The Vaccine Blog
The Vaccine Blog
In a pretty fair estimate - about 40% of people have already decided they will for sure get the covid vaccine. About 40% are certain they will not. This blog is for the 20% who want more information to make an educated decision and maybe for a few in the other 2 camps to help them understand that the opposing view has some merits and maybe to not hate on others for a decision that is contrary to theirs.
Vaccines in general are controversial. A vaccine that has been developed within a year of sequencing a novel virus adds to distress that safety corners have been cut. The first of a new type of vaccine - one made from mRNA and not from killed or attenuated virus, is cause for suspect because its never been used before. A vaccine for a disease that seems most deadly to the elderly and co-morbid and is relatively mild for the general population, is controversial. Lastly, the current years political climate and politicians saying unhelpful and partisan statements have only added to the confusion.
To best make the decision, lets do a little background vaccine education: a general history of vaccines, the anti-vax movements, types of vaccines with a special focus on the mRNA Covid vaccine versions as well as their 2020 FDA approval process. With that as a background, I will tell you what I am planning on doing and I will present some common sense questions for you to ask yourself to help you decide what you want to do.
Very brief 100 year history of vaccines - the successes and notable failures:
Any talk on vaccine history usually begins over 200 years ago with Edward Jenner in 1796. Jenner, an English physician, like other physicians of the time had to deal with a terrible infectious killer - smallpox. Although far less contagious then Covid-19, it was far more deadly; Thirty percent of people who got small pox died and those that didn’t were left with horrible scars. Physicians before Jenner had gotten the idea of inoculation of a small amount of fluid containing active smallpox virus from the pustule of an infected patient and scratching it into another person to get them to develop immunity from it. Although this smaller dose of the live virus often proved effective at producing immunity, it still carried a death rate of around 3 people out of every 100 who were inoculated. Not what you would call an acceptable complication rate.
Jenner noticed that cattle workers and milkmaids who were exposed to and got the cow version of the disease - cowpox - seemed to not get the human small pox virus. In 1796, a milkmaid came to him to be treated for her acute cowpox infection and he (in what today would be about the most unethical clinical trial) took the opportunity to grab the son of his gardener and inoculate him with the cowpox pustule from this milkmaid. Then, two weeks later (with what I’m sure was pretty suspect informed consent) he exposed the child to smallpox (and its 30% mortality rate) and low and behold the child was immune. This was oft repeated over the next few years proving that this related, but non lethal virus could invoke immunity to the human, lethal version. Basically the lesson learned - injection of the direct disease in someone, bad, but injection of modified version (in this case related species disease) had low lethality and high success. To fast forward the small pox story by 150 years, The World Health Organization through an international immunization program declared that smallpox the disease has been completely eliminated from the planet due to vaccination.
For the sake of brevity and jumping over other stops along the vaccine timeline we next move to the 1950s and Polio and the Salk and Sabin vaccines. Polio was a terrible disease that would cause death in 5-10% of people who got it and paralysis in many of those who survived it. An early attempt at a live vaccine resulted in some deaths or local paralysis in the arm of patients that received the injection. Not great. In the early 1950’s as the US was seeing a spike in polio cases (and related deaths and paralysis) the causative virus was able to be isolated and grown in the lab in living tissue. Jonas Salk was able to take this isolated virus and chemically kill it. Then, by injecting the dead virus into “volunteers” (wont go through the ethics of mentally institutionalized patients being volunteers) found it to being around 60% effective at preventing infection and 90% at preventing the severe form that caused death. So in addition to the pox example of using related viruses, using a killed virus as in the Salk vaccine, also proved to be an effective form of vaccination.
Contemporaneous to Salk, Dr. Sabin was working on a polio vaccine but one that could be distributed more widely - one that was taken orally and not via injection. The oral virus he used was live, but it was “attenuated” - he specifically picked viral strains that did not cause human disease and only uses those attenuated strains in this oral vaccine cocktail. This version was also super effective and the ease of oral administration (oral vs injection) caused it to supplant Salk’s version. Again, fast forwarding, Polio was deemed completely eliminated as a disease in the americas in 1994 and ceases to be a disease except in a few “3rd world” countries.
