Computer generated transcript

Warning!
The following transcript was generated automatically from the content and has not been checked or corrected manually.

Hi. My name's hello. Right. Hi. My name is Tony Hazel. I'm a GP in the UK I'm going to be talking today about vaccine hesitancy and the difficult Converse conversations which we have to have sometimes in primary care with with people who don't want to be vaccinated and particularly with people who don't want their Children vaccinated. Obviously, I'm speaking from a UK perspective in UK using UK resources. Um, the rules in in different countries, maybe different. There are some countries where you you can't send your child to nursery if you're not vaccinated. Um, but the general principles are the same. Um, those are my declarations of interests. So this is what I'm going to talk talk about today. A brief history vaccinations generally and of the anti vaccination movement. A little bit about measles, um, bit about vaccines and autism. How how to use the presumptive ask to increase vaccination rates, how to talk to a parent who's hesitant about vaccinating their child. And I'll just cover a few of the common issues that have come up about the covid 19 vaccine. So this is Edward Jenner, Um, in 17 96 he noticed that milkmaids. Women who milked cows for a living. They were exposed to cowpox, and they didn't seem to get smallpox and smallpox At that time. It was a very deadly illness. It's now largely been eradicated. Uh, and he noticed that. And so in 17 96 he took some material from a cowpox lesion, and he rubbed it into the scratch skin of his gardener's son, who had a cow pox illness. And then he very bravely, really for the boy. Add for Edward who who would have probably been done for murder if this child had died. Um, exposed him to smallpox and the boy did not develop smallpox and vaccination developed out of this. This isn't the first known, um, uh, incidents of this sort of thing being done, but he is really considered to be the father of vaccination, and smallpox was eradicated worldwide in 1967 So benefits of vaccination you know, no doctor should be anti vaccine. There is absolutely no excuse for a healthcare professional not understanding the benefits of vaccination. Since we started vaccinating in the UK in 1976 against measles, we think we've prevented for 2.5 1000 deaths and 20 million cases. There's probably an estimated 1300 babies who were not born with congenital rubella due to vaccination. And if any of you have actually seen congenital rubella as I have, you will know that preventing even one case is an extremely worthwhile to do worthwhile thing to do. We've had big reductions of 50% in invasive meningococcal disease, 26% in gastroenteritis. Admission's genital warts have plummeted due to HPV vaccination, and the fact that we are now routinely vaccinating against a HPV is likely to have an effect on the cervical smear program that we will be able to probably do it less often in the future. And it's estimated that nearly 40,000 cases of invasive pneumococcal disease have been prevented, so vaccination is absolutely worth doing. Not everyone disagrees, and this is the sort of vaccine hesitancy continuum. So over on the left over on the green, you've got the sensible people who get vaccinated, and then you've got some who are a bit doubtful, and then you've got some who might delay. But they'll probably have it done in the end, and then that the very tip you've got the small number of vaccine refusals in the orange and absolute vaccine deniers in the red. So it's a it's a continuum. And this is relevant because the amount of time you spend trying to talk to someone who is anti vaccine should vary depending on whether they are vaccine hesitant or they are a vaccine deny. So it is just worth trying to work that out. The W. H. O says that vaccine hesitancy is on the top 10 threats to global health, and I'm sure they're I'm sure they're right about that. So a vaccine denier that was the very small tip of that diagram on the previous page in red is a very small subgroup at the extreme end of those who have concerns about vaccine. And the W. H. O. Um says that these groups are like science deniers. They are like religious and political fanatics. You are not going to change their mind. A vaccine refuse er is someone who will automatically refuse vaccinations. But they might be convinced by the evidence, whereas a vaccine deny is not going to be convinced by the evidence. Now, the relevance of this is that health care. Professional time is valuable. Every minute we spend with one patient, we're not spending it with someone else. If you are in a room on your own with someone who is a fanatic vaccine denier, do not waste your time trying to persuade them you're not going to manage it. It's worth maybe a bit of time trying to present a trying to persuade a vaccine refusal or someone who's vaccine hesitant but not a vaccine denier. Um, the only exception to that is when there is another audience. So the w h