I don't think it's just conspiracy theorists though. I can tell you now that I won't be taking it either and I am definitely not a conspiracy theorist. I also have a number of friends and relatives of mine who have told me that they won't be taking it either. My gut feeling from conversations that I've had with various people over the past few months is that that French statistic you referred to is probably pretty similar to public opinion here in the UK.

Myself, I'm a firm believer that everyone has to make their own decisions on how best to stay safe from this virus. Personally, I'm just not scared enough of it to take a new vaccine that has been rushed through development, no matter how many checks and tests have been carried out on it -- and I imagine that's a fairly widely held opinion among people under 50, with no underlying health problems. Unfortunately, the spectre of things like the Thalidomide drug which resulted in such terrible birth defects in the 1950s and 1960s is still very much alive in most people's minds. It's not that I don't trust science or believe in the ruggedness of the scientific processes used to test this vaccine, it's more a case of accidents can happen and "why risk it?"

In addition, I've always been a firm believer that you shouldn't take any medicine unless you absolutely have too -- even aspirin! So, it's a risk assessment thing for me; I'd have to be a real statistical outlier to become seriously ill or die from COVID-19 and therefore I'm not scared of it enough to take a vaccine. Same goes for the common flu vaccine too BTW.

Now, my 90 year-old Grandmother or 70 year-old mother though? Absolutely I'd want them to take it (and they are planning to) because the risk to them posed by the virus is much, much greater than the chances of there being any unwanted side effects of the vaccine. But for healthy, fit people below 50? As I say, I suspect there'll be a lot of them not wanting to take it. In particular, I wouldn't give it to my children if I was a parent because the virus poses almost no risk whatsoever to that age group.

Great response and typically excellent info, RR, as I would expect from you...you are an expert, after all. But personally, I still won't be taking the COVID-19 vaccine any more than I would take the flu vaccine. At least not immediately. 5 or 10 years down the line? Yeah, maybe...especially as I'd be over 50 myself by then.

I had actually already read something a while back about the vaccine working less effectively in the 80 or 90 year old range, but that is the case for pretty much all vaccines, right? As I understand it, doctors already add immune-system boosting ingredients (for want of a better term) to things like the flu vaccine when it is administered to the very elderly. Surely the same thing would happen with the COVID-19 vaccine? As with flu, relying on other members of society to not infect the very elderly isn't really an effective way to vaccinate that age group. So immune-system boosting drugs to accompany the Coronavirus vaccine are surely a no-brainer?

Actually, to digress a little, you hit on an interesting point with the 90-year-old grandmother and the degradation of her thymus and t-cell production: what you're talking about here is essentially natural selection at play. That is what we have seen with the death tolls in almost every country. It is unfortunately the "low hanging fruit" that the virus has picked off.

There was a great statistic that the BBC reported back in early August, five months after the pandemic had begun to seriously sweep the U.K., and that was that although 45,000 people had died of it by that point, only around 250 people under the age 50 and with no underlying health conditions or obesity had actually died of COVID-19. I don't know what the number is now, as of November 2020, but clearly the virus poses little risk to the majority of the health, under 50s population.

That in a nutshell is why I'm a lockdown skeptic. I'm with the World Health Organisation in thinking that lockdowns are too damaging to the economy, too damaging to the fabric of our society, and too dangerous for people's mental health to be the way forward. Since around mid-April, about a month into our first lockdown here in the UK, I've been in favour of your "Option b)": the elderly, vulnerable and obese should shelter at home and be protected, but the rest of us should just get on with life as normal, while taking all possible precautions that we can (cleaning hands regularly, wearing masks etc). Now, that might sound harsh, but these are drastic times and unfortunately I feel that such harsh measures are needed. Of course, no one's asking me what we should do anyway, so who cares what I think? But that's been my view for months now.

A honest to goodness discussion! I love those!


Obviously that's your call, but getting vaccinated against COVID is the same as wearing a mask. It's something we do for others, not for us personally.


Absolutely, all vaccines work less and less the older you get. It's due to our aforementioned decline in immune efficiency.

However, we can not compensate for that effect... it's hardwired in our very biology. The compounds you refer to are called adjuvants, and they're not particularly meant for the elderly; an adjuvant is a booster required for most vaccines. It doesn't matter if one is a toddler of a great-grandfather.

The thing is that a vaccine on its own is rarely very immunogenic. For it to work and help us develop an immunity against a pathogen, we must also kick the immune cells into action. In most cases, the adjuvant includes alum (a salt of aluminium). The antigen in the vaccine is adsorbed onto the surface of the alum, and is released progressively in the body; thanks to this prolonged exposure, our immune cells have a better chance of mounting an appropriate response. Another type of adjuvant, instead of releasing the immunogen slowly over time, will trigger innate immunity; that, in turn, makes adaptive immunity far more efficient.

