Video Q & A
This video was recorded on 22nd December 2020 and answers questions put to us by sarcoidosis patients about the coronavirus vaccines.
You can find the latest UK Government information here.
Charlene: Good afternoon everyone. Thank you for joining another of our live Q&A sessions. Today we’re very lucky and to be joined by Dr Anna Blakney and Dr Robina Coker who are going to be answering all of your questions that you’ve been sending in around the covid vaccine so thank you for all of those. If you do have any questions that you would still like answered you can always comment them during the live stream and we will have someone checking those and getting around to them. So we’ll try to answer as many as possible but without further ado I’d just like to introduce both Dr Robina Coker and Anna Blakney. Many of you will recognise Dr Robina Coker. We’ve had some videos with her so far already, so you might recognise her but for those who don’t know she is a respiratory consultant at Hammersmith Hospital. She is also the Clinical Director of the NIHR Clinical Research Network so we’re very lucky to have her with us today. She’s also a member of our SarcoidosisUK board so thank you so much for your time again Robina. I’m also very pleased to introduce Dr Anna Blakney who is joining us. She is from the US and she is part of a team developing a covid vaccine at Imperial College London. She is a bioengineer with training in drug delivery systems for the treatment and prevention of infectious diseases and her background includes training in chemical and biological engineering, polymeric biomaterials, drug delivery, host response, vaccinology and other areas as well so thank you so much for joining us Anna we’re absolutely delighted to have you.
Anna: My pleasure, thanks for having me.
Charlene: Thank you. It’s also very much worth noting that you have become somewhat of an internet star with your kind of creative vaccine explanations on TikTok. Anna has reached over 200,000 followers and has 2.8 million likes across the TIkTok platform, which is just absolutely incredible. Do you want to just touch on that a little bit Anna and talk about how that got started. Where did that all come from?
Anna: Yes it’s not necessarily the most obvious application of having a PHD I will admit but I’m a part of Team Halo which is a collaboration between the UN and the vaccine confidence project and so really the whole idea with starting this was being able to connect scientists who are working on covid 19 vaccines with the general public and the platform they choose to do this over is TikTok. I hadn’t been on it before October and I think it’s actually a really great platform for it because you just make these short 15 or 60 second videos and you can show people really easily what you do in the lab, how you make a vaccine, how you test it and also be able to explain different concepts about it. Yeah it’s i think it’s actually a really great way to connect to people and you know try and educate everybody on these vaccines that have been developed this year.
Charlene: Yeah definitely. It’s a fantastic thing that you’re doing and as you said just another great way and for people to kind of engage with the information and it’s such a new innovative way and that you can spread that kind of really sound knowledge that people do need to know about and it’s absolutely fantastic what you’re doing so thank you so much for that. We’re absolutely honoured to have you joining us today. I’m sure we’re going to be getting some very valuable answers that everyone’s very keen to know. So how this is going to work, Robina will kind of bring more of the sarcoidosis knowledge and then Anna will be able to kind of implement some of her expertise with the vaccine side of things. So without further ado we’ll get onto some of the questions that have been sent in. As I said if you do have any others during the course of the video do just comment them live and we’ll try to get around to as many as possible. So obviously from our community people the main question people are keen to know is that do sarcoidosis patients come under the vulnerable category for getting the vaccine. So are they going to be one of the first in line? Perhaps Robina you’d be able to answer that one for us.
Robina: Yes as everybody knows who’s watching I expect, that sarcoidosis varies hugely from patient to patient and it can be very mild or it can be much more severe and involve a lot of different organs and the severity can vary and the treatments can vary. So it will be your GP who has made a decision based on the clinical information that they have and on your specialist’s recommendations as to whether you’re in a clinically extremely vulnerable group and that as I say will be based on the degree of organ involvement, the severity and the medications that you’re taking. So you may find people with very mild sarcoidosis are not and those with much more severe disease are.
Charlene: Yeah that’s completely understandable and then we’ve had a question from Nadia K. Thank you for commenting Nadia. She has said, “Is the Pfizer vaccine the best one for us or could we wait until one of the other formulations do arrive?”