Other vaccines against debilitating disease were developed around this time - Diptheria, Tetanus, Measles, Mumps and Rubella all proved safe and effective and are diseases that in our 21st century modern world, we don’t even think about getting because for all intents and purposes - they don’t exist as diseases as a result of widespread vaccination.
Indeed the last 20 years has brought new vaccines that have been safe and effective and have prolonged life and prevented morbidity including vaccines against Pneumococcal Pneumonia, Hepatitis B, and Human Papiloma Virus (which causes cervical/uterine cancer).
The story painted above seems like a rosey path with limitless successes. However the road has not been so smooth. The early days of small pox showed lots of trial and error - and deaths of people who were vaccinated who may not have gotten small pox - a terrible trade off of potential cure being worse then (not getting) the disease. One of the manufactures of the Salk injectable Polio vaccine messed up their “virus killing” process and some of its vaccine lots killed or paralyzed people. Lastly, trials in the 1960s for a vaccine against the virus that causes the common cold - RSV - were an abject failure with the death of some children in the vaccine group. These children were being vaccinated for a disease that kills less then 200 of the 2 million kids that get it a year. So there has been a bit of a conundrum between laypeople and medicine/science communities: we have the rare silver bullet for something in medicine, the ability to entirely eliminate a disease off the face of the planet with a single shot (or with covid-19, two shots), however we have also hurt people with sometimes unethical clinical trials or good vaccines that suffered from poor manufacturing and caused harm. With this as the checkered history of vaccine development, there was a resulting parallel rise of widespread anti-vax movements.
Almost as soon as there was a small pox vaccine there was an anti-vax movement. In England where this vaccine was first developed and America where the disease was widespread, they began to pass compulsory laws mandating vaccination with penalties for failure to comply. With that, anti-vax movements arose against compulsion. By the late 1890’s marches throughout England led the British to remove penalties for the dissenting from getting vaccinated. In parallel to the English movement, Anti-vaccination societies arose in America and several leagues were able to get individual states to remove individual vaccination mandates. However, after a significant pox outbreak in 1902 in Cambridge, Massachusetts, that city mandated vaccination. A dissenting man by the name of Henning Jacobson refused and criminal charges were filed against him by the state. His case was ultimately appealed all the way to the Supreme Court where they UPHELD states rights to compel individual behavior in a public health emergency (and force vaccination).
In the late 1970’s and early 80’s, parallel documentaries in England and America led to anti-vax campaigns against the Diptheria-Tetanus-Pertussis vaccine, citing possible neurological and encephalitis risk. A review of all scientific literature and prospective studies debunked any association and lawsuits against the vaccine manufactures (although in the short term scaring some into stopping production) ultimately failed.
The year 1998 brought a new round of the anti-vax movement which many readers may remember. This was surrounding the MMR (measles, mumps and rubella) vaccine. A doctor in England, Andrew Wakefield, published in one of the worlds most respected medical journals - The Lancet, an association between the ubiquitous childhood MMR vaccine and increased rates of subsequent autism. This led to American Celebrities (Jenny McCarthy* and others) to popularize the movement against MMR and ultimately a decline in vaccination rates. Over the next few years prospective studies were relaunched on MMR. Retrospective data was re-analyzed. All data conclusive disproved any increased incidence of autism. Shortly after, in 2004, it came out the Dr. Wakefield prior to publishing his work in the Lancet, was hired by some plaintiffs attorneys in England to look at a connection between Autism and MMR. In 2011, evidence was published (in the British Medical Journal) that conclusively showed that Wakefield had not only a relationship with plaintiff attorneys, but had falsified the data in the original article and hoped to financial profit from it. Thus, one man with fraudulent intentions, started an anti-vax movement by playing on peoples’ fears about vaccination in children, that ultimately restarted hotspots of mumps which had thought to have been eliminated in the western world.