o. Point out that if you are speaking in public, for example, and a vaccine denier asks the question, then it is worth engaging them with them because your actual audience is the wider audience for your, for for your talk, not for the vaccine denial in healthcare. The wider audience might be other family members. So if mom is an absolute vaccine denier, but Dad is there too, or grandma or someone else, then it is worth having that conversation because you might persuade the other person in the family. But it is not worth having a conversation with a full on vaccine. Deny if they are the only person there. Um, and I think this this, um, sums up very well how vaccine denies. Join the dots. Not always in a logical way. We've all seen this sort of stuff on the Internet, and there is a huge link between the anti vaccine movement and social media. Social media is great for helping people to connect in situations such as in war and difficult situations that can keep people talking to each other. I use a lot of social media as part of work among quite a lot of medic groups, which are extremely useful. But there is no doubt that social media has helped to fuel the anti vax movement. Social media account held by anti vax is have the increased. They're following by nearly 18 by nearly eight million between 2019 and 2020. They have huge number of followers. There is a big correlation with getting all your information from social media and being vaccine hesitant. There is change starting to happen over sliders, pre Elon Musk's ownership of Twitter. So who knows what will go on there? Certainly some posts are being marked as fake news I noticed that when I have medical discussion about Covid 19 on Facebook often pops up a little thing saying, Do you want to visit the Covid 19 information center? But I think there is a long way to go, and certainly in the sort of darker, less regulated bits of the Internet, there is a lot of very concerning discussion going on about vaccination. Um, and this is just really to remind you that the vocal vaccine denier is a small chunk of the people who are vaccine hesitant in some way or another. So don't bother to engage with the vaccine deny unless there's someone else in the room. But it is worth this hesitant group and this Vaccine Refusal group. It is worth having a discussion with them. So let's talk a little bit about measles because, um, the MMR measles, mumps and rubella vaccine is one of the ones that has been a huge focus for vaccine deniers. But before the MMR, there are about 100 and 70,000 cases of measles a year in the UK, and you see it had massively dropped with vaccination. And then, of course, it dropped again during Covid but I presume has come up since then. Um, in 2018, we had about 90. Just under 95% coverage, Um, for the first MMR vaccine and and a bit under 90 for the second. So what's the problem with measles? Um, symptomatically. It can be a little bit like any other childhood infection. The child feels a bit rubbish. They've got or any nose. They're snotty temperature. They can have a temperature up to 39 they get a rash. And this is the typical thing to look out for. It's an erythematous, a red rash that starts usually on the face behind the ears and then joins up and spreads down the body. And it lasts about a week. And these little white spots on the buck click mucosa the Koplik spots. They are pathognomonic. If you see that, does the child has measles? Um, the rash only lasts a week. The child gets better on their own. What's the problem? And this is what a lot of people say about measles. It's just a childhood illness. My kid gets better from all they're other coughs and colds. Why should I worry about measles? Well, the problem with measles is that, yes, most kids will get better from it. But quite a lot won't, um In developed countries, 10 to 20% have complications for several weeks. After you have measles, you have increased susceptibility to other opportunistic infections. Complications can be in the respiratory tracts such as pneumonitis and pneumonia, more severely in the central nervous system. And there is this really nasty thing called subacute sclerosing panencephalitis. One in 25,000 people, they get their measles, they appear to recover their absolutely better. Seven years later, they get seizures, a decline in central nervous system function, and it is inevitably progressive and fatal. There's nothing you can do about it. So it is always worth asking someone, particularly young adult who suddenly presents with seizures, and they're nervous function going off. Did you ever have measles? If they had measles seven or eight years ago, then think about suburb disclosing panic artful itis as a diagnosis. Um, and as I say, it's something that you can't do much about. Um, Roald Dahl's a very famous author in the UK I don't know how popular he is in Ukraine, he wrote books like Charlie and the Chocolate factory and the big friendly giant. Um, and his daughter died of measles. This is on the website of the Royal Dahl Museum. Um, and Olivia, my eldest daughter, caught measles when she was seven. I read to her in bed and was not particularly alarmed. Then one day, when it came to her turn to make a little animal out of pipe cleaners, her fingers in her mind weren't working together and she couldn't do anything. I feel sleepy. 