Hesitations on vaccines
The Hong Kong government has begun to provide various groups of citizens who are at increased risk of COVID-19 exposure with COVID-19 vaccines (Sinovac and BioNTech) from the end of February and the vaccination is expected to be widely available to more Hongkongers.
However, the number of deaths after vaccination currently has caused tensions and hesitations on vaccines in Hong Kong with more discussions about ‘Should we get the COVID-19 vaccine?’, perhaps the answer to this question will not be discovered temporarily.
Therefore, let’s have an overview of the pandemic pre-vaccination protocol interventions from The Institute for Functional Medicine (IFM) that may improve the immune response to vaccination with nutritional suggestions.
What can you do if you are considering vaccination?
Options to support immune function
- Vitamin A,C,D,E
These all are anti-inflammation vitamins and are critical in how the immune system functions, vitamin C and vitamin E can be powerful antioxidants;  Vitamin A and vitamin D are infection-fighters that modulate inflammation. 
- Vitamin B6, Vitamin B12, Folate
They are in charge of keeping the immune system strong, support for making of new and producing a sufficient number of red blood cells, and transporting oxygen throughout the body.
- Iron, Zinc, Copper, Selenium
Iron, which helps your body carry oxygen to cells, plays a part in many of the immune system processes. Zinc is needed for the production of new immune system cells. The white blood cells of the human immune system surround invading bacteria upon activation before boosting their levels of copper ions in order to break down the threatening intruders. Selenium is a powerful antioxidant that fights oxidative stress and has an effect on the immune system being important for preventing infections.
Mushrooms may support a healthy immune response, lower inflammation, and through interaction with the gut microbiota, improved immune cell functionality.
Beta-glucans have been shown to protect against infection by bacteria, viruses, and pathogenic microorganisms. 
Research shows it increases the number of white blood cells, which fight infections. 
Quercetin is known for its antioxidant activity and most likely universally suppresses the accumulation and activation of immune cells, including anti-inflammatory cells. 
Resveratrol regulates immunity by interfering with immune cell regulation, proinflammatory cytokines' synthesis, and gene expression. 
Options to Improve Physiological Function
Curcumin is a highly pleiotropic molecule that can be modulators of various intracellular signaling pathways that maintain cell growth. It has been reported as anti-inflammatory, anti-angiogenic, antioxidant, wound healing, anti-cancer, anti-Alzheimer, and anti-arthritis and possesses an excellent safety profile. 
Resveratrol includes anti-inflammatory and immunomodulatory activities as well as a wide range of health benefits ranging from chemoprevention to cardioprotection. Recent studies implicated that resveratrol also possesses anti-aging properties. 
European Food Safety Authority has published a number of health claims finding that quercetin has beneficial physiological effects in the protection of DNA, proteins, and lipids from oxidative damage. 
Study is shown that melatonin enhances both innate and cellular immunity, and the findings suggest that melatonin could be an effective way for arresting neoplastic growth and for destroying virus-infected cells. 
- Green Tea Extract
Green tea is rich in polyphenol compounds especially epigallocatechin-3-gallate (EGCG) and epicatechin gallate(ECG) have the ability to suppress the activities of bacterial and viral factors and can even reverse the resistance of tough pathogens. 
Glutathione stimulates the production along with activating your natural killer (NK) cells. This enhances the activity of your immune system and also helps act as an antioxidant to your immune system. 
- N-acetylcysteine (NAC)
N-acetylcysteine acts as an immune-modulating agent which also is a precursor of the antioxidant glutathione that can boost the immune system, suppress viral replication, and reduce inflammation. 
Andrographis contains andrographolide which is a bitter-tasting compound that has been shown to improve the function of the immune system. It can boost numbers of white blood cells and appears to have direct antimicrobial action against cold and flu viruses. 
Supports healthy activation of T helper type 1 (Th1) cells to promote innate immunity and cell-mediated immune defenses. 
What can you do if you are waiting to receive vaccination?
If vaccination is imminent within days
Avoid acute stressors
Stressors are events or conditions in your surroundings that may trigger stress. Acute stress is your body's immediate reaction to a perceived threat, challenge, or scare. Breathing exercises and cognitive reframing as learning to change the way you look at the situation to manage your stress levels are great solutions for lessening acute stress
- Obtain adequate sleep
Make regular, sufficient sleep a daily wellness priority, the recommended amount of sleep for a healthy adult is at least seven hours. A study in the International Journal of Behavioral Medicine found that flu vaccines appear to be more effective in people who get a sufficient amount of sleep during the two nights prior to receiving the shot. 
- Avoid anti-inflammatory medication 2 days pre & post
According to Dr. Anita Gupta at Johns Hopkins University School of Medicine, taking anti-inflammatory medication before getting the COVID-19 vaccine may reduce the vaccine’s effectiveness. 
- If active infection, postpone vaccination
See a doctor right away if you notice any of the following signs and symptoms of an infection such as fever, chills and sweats, shortness of breath, vomiting, etc. Find out from your doctor when your white blood cell count is likely to be the lowest since this is when you’re most at risk for infection.
