by ETHAN LEVY, PA-C, MPAS, MSESS, AT-C, CSCS
Significant anticipation and hesitancy has been accumulating since Operation Warp Speed (the federal government’s expedited COVID-19 vaccine development program) led to the approval of vaccines directed against SARS-CoV-2, the virus that causes COVID-19. Currently, vaccines from two companies (Pfizer and Moderna) have been granted Emergency Use Authorization (EUA) by the United States FDA. Several other vaccines are being developed and/or waiting in line to petition for EUA. The most at-risk categories of people have started receiving the vaccine, and consideration of taking a vaccine will become personal to us all as the roll-out continues.
There appears to be huge variability in how the U.S. public is responding to taking the vaccine, and understandably so. There are those eager to be among the first in line to receive it based on current reports of 94-95% efficacy, and others who question the safety and effectiveness of the vaccine given how fast it came to fruition. With so much unknown about the vaccine, it is understandable hesitancy will continue. As we discuss COVID-19 vaccines, we think it is appropriate to be mindful that approximately a quarter million Americans are testing newly-positive for the virus each day, and we are seeing days where over 4,000 people are dying from the virus or associated complications, and scores of people who recovered from initial infection are experiencing chronic issues.
Understanding Messenger RNA (mRNA) Vaccines
The currently approved Pfizer and Moderna vaccines are both classified as a messenger RNA (mRNA) type vaccines, and are each administered over two doses, which are given 21 and 28 days apart respectively. The mechanism of action utilizing mRNA for a vaccine is novel, but the technology has been studied for quite some time. Essentially, the vaccine delivers part of the virus’ genetic code (mRNA) for our cells to make a piece of the spike protein, which is found on the surface of the virus. This then signals our immune system to produce antibodies that recognize and neutralize the spike protein of the actual virus if the person becomes infected. By coating a live viral particle with a neutralizing antibody, the spike protein cannot stick to the ACE-1 receptor found on human cells, which means the virus should not pass into that cell to replicate or damage that cell. Because mRNA does not enter into the nucleus of the cell, it does not get incorporated into one’s DNA. It does not instruct the body to produce the actual virus because it is only a blueprint for the spike protein.
It should be noted, while the vaccine reduces the chance of getting sick from the virus by ~95%, we do not yet know if a person could contract and transmit the virus to someone else before the virus has been cleared from the host’s body. We also do not know how long a person will maintain protection after receiving the second dose of the vaccine. Through ongoing research this information should eventually be determined.
Societal and Individual Considerations
At the individual level, each person/family will need to determine the specific benefits-to-risk ratio for getting vaccinated versus getting infected. From a societal perspective, to get past COVID-19, the country and world need to achieve herd immunity. While many in the media have used this term incorrectly, herd immunity is obtained when enough people are immune from the virus (either through vaccination or from natural infection), and the virus no longer has the ability to widely spread.
We anticipate many people will continue to seek our guidance about whether to get vaccinated once the opportunity arises. As most people know, we do not use a one-size-fits-all approach. Rather than issuing a general statement recommending or not recommending the COVID-19 vaccine, as with all vaccines we take the approach of discussing the benefits and risks for each patient based on a case-by-case review and discussion.
There are many considerations that each person may choose to take into account. For example, there are some absolute contra-indications listed by the manufacturers, such as being allergic to ingredients such as polyethylene glycol or polysorbate, as well as those who have had a serious allergic reaction to a first dose of the vaccine.
According to official reports, 25 million Americans have tested positive for SARS-CoV-2, and over 400,000 have died (which calculates to a 1.6% mortality rate). Many health professionals suspect considerably more people have actually been infected; possibly up to 2-3x the amount currently being reported. If true, the mortality rate would be reduced to approximately 0.5-1.0%. For point of reference 0.2% of people die after contracting measles and 0.1% die from influenza. Whichever rate one looks at, COVID-19 is more deadly than either of these other two viruses.
The most common side effects expected from the vaccine include a fever, localized redness, flu-like symptoms, and swollen lymph nodes. These are all common symptoms of inflammation, and vaccines bring an inflammatory response. Additionally, there have been serious allergic reactions following receipt of the vaccine. As of earlier this month, there were 2.5 reported cases of anaphylactic reactions per 1 million doses of the Moderna vaccine and 10 reported cases per 1 million of the Pfizer vaccine. All individuals recovered. There has also been a case of a previously healthy physician in South Florida who, within a few days of receiving the vaccine, developed a platelet abnormality which led to his death. There is also little data on safety during pregnancy or for those with auto-immune and hyper-inflammatory conditions, though such individuals are eligible to take the vaccines.
Regardless of a person’s personal decision on getting a COVID-19 vaccine, the reality is it will still be a while before the virus is under control. A great deal of important data is still lacking at this time, which we will learn and discover in the months and years ahead. Our Wholistic Pediatrics and Family Care medical providers can help you steer through these uncharted waters based on your individual needs. As always, for those who make an informed decision to receive or abstain from the vaccine, we are fully prepared to advise on the best methods for strengthening and balancing one’s immune system, and controlling inflammation to minimize the risks associated with either decision.