12 hours later, she was dead. There was nothing he could do about it. There is still nothing we can do about it once the child has measles, but we can stop them from getting it. So in 1998 a man called Andrew Wakefield and a load of other doctors published a paper in The Lancet that linked autism and gastrointestinal disease to the MMR. It was disputed and disproved pretty much straight away within two months, certainly by the Medical Research Council and by a large study from Finland. But the problem is, the damage was done. They say that a lie can get around the world before the truth has time to put its boots on, and that was very much the case here. So within three years, vaccination rates have plummeted to well below 95% and we were seeing an increase in cases of measles. Now, any doctor and any researcher can make a mistake. Um, and papers are sometimes edited after publication and there sometimes attracted because a genuine mistake has been made. None of us are perfect. Sometimes these things aren't genuine mistakes. Sometimes these things are intentional and dishonest. And sadly, that was the case here. So Andrew Wakefield was struck off. That means his medical license to practice in the UK was removed after the longest running case in the history of the General Medical Council, the body that regulates doctors in the UK He was found guilty of 1st 30 charges, and they used words like dis or dishonest, irresponsible, callous disregard for the distress and pain of Children. He had loads of undeclared conflicts of interest, including a patent for the single MMR vaccination Sorry paint night for single vaccines for the M measles. The mumps and the rebellious are clearly of people lose trust in the joint vaccination and they go off to have single ones. He was going to become a very wealthy man. His study didn't have ethical approval. He did all sorts of things, like take blood from his Children's friends at their birthday parties. And he'd received nearly half a million pounds in legal aid by lawyers who are hoping to mount a challenge. The MMR vaccination. So I'm going to talk a little bit later about how you can talk to parents about the MMR and about autism. But I think it is reasonable to make the 0.2 parents that this wasn't just an honest scientist who made a mistake. This was a deliberate attempt to mislead. So going back to sort of what you know, talking, talking generally, two parents, the presumptive ask is basically when you assume that the person or the child is going to be vaccinated. So instead of saying, would you like a flu vaccine, you say it's time for your flu vaccination? Hang on, I'm just going to get it from the fridge. So you are making the assumption which will give the patient the assumption that the vaccination is a good thing Now. Obviously we don't vaccinate without consent, and the patient has every right to say no. Hang on. I don't want it. But there is evidence that using the productive presumptive are significantly increases, uh, vaccination rates. So it is something worth doing and just having a few phrases on the tip of your tongue. Now a point about consent and vaccination for Children. So we don't ask that both parents come to the vaccination appointment. We will vaccinate a child when anyone parent comes. We will vaccinate a child if they're brought by their grandmother or something, you know, as long as they have consent from the parents. So we assume that both give consent, and that is absolutely fine. But if we know that a person with parental authority, parental risk, responsibility, objects, So if we know that Mum wants a child vaccinated and Dad doesn't, then unfortunately, we cannot vaccinate that child without a court to order. I think it's it's ridiculous. You know, the parent who wants a child vaccinated should be allowed to prevail because vaccinations clearly in the child's best interest. But unfortunately in the UK, that is how the law stands at the moment, and obviously that may vary depending on what country you're working in. So how to talk to a vaccine host and parent? If it's MMR they're worried about, then tell them about Andrew Wakefield. Tell them about the problems. Make sure they understand The second one is really important. I often hear parents say something like, Well, if they get measles and they and they have a side effect from measles, that's not my fault. They've just got the measles. It happens. It's the measles fault. But if they're harmed by the vaccination, then that's me. I've harmed them. Um, it's a sort of like, Well, if I don't do anything, it's a kind of rabbit caught in the headlights. If I don't do anything, I can't cause my child any harm. Debunk this myth, make it clear that