If vaccination is weeks to months away
- Enhance immune function
- Address inflammation
- Smoking cessation
- Weight loss
- Stress management
- Physical fitness e.g enough exercise
- Mind/body therapies
- Increase dietary fiber intake
- Optimize gut microbiota e.g taking probiotic
- Address autoimmunity
- Address hormone balance
Epresat Multivitamin is a delicious blend of 8 essential vitamins, specially selected aqueous herbal extracts and natural fruit juice concentrates with added wheat germ, honey and yeast extract. Vitamin A, C, D, E, B6, and Thiamin, Riboflavin, Niacin
Cumacure is made of curcumin (active agent of Curcuma), which has been in the center of active research in the past years and proven several interesting virtues including helps to reduce all inflammatory states, helps the body to reduce oxidative stress and helps to maintain efficient natural defences, etc.
Floravital is rich in Iron, Vitamins B2, B6, B12 & Vitamin C , contribute to the reduction of tiredness and fatigue.
Zou Cha tea or “tea for joints” in Chinese, is a Sencha green tea with turmeric and meadowsweet. This combination, by using the TeaPlus® process, has been devised as a way to reduce inflammation.
- Mora, J. R., Iwata, M., & von Andrian, U. H. (2008). Vitamin effects on the immune system: vitamins A and D take centre stage. Nature reviews. Immunology, 8(9), 685–698. https://doi.org/10.1038/nri2378
- Shaik-Dasthagirisaheb, Yazdani & Varvara, Giuseppe & Murmura, Giovanna & Saggini, Andrea & Caraffa, A & Antinolfi, Pierluigi & Tete, Stefano & Tripodi, D & Conti, F & Cianchetti, E & Toniato, Elena & Rosati, M & Speranza, Lorenza & Pantalone, Andrea & Saggini, Raoul & Tei, Meshack & Speziali, A & Conti, Pio & Theoharides, Theoharis & Pandolfi, Franco. (2012). Role of vitamins D, E and C in immunity and inflammation. Journal of biological regulators and homeostatic agents. 27. 291-5.
- Kim, H. S., Hong, J. T., Kim, Y., & Han, S. B. (2011). Stimulatory Effect of β-glucans on Immune Cells. Immune network, 11(4), 191–195. https://doi.org/10.4110/in.2011.11.4.191
- Jennifer Robinson. (2019). Echinacea for the common cold, WebMD Medical Reference https://www.webmd.com/cold-and-flu/cold-guide/echinacea-common-cold#1
- Li, Y., Yao, J., Han, C., Yang, J., Chaudhry, M. T., Wang, S., Liu, H., & Yin, Y. (2016). Quercetin, Inflammation and Immunity. Nutrients, 8(3), 167. https://doi.org/10.3390/nu8030167
- Malaguarnera L. Influence of Resveratrol on the Immune Response. Nutrients. 2019 Apr 26;11(5):946. doi: 10.3390/nu11050946. PMID: 31035454; PMCID: PMC6566902.
- Ahsan R, Arshad M, Khushtar M, Ahmad MA, Muazzam M, Akhter MS, Gupta G, Muzahid M. A Comprehensive Review on Physiological Effects of Curcumin. Drug Res (Stuttg). 2020 Oct;70(10):441-447. doi: 10.1055/a-1207-9469. Epub 2020 Aug 3. PMID: 32746480.
- Kalantari H, Das DK. Physiological effects of resveratrol. Biofactors. 2010 Sep-Oct;36(5):401-6. doi: 10.1002/biof.100. PMID: 20623511.
- EFSA. Scientific Opinion on the substantiation of health claims related to quercetin and protection of DNA, proteins and lipids from oxidative damage (ID 1647), “cardiovascular system” (ID 1844), “mental state and performance” (ID 1845), and “liver, kidneys” (ID 1846) pursuant to Article 13(1) of Regulation (EC) No 1924/2006. EFSA Journal. 2011;9(4):1–15.
- Srinivasan, V., Maestroni, G. J., Cardinali, D. P., Esquifino, A. I., Perumal, S. R., & Miller, S. C. (2005). Melatonin, immune function and aging. Immunity & ageing : I & A, 2, 17. https://doi.org/10.1186/1742-4933-2-17
- Kei Nishida. (2019). How green tea helps to improve your immune system, Japanese Greentea Co. https://www.japanesegreenteain.com/blogs/green-tea-and-health/how-green-tea-helps-to-improve-your-immune-system
- Rodrigues, C., & Percival, S. S. (2019). Immunomodulatory Effects of Glutathione, Garlic Derivatives, and Hydrogen Sulfide. Nutrients, 11(2), 295. https://doi.org/10.3390/nu11020295
- Shi, Z., & Puyo, C. A. (2020). N-Acetylcysteine to Combat COVID-19: An Evidence Review. Therapeutics and clinical risk management, 16, 1047–1055. https://doi.org/10.2147/TCRM.S273700
- Ding Y, Chen L, Wu W, Yang J, Yang Z, Liu S. Andrographolide inhibits influenza A virus-induced inflammation in a murine model through NF-κB and JAK-STAT signaling pathway. Microbes Infect. 2017 Dec;19(12):605-615. doi: 10.1016/j.micinf.2017.08.009. Epub 2017 Sep 7. PMID: 28889969.
- Ivanovska N, Philipov S, Hristova M. Influence of berberine on T-cell mediated immunity. Immunopharmacol Immunotoxicol. 1999 Nov;21(4):771-86. doi: 10.3109/08923979909007141. PMID: 10584211.
- Prather, A.A., Pressman, S.D., Miller, G.E. et al. Temporal Links Between Self-Reported Sleep and Antibody Responses to the Influenza Vaccine. Int.J. Behav. Med. 28, 151–158 (2021). https://doi.org/10.1007/s12529-020-09879-4