Before we leave the topic of anti-vax, its worth pointing out that their is a less direct but equally ardent movement to “green” vaccines more - eliminate additives and preservatives. Thimerosal is a mercury containing compound traditionally added to most vaccines for preservation. Although any evidence linking thimerosal in doses used in vaccines is weak (although not fully disproven), it has been removed from all childhood vaccines. Of note it is still used in some flu and other adult vaccines.
Types of Vaccines: Killed, Attenuated, and mRNA
So with that long historical background, we can touch on the science behind the types or classes of vaccines. Above we talked about the classical 2 types of vaccines: killed and attenuated. Vaccines that have either been temperature or chemically killed, or vaccines that have been neutered to strains that don’t cause the primary disease but still evoke a sufficient immune response to the “real thing”.
Both of these types share one thing in common. Isolating the wild type virus and then either culturing it in a laboratory and grow it en masse and then kill it to make it suitable for injection (in large quantities), or growing the neutered strains en masse in culture. Both are a time consuming and laborious process that in part speak to why it takes so long to make new vaccines. You have to grow it, find a way to kill it or isolate a strain that doesn’t infect, test it and repeatedly go back to the lab and grow more until you have it right. Once you have it “right” (typically a years long process), you have to grow enough in culture to make for mass distribution.
Indeed some of the vaccines that will be submitted for approval in the near future for covid use this tried and true process - a process that has been sped up due to background knowledge on related viruses. However, unlike all vaccines that came before it, the first 2 vaccines that received FDA approval (from Pfizer and Modena) due not use either of this killed or attenuated model but rely on something else - something called mRNA.
As I mentioned in previous blogs (including the last one on mental health), as humans we are hardwired/encoded at conception and that code lives in every cell in our body. This source code, our DNA, lives in the center of our walled cells behind another wall - in an area of the cell called the nucleus. It is very difficult to get much in our out of this inner wall between the majority of the cell and this DNA containing nucleus. Cells make things, and they do this under direction of the DNA. How does this happen with this wall between the “brains of the cell” and the rest of it where all the action happens? The DNA when it wants to make the cells machinery create something, unspools a particular area and it builds a small protein chain as a mirror image of one of the DNA strands that was unspooled. This small single stranded chain (not complexly double stranded like our DNA) is called RNA and since its the job of this special type of RNA to take a message from the DNA to the main part of the cell that can make proteins, it is called messenger RNA or mRNA for short. The mRNA goes from the nucleus to the factory part of the cell where it is translated again from the mirror image into the original image and this new RNA or protein executes the DNA’s order to make stuff. Inherently beautifully designed, the mRNA rapidly self destructs as soon as the message has been translated, so as not to keep giving more and more instructions that have already been received. Messenger RNA therefore is incredibly efficient but inherently unstable and destroys rapidly as a single use item.
Viruses come in two forms, ones that have DNA in them and ones that only have RNA in them. Both viruses reek havoc on humans by living in a capsid, a transport pod, that can attach to a human cell and inject its genetic components to take over that same cellular machinery and have the cell make more virus particles. The cell releases these new viruses and these new viruses attack other cells and so on. Luckily our cells have a defense mechanism. When a cell is infected, it sends out a little flag on the surface of the cell and a special type of white blood cell sees that flag and it identifies trouble. This white blood cells calls other specialty cells to it to try and kill the cell that has been taken over, and it starts looking for the virus and when it finds it, the white blood cells make antibody after antibody until it finds an antibody to a part of the virus that is its that is Achilles heel. These are the neutralizing antibodies needed to stop infection by stopping the virus from attaching to the human cell or another weakness it can exploit.
