths in Poland. However, real figures are very likely to be higher.

Since the new disease was first identified in January 2020, scientists all over the globe have been engaged in intensive research into COVID-19 and its pathogen the SARS-CoV-2 virus. The rapid rate and meticulousness of the research and the results of the hard work are impressive: scientists have identified the pathogen responsible for COVID-19, determined its genetic material, developed genetic and serological tests for SARS-CoV-2 and studied the epidemic parameters of the disease. Work on developing a vaccine started immediately after the genetic material of SARS-CoV-2 was recognized on 11 January 2020.

As has been the case for many other infectious diseases, it is likely that an effective vaccine will help us combat this highly dangerous disease. The seriousness of the pandemic is shown by the number of excess deaths in 2020. During the first week of November 2020, the number of deaths recorded was 86% higher than the average of the previous five years combined. In individuals aged 65 an over, mortality was over 100% greater.

Due to an absence of a vaccine or effective treatment, the main ways of preventing the spread of COVID-19 have so far been wearing masks, regular hand-washing, maintaining social distance and limiting social contact. The latter involves closing down major sections of the economy, which leads to a reduced availability of goods and services as well as driving up unemployment levels, leaving growing numbers of people with no means of supporting themselves. All this and the unease which naturally goes with the pandemic and uncertainty over the future have also led to reduced investment and consumption levels. As a result, at the end of 2020 we will see a reduced GDP, estimated at around 8% with respect to the pre-pandemic level in Poland; in turn, this results in increasing unemployment (estimated at between 5% and 9%, depending on sources). The economic crisis and the need to rescue the economy lead to growing levels of public debt (from 48% of GDP in 2019 to around 65% in 2020 in Poland).

The recent announcements of the development of vaccines against COVID-19 have stirred a range of emotions, from joy and hope for a quick end of the pandemic to fears of supposed adverse side effects, fed by widespread misinformation. This position statement is mainly aimed at people who are uncertain about the vaccine and who would like to learn more about the scientific consensus on the COVID-19 vaccine.

What do we know about vaccination?

Vaccination is undoubtedly one of the greatest achievements of modern medicine, and vaccines are the most effective protection we have against numerous dangerous infectious diseases. Their current effectiveness, as measured by the reduction in the number of cases of measles, tetanus, whooping cough, polio, mumps, rubella and hepatitis B, is between 95% and 99%. In terms of smallpox, the global vaccination program has led to a complete eradication of the disease. Contemporary vaccines are safe and effective, while the rare complications are well studied and treatable. In case of the most dangerous vaccine developed thus far (against smallpox), the death rate following vaccination was one in a million ­– a lower risk than the danger of being struck by lightning in a given year. It should be added that even this risk was fully justified, given that the death rate for smallpox was 30% in unvaccinated individuals. Prior to the development of the vaccine, smallpox epidemics devastated entire cities and regions.

Other vaccines available today have extremely high safety profiles. The risk of a life-threatening anaphylactic reaction to a vaccine is approx. 1.3 in a million. However, even when such reactions occur, they come immediately after vaccination, while the patient is still under the care of medical professionals who are trained to respond. Other serious side-effects are rare (a rate below 1/40,000 in Poland), while mild reactions (a rate below 1/100 in Poland) usually clear up without treatment. In practice, no deaths are noted following vaccination. According to data available thus far, we can expect the COVID-19 vaccine to have a similar safety profile.

Ensuring safety is a fundamental element of the vaccine development process involving specialists from all over the globe. Science undeniably rubs shoulders with big business here, since only major international companies have the financial and logistical resources to develop and introduce new vaccines. Safety concerns are equally important for pharmaceutical companies, since being forced to withdraw a product from the market due to serious side effects entails major financial losses and reputation damage.

