Welcome to my last blog post of 2020 on the COVID-19 vaccine..huh? what? Whew, it has been a year. Normally my last blog post of the year is on travel, food & wine recaps or a Holiday gift guide. You know, fun stuff.
Earlier this year my blog post on Coronavirus went viral. Like that post, this one lays out information on COVID-19 vaccines in a manner that is easy to digest. I will be discussing why I decided to take the Pfizer BioNTech mRNA COVID-19 vaccine. I received it on Monday December 28th and I have been doing well. I had minimal arm soreness at the site of the injection for 12 hours and no other symptoms since. (YEAH)
The Pfizer mRNA vaccine is one of many COVID-19 vaccines that will be available to the general public. As you read thru this post, I hope you decide to take a vaccine when it becomes available to you. I will be answering a lot of the FAQ that have come up on social media and have been asked of me personally as a physician.
I am writing this post not just as a blogger, a traveler, but also as a wife, a family member, a physician and more importantly as a Black physician.
There is a lot of mistrust among communities of color in regard to American medicine and healthcare. This is based on decades and generations of mismanagement and poor treatment of minorities. Disparities in health care still exists. But it is being acknowledged and we are on a mission to change that.
Black physicians, scientists and volunteers have been a part of the COVID-19 vaccine studies from the beginning and continue to be involved. African-Americans have been disproportionally affected by COVID-19 in terms of morbidity and mortality so it is imperative that this population has access to and receives the vaccine.
Reason #1 for taking the COVID-19 Vaccine: Vaccine over the Disease & Death.
For those of you reading my blog for the first time, I refer to myself as a “Blogger by Day and a Physician by Night”. I work at a hospital in Atlanta, Georgia so I have been on the front line during this pandemic. I won’t lie. The first time I had to see a patient with confirmed COVID-19, I was in a panic. This is coming from a physician that has been practicing medicine for over 20 years. But reading the stories of healthy doctors and nurses in China, Italy and the US who had become infected with Coronavirus from patients and died, had me shook. In my mind I kept thinking “I do not want to die. I do not want to bring this virus home to my family.”
There has also been a shortage of PPE (personal protective equipment) so for the first time in my career, we have been rationing and reusing equipment. This puts healthcare workers at higher risk of contracting the virus.
There is this misconception out there that young healthy people do not die or get severe disease from Coronavirus. That is simply not true. It is true that the elderly, nursing home residents, people with compromised immune systems and chronic illnesses such as heart disease and asthma have a higher risk of severe disease and mortality. But healthy young and middle-aged people and even children have died from COVID-19. There are experimental and compassionate use of drugs currently available. But they are not all available to all people. (read between those lines). Do you really want to roll those dice?
In addition, there are ongoing studies looking at the long-term effects of people who have recovered from COVID-19. Reports of breathing/respiratory issues and heart/cardiac issues have already been reported.
Reason #2: The mRNA Technology is not new and is well studied.
Disclaimer-Even though I am a physician, the COVID-19 vaccine is not required for my job. I decided to take it based on my research and because I believe in science. Knowledge is power and it helps us overcome fear.
I can honestly say that a few months ago I was a skeptic. I was very nervous about the idea of taking a vaccine based on new technology and one that seemed to have been developed so quickly. But as I took a deep dive into the research, I realized I was wrong. The science for this has been in the works for decades.
How do mRNA vaccines work?
Traditional vaccines use a weakened (live) or killed part of the virus or bacteria (germ) as part of a vaccine. Once it enters your body it triggers an immune response-your body creates antibodies. If at a later date the actual germ enters your body, the antibodies attack this germ and tries to prevent infection and the resulting disease.
It is important to note that again mRNA technology is not new. It has been around for decades. mRNA vaccines have been studied for Zika, rabies, CMV and Influenza. Human trials of cancer vaccines using mRNA for immunotherapy has been around since 2011.