Small parenthesis time : we have, broadly speaking, two main types of immune responses. The first one, innate immunity, depends on certain receptors carried by our white blood cells. These receptors are not variable, are shared by everyone, and are activated by classes of molecules associated with pathogens we have faced for millions of years: the mannose-rich glycosylation patterns of fungi, for example, trigger our innate immunity, and so will bacterial peptidoglycans (the material of the bacterial cell wall). When a white blood cell called a macrophage meets a bacterium, it recognizes it thanks to its receptors, "eats" it and sends a signal (a cytokine) that says, in chemical terms, "message to all: I have just met a bacterium. Take appropriate action".

The second type is acquired or adaptive immunity. That's the one that leads to the eventual production of antibodies. It broadly works like this: two types of white blood cells, B and T cells, each have a certain genetic tool kit with which to build a receptor. As they mature, each of these cells will use its kit to assemble a receptor that will be unique to each particular one; the goal is to create such a vast repertoire of cells each with a specific receptor that no matter what we might encounter later in life, we should have at least one B cell and one T cell capable of recognizing it. No promise, but that's the general plan.

Both B and T cells must then finish their maturation by a process of double selection: the ones whose brand new and unique receptor reacts with our own body are destroyed (to avoid autoimmune reactions), and the ones that can't recognize anything because the random nature of their assembly led to a nonfunctional model die as well, so that all we're left with are B and T cell with receptors potentially capable of recognizing a foreign molecule, but not our own.

When we inject a vaccine with no adjuvant, a macrophage will "eat" it (as it eats all the crap floating around in our body) and will present it to a T cell, essentially saying "look, I found this, and I have no particular opinion on what it is". The T cell with the appropriate receptor will say "yeah, I recognize that thing; it's what I was born to recognize, in fact". Elsewhere, another macrophage (or the same, although that seems unlikely) will present the vaccine to a B cell, telling it the same thing; the B cell will also say "yeah, I recognize that". If the T and the B cell meet (which they will, in the lymph nodes or in the spleen), they will agree that they both met the foreign structure that they were designed to recognize; the T cell will then tell the B cell to proliferate and start churning out antibodies. Both of them will also give rise to memory cells, and if we ever meet the same antigen again, their reaction time will be massively shorter. (The antibodies from a memory B cell will also be of far better specificity than the initial batch)*.

Now with an adjuvant like alum, we get that scenario repeated over a long period, leading to the production of more antibodies. With an adjuvant that stimulates the macrophage, we also get the same scenario... except that instead of saying "message to all: I have just met a bacterium. Take appropriate action", it says "OMEGERD THIS STUFF IS SAURON COME BACK FROM MORDOR EVERYONE SCRAMBLE!!!"

Without any adjuvant, most vaccines don't work very well, hence their habitual presence. End of the parenthesis!


Very true, except that "immune-boosting drugs" don't really exist... or rather, they're not what we usually think they are. All the ads about things that "boost our immune response" are hogwash. When one is healthy, (in the sense that their immune system isn't depressed by disease, by drugs or by some other condition), that's as good as the immune system gets; taking extra doses of vitamin C, zinc or whatever is not going to help. It is possible to stimulate the immune system by giving pro-inflammatory substances, but that's literally playing with fire. When I hear someone say "drink this herbal tea, it boosts the immune response", what I think is "great; it's going to give me lupus or rhumatoid arthritis". Too much of an immune response is as bad as too little. In fact, in a sense, it's worse; because when your immune system works against yourself, you destroy your own body and there's no foreign enemy to get rid of.

What we can use on top of a vaccine is something that interferes with the virus's modus operandi (analogs of nucleotides that mess with the replication of the virus's genetic material, or drugs that prevent it from entering the cell). We can also use drugs that will limit the severity of the immune response! It seems counterintuitive, but since most COVID-related deaths are due to a cytokine storm and the associated unchecked inflammation in the lungs, an immune suppressant might actually do good. I think I read that cyclopsporine is considered as a drug against coronaviridae.


Absolutely. It's nature at its most efficient, cruel and unfeeling. Humans just aren't supposed to live so long; once we reach the age when our grandkids can fend for themselves, every extra year is a gift. Things like viral infection, osteoporosis, cataracts and spinal stenosis are a reminder of that sad and unfortunate reality.



True. I was quite upset by many TV ads from our government, showing young healthy adults who almost died from COVID. While these people do exist, they are a minuscule minority. We still have zero victim below the age of 20 in Quebec. It is really the people over 80 who are at serious risk. We shouldn't give the falsely reassuring message that young people can't catch COVID or suffer from it, because it's like an invitation for young people not to care at all (and even if you don't die, COVID can stil lead to a pretty bad and debilitating pneumonia), but in terms of "who's actually going to die", it is clearly people over 80.