Robina: Well I’m going to defer to Anna in a moment but initially I would say my impression from the data that I’ve seen is that the Pfizer vaccine absolutely would be the best one because it has the highest efficacy so far, so 95% efficacy. I think it’s worth saying that that way exceeds most of the seasonal flu vaccines efficacy. We hardly ever have that and I think it’s better than any of us ever really dared hope for and the other thing to remember is that a number of people with sarcoidosis may be taking immunosuppressive drugs and the situation there is that the immunosuppressive drugs may limit slightly your immune response so they may mean the vaccine isn’t quite as efficient if you’re taking immunosuppressive agents. So therefore I think it’s great if you can actually get a vaccine that’s got a really high efficacy. Now of course there are other vaccines coming on. We know about the Pfizer vaccine, we know about the Oxford vaccine and we know a little bit about the Moderna vaccine and there are other vaccines coming quick and fast behind, but on the data that we have I think the Pfizer one has the greatest efficacy and therefore would certainly be my preference but Anna you may have more to add on that.
Anna: Yeah so I think those are really good points so I guess when I talk about what a good vaccine is, there’s a couple different components to it, right? So efficacy is definitely the most important, so as Robina said, having a 95% efficacy is really good, like you can’t really make a better vaccine than that. So I think yeah, as she said, all the scientists and clinicians that worked on those clinical trials were even surprised that it was that high and the first vaccine, even Pfizer and BioNTech. So you actually have to specify in the beginning of your clinical trial what you think the upper range of the efficacy will be and they thought it would be like 70%. So they completely blew that out of the water. So it’s a really good vaccine in that way and the other side of that really is the side effects, so thinking about are there any associated side effects with the vaccine? With any vaccine it’s always a risk, right? So you do have to consider that there may be side effects. With the RNA vaccines in particular they’re really mild so actually from an immunologist standpoint, if you have side effects to a vaccine that’s actually usually really promising for us because it means the vaccine is working in some way because you know we’re trying to convince your body, like really trick it almost, into thinking it has a virus without actually having the virus. So there are mild side effects usually from RNA vaccines because your body has evolved over time to recognise foreign RNA but you mostly just get flu-like symptoms that are usually really mild and go away within one to three days. So that’s kind of what you can expect from it. So that’s for the Pfizer, BioNTech and Moderna vaccines so they’re very very similar. The only difference mainly is slightly different formulations but they’re both in lipid nanoparticles. The Pfizer BioNTech vaccine is a lower dose, so it’s 30 micrograms whereas the Moderna vaccine is a higher dose of 100 micrograms. So there might be slightly more side effects associated with a higher dose of RNA but they both have really good efficacy. So that’s kind of how I judge it, you know making my own personal choice to get a vaccine or not, going forwards but I think the Pfizer BioNTech is a really good option.
Charlene: I see, okay. So am I correct in thinking Anna that you’re involved in some of your own work at Imperial about developments around other vaccines? What are you currently working on at the moment?
Anna: Yeah so I also work in RNA vaccine development so i’m probably biased in that way, but yeah so imperials vaccine is a different type of RNA called self-amplifying RNA which is just a fancy way of saying that once the RNA is in your cells it’s able to make copies of itself. Historically we’ve seen that this enables you to use a much lower dose of RNA, so you know I said the Pfizer BioNTech and Moderna doses were 30 and 100 micrograms. What we’re testing in our clinical trial is between 0.1 and 10 micrograms, so hoping to go even lower and have even fewer side effects from this kind of second-generation vaccine. Our vaccine is still in phase two clinical trials, which should be wrapping up any day now and planning to start our phase three in January. So it’s definitely behind kind of the big Pharma but yeah just chugging along.
Charlene: Wow thank you for explaining that. That’s really interesting. It’s very much reassuring as well to know that there are so many more developments taking place and that continued research into new vaccines and developments is constantly on-going. So that’s very reassuring to know. Something that I think a lot of patients with sarcoid are keen to know is if anyone is known to have already taken the vaccine that has sarcoidosis? Robina do you have any information on that? Do we have any data?