good parents vaccinate their Children that they are making an active decision not to protect their child. And if their child comes to harm from measles, it will be their fault for making the active decision. And I I use words like that with parents. Don't deny that vaccines can sometimes cause harm. Any medical treatment that has an effect can have a side effect and I'll talk about this a little bit more later on. But you know, if we deny that any harm is ever caused by vaccines and I think we're giving, we're saying unrealistic things and we people will not believe us. One of the other things that people say, Oh oh, I don't want to bring my child for all these vaccinations like, you know, the newborn, diphtheria, tetanus, pertussis, all of these at the same time because it overloads the immune system well, that is utter scientific nonsense, because a child is exposed to many more antigens just walking around in a normal day, so you can make it quite clear that that's not a problem. Be confident in saying that there's no mercury in UK vaccinations and make it very clear, certainly in the UK that they cannot opt for single vaccinations because there is no available months vaccination in the UK, and I suspect that there is no available months vaccination in many parts of the world. Um, and of course, if they go, if they did manage to somehow get that or if they do, the other 21 single, they're leaving their child unprotected for a lot longer, and there's a risk of not following up for all these second vaccinations. So, as I said, harms happen. The only medicine that probably has no side effects is homeopathy because it's essentially water. Any medicine that has an effect will have a side effect. So we have common, self limiting side effects, such as pain or redness at the injection site, fever, malaise or fainting. But in the UK, there is a vaccine damage payment fund, and it's paid out 74 million lbs since 1978 so some people are genuinely harmed. We know that about one in 50,000 Children who have the rotavirus vaccination will get into susceptive in roughly one in a million Children who have the MMR, we'll get we'll get encapsulitis. But one in 1000 who have measles will get a couple itis, so there's a much greater risk from the disease than from the vaccination. Um, probably about one in 900,000 Children get anaphylaxis from a vaccination. There's been some very rare cases of neurological damage due to pertussis and the occasional case of Guillain Barre syndrome from flu. But again probably the risk from the disease is more than the risk from the vaccination, so that the the thing here, the thing to say is, yeah, I'm not denying that vaccines can have side effects, but the benefits of the vaccine far far outweigh the risks. Vaccinations do not overload the immune system, so we all come into contact with millions of bugs or germs or call them what you will every day. Um, and it has been estimated that the immune system of the human body could cope with thousands of vaccines given at the same time. Um, and of course, a vaccine only contains part of the infection that it's vaccinating against, so it causes less challenge to the immune system than the disease. And vaccines do not weaken the immune system. That's another quite common thing that the anti vaxxers will say so vaccines and mercury There is no mercury in routine childhood UK vaccinations. I'd be surprised if there is in in vaccinations used in other countries, or obviously I I don't have the knowledge about every individual country. Um, there are very few vaccinations are more unusual ones, like anthrax and Japanese and careful itis where they contain a small amount. Um, and the Thio Mursal that is in vaccines is absolutely safe. There is no evidence of an association between that and side effects, including neuro developmental problems such as autism. So why has autism increased? A common anti vax trope is. When I was a child, we didn't have all these vaccinations and you didn't see all these autistic kids around. And now we vaccinate our kids and there's loads of autism around. And this is the sort of poster that you might see on social media trying to make a link between increases in autism rates and increases in the number of vaccinations given to Children. So when autism was first described in the 19 forties, the first description by Leo Kanner was a group of very, very severely affected Children who we would now to be considered to be at the most severe end, largely nonverbal and so on. And then around the same time, there was a broader spectrum described by Hans Asperger, which led to the coin the phrase Asperger's syndrome. Although we don't use that anymore because of some concerns about Asperger, what we tend to use a phrase autistic spectrum, but the the the increased prevalence is basically to do with the widened diagnostic criteria. So, um, there are Children who we are now recognizing as being autistic, who decades ago wouldn't have had that label. But they would have been given some other, less