Verification of the safety of all new drugs, including vaccines, is handled by independent agencies. The largest ones are the European Medicines Agency (EMA) headquartered in Amsterdam, the Federal Drugs Agency (FDA) in the US and the World Health Organization (WHO). As a member of the EU, the most relevant agency for Poland is the EMA which evaluates and supervises medicinal products. The independent international agency works closely with experts in individual countries and analyzes data generated during preclinical and clinical trials. Vaccines and other drugs are only launched to market once the EMA approves all research, resolves all doubts and decides that the results show the product to be safe and effective. In order to accelerate the approval of the COVID-19 vaccine, the EMA introduced the rolling-review process to appraise data as it becomes available. The EMA also conducts close observations of the takeup of vaccination and its safety and effectiveness. The agency must formerly approve any COVID-19 vaccine before it is launched to market.

Since Poland is a member of the EU, our access to the vaccine is guaranteed once it is approved. Currently, the main issue is the development of an effective vaccination program. In the event of no vaccine being available, it is likely that at least 75% of our population will become infected, and the majority of those individuals will develop symptoms. This will result in hundreds of thousands of deaths and long-term effects (known as “long COVID”). The numbers seem abstract, yet they mean something very real: they mean that COVID-19 is likely to affect all families to some degree. We will all know someone who died of COVID-19, and we will all feel the effects of the crisis even more profoundly than before. This is no longer a vague, distant risk it seemed just a few months ago. The extensive research and observations carried out over the last few months mean we now understand how fast the virus spreads and how many social restrictions are necessary to stop the rapid progress of the pandemic. Tallying up the individual and social benefits clearly indicates that a vaccination program is necessary. The main risk, albeit low, is that there is currently no fool-proof guarantee that the vaccine will result in full individual immunity. However, when the entire population is vaccinated, the risk of infection in individuals who have not developed immunity or should not have the vaccine for medical reasons is extremely low.

In summary, getting vaccinated against COVID-19 will prevent infection with the virus or will mean a less severe course of disease. This last point is important, since individuals experiencing milder COVID-19 symptoms are less likely to infect others. Another aim of a mass vaccination program is to achieve herd immunity and eliminate the pandemic. Assuming that vaccinated individuals are not infected and do not pass on the virus, it is sufficient to vaccinate between 60% and 70% of the population. However, in the less-likely event that vaccinated individuals do experience mild symptoms and spread the virus, this number must be higher.

As such, a vaccination program will mean the following:

• The vast majority of vaccinated individuals will not develop COVID-19 symptoms;
• Even if vaccinated individuals go on to become infected, their symptoms will be milder;
• Vaccinated individuals will not spread the infection; in the rare event that they do, the symptoms will be milder;
• When a mass vaccination program is implemented, the pandemic will be defeated.

What else do we not know?

The EMA is yet to issue an opinion on the safety and effectiveness of the recently-developed COVID-19 vaccines; the agency is in the process of reviewing the documentation of clinical trials. Preliminary results show that the effectiveness of the vaccines exceeds 90%, which is significantly higher than for the annual flu vaccine. We still don’t know how long the immunity will last and whether two doses of the vaccine will be effective for a single year or several. If the immunity turns out to be short-term, it will be necessary to modify the strategy and administer booster doses. However, in spite of these questions there can be no doubt that as soon as the vaccine is approved, the benefits of a vaccination program will vastly outweigh any drawbacks.

Who should get the vaccine?

As is the case for all other vaccines, prior to inoculation all individuals will be assessed by a specialist. At this stage, any patients with contraindications will be asked to return at a later date. The main contraindication against vaccination is a known severe allergy to any of the vaccine components. All manufacturers are obliged to provide full information on the components of their vaccine and list any contraindications. Severely ill patients will also be vaccinated at a later date; however, a mild cold or asymptomatic COVID-19 will not be a contraindication. Where exactly does the line lie? That will be determined by the specialist conducting the preliminary examination.

There is also the question of whether individuals who had previously been infected with COVID-19 can or should be vaccinated. In our opinion they indeed can and should, although not necessarily as a priority and vaccine availability permitting. According to current information, vaccinating individuals who have acquired immunity as a result of a natural infection will not have an adverse effect on their health. However, we do not know how long the immunity will be maintained following recovery. For other coronaviruses, in some individuals’ immunity weakens to allow reinfection as early as within a few months; for the majority, immunity is maintained for up to two years. Vaccination is likely to significantly prolong immunity; it will also dramatically reduce the likelihood of severe symptoms and death from reinfection, in particular for at-risk individuals.