Robina: I haven’t seen any data specifically. Of course in the early trials they will have tended to eliminate people with long-term conditions but I would say on the other side of the argument that we give the seasonal influenza vaccine to people with sarcoidosis and other long-term chronic conditions. Indeed we prioritise people with those conditions for the vaccine and we don’t see problems in people with sarcoidosis so I’ve got no reason to think that the Pfizer vaccine or the Oxford vaccine would be any different.
Charlene: Okay for sure, and then once someone and with sarcoidosis takes the vaccine, will they then be tested for certain antibodies in the weeks following that or is the next stage just getting that second shot? What’s the kind of aftercare process of taking the vaccine?
Robina: There’s no routine testing for antibodies, just like we don’t test for other after other vaccines. We give the vaccine and assume that you’re as protected as we can make you. The next step is absolutely to make sure you get the second dose that’s really key. With the Pfizer vaccine it’s 21 days after the first shot so you’ll normally have to book your appointments together to make sure that you get that, and obviously you need to be really careful with “Hands, Face, Space” following government guidelines in between, because we know that you don’t develop immunity until seven days after the second shot so it’s really important that you continue to follow all the precautions, however tired of them you are, until at least seven days after your second booster shot.
Charlene: Yeah, important to emphasise that that note about still taking precautions after the vaccine and things, just because of that slight uncertainty. Always best to act on the side of caution. We’ve had a question from Jonathan Owen and he, as many others, are kind of concerned that his dormant sarcoidosis might be flared up by taking the vaccination or something that is in it. Do you think there’s any possibility of that? Of causing a flare-up for someone’s sarcoidosis that has been dormant?
Robina: I mean there are two things I’d say to that. Based on the experience with the flu vaccine, I’ve not seen sarcoid ever flare following flu vaccination, although I have seen sarcoid flare with other acute events and I know there were concerns about whether there would be priming of the immune system such that you might get a more severe reaction, for instance when you encounter the current virus, but in fact, although the numbers are relatively small, I have to say they look pretty significant to me and Anna may comment further on this, but with the Pfizer vaccine, there were only 10 cases of severe covid in the whole group, and nine of those were in the group that had received a dummy injection and didn’t receive the vaccine. Nine to one is a pretty high ratio statistically even if you’ve got small numbers and I don’t know Anna if you want to come in on that, but I found that pretty reassuring when I looked at that.
Anna: Yeah. I agree the numbers are really strong just as far as being able to prevent disease severity. Obviously the next question then in everybody’s mind is, does it prevent transmission? Which is something they’re still looking at and following up but as Robina said, you know the nine to one ratio I think is quite convincing. Working with those small numbers, you always hope that it’s something that clear, as opposed to being like a seven to three or six to four split when you may not necessarily be able to tell the difference. So the mechanism behind that is called antibody dependent enhancement, which just means you have a low titer of antibodies, like if you make a poor immune response and this can cause a higher disease severity, but they haven’t they haven’t reported any of that yet
Charlene: Okay great. Thank you to everyone that’s been tuning in live. We’ve had some people commenting questions as we’ve been live so Jo Hammond has said that they’re particularly worried about the long-term side effects of the vaccine, especially as we don’t know if previous exposure to a vaccine has caused their sarcoidosis and similarly another commenter has said that they are also concerned about the long-term side effects since it was only tested for 10 months. What are your thoughts on this Anna? In terms of the long-term side effects of a vaccine is this something that people should be particularly worried about?