complementary label. Often, you know, backwards odd. Some of these people would have ended up in institutions without a diagnosis. So there is no doubt that it is to the benefit of Children with autism that we are diagnosing them. But the true prevalence has not increased. And there's been some very interesting studies looking back to the 19 seventies, showing that the prevalence of autistics traits traits have remained static and also some interesting ones with Children who appeared to the parents of Children who appeared to demonstrate to develop autism after their MMR showing that actually a lot of the traits had started to become apparent just before the MMR. And of course, we give the MMR at around the time that autism becomes apparent. So in the same way that the flu vaccine doesn't cause flu, but we give it in the cough and cold season season, so there will always be some people who get a cold or flu straight after their flu vaccination, we give MMR roughly the time that symptoms of autism start to become noticed. So, um, the Green book is the sort of bible of vaccination in the UK Um, and these are some useful facts to have at your fingertips. I think most parents can understand the sort of brief principles of cause and effect, so autism is not more common in Children who are unvaccinated against MMR. There has been no clustering of autism diagnoses after the MMR vaccination, and crucially, that increase in the apparent prevalence and diagnosis rate of autism started in the UK before the MMR vaccine was introduced. The MMR was withdrawn in January in 1993 and cases continued to rise Cases of autism, as they have done worldwide, and there's no correlation between coverage of MMR and autism rates. So if there was a connection, you'd expect that in an area with low MMR coverage, there'd be less autism and vice versa. Um, there's been no vaccine virus detected in Children with autism, and there's been big meta analyses that don't show any link. So these are useful facts that either have at your fingertips or if you can't quite remember them. And you're somewhere where you've got a computer in front of you. I put the link to the green book at the bottom and they're all listed there. So move away from the MMR and autism now on to covid 19. So I've spent awful lot of time over the last two years trying to persuade people to have their covid 19 vaccine. Um, I've largely given up now because I think anyone who was going to have it has had it by now. Um, but a particular thing was young women women of childbearing age who didn't want to have the vaccine because they were either trying to get pregnant or they were pregnant or they were breastfeeding. And this is actually a group that I have had some success once. You sort of explain the facts in managing to get them to have the vaccine and therefore keep themselves protected. So I thought it was worth just making sure that, you know, you have these facts to your hand, so the covid 19 vaccine doesn't reduce fertility. There have been anecdotes, and I think quite a lot of cases of women whose, um periods have been disrupted for a couple of months after having the vaccine. This isn't uncommon with other vaccinations or with any sort of, um, infective condition. Like if you get the flu or indeed you get covid 19. But it doesn't mean that your fertility is reduced. Of course. Covid 19. Um, if you have covid 19 and you're pregnant, particularly the third trimester, you are much more likely than others to be admitted or to be severely ill or to die from your covid 19. And I've I've seen interviews with people who work on covid 19 intensive care units, saying that, you know, among all the terrible trauma through the pandemic, absolute worst thing was some of the pregnant women. There were some peri mortem cesarean sections baby's born who will never meet their mother because the woman died of covid 19. Um, you can't catch covid 19 from the vaccine. Clearly, it's not a live vaccine, um, and as well as being pregnant, increasing your risk of getting seriously ill with covid the disease itself increase the risk of complications in your pregnancy. So things like still birth and prematurity are more likely if you get the Covid 19 infection, whereas the large amount of experience we now have it shows that there is no increase in miscarriage, prematurity, stillbirth, congenital abnormalities or having a small for gestational age baby. If you have the vaccine in pregnancy, a lot of people point to some of the vaccines not having a license for pregnancy. Lots and lots of things that we give don't have a license for pregnancy and indeed for use in Children. Because, um, if for a lot of medicines the study just aren't done in pregnant women, it's far too complicated. You wouldn't get women coming along to have the thing done, so that is just a bit of a red herring, because it's very, very common. But they've been over 350,000 pregnant women in the US in the UK combined who have had the vaccine and no interest, no increase in any of these