As we have known since March, the spike protein is the Achilles heel of SARS-Cov2. The spike protein is a needed attachment for Cov-2 to dump its contents into our cells. So when our bodies make antibodies to the spike protein and block its attaching ability to our cells, Corona can’t inject its contents into our cells taking over and causing cytokines chaos.
If we know the Achilles heel (the spike protein), why don’t we just tell our cells to make antibodies and memory to that? We can do that and the means is through mRNA as described above. Instead of getting infected and having each and every one of us gear up our machinery go through trial and error until it finds that the spike protein in Achilles heel and then opens our DNA in the nucleus to send out an mRNA thread to our factory to make specific spike protein antibodies to it, why not just give us that mRNA thread and tell our machinery to get it right out the gate?
That’s what mRNA vaccines do. They take the weakness of the virus and tell our machinery to attack there without days and weeks of trial and error. They also do it without having to grow viruses en Masse in laboratories and without failed attempts that drive it back to the starting board. They do it without having to chemically kill or finding similar but non-infectious strains to get our bodies to react. There is no actual virus being injected. Just a single, short lived instruction to our cells machinery to make what is specifically needed. Elegant. Focused. Without risk of reactivating a supposedly dead or weakened virus.
Surely there is a catch or we would have replace all vaccines this way a decade ago when this approach was discovered. mRNA as stated above, is inherently short lived. In fact, if you inject it without any protection to the mRNA your muscle would destroy it within seconds of injection and you wouldn’t get enough to your immune system to do anything to help. Just like viruses need a capsule, for them to work, the mRNA needed a protective capsule. Through feats of astounding since, microscopic bubbles that could protect the cargo long enough to get to the immune system but would also short lived enough to not last too long and that disintegrate into harmless microscopic fat and proteins were created. These bubbles have been tested for safety (inertness). These scientists then perfected a technique to insert the mRNA inside these amazing pods, like a 5 star pastry chef creating the perfect cream puff. The filling of the pod with spike protein antibody instructions is a thing of miraculous scientific advance.
So these mRNA vaccines, despite being the first vaccines that have come to market in this new category, have been in the making for 10 years and have a inherent safety profile (less dangerous) then the traditional versions.
Covid Vaccines, Was the process rushed?:
If there is one over-riding concern that people have in their decision to get it or not it is: was this vaccine process rushed? Were corners cut? And if so what effects do we not know about?
The government has done itself no favors by bragging about the speed to market with this. This pat yourself on the back mentality flys in the face of people whose chief concern is safety. Yes, this is beyond a doubt the fastest from genetic sequence of a virus (in January) to being FDA approved and delivered (in December) vaccine ever developed. Not by months but by years.
So if it wasn’t done by cutting corners, how could it possibly have been done?
The first is speed improvements seen in genetic sequencing - a process that a decade ago that took a room full of equipment and months to sequence now can be done on a table top instrument in hours to days.
So you have the genetic sequence, but that does not tell you it’s Achilles heal right? Well, we were somewhat fortunate that SARS-COV2 shares some traits as SARS-COV1 or what most people know of is the SARS epidemic from a decade ago. There was a lot of studying done and they found the spike protein was one of SARS’ Achilles heals. So they had a great starting point to hypothesize from and it turned out that again that spot worked. Time was saved from trial and error and months of trials and then waiting for analysis of antibodies from infected patients.
Next and perhaps most important in the time saving sequence, you had the government step in with guaranteed purchases to mitigate cost risk for the vaccine companies. Why was this such a time saver? Literally it costs upwards of a billion dollars or more typically to make a vaccine. If you are a private company you need to make sure you will likely get that investment back. You move slower, do a phase 1, wait for results, then plan phase 2 and execute and evaluate and wait, then plan phase 3 and execute that. If all looks good you start the length FDA approval process as other drugs may be ahead of you in line. Once approved and only then do you start the expensive mass production and you are in business. The government didn’t tell these companies to skip steps. They just said, go all in once you have done your phase 1 dosing and phase 2 safety studies. Don’t wait for the result of phase 3 (does it work and is it safe in large numbers) to start production which takes months. Start the expensive manufacturing phase and success or fail of the phase 3 studies, it doesn’t matter, the government will purchase it and destroy if its failed and distribute if approved. This tens of billions of dollars in risk mitigation by the US government saved in time a year and with the resulting positive trials, hundreds of thousands of lives.