I think the same. I am not unsympathetic to lockdown skeptics, as I think the lockdown was an appropriate emergency measure in the begining, but makes for a lousy long-term strategy.

I still trust specialists to properly advise our assorted governments. That being said, there is that old saying according to which to a hammer, any problem is a nail. Doctors will do their best to limit the number of casualties, and no other consideration will weigh much for them. No criticism there; they're doing their job. But as a citizen, I not only do not believe in a zero-risk life; I even view it as undesirable.

COVID is an epidemic that will kill thousands, even hundreds of thousands of our citizens. That's a lot, and naturally we must find ways to assuage that problem. However, people die for a lot of reasons; if we look not at the number of COVID deaths but at the number of extra deaths, we get a better idea of how bad the pandemic is. (If someone dies from COVID today but would have died from the flu anyway, it is still tragic, but somewhat diminishes the societal sense of urgency). Now looking at the extra mortality, we do see that during a wave, still too many people die. We should do something.

How far should we go? There is the question that I'm glad I don't have to answer, and take responsibility for, because I don't really know. Trying to develop a vaccine is a no-brainer, as is finding other medical treatments. But how much should we prevent people from interacting, and especially from going to work? That has serious societal implications too.

The insufferable bromide "if we could save only one, it would be all worth it" is romantic nonsense. 30,000 Americans die of the flu each year, and we don't go into quarantine for it; I would therefore assume that 30,000 deaths annually is an acceptable number. 60,000 deaths from flu is a bad year, but is not unheard of. No quarantine. So is 60,000 deaths acceptable? Would 80,000? Would 100,000? where do we draw the line and pull the alarm? Remember, COVID and the flu kill pretty much the same categories of citizens. Hard choices.

Going forward, option 3 remains my favourite choice of strategy, even if it means making vaccination mandatory! After all, to protect our country as a whole, we sometimes resort to a military draft. A shot seems quite reasonable a price to pay in comparison!




*The T cell in this situation is called a helper T cell (or CD4+ cell). Another type of T cell is activated the same way, but its role is not to stimulate B cells; it is to hunt down normal cells that were infected with the virus and cause them to apoptose, or commit cellular suicide. The reason the HIV virus is so dangerous is that it targets helper T cells; the more it kills them, the less we can mount an immune response... against anything.

You're right that we don't know the long term effects of COVID-19 as yet. But I would also say that evidence of the so-called "long covid" is largely anecdotal at the moment. That said, post-viral fatigue is a well known and well documented thing -- hell, I remember coming down with proper flu one Xmas, and I still didn't feel quite right in February! So, I don't mean to suggest that the so-called "long covid" symptoms are entirely psychosomatic or attributable to hypochondria, but I strongly suspect that's a component of it. However, at this stage, with so little real medical and scientific evidence about the long term effects of COVID-19, I'm reserving judgement.

I'm in no rush to get a covid vaccine, I'll let the more vulnerable go first, but not because I think there is anything wrong with the vaccines. I do trust both Pfizer and Moderna and the testing they've gone through and it's independence. I never get flu shots, I'm not in the groups at risk of that being deadly, but I would get a coivd vaccine for my parents' sake and to clear travel restrictions.

Vaccines, like many things, most forms of travel, come with risks. It's the anti-vaccers that have some sort of deliberate conspiracy scenario or extreme claims about them that I might shake my head at.

I do know that even healthy seeming children can and have died from covid, I don't 'believe' but know they can transmit it, and yet we still have some even here saying that they can't transmit it and so schools should remain open (multiple closed in just one Vancouver area municipality right now). I chalk that up as unforced error at this point like being against masks was staring around April sometimes would be. Why is it taking so long to get everyone all the correct ad reality backed information in this so-called information age? I'm for accurate info to get us all back to work and other activities a.s.a.p. and anything else keeps us away from that goal. Thinking positive and hopeful, wishing well and stepping out on faith are good things, but there really is no place for 'believe' in this virus situation. I'm sure people in Pompeii had magical amulets around their necks, but that was two thousand years ago. I kind of want to have something besides that if I we can, as in those who help themselves.

My brother works in health care and gets tested tomorrow, so I will still have positive thoughts and well wishes. Fingers crossed too!

The thing about "do what you gotta do to protect yourself and I'll do what I gotta do to protect myself" is that most of the safety measures we have for COVID-19 protect other people, not ourselves, so for ourselves to be protected, we need others to also take them, or it doesn't work. The studies show that masks, sure, offer some amount of protection to the wearer, but primarily protect those around the wearer. It only works well when both people do it. Same with vaccines. It's not just about you, it's about those around you.