Anna: So I get this question all the time and I understand it, like you don’t want to take a vaccine that then 10 years down the line is shown to cause something. So I think it’s important to consider the situation and the decisions that we’re making, right? So yes, the clinical trials have only gone on for 10 months, right? So we don’t know 10 years down the line what it may cause but the way we kind of infer this is comparing to similar vaccines that have been used. So we keep saying that RNA vaccines are a relatively new technology, this is true, but it’s really only because relatively all the old ways of making vaccines are really old. So the first RNA vaccine trial was actually done in humans in 2013. So we didn’t know until this year with the phase 3 trial that they could work so well but they actually have been tested for a number of years now. So because with RNA vaccines, it was a very similar formulation that they’ve used for you know seven years now, we can go back and look at those patients and see that there weren’t any weird side effects from that clinical trial and say “okay so this does have a good safety profile so we think that vaccines made in the same way with similar ingredients will have a similar safety profile”. The other thing to consider I guess that convinces me, is that there’s a similar drug which is called Onpattro, so it’s not a vaccine it’s a treatment and that was approved by the FDA in 2018, so it’s a very similar formulation. It’s RNA and lipid nanoparticles and to get FDA approved obviously they had to have years of long-term surveillance of patients. So we do actually have a lot more data than it seems obvious about RNA vaccines and different RNA formulations so our best guess is that they won’t have long-term side effects, but the other side of the sword is really thinking about long-term side effects of covid, right? Because we actually, I would say, understand even less about the virus and the long-term effects that it may have, so we know now that it can cause lasting damage to your lungs or brain or heart and so you know it’s kind of taking a risk between getting the vaccine which, we think will have maybe some short-term side effects that are abated and then unlikely to have long-term side effects, versus getting a virus that may actually cause long-term damage. So that’s kind of how I think of the choice of getting the vaccine or not.
Charlene: Thank you, I think that’s really important and such a key thing to note is that although it might seem that the vaccine was developed quite quickly, we do kind of have this history and this back database of this type of vaccination and so it’s not like it’s something that’s completely in the dark for us, so thank you for explaining that Anna. We’ve had quite a few questions coming in around medications and taking the vaccine, so Robina’s already mentioned people who are on immunosuppressants, and just to clarify Robina, should people stop taking their immunosuppressants temporarily to be able to have the current covid vaccine?
Robina: No, there’s no indication for that. I think we said previously in one of these sessions, the vaccines that we really worry about in people who are immunosuppressed and that includes people on oral steroids like prednisolone, are live vaccines. So there is a live polio vaccine although it’s not the one that’s usually used, yellow fever is live and Anna may be able to add one or two. I think rabies might be as well, but generally in this country we don’t need yellow fever or rabies vaccinations, but if you are immunosuppressed and you want to travel to a country that insists on those vaccinations then you will have a problem, so that’s where you have to have a discussion with your doctor about the risk and risks and the benefits of traveling and stopping your medication or not traveling and continuing your medication, but these vaccines don’t contain any virus and they don’t contain any live virus so there is no risk to somebody who’s immunosuppressed in that respect.
Charlene: Okay thank you and Jo West has commented live on the video saying, “is the vaccine safe to take during an acute flare of neurosarcoidosis that is currently requiring increased immunosuppressive medication?” So it’s not her usual level of immunosuppression, it’s actually an increased amount. Does the same advice still apply?
Robina: I think it’s tricky I think if you have any acute illness you’re usually recommended not to have vaccination at the time, not least because the possible side effects and vaccination could then get mixed up with the acute illness and the acute illness could be attributed to the vaccine and so on. So I think it’s tricky, I think your condition needs to be reasonably stable before you have vaccination but if it’s just that somebody has stepped up your treatment and you’re taking a bit more and you’re stable on that increased dose then I don’t see why you shouldn’t have it, but bear in mind as well I’m not responsible for any individual’s care, so I can only give general advice and I’d always recommend in that situation that you contact your specialist who I’m sure will be happy also to give further advice on that.
Charlene: Of course, we would just like to emphasise that obviously we do these Q&A videos to try to spread as much quality information as possible, however if it’s down to a specific case of your individual care it is always important to speak to your doctor or consultant. For everyone’s reference as well, we did release a statement on vaccines today which you can find over on our Facebook page on our website. That also does outline the fact that if you have kind of specific questions that are really unique to your own case that you should still be speaking to your consultant and/or doctor and that we are here primarily serving as providing quality advice and information but you must still take that up with your doctor if necessary. Just in terms of a few more medication questions with regards to the vaccine, we had a comment from Nusrat who said, “I’m allergic to Penicillin, can I still take this vaccination?”