Phase 1 and 2 studies were performed quickly and these companies either partnered with other companies to execute quickly on the study and manufacturing (Pfizer-BioNTech) (Moderna- NIH) and developed full blown phase 3 double blinded, placebo controlled, prospective, randomized studies on 40k patients EACH. By partnering these companies shaved a year from what they could do on their own.
So although the process was the fastest ever by a mile, it was NOT by neglecting science, rushing incomplete studies through the FDA for approval, or political pressure on the FDA to release before the election. It was through a prior decade of innovation, strategic partnership between industry players, and a government that committed to write the check for the process wether it succeeded or failed. In short it was the rarest thing in the world - the scientists “scienced” the crap out of this, the government wrote a blank check and got out of the scientists and private industries way, and the regulators didn’t yield to political pressure and worked their approval process when the data came in, not when it was beneficial for one political party or the other.
Phase 3 studies: The results
If you need a refresher on the best kind of scientific studies, I recommend going back to my January blog on the Healthy User Effect, where I go through each of those terms like prospective, randomized, placebo controlled and talk about how these things eliminate any biases. Good studies are what separates a therapy that has promise based on an anecdotal story or a small study but really doesn’t hold up under real scrutiny (i.e. Hydroxychloroquine) from true, objective, reproducible science. (As an aside, there hasn’t been a time when a politician this spring ,summer and fall has said the words, “we are following the science”, where they were actually following any science but instead casting their own selection bias of sparse anecdotes, small studies and other media reports. That is not science, it is a bias in picking data that supports your own hypothesis and ignoring that which does not. Science is the opposite - it is scrutiny without bias. And for that you need a well controlled study.)
The Pfizer and Moderna studies checked every box. First they were large - 40,000 people. The science people and the study participants didn’t know if they were getting shot or placebo, they all just observed what happened. The people who signed up were matched with an equal number of people in each vaccine-placebo comparison group and equal of numbers by race, gender, age, co-morbidities. They had equivalent drop out rates and people lost to follow up. They studied these people before the first shot, before the second shot a month later and continued to observe them for 2 months AFTER the second shot to observe for longer term side effects.
The first thing you look to take away - how effective is it? These mRNA vaccines proved efficacy beyond what they could have hoped - in the 95% range. It was effective in the elderly and the younger populations. It was effective with caucasians and Hispanics. Men and women had the same efficacy rate. Group after group showed consistent results. At that rate with pervasive use of the vaccine you get elimination of Covid the virus from the planet.
Next and equally important to those receiving it - is it safe? For this you look at the data two ways - were there any bad things that happened to the vaccine group and how did that compare to the placebo group. Looking at deaths first - there were actually more in the placebo group but there were some in both groups - attributable though to heart disease not vaccine complication. It was just their time. There was no paralysis, auto immune conditions, or frankly any observed difference between the groups except for 1 condition. In the Pfizer study 4 patients developed Bell’s palsy in the vaccine group and None in the placebo group. In the Moderna, 3 developed it in the vaccine group and 1 did in the placebo group. So does this mean that the vaccine causes Bell’s palsy?
First what is Bell’s palsy? It is a (usually) temporary condition where the nerve that innervates the muscles on one side of the face gets inflammation and stops working, leaving the patient with a droop in their face. It can be caused by viral infections and usually resolves with time. It can also occur spontaneously and this is important because it is not rare - in fact the incidence observed of 4/20,000 in the vaccine group is LOWER than what they expected to see in the general population. Still, it is important to note and observe if there is a slightly higher rate as we expand to millions. The data says the risk is very low.