complications. There is no risk to delay till 12 weeks. I can completely understand why people do, because, um, obviously your your miscarriage risk is increased in the 1st 12 weeks, and I can understand that someone thinks Well, if I'm eight weeks pregnant and I have the vaccine today and I miscarried tomorrow, I'm always going to wonder. And I get why people do that, and it's someone is worried. Then just saying, Well, look at your appointment now for 12 weeks doesn't seem unreasonable. But if a patient wants to go ahead and they're just looking for reassurance, you can reassure them that there's no connection with miscarriage and no reason to wait 12 weeks, and there's no reason not to breastfeed. And indeed, you might get some, um, antibodies in the breast milk, which might benefit the child. So we don't use the AstraZeneca AstraZeneca vaccine in the UK anymore, not because of these side effects, but because the Pfizer's and Moderna and other brands have been shown to be more effective, and we have enough stocks of them. But I suspect it is still being used a lot, and it is a good, uh, an effective vaccine. There were some cases of idiosyncratic blood clots, very small number, so 440 for reports and 86 deaths after 49.1 million doses of the vaccine, roughly split evenly between 1st and 2nd doses. So obviously any death from a from a vaccine or from any medical cause is a tragedy. But they will likely have been more deaths from covid prevented by the use of this vaccine. It's an idiosyncratic reaction, so that's probably the most important thing. If you're working in a clinic, which is using the AstraZeneca vaccine, Um, if someone has an increase in risk factors for blood clots such as they have obesity or they've had a blood clot in the past or they're taking the combined contraceptive pill or something like that, they can still have the AstraZeneca vaccine that doesn't put them at a higher risk of blood clots. Um, and of course, we all know now that lots of people who died from Covid 19 actually died from blood clots. So the risk of thrombosis is greater from covid 19, the disease than from any vaccination. So in summary, there's no link between vaccine and autism, and this is absolutely clear, and you need to be clear to patient's. It's not all the links, very small or oh, the risk is tiny. There is no link. It is worth trying to convince someone who is vaccine hesitant, and you're probably more likely to convince them if you have some facts at your fingertips. But don't bother with your true vaccine denies when you are talking about the MMR, you know, I think it is worth saying that in the G. M. C's report, they called him dishonest. Um, so this is not a case of someone who made a mistake. This is someone who had significant financial interests in getting us to stop vaccinating our Children with the MMR. Um, and measles is not just a routine childhood illness. It's a serious and sometimes fatal disease. So thank you very much. I'll stop share ing. I'm happy to take any questions either from the chat or I can't see any yet or individually anything. I know people are having some problems with Internet, which might cause problems with putting questions in the chat and so on. Thank you. You're welcome. Uh, just a question for you, doctor. Um, so just regarding the, uh, vaccines in terms of, like, combining vaccines, do we do we? Is there anything because they don't test people combining vaccines? So is it like a general rule? Not too or like all the way we should. Yeah, no, that's a very good question. So when the Covid 19 vaccine first came out, it was advised that you separate covid and flu, which we were giving it a similar time by a week. But that was more precautionary. So with non live vaccines, there is no reason to separate them. The only reason is that obviously, if someone gets a side effect and you given to vaccinations, then you don't know which one they have the side effect, too. Um, generally speaking, if you give them in different arms and you record which arm one was given in, then if the arm goes red, you know which one it was. If you have to give them the same arm, just space them out by at least 2.5 centimeters. There are a few live vaccines that shouldn't be given together, and I generally it's often sensible to separate live vaccines by a month. But to be honest, I would usually look that up because it it varies depending on the vaccination. But none of the covid vaccinations alive. Thank you, Doctor. Just another one. Um, it was regarding like when you were saying the live vaccines. So you know when you have like, um, like someone with a low immunity like, say, they're taking they're taking certain medications or a cancer patient or HIV? Would you Do you do like a risk benefit, or do you straightaway? Just don't give them a live vaccine. How do you do it with, Um, yes. So I would usually check with their consultant because it can vary depending on the condition. But, yes, you're absolutely right that there are some people who can't have to