Robina: Yes, you should be able to take it and remember there’s no protein in the vaccine so there should be a very low incidence of allergic reactions. Obviously there have been a couple of reports of allergic reactions which obviously caused consternation and anxiety although I understand that individuals have recovered fully and very quickly, but the advice at the moment is if you have a history of anaphylaxis, so a severe life-threatening allergic reaction to anything, you shouldn’t have the vaccine, but as long as it’s not an anaphylactic life-threatening reaction, you should be able to have it. Now penicillin is difficult one, if you do get you know swelling of the lips and angioedema and facial swelling and difficulty breathing and wheezing, then you will be told not to have this particular vaccine, the Pfizer vaccine, but we don’t have any advice yet obviously for the Oxford vaccine, it’s not yet approved. We’re still waiting on the Moderna vaccine so it’s likely, I would hope that Anna may want to come in on this, that there will be another covid vaccine down the line that you can have.
Charlene: So for people who are at the top of the list at the moment and they’ve maybe been contacted, they’ve received a letter or something to say that they are on this first priority list of getting the vaccination, but they do have sarcoidosis and they maybe have a few other concerns, would your advice be to them to go ahead with it or is there any positive in them kind of waiting for the next vaccines to arrive? Is it the case that they should go for this first one if they are on the priority list?
Robina: I would suggest they go ahead with it, partly because they are on the priority list and somebody’s made that decision and partly because at the moment it appears to be the one with the greatest efficacy, and as I said before if you’re immunosuppressed, you may not produce such a good antibody response anyway. I think if you’ve got concerns or you are worried about allergies and so on and you’re under specialist care, I think it’s perfectly reasonable to just drop a note or a call to your helpline, your sarcoid specialist and just ask them, but obviously remember they will be busy too and if you get inundated with queries you may just sort of get a generic response. I think the information you’ve put out on the SarcoidosisUK website is very helpful.
Charlene: Of course, we would urge everyone to look. We’ve also got a coronavirus FAQ section on our website and if you need any more specific information and then that is a very useful source that you can go check out as well. Carol Wales has commented saying “is it safe for us who have a gluten intolerance to be able to take the vaccine?”
Robina: As far as I know yes, Anna there’s no cross reactivity with gluten that I know of?
Anna: Not that I’ve seen, no.
Charlene: Fantastic and then just a couple of questions around reactions to the vaccine. One user said “it has been suggested that how we react to the flu jab might be an indicator of how we will react to the vaccine, is this true?”
Robina: Well it’s a different type of vaccine so I don’t think you could necessarily extrapolate but as Anna said you may get mild sort of flu-like symptoms, because as she said you’re trying to trick the body into thinking that it’s having the infection without giving it the infection. You may get a bit of a sore arm at the injection site so all those are to be expected as minor side effects.
Charlene: Okay fantastic, thank you. We’ve had um a live comment from Rob and he has asked a question that I’m sure many other people will want to know as well. It’s regarding the new strain of the virus, which we will all have seen on the news over the last few days. People are keen to know whether this Pfizer vaccine is still going to work against the new strain. Anna is that possibly something that you’d be able to answer for us?
Anna: Sure, yes. So obviously you know it’s of huge concern and scientists are constantly monitoring the mutation so there’s actually been a few mutations thus far, so most of Europe has what’s called the D614G mutation which is different from the original strain from Wuhan. There was a different variant called the A222V that people picked up on holiday in Spain this summer, so it is constantly mutating. The newest one is a two amino acid deletion and really what’s causing concern and it’s gotten a lot of media lately, is because, we are now seeing more and more of this strain in the UK, so you know it is the prevalent strain now that’s circulating here, and we’re also seeing a higher number of cases. There’s not any data yet as to whether it is more transmissible or more contagious so this is something that obviously we’re studying, so you know this then brings into the question, getting back to the original question, how does this affect the vaccine? So I think there was a press release this morning from the Pfizer CEO saying they need about two weeks to test whether the vaccine will still work? This should actually happen pretty quickly so the way they do this is they take blood from people that have been vaccinated with the Pfizer BioNTech vaccine, they do experiments in the lab looking at whether it neutralises this new strain of virus in the same way and then they can say whether the vaccine changes the way that it neutralises the virus. So these are these are tests that are on-going so we don’t know yet if the vaccine will have any different efficacy against this new strain but what’s important to consider is that a few mutations in the spike protein are not going to make the efficacy drop to zero, right? It’s not just a binary. It’s still the same protein. It might be slightly less efficacious, which is something that will have to be defined, but it’s not going to completely stop working. So really my answer is to be determined, so just stay posted.
