Vaccines & PH: An update

Published 8th May 2021

We caught up with PH expert Dr Mark Toshner, who was also the local investigator (LI) in the Oxford/AstraZeneca COVID-19 vaccine trial, to discuss side effects, success and what the rest of the year may look like as the country starts to open up again.

As well as playing a role in the Oxford COVID-19 vaccine trial, Dr Mark Toshner is also a pulmonary hypertension consultant at Royal Papworth Hospital and a Cambridge University lecturer.

Key points

In terms of the pandemic and vaccinations in the UK, we are in a very good place as we go into the summer.

The vaccine programme has been a huge success and along with the lockdown we’ve recently come out of, it has had a dramatic impact on the prevalence of COVID-19. We now have some of the lowest cases in Europe.

At-risk populations (including those with PH) have been vaccinated in very high proportions. There has been a take-up of over 95% and the vaccinations of people with PH have gone well and safely.

There is a rare side effect with the AstraZeneca and Janssen (Johnson & Johnson) vaccines. It has been shown that these vaccines can cause blood clotting in unusual places, but it is very rare.

Dr Toshner said: “It’s about balancing benefit and risk. I am keen that people have a clear understanding of the data (risks Vs benefits) and are allowed to make their own decisions. Informed choice is important, but the choices should be made with the best information at your fingertips.”

At around 9 minutes 20 seconds into the above video, Dr Toshner presents data that shows the cases of COVID-19 hospitalisation and ICU admission prevented by these vaccines, compared to the cases of clotting. You may find this information useful when making a decision.

There is a lot of evidence that shows having a vaccine also prevents transmission of the virus. So, having a vaccine protects others as well as yourself.

There is no evidence that people with chronic thromboembolic pulmonary hypertension (CTEPH) are at greater risk of developing clots from the AstraZeneca and Janssen (Johnson & Johnson) vaccines.

Dr Toshner said: “This side effect isn’t like a ‘normal’ clot. The body is generating an antibody that, by coincidence, recognises a particular protein involved in the clotting factors around platelets [cells in your in blood, which help stop bleeding].

That is not a classic cause of clots in people with CTEPH and we haven’t seen any patients with CTEPH who have had this particular complication.  We don’t think it is a particular risk factor for them.

We can be confident that the rare risk of clotting with the AstraZeneca and Janssen vaccines does not appear any more relevant to our PH patients.”

We can be ‘cautiously optimistic’ now about getting ‘back to normal’ this year.

De Toshner said: “I believe this phased reintroduction of normal life is the right approach. Even when we get back to ‘normal life’ later in the summer, people are still likely be more cautious and I expect that will include those with PH. From speaking to patients in clinics, on the phone and on the wards, they perceive the risk to them as being pretty high so have generally been more cautious and sensible. Things like face masks may continue if you in a poorly ventilated place, but we need to feel our way through it all.”

We need to think about the rest of the world when it comes to vaccines.

We’ve done a great job of vaccinating in the UK but there are huge areas of the world where vaccines haven’t really started, and countries like India that are really struggling with infections.

Dr Toshner said: “We now need to be looking outside of our patch and looking at vaccine supply as an international issue. There’s a real risk of ‘vaccine nationalism’ now and as a country we need to start thinking about how we can help the others.”

COVID-19 vaccines are here to stay.

It is likely we will receive boosters every year, particularly those with health conditions like PH. Like flu jabs, these boosters may be adapted to cope with new strains / variants.

There is more work to do around vaccines for children.

Some countries are already offering the Pfizer vaccine to children, but it’s a very complex area.

Dr Toshner said: “The proportion of children who become unwell from COVID-19 is very low, so we need to be very sure the risk / benefit balance is right and that safety is good enough. For some of the vaccines right now, I don’t think that is the case and there is more work to be done to demonstrate safety.”

It is possible there will be a third wave in the winter, but vaccines mean it will be nowhere near as bad as what we’ve seen.

The virus is better understood now and as communities we have learned how to pull together. Showing kindness, being gentler with other and looking out for each other needs to continue beyond the pandemic.

There is no need for panic around the potential of new variants of COVID-19.

It can be difficult to cut through the barrage of daily news we get about COVID-19 and sometimes the negative stories can outweigh the positive ones.

Dr Toshner said: “If you can dial down some of the hysteria, we are yet to demonstrate serious vaccine escape from the variants [the chances of the current vaccines not working against new variants].

It’s not a quickly mutating virus; we are seeing new variants simply because there is so much of the virus about [in the world]. There are a few variants being observed and we are yet to see real-world evidence that the vaccines don’t work against them.

The ‘platform technologies’ for these vaccines are really adaptive and already, studies are being run where the new genetic code [for the variant] is plugged into the vaccine. So, I would say that we are in a pretty positive position – much more positive than we could have hoped for six months ago.

That does not mean we let our guard down and assume this is all finished – but it does mean we can feel positive about the future.”

Last medically reviewed: May, 2021 • Due for review: May, 2024