What was observed with increase frequency in the vaccine group is things like fatigue, fever, aches, weakness that could last for 24 - 48 hours. Instead of calling this a side effect it should really be called the intended effect - we want an immune response, that causes these symptoms as a result of our immune system making antibodies and cellular memory. Those responses are a positive thing and if you choose to get the vaccine, embrace them as a sign you are on the other side of all this.
Lastly a note on Allergic Reactions. This did not show up in the study group but there have been a few noted reactions as we have started to vaccinate the population. This is not unexpected. Allergy can occur to anything someone inhales, ingests or injects in their body. There are people who are more susceptible to getting these reactions but there isn’t a drug or a food out there that someone hasn’t had this type of reaction to. It is not a reason to NOT get the shot, but it is a reason to do it with medical personnel present.
In summary the effectiveness of these vaccines blew away expectations and the safety immediately and over 2 months after, proved extremely safe.
False Critical Thinking and Conspiracy Theories:
Before we get to an algorithm on to vaccinate or to not vaccinate, I need to address some conspiracy theories and non science based speculation that is out there and put them to bed as to reasons not to vaccinate. Some of these are wild thinking, others just suffer from a lack of scientific background and critical thinking. What they are not, is scientific facts.
Theory 1: Bill Gates has partially funded this and in doing so gave a directive to implant microchip/micro antenna in the vaccine to be able to track us.
I saw this early on this summer before phase 3 trials even started but I still see some of this on social media. I am not trying to disparage but it simply lacks science, logic and fails a test of critical thinking. First the science - There is a small credible argument to the possibility - we do have RFID (radio frequency tracking chips) that are as small as 0.15 millimeters which is small enough to be injected through a tiny 25g needle. However, valid science and critical thinking in this theory stop there.
First, something 0.15 millimeters although small, is not microscopic - you would see that with the human eye. No one has reported seeing floating black RFIDs in the vials. Second, all of the vials are multi-dose - Critically, there is no way to get a one to one ratio of a microchip and vaccine in the same vial. You would have to have thousands of microchips to assure you get one in the dose, and again you would see these. Lastly, from a critical thought perspective, why would government or Mr. Gates need to do this? Ask yourself how many minutes you have been more than 100 feet from your mobile phone in the last year? If you are like most people probably less then 60 minutes. Your mobile has GPS, a power source and you already have given default access to apps to location track you. You are already microchipped, its just outside your body. The government and Bill don’t need to inject you to find you.
Theory 2: The RNA vaccine will change your DNA
One of the purposes of my lengthy explanation of mRNA is to dispel the lack of science behind this. DNA is the hard coded blueprint that lives inside the nucleus which has a protective wall around it to not let these substances in. Also mentioned the mRNA lives for seconds to minutes. The mRNA can not get inside the nucleus where your DNA lives. Even if it could, mRNA is a messenger copy of DNA - We cant turn that into DNA. We make DNA only from our own DNA not from any of the RNA that is human or virus. The internal machinery doesn’t work that way.
Theory 3: The vaccine can cause an autoimmune condition not seen in just 2 months of post vaccine testing.
Of the theories this at least has a hint of scientific thought behind it. When we get an infection or a vaccination, we generate an immune response. Usually we generate this immune response to only things foreign and not to your own cells (self). However, some people, often through unknown triggers (some of which could be infectious/vaccine) generate some antibodies to their own tissue causing arthritis and other auto-immune conditions. So anytime we do something like this we need to look for this. There were no reports at inoculation or in the 2 month period of any increased auto-immune reactions. None. Could there be a delayed reaction? Possible. But since the immune response in these mRNA is just to the mRNA/spike protein and not to the entire virus particle - the body generates a more focused response with the vaccine then it would with getting the virus in the wild. Thus, on first principles, it is more likely to have auto-immunity triggered from wild virus then from focused mRNA vaccine.
