“You cannot escape the responsibility of tomorrow by evading it today.”
-Abraham Lincoln
Now that vaccines will shortly be available to all adult Vermonters, it’s time for a direct discussion. A science based, evidence-based discussion. Because we ALL need to get vaccinated.
How did they produce these vaccines so quickly and can they really claim that they are safe?
The development of these vaccines was extraordinarily fast, but the shortcuts taken were largely regulatory and financial. Pharmaceutical companies can generate a product much more quickly when the Feds guarantee to cover financial losses and cut regulatory red tape and response times. Medication production is slow largely because the system is slow.
More so, the technology behind the mRNA vaccines is actually a couple of decades old. Creating the mRNA was easy, the trick was getting it into people. The mRNA vaccine result was a mixture of fats, salts, and the mRNA requiring cold storage. Nothing had to be grown, no eggs involved, and this translates into speed. There are no preservatives or additional chemicals, such that these vaccines are quite “clean”.
These vaccines don’t have long-term safety data. (They can’t, they’re new.) But at the same time, there isn’t a reason to expect long term issues. When you buy a new car, is it possible that the brakes might fail on your way home? Yes. But you have no good reason to expect that, so you don’t spend time worrying about it.
To bolster this argument, you can take assurance in the fact that more than 122 million Americans have volunteered to get vaccinated already, and received at least 1 dose of one of these vaccines as of April 14. If there were common issues, we would have experienced them by now.
So what is mRNA anyways, and why should I let someone put it in my body?
mRNA is genetic material that acts as an instruction manual for your cells to build something. In this case, the instructions are for the spike protein of the COVID virus. It’s not the whole virus, so you can’t actually get COVID from the vaccine, but it’s enough for your immune system to recognize COVID in the future. While it sounds scary to put RNA into your body, this is just mimicking real viruses. This happens every single time you get a viral illness, from pink eye to bronchitis to a cold. This is not only not new to you, it’s common. It just doesn’t normally arrive in an injection.
But what about these blood clots I’ve been hearing about?
For our purposes, the AstraZeneca vaccine is irrelevant. It may or may not be associated with clots, but it’s not available in the US at this time.
The FDA is prudently investigating six reports of a rare type of clot that may be associated with the Johnson & Johnson vaccine, while pausing distribution. It’s unclear as to whether or not the vaccine and the clots are truly related, but if so, the risk appears to be less than 1 in 1 million. Fatality rates for ages 20-44 for COVID in the US are currently about 0.1%, or 1 in 1,000.
Long story short, you should be a lot more worried about COVID than blood clots.
How is Johnson & Johnson different?
Johnson & Johnson is a DNA vaccine, and instead of encasing it in fat particles, they put the DNA in the shell of a different virus. This is trickier to produce, but has the advantage of single dose and easier storage. The DNA in Johnson & Johnson, and the mRNA in Pfizer and Moderna, all code for COVID spike proteins. Thus, all three vaccines give you very similar protection.
Aren’t some of these vaccines better than others?
No, not really. All three vaccines available in the US are excellent. You may have read about different efficacy rates. These differences stem from differences in study design, as Pfizer, Moderna, and Johnson & Johnson did not use the same definitions of mild, moderate, and severe COVID. Similarly, Johnson & Johnson was tested in an environment that included some of the COVID variants which are now common, while Pfizer and Moderna were not. Thus, direct comparisons of efficacy rates are useless.
Lastly, when we consider efficacy, we need to focus on the numbers that are truly important. Let’s take the Johnson & Johnson vaccine, which has the lowest cited efficacy rates at 72%. But 72% is not a problem. Why? Because amongst the roughly 40,000 participants in the Johnson & Johnson trial, there were zero hospitalizations, and zero deaths. For the most worrisome outcomes, efficacy is 100%.
Which vaccine is right for you? The next available vaccine.
I’m 20. You said my risk of death was 1 in 1000. Why should I bother to get an appointment and get a vaccination?
Lots of reasons. First and foremost, surviving COVID is not a get out of jail free card. A recent study in The Lancet reveals that 1/3 of all COVID patients will be diagnosed with a neurological or psychological condition within six months. Even if you are not likely to die, you don’t want this. And these are just some of the long-haul symptoms.
Second, privileges are being tied to COVID vaccination. Colleges and universities are starting to require vaccination for in-person attendance. Governor Scott has tied Vermont’s re-opening to vaccination percentages. Businesses and services are starting to allow attendance based on vaccination status. Not being vaccinated may cost you opportunities.
Third, we are a community. All of us rely on each other to live in a civil society. We trust that our neighbors will obey traffic laws to keep all of us safe. We trust that the ambulance service will arrive when we call for an emergency. We trust that road crews will properly clear snow and ice so that we can travel. We have basic rules by which we live by, and we assume people will play their part. Some rules are written, some are laws, and some are just social norms. They all are necessary for us to safely and freely enjoy the things we want. Getting vaccinated and contributing to herd immunity is part of that social contract. This is an opportunity for all of us to protect the most vulnerable amongst us.
Isn’t this vaccine just a sham so that the Government and Big Pharma can microchip us and track our activities?
No. That’s your smartphone.
Joshua T. White, MD, MBA
Chief Medical Officer
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For more information about coronavirus, visit giffordhealthcare.org/coronavirus-covid-19, cdc.gov or healthvermont.gov.
