A Reformed Skeptic’s View of the COVID Vaccine
A couple of months ago, a friend and patient asked if I was planning to take the COVID-19 vaccine when it became available. My answer was short and sweet: “There hasn’t been enough time to develop a safe and effective vaccine.”
Since that time, I have had time to extensively research the available literature on the development of the vaccine. Also, I have seen patients and friends become ill and some of them even die. It seems as though this “second wave” of the pandemic, at least in our area, is significantly worse than the first. Finally, I contracted the virus myself and felt firsthand the effects. I have recovered completely and thankfully none of my family members were infected, but while I was sick I worried constantly that I would make someone I love (potentially fatally) ill. All of these things have combined to give me a change of heart about the vaccine, and I’d like to share some of what I’ve learned with you.
The best format for this is probably the good old-fashioned Question and Answer document. If you don’t see your question listed, feel free to reply to the original facebook post found here and I will try my best to answer.
So let’s get started with some of the most common questions about the vaccine.
1. Is the vaccine safe?
a. This is the most important question to be answered, and the one that gave me the most trouble before I dug into the data. The human phase 3 trials for two mRNA vaccines (we’ll talk about what that means shortly) have recently been completed. These vaccines have been developed by Pfizer (already approved) and Moderna (anticipated approval 12/17/20). These trials included a combined total of roughly 80,000 individuals who received either the vaccine or a placebo. Short term safety was excellent, with common side effects of the vaccine being similar to flu vaccines (injection site soreness, mild fever, fatigue), and usually even milder.
The FDA typically requires 6 weeks of safety data before medications or vaccinations can be approved. The COVID-19 vaccines have displayed 8 weeks of safety data. This safety data has been reviewed by independent experts and organizations.
Long-term safety will obviously not be known for sure until time passes, but that is also true for the yearly flu vaccine, pneumonia vaccines, and the shingles vaccine that are routinely given. Honestly we don’t know the long-term effects of COVID-19 infection either. Therefore the balance of safety leans even further towards vaccination.
2. Is the vaccine effective?
a. In a word, yes. Studies to date have shown a remarkable effectiveness rate of 90-95%. In contrast, the annual flu vaccine has had an estimated effectiveness rate of 40-60% over the last few years. I believe that the high effectiveness rate of mRNA vaccines will be proven to be the result of the novel mechanism of action of the vaccine, which we will discuss next.
3. How does the vaccine work?
a. Both the Pfizer and Moderna vaccines are known as mRNA vaccines. In order to understand how they work, it’s critical to understand a little bit about mRNA, or messenger RNA. First, note that DNA is double-stranded and RNA (mRNA, rRNA and tRNA) are single stranded.
Messenger RNA is used to create proteins in the cytoplasm of our cells. This is different from DNA. In humans (and most other organisms) DNA is located in the nucleus of the cell, not the cytoplasm. DNA is transcribed into RNA, which then is translated into proteins. The coronavirus does not have any DNA, it only has RNA. Scientists have used these biologic facts to create a safe vaccine.
In short, the vaccine contains a very small “snippet” of coronavirus mRNA. This mRNA piece is taken up by our human muscle cells, and our cells use it to create copies of the COVID-19 “spike” protein (these spike proteins are the little spurs you see sticking out of the “ball” on pictures of the virus). This spike is then delivered to the wall of our cells, where other (immune) cells recognize it as foreign and mount an immune response, conferring the immunity that was the purpose of the vaccine to begin with. This mRNA NEVER GETS INTO THE NUCLEUS of our cells, so it cannot combine with our own human DNA. After the mRNA is used to make the spike proteins, it is destroyed by our cells.
b. There are several other vaccines in trials at this time, some of which work differently. None of the vaccines being studied contain live or killed viruses particles. As such, the vaccine CANNOT give you COVID. At this time it seems that most of us will receive either the Pfizer or Moderna mRNA vaccines.
4. When does protection start after I get the vaccine, and how long does it last?
a. Most vaccines will require two doses, given either 3 (Pfizer) or 4 (Moderna) weeks apart. Immunity from the vaccine will take about two weeks to develop.
We do not know how long immunity may last. It could be a lifetime (like the shingles vaccine), or only a year or less. It may be that we will need to vaccinate against COVID-19 annually much like the flu. The answers to these questions will take time and more research.
5. After I get the vaccine and two weeks have passed, will I still have to wear a mask?
a. Yes, until enough people have been vaccinated (see the discussion of herd immunity below).
6. If I have already had COVID-19, should I still be vaccinated?
a. Yes. We believe that vaccination after infection is safe and very well may confer even better immunity.
7. Why should I get the vaccine?
a. Well now we need to discuss herd immunity. Contrary to what you may have heard or read, herd immunity is “a thing,” and in fact is the basis of all vaccination programs we’ve ever used, including Polio, measles, and others. Remember when there was a small outbreak of measles in the U.S. a couple of years ago? It never went anywhere, right? You can thank herd immunity for that.
For COVID-19, the estimates for the number of people that would need to have immunity (we HOPE that means vaccinated people plus people who are immune based on previous infection) will need to be 50%-%70 of the population. While it’s true that young healthy people are likely to have very mild disease if they do get infected, it’s also true that those asymptomatic people can transmit disease to older or more at-risk people. If enough people are vaccinated, the rates of transmission will be so low that we can all (one day) get back to normal life.