Theory 4: The virus will (and IS) mutating so the vaccine wont be effective anyway.
It is true this virus has mutated. See my blog post from April when we went through the likelihood of this and its pretty much following that laid out path. Its mutation rate is far greater then a virus like measles but far less then the annual influenza. These mRNA vaccines target the Achilles heel - the spike protein and cause a vigorous immune response to that. If the spike protein mutates too much and the immune system cant recognize it - the vaccine would be useless. So is this likely and if so, why get vaccinated?
There have been over a dozen reported strains so far with 2 being significant - the first in the spring in Italy that made the virus more potent then the original Wuhan strain, and now the new UK strain that increases infectiousness but not severity of infection. There was one small change in the spike protein gene in the first mutation and a couple in this new one. These changes are the virus adapting to attack us better. Despite these mutations, the Achilles heel is still the spike and the vaccine offers superior protection to natively generated antibodies to the wild type virus because of its specificity. At some point, probably years down the line, this virus may mutate enough to evade this vaccine. But by then, we will modify it quickly like we do with the flu and confer safety without the hassle we have had this year.
What to do:
Covid-19 and the SARS-Cov2 virus is a serious threat that kills many people over 70. It kills obese, and co-morbid people less then 70. It is worse for Hispanics, African-Americans, people with A blood types and people with low Vitamin D’s. Beyond death their are emerging groups of long covid suffers - people developing longer term sequela (higher in men then women), like auto immune conditions, clotting disorders, and persistent loss of taste and smell. It is not the flu.
However it is also true that it is particularly mild in children (who are also poor spreaders). It is rare for teens and 20-30 year olds who don’t check any of the boxes above to have a prolonged problem.
So Covid is a mixed bag on the individual level. Vaccines, because of their checkered history, should instill a sense of individual caution when a new one comes out - being cautious and thoughtful about it is not the same as signing up for an all out anti-vaccine movement, its smart science. Further caution is warranted when politicians grandstand about how fast they are rushing it. So you have to science the crap out of it to make sure the cure isn’t worse then the disease. In my assessment, and more importantly the assessment of 100s of scientists and clinicians far smarter then me, this vaccine is not only effective but unequivocally safe.
So what to do...Let’s start with me, a 54 year old, blood type A male, with an optimal vitamin D and with no co-morbidities, but also works in healthcare where I interact with those with co-morbidities and people older then me. I also have a 92 year old father and an 85 year old mother who I haven’t seen in over a year and don’t want to be the unintended vector that gets them. My conclusion: I am low risk for anything bad happing to me so I am not afraid to get the virus. However, I also don’t want to be an inadvertent super spreader and infect patients and I don’t want to infect my own family members. I want the buck to stop with me and I believe that my risk of infecting my parents or someone else inadvertently far outweighs any risk for me to take the vaccine. I am lucky enough to have been in an early traunch and I have received the first dose of the Moderna vaccine.
What about other scenarios?
If you are over 60? get the vaccine. Its really a no brainer risk benefit: Your risks of any short or long term effect of the vaccine are lower then something bad happening from the virus. You could die from the virus. Even if they come up with some rare thing that they didn’t find in the 40k people who were vaccinated - something that occurs in 1 in a million. Your risks of dying or having a bad complication are far higher getting the wild type infection. Get the vaccine.
If you are taking care of someone or want to be around those over 60 years of age or more - get the vaccine. Most cases of Covid are spread via asymptomatic transmission. You can be a vector and not know it. In this case its not a matter of risk benefit, its a matter of community service and doing something for those around you - not unlike charity, the direct benefit is more for the other person than you, but my guess, like charity you will feel all the better for serving the community.
If you are less then 16 - don’t get it. It simply wasn’t tested or approved yet and since your risk of having a bad result from covid is near zero and since kids are not great transmitters, I would wait until the science and data is there. The risk benefit tilt is skewed the other way since there is very little risk to the individual or community.