Charlene: Okay thank you Anna. We’ve had a question from another user commenting live who would just like some clarity on who exactly decides who gets the vaccines first. Their personal experience has been that their GP is not very supportive of her husband who has sarcoidosis getting the vaccine. So just for some clarity on where this priority list comes from, who is involved in this decision making as to who’s going to be getting the vaccine first? Robina or Anna are either of you’re able to answer that?
Robina: Yes, I mean my understanding just to kick off is that it comes from the government guidance. Obviously the very elderly were prioritised to start with and then they’re gradually working down the age groups and they are including frontline NHS healthcare workers as well in the second group. I think it’s the next group where patients with long-term chronic conditions will get priority, but remember there aren’t so many people over 90 in this country. There are rather more over 80 and there are a lot of people over 70, so it’s going to take quite a while to work down those groups and you know this is a massive undertaking. GP surgeries are pooling efforts. Some are contributing space, some are contributing staff, some are contributing admin skills and comms, but they’re working you know flat out seven days a week from seven in the morning till ten at night, delivering the vaccine and I think actually it’s a huge achievement to have delivered half a million so far. That is absolutely fantastic. It’s never been done. This has never ever been done in history. So yes it is frustrating, it is difficult. If you’re worried again and you’re under a specialist for your sarcoid, go and contact them and see what they think. It may be that it needs a conversation with the GP, but just bear in mind, many people would like this vaccine as soon as possible and everybody’s just going to have to be patient I think and wait until it’s their turn, but it is difficult I realise.
Charlene: Yeah, definitely. We’ve had a comment from sally. Thank you for tuning in sally. She’s commented via Facebook saying that she was diagnosed with pulmonary sarcoidosis and had covid in November and is still struggling. She is wondering how she would know if she had long covid and then secondly whether she should still get the vaccination considering she has already had the virus.
Robina: Yeah so on the long covid there is now a nice short rapid guideline on long covered and that will give you the time scale. I think it’s symptoms more than six weeks out, but I’d have to check that so don’t quote me, but I think it’s open access so you can have a look at that, bearing in mind that you know all viral infections can take quite a long time to recover from, I mean if you have a really bad bout of seasonal flu it will knock you back for several weeks, so that’s not unheard of and covid’s no different, it’s just that we know in some people it’s really much more prolonged than that. In terms of having the vaccine people are advised to have the vaccine when they’ve had covid but I wouldn’t suggest that you have it when you’re still recovering. Anna you got any more thoughts on that?
Anna: Yeah, I think that is the advisory right now, so they did a special arm of the clinical trial. In the first instance they were just looking at 18 to 55 year-olds or also in the elderly in this case, who were antibody negative at the start, just making sure the vaccine had an antibody response, but they also, as a special arm of the clinical trial, included people that were antibody positive when they first started the trial. So they had already been exposed to covid and had already generated an immune response and really conclusively what they saw was that the vaccine does boost the immune response. So now it’s indicated for people that previously have had covid 19 to get the vaccine as well. This is actually really important because we know that from the natural infection, the antibodies last for about three to six months before they start to wane so you may not be protected for more than three to six months after you have the natural infection, so really important for people to be getting the vaccine even if they’ve already had covid.
Charlene: Okay thank you for clarifying both of you. It’s great to have both of your input on that. So at the moment we’re at the stage where obviously the vaccine is not compulsory to take. Do you think that maybe for healthcare workers first of all or then extending to the general public, do we see it in the in the future at all that this is going be something that is strongly encouraged or will it cross the point where everyone will have to have their dosage at some point? Do we have any knowledge on that so far?