be vaccinated. And that's why, for example, for the MMR, it's really important that the bulk of the population is vaccinated so that those few Children who maybe have had a transplant or something and can't have a live vaccine get the herd immunity benefit from the rest of the population. So I would you usually double check with their specialist's. The other sort of specialist situation that there is is sometimes if a patient has had whole body irradiation and then had a bone marrow transplant that can wipe out some of your immunity. So we sometimes see these patient's in primary care, and they have to have all their childhood vaccines over again. Obviously spaced out over an appropriate time. Uh, answered. Thank you, Doctor. If anyone has any other questions, you can, uh, mute and ask the doctor. You can type in the chat if you'd like just. Oh, someone's, um muting Madu. Have you got a question? Yeah, that needs it again. Uh, I've got another one for you. I happen to be in, uh, in Serbia. And they have this rule whereby if a parent refuses to vaccinate their child, they come under some financial, um, like, uh, like, attacks or something like that. And they also they're not allowed to go to school. So in the UK is their rules where you're not allowed to go to school if you don't have actions? No, there aren't. So I think they do similar in Australia. I'm not sure if it's school, but certainly nursery. So I mean, when I rule the world, it would I think that not vaccinating your Children is a child protection issue. This is my personal opinion. Um, I think that choosing not to protect your Children against these potentially fatal illnesses is neglect. So if I was in charge. Yes, I would make child related benefits sub dependent on full vaccination. I think that it if you did that, a lot of those who are just vaccine hesitant would get their Children vaccine vaccinated and you would be left with a much smaller core of the truly vaccine denier group. And then that group would be small enough that they could be dealt with through the court's and through the sort of child safeguarding. Because I do think it a safeguarding issue that is entirely my opinion. The law in the UK does not agree with me at the moment. There are absolutely no come back, no legal or financial come back in the UK for parents who don't vaccinate their Children. And as I said, if if the parents disagree, then for some bizarre reason we don't say Well, obviously the child, the parent who wants a vaccination is acting in the child's best interest. They should be vaccinated. We actually have to get tell that parents go to court to overcome the objections of their co parents. So yeah, I think things will be different if I if I was in charge, but it depends what country you're in. So obviously, if you're you know, if you move to a different country and you're dealing with vaccination, then you need to find out what the issues are in that country. Thank you, Doctor. Okay, the the feedback link is, uh, in the in the chat, obviously, to provide feedback for a doctor and, uh, regarding whether we can adjust the sessions for any particular topics you need. Um, it will be helpful to to know your feedback, So please make sure you are putting your, uh, feedback. Abdullah means they pay a fine. Yes, they do. Pay a fine in in Serbia if you don't. Uh, the the rule is is there's no financial problem for not having the vaccine. It's what comes along with that. So you can't go to certain public things. And so they make it difficult for you. Uh, yeah. So that makes sense to have it in the UK even more. But I wanted to ask you as well, like, uh, if a pregnant lady gets vaccinated, Does does the child need the vaccination or do they get the the antibodies? So there are some vaccinations. You do get some antibodies through the placenta. So, for example, we now vaccinate against pertussis whooping cough in pregnancy. And one benefit of that is that the child will get some through the placenta. Because we know that, um, that, uh, whooping cough in a newborn can be extremely dangerous in the first three months of life. So, yeah, there's certainly can be some benefit. I'm not entirely sure how much of the covid vaccine goes through the placenta. And my understanding is that, unlike some other conditions, actually, covid is not that serious, even in newborns foremost. Although, of course, there are the occasional child who's seriously ill, but yes, vaccinating a pregnant woman can have have beneficial effects on her baby. Perfect. Thank you, Doctor, for for answering the questions. Um, so the next, uh, lectures lecturers? Um, uh, Well, thank you so much, doctor. For your time. Uh, we'll see you soon. Thank you, Doctor. Guys, I'm gonna put the certificate, uh, in the chat. Uh, in the next few minutes, however, you need to fill in the, uh, feedback link. Uh, the house kindly posted the next links. Uh, so please do attend as well. Just a few minutes for you guys to give the feedback, and then we'll put the, uh, the certificate on