If you are in your 20’s - 50’s and not around those who are at risk and willing to get tested before visiting a parent or grandma, you are prob good to go either way - vaccinate or wait for longer term data. If you are afraid to go out in public due to covid, if you are having anxiety and depression and you feel limited in your need for social contact - get the vaccine and get back to living. If you are comfortable in this environment and are ok letting nature take its course, pause and see more data.
If you are obese, have diabetes, are immunocompromised - get the vaccine. Again risk benefit is so highly tilted to vaccine benefit.
If you are pregnant - talk to your OB. In the studies they specifically excluded known pregnant people. However 4 people got pregnant during the study period and no adverse effects were noted in these women, HOWEVER this was a 4 month study - not a one year that you would like to see for full effects on pregnancy, delivery or effects on fetus. So my conclusion here is, on one hand similar to the sub 18 group, its not studied, so I wouldn’t just run out and get it, but on the other hand it is different in that there are risks for some pregnant women who have pregnancy related conditions that could lead them to a more severe response if they contracted the wild type covid. Its important to have an open discussion with your OB and risk assess together. However if you get pregnant during the vaccine process, I would not worry as it appears safe.
If you have had Covid, it does NOT mean you should not get vaccinated. Although there have only been 2 documented cases of reinfection the disease is less then a year old. Immunity could wane. Mutations may develop that may evade the more generalized response from the wild type virus but not be able to evade the specific focus on the spike protein that the mRNA has. Also, having a booster is likely necessary - especially if you were a mild responder the first time. However, again weigh which category above you are in.
I am and always will be a nutrition / healthy lifestyle first, supplement second, medication when needed, doctor. Although not a quick silver bullet like a single (or double) shot vaccine to eradicate a disease, I believe most of our modern day worst diseases (Diabetes, heart disease, stroke...) can be prevented, treated or cured with that mantra. Although those strategies have for sure not gotten enough focus from traditional western medicine practitioners, we have to give credit to that which traditional western medicine does best - annihilating infection. When infectious diseases in history have been annihilated, their has been a subsequent improvement in quality of life with a resulting extension of lifespan. Before Pasteur, death from an infected surgical or field wound, or a maternal infection post delivery were common. Communicable diseases like those mentioned above would ravage communities with intermittent outbreaks. Strep throat would not infrequently become a severe heart valve disease. Because of antibiotics, we can now relieve debilitating arthritic pain without surgical infection while replacing hips and knees. We can remove a tumor in the brain or body without infecting the site we operate. Life is simply better because of vaccines, antivirals, and antibiotics. All other advances in medicine, pale in comparison to the successes western medicine has had in a war against infection.
The choice between taking a vaccine for a highly deadly disease like small pox or polio or rolling the dice and getting the wild type virus infection is not a tough one personally. The choice becomes more difficult in a disease like covid, that for those under 70 and without co-morbidities, the risk of death is VERY low. It ultimately comes down to a few important factors:
The first two - Is the vaccine safe? And Is the vaccine effective? The science has answered. These vaccines are safe and effective.
Next, you have to ask, Is the threat of Covid-19 changing they way I interact in the world - Am I not visiting people I want to be around? Am I more anxious, depressed due to the threat of covid? If so - get the vaccine - waiting for heard immunity and letting others do the heavy lifting is a bigger threat then your risk of enduring stress and mental illness (see last blog).
If you don’t feel impacted I think its fair to follow the above groups I discussed above. But I do urge people to not stand on principle. First don’t be a jerk and judge anyone for their decision. There are good reasons to vaccinate and good reasons for a select group to be cautious. If you are in the coin flip group and still struggling, I would recommend getting the vaccine, if not for yourself, for those around you. There are probably 1000 readers of this blog that can recount the story of the Good Samaritan from the Bible far better then me. There are just times in your life when you should consider thinking of others and take one for the (humankind) team. I think for most of us, one of those times should be now.
As always, Be Well