The vaccine will not be administered to pregnant women or children in the first instance. This does not mean that the vaccine poses a risk in those groups but rather that it is yet to undergo relevant clinical trials. Vaccinating pregnant women and children will not be recommended until we are 100% confident about safety.

How should we talk about vaccination?

We are aware that individual opinions on vaccination are influenced by many factors, including personal health. According to polls conducted by the Centre for Public Opinion Research, the willingness to take the vaccine is closely correlated with major concerns about infection. According to the same polls, 36% of people in Poland say they will have the vaccine vs. 47% declaring that they will not. The main reason for rejecting the vaccine is concerns about side effects (69%), followed by a general aversion to vaccination (30%) and fears over effectiveness (25%). Analysis of social media reveals concerns such as a lack of trust in medical professionals and vaccine manufacturers, a lack of trust in politicians and a belief that pharmaceutical companies are simply in it for the money. This shows the importance of people’s personal perception of danger, trust in information sources and trust in those who encourage vaccination. The pandemic is a source of uncertainty, which in turn breeds fear. We are afraid of things we do not understand, which is precisely why the availability of clear, reliable explanations is so essential. However, uncertainty is also an integral part of science and scientific discovery. To the average listener, the language of science may appear to be filled with obscurities and contradictions. We all experience incomprehension, confusion and doubt at times, and they can lead us to seek apparently simple and convincing yet completely untrue explanations, such as conspiracy theories spread by members of the anti-vaccination movement. People need information that can explain for their rational and irrational fears. The way scientific information is disseminated will affect whether people take their answers from experts or from those who consciously spread misinformation and undermine scientific evidence.

Scientists provide reliable data from verified sources and recommendations formulated by multidisciplinary teams of independent experts. However, science is not enough; it needs to be supported by trusted individuals who are able to reach out to millions of people. Since Poland is highly polarized politically, it would be ideal if politicians from all parties came together in support of vaccination. Each would be more likely to get the message across to their own electorate. A universal campaign promoting vaccination should also involve individuals from outside political circles, such as trusted and popular representatives of the worlds of science, sport, the arts and the media. This would go some way towards reducing the currently high levels of distrust. We should show by example that we are not afraid of the vaccine: our entire COVID-19 Advisory Team would like to state that all members will be vaccinated as soon as the vaccine is approved by the EMA and as soon as they are eligible.

Research shows that Polish citizens regard their close family and friends as the most reliable source of information on COVID-19. This means we should all speak out in support of vaccination, therefore we encourage you to disseminate accurate information about the vaccine among your friends and family. The attitude “since everyone else is getting vaccinated, there is no need for me to” leads down a dangerous path – if other people were also to adopt this strategy, we will simply not defeat the pandemic. We appeal to all members of the public to make the only rational decision, which is to have the vaccine as soon as it is approved by the EMA.

About the team

The Interdisciplinary COVID-19 Advisory Team to the President of the Polish Academy of Sciences was set up on 30 June 2020. The team is chaired by Prof. Jerzy Duszyński, President of PAS, with Prof. Krzysztof Pyrć (Jagiellonian University) as deputy chair and Dr. Anna Plater-Zyberk (Polish Academy of Sciences) as its secretary.

Other members of the team are:

• Dr. Aneta Afelt (University of Warsaw)
• Prof. Małgorzata Kossowska (Jagiellonian University)
• Prof. Radosław Owczuk (Medical University of Gdańsk)
• Dr. Anna Ochab-Marcinek (PAS Institute of Physical Chemistry)
• Dr. Wojciech Paczos (PAS Institute of Economics, Cardiff University)
• Dr. Magdalena Rosińska (National Institute for Public Health – National Hygiene Institute, Warsaw)
• Prof. Andrzej Rychard (PAS Institute of Philosophy and Sociology)
• Dr. Tomasz Smiatacz (Medical University of Gdańsk)