Robina: I would imagine in this country the government would be very reluctant to make it compulsory. NHS hospitals already have a very strong encouraging presence in terms of their staff getting the flu vaccine, but it’s not compulsory, although it is reported and it is monitored and there is quite a lot of pressure on people to get it. I would imagine it’s not going to exceed that and it’s not going to be made mandatory. What I can’t predict though is how other countries might react and for the last 20 years or so, people have got used to traveling all over the world with virtually no restrictions. I am old enough to remember the last smallpox outbreak when I was a child. My parents and I lived abroad at the time and we were in England when it when it happened and before we could go back home, we had to go and have a small box vaccination at the local GP surgery as an emergency. So you know that’s not just an illustration and when I was doing my student elective in Africa many years ago, I had to have rabies and yellow fever before I could travel there. So countries set their own vaccination requirements and I imagine that New Zealand will not let people in in future unless they’ve had a covid vaccine. I mean seeing the way that government has responded I would imagine that will be mandatory for anyone wanting to visit that country, but that’s just that’s just my impression and speculation.
Anna: I wholeheartedly agree. I also really firmly believe people should make their own choice about what they’re putting into their body, so you know I actually tried to never convince people to get the vaccine, I try to just give them the information so that they can make a good decision for themselves. So i think here in the UK it’s not going to be mandatory from the government which i think is right, but as Robina said it may be required for travel or other things that you sometimes have to get vaccinations for like attending a university or something like that, so to be determined when those guidelines will be set in place. I wouldn’t be surprised if there were travel regulations sooner than later just because there’s really no other way to control with the global spread of people since we already know this virus knows no borders, so yeah remains to be seen but it’s not mandatory at the moment.
Charlene: Yeah for sure, I think a lot of this does just remain to be seen and a lot of it is just speculation at the moment, how this will continue to pan out and things but it’s definitely been very reassuring, the answers that you guys have given today and I think it will bring a lot more clarity to people because I know that there is a lot of speculation around the vaccine. As a charity SarcoidosisUK, our position is very clear that we do support the vaccine and we very much encourage people to take it if they are comfortable to do so, it’s something that is going to be kind of looked at very carefully in the coming months as well with the new developments of the other vaccines. So I’m sure that we’ll possibly be holding more of these in the future but in terms of them today’s questions that is just about it. We’ve had a last remaining one from a few people online that have just said “thank you this session has been extremely reassuring” and we’ve given the answers and that people have been looking for. Everyone’s expressed their absolute gratitude to both of you for answering the questions. So thank you so much guys and for taking the time out and for anyone who’s watching and possibly not been able to tune into the whole thing, this whole video will be put up on our website along with the full transcript so you will have a chance to be able to go back watch the whole thing if you need to re-watch certain bits and read the transcript as well. It will also stay up on all of our social media pages so do take a look back if you if you didn’t manage to catch the whole thing but as I said earlier SarcoidosisUK have also released a statement around the vaccine, which is available on our Facebook page and website as well and if there are any more developments, as I’m sure there will be in the coming months, we will be quick to respond to those accordingly. I think that is everything for today, so thank you so much Anna and Robina for joining as I said it’s been absolutely invaluable the information and advice that you’ve given today and I think it’s cleared a lot of things up for so many people, so thank you very much. Lovely to have you join us.
Robina: We wish everyone a happy Christmas and a better New Year!
Charlene: On behalf of myself and the rest of SarcoidosisUK, Merry Christmas everyone. I hope that whatever tier you’re in and restrictions you’re currently under, that you’re still able to enjoy the festivities. I know that it’s a very challenging time for a lot of people and we understand this Christmas is looking very different to previous years so I hope that 2021 brings kind of better things for everyone and that you can still kind of enjoy this Christmas period. Thank you so much everyone for tuning in and thank you again Dr Robina and Dr Anna as well, greatly appreciated. Thanks everyone!