Since the mRNA platform already existed, once the genomic sequence of the new Coronavirus was shared with the international community, scientists and researchers quickly went into action.
Of note, scientists like Dr.Kizzy Corbett who is the lead of the Vaccine Research Center Coronavirus Team at NIH, had already been doing research on Coronavirus based on the first SARS (SARS-CoV-1) outbreak in 2003. She was instrumental in the development of the Moderna mRNA vaccine.
Add all of this up with an entire world crippled by a pandemic, a virus that was spreading thru communities and therefore easy to test for, and financial resources given to pharmaceutical companies and researchers-this is why the COVID-19 vaccine seemed to develop so fast.
mRNA vaccines works by delivering instructions to our cells to make part of a protein located on the coronavirus. This spike protein is considered essential for the coronavirus to infect our cells and cause infection. The mRNA is packaged in lipid/fat, salt, sugar and some electrolytes in order for it to enter our cells. Once inside the cells it delivers the instructions. It does not alter the DNA of the cell. Once the protein piece is made the mRNA is broken down and is disposed of. GONE!
Our cells then display the protein piece on the surface of the cells. Our body recognizes this protein piece as being foreign material. It starts making antibodies against this protein similar to what occurs in a natural Coronavirus infection. Our body gets rid of these cells with the foreign proteins, but the antibodies have a memory. If the actual Coronavirus enters the body of someone who has been vaccinated with the mRNA vaccine, the antibodies that were produced will recognize that spike protein and attack the virus therefore preventing infection and disease.
A few important things to keep in mind about the mRNA vaccines 1) They do not use any part of the live Coronavirus that causes COVID-19 2) The mRNA is destroyed and does not remain in your body 3) It does NOT alter your DNA.
Reason #3: The COVID-19 mRNA Vaccine studies showed excellent results with few side effects.
Pfizer BioNTech mRNA Vaccine Study:
***Of note, pregnant women and children <16 were not included in the Pfizer and Moderna studies.
The Pfizer clinical trial is a double-blind study of an mRNA vaccine encoding the SARS-CoV-2 spike protein. It includes over 40,000 participants over the age of 16 with a median age of 52 years. Half of the participants received placebo while half of the participants received the mRNA vaccine with instructions for a piece of the spike protein as described above.
The majority of the participants are from the United States, but the study also includes participants from South Africa, Germany and Brazil. There is equal distribution of male and female, 83% white, 28% Hispanic or Latinx, 9% Black or African American, 4% Asian. The study also includes people with stable chronic medical conditions.
Participants in the vaccine group received 2 doses of the vaccine in their deltoid muscle spaced 21 days apart. The participants were monitored for symptoms of COVID-19 disease for 2 months as well as local and systemic reactions to the vaccine.
****The vaccine doesn’t prevent infection only serious disease-WRONG! It is important to note this here-participants were monitored for symptoms of COVID-19 after receiving the placebo and vaccine shots. If they exhibited symptoms, they were tested for COVID-19. Those that were confirmed positive were plotted on the tables and graphs and later stratified as mild or severe disease. They did NOT test participants for COVID-19 that did not exhibit symptoms. Therefore, there is no way to know for sure, in this study, if participants that received the vaccine could have become infected, remained asymptomatic and transmitted the virus to others. There are ongoing studies to check for this. Keep in mind the main mode of transmission is via respiratory droplets IE coughing, sneezing, blowing your nose etc. So, asymptomatic spread of the virus is less than symptomatic spread. But it is still a concern. The Moderna study did check for this with good results (see below).
This is the reason the recommendation is for vaccinated individuals to still wear masks until we have more information. Plus, vaccines are not 100%. Not everyone that is vaccinated will mount an immune response or rid their body of all of the virus. Therefore, it is possible to still become infected and transmit the virus. Until we know more it is better to play it safe. Wear masks, social distance, wash your hands and use hand sanitizer. Thank you.
Back to the study..
As you can see by the graph below, after just 12 days from the time the 1st dose was given, there was protection from symptoms/COVID-19 disease. Between the first and second dose, 82 cases in the placebo group compared to only 39 cases in the vaccine group showed symptoms of COVID-19 disease. The vaccine efficacy at this stage was 52%.
7 days after the second dose, there were 162 cases of COVID19 disease in the placebo group compared to only 8 cases in the vaccine group. This equals 95% efficacy in preventing COVID-19. Just as a comparison, based on the different strains of the Influenza virus every year, the efficacy of the Flu vaccine ranges from 40-60%. 95% efficacy for a vaccine is extremely high.
In terms of side effects during the 2-month period, there were reports of mild to moderate pain at the injection site, headache and fatigue. Local reactions resolved in 1-2 days. The systemic symptoms of fever, fatigue and headache occurred more frequently after the second dose. This is related to your body mounting a stronger immune response. No deaths were attributed to vaccine administration. There were a few cases of Bell’s palsy (I believe 4) noted in reports but not at a number larger than which occurs in the general population. This is being monitored. In addition, there have also been about 4 anaphylactic reactions. When you do receive your vaccine, everyone is monitored for at least 15 minutes after vaccine administration. 30 minutes if you have a history of allergies.
Moderna mRNA Study:
The Moderna mRNA study is similar in design. It includes over 30,000 participants over the age of 18 with a median age of 53 located in the United States. Some patients have stable chronic medical conditions. 47.4% were female, 36.5% represented communities of color with 20% Hispanic/Latino, 9.7% African American, 4.7% Asian. 25.4% are healthcare workers.
Participants assigned to the vaccine group received 2 doses 28 days apart. Participants were monitored for symptoms and then tested for COVID-19. Participants were also observed for side effects and adverse effects.
After just 1 dose of the Moderna mRNA vaccine, there was vaccine efficacy of 80.2%. After 2 doses the vaccine efficacy was 94.5%.
During the Moderna study they did test a subset of asymptomatic patients for SARS-CoV-2. Four weeks after the 1st dose of the vaccine 0.1% of participants that received the vaccine tested positive compared to a larger number of 0.3% in the placebo group that tested positive. This is a good sign that the vaccine reduces asymptomatic infection.
Side effects and adverse reactions included injection site pain, fatigue, headache, muscle pain, chills, joint pain and chills. Severe reactions were more common after the second dose. Lymphadenopathy was also documented and 3 cases of Bell’s palsy. 1.5% hypersensitivity reactions occurred but no anaphylactic reactions were reported.
Should I get the Pfizer or the Moderna mRNA Vaccines?
As you can tell from reading above, at the end of the 2 month studies the vaccine efficacies are similar at about 95%. Both also significantly reduced cases of severe disease.
The differences that have come up are 1) storage-the Pfizer vaccines have to be stored at below freezing temperatures vs Moderna which can be stored in a regular freezer. Some people worry about transportation, storage and administration of the Pfizer vaccines based on this. 2) The 1st dose of the Moderna vaccine does offer greater protection vs the 1st dose of the Pfizer vaccine. 3) Dr. Kizzie Corbett is the African-American scientist at NIH that was instrumental in developing the Moderna vaccine. This may give comfort to communities of color considering the vaccine. 4) It has been reported that more side effects occurred in the Moderna studies after the second dose. But again, side effects are associated with your body churning out a great immune response.
In the end you may not have a choice based on what your employer, health department or insurance plan is offering. My advice-do your research, speak to your doctor, and take whichever one is available.
Reason #4: Other COVID-19 vaccines options will be available…
Astra Zeneca /Oxford University Vaccine:
This vaccine was made in the UK and has been approved for emergency use. It works a bit different from the vaccines listed above. It utilizes a chimpanzee Adenovirus to store the DNA code of the Coronavirus spike protein. When this vaccine is injected, the adenovirus vector travels to the nucleus of your cells.
The DNA of the coronavirus spike protein is released, is read by the nucleus of the cell and copied into mRNA. The mRNA leaves the nucleus of the cell, the cell reads the instructions and begins making spike proteins. These are presented on the surface of the cells and provokes an immune response.
This vaccine is given in two doses 4-12 weeks apart. Efficacy after any one dose was 52.7%, after one full dose it was 73%. There was some confusion with this study since some participants were given two full doses while others were given a half dose followed by a full dose. Participants that received a half dose followed by a full dose had a higher efficacy of 90% while those that received 2 full doses had an efficacy of 62%. Therefore the overall vaccine efficacy is being reported at about 70%.
Although the efficacy is lower, there are other benefits to this vaccine. It is cheaper than the Pfizer and Moderna vaccines. Astra Zeneca has pledged to sell this vaccine for a few dollars per dose without a profit margin which would means it can be distributed to more countries. Pfizer costs $18.50 to $19.50 per dose and Moderna costs $37 per dose. Also, it can be kept in refrigerators vs freezing temperatures. Reports so far show this vaccine is effective against the new strain of Coronavirus in the UK.
Johnson & Johnson Vaccine (Ad26.COV2.S):
The Johnson & Johnson vaccine is in Phase 3 trials in the United States. Phase 3 trial results of 45,000 people are expected by the end of January. The vaccine is similar to the Astra Zeneca vaccine method above. It uses a weakened form of Adenovirus to carry genetic material of Coronavirus into the body. Your body then produces pieces of the virus which elicits an immune response.
These results are from initial trials of 805 volunteers. J&J randomly assigned healthy adults in groups in ages 18-55 and 65 and older. Some participants received a low dose while others received a high dose while others received placebo. Some participants in the 18-55 year old age group also received a second dose of the vaccine.
By 28 days after receiving the vaccine, most (90%) of the volunteers produced detectable neutralizing antibodies-both antibody and T-cell responses. Researchers believe these antibodies are crucial in defending cells against the virus. By day #57 all volunteers had detectable antibodies regardless of vaccine dose or age group. These antibodies remained stable for at least 71 days in the 18-55 age group. The Phase 3 trials are reportedly checking if the vaccine protects against infection and symptomatic disease.
Common side effects included fever, fatigue, headache, muscle aches and pain at the injection site. Side effects were less common in the older age group, those who received only one dose of the vaccine and those who received a lower dose.
The Johnson and Johnson vaccine could receive authorization for use in the United States in February. Since it only requires 1 dose and does not require freezing temperatures for storage, there are benefits for vaccine delivery to the public.
If you live abroad, you may have heard of the Chinese COVID-19 vaccine made by Sinopharm. This is more of a traditional vaccine technique. Parts of the virus are inactivated to make it noninfectious but retain enough of its protein surfaces to elicit an immune response. The UAE and Bahrain recently approved its use there. But, there has been a lack of public data released on the safety and efficacy of the studies.
The Sputnik V vaccine is being used in Russia although it did not undergo extensive trials. It is an Adenovirus vector-based vaccine using 2 different vs 1 Adenovirus vector.
*****If you have allergies should you get the COVID-19 vaccines?
Currently the recommendation is that unless you have an allergy to any of the components of the vaccines, if you have had an anaphylactic reaction to vaccines in the past, or if you have an allergic or anaphylactic reaction to the 1st dose of the vaccines, you can take the COVID-19 vaccines currently under emergency use authorization in the US-Pfizer and Moderna. However, I do recommend checking with your doctor and allergist prior.
Reason #5: Taking the COVID-19 Vaccine is the only way to achieve Herd Immunity.
The COVID-19 numbers are staggering. Over 80,850,600 global cases and over 1,766,330 million deaths. In the United States over 19 million cases and over 330,000 deaths. In California there are over 2 million cases. 1 million cases were registered in just 6 weeks!
Herd immunity is defined by Wikipedia as “a form of indirect protection from infectious disease that occurs when a sufficient percentage of a population has become immune to an infection, whether through vaccination or previous infections, thereby reducing the likelihood of infection for individuals who lack immunity”.
However according to the World Health Organization herd immunity or “population immunity” is a concept used for vaccination purposes. It is achieved by protecting people from a virus not exposing them to it.
The idea that anyone would be willing to let Coronavirus “run thru the community or nation” and tally up more deaths in order to achieve herd immunity is plain evil.
Herd immunity is reached by meeting a certain threshold of vaccinating the population-the majority of the population. The percentage varies per disease.
According to Dr.Fauci, about 70 to 85% of Americans will need to be vaccinated against COVID-19 in order to reach herd immunity. That equals 230 million to 279 million of the total US population. At that point a significant portion of the population will be inoculated against the virus. This will decrease cases and prevent further spread.
I feel strongly that this is a community responsible. Whether you feel that you are young, healthy and not at risk for serious complications from COVID-19, you can become infected and spread it to someone who is. Your infant child, your grandparent, your co-worker with heart disease.
A Kaiser research project published a survey on December 15, 2020. It found an increase in the public saying that they would “definitely or probably get a COVID-19 vaccine if it was determined to be safe by scientists and available for free to everyone who wanted it”. That number was 71% compared to 63% in September. This study gives me hope that we can encourage the public to receive COVID-19 vaccines and achieve herd immunity.
Reason #6: Get the COVID-19 Vaccine to travel again. (YES!!)
If you follow me on social media, you know that I do not believe in judging or shaming anyone for traveling during the pandemic. I have actually written blog posts and had Live broadcasts keeping my readers and followers informed on CDC and State Department travel guidelines and how to stay safe and healthy while traveling.
However, I have stayed close to home this year. I have taken two short trips since our cruise in January. My husband and I did a 4-hour road trip to Hilton Head from Atlanta and I have taken a 40-minute flight on Delta to Northern Florida. No international trips. I have been too nervous about contracting the virus and also unknowingly spreading it to others.
Receiving the COVID-19 vaccine gives me a feeling of relief and security. I know that when I do decide to travel again, I will have protection against becoming infected with the virus.
In a recent article by MMGY, they mentioned a “Vaxication”-the first trip people will take after being vaccinated. Per Expedia, in a recent survey, 57% people said they would feel more comfortable traveling if a vaccine were available. Having the COVID-19 vaccine may allow for more travel freedoms with where you are allowed to go and what you are allowed to do. And, you may avoid mandatory quarantines.
Also, the world is changing. As we have seen, there have been increasing requirements by airlines, cruise ships, cities, states and countries for COVID-19 screenings, tests and quarantines. As vaccines becomes more available, this may also become a recommendation or requirement. Qantas caused an uproar prior to COVID-19 vaccine approvals stating that the airline would require the vaccine for their passengers.
You may encounter “immunity passports” and “e-vaccination certificates”. Israel is the first country to announce COVID vaccine passports or “green passports” to residents who have received the COVID-19 vaccine. It will lift certain restrictions and allow greater access to cultural events and restaurants.
Several international organizations are working on health apps to track the Coronavirus status of travelers. The International Air Transport Association has “Travel Pass” in the works while some of the world’s biggest airlines are developing “Common Pass”.
However, taking the vaccine may not replace COVID-19 testing at this time since studies have not shown yet and do not guarantee that you are not infected/infectious at the time of travel.
Reason #7: If you live in the United States the COVID-19 Vaccine is free.
“Operation Warp Speed” in the US is a public-private partnership by the US government to facilitate and accelerate the development and distribution of COVID-19 vaccines. But the government was not involved with the scientific studies. It will allow everyone in the United States to receive the vaccines for free which is amazing.
The CDC (Centers for Disease Control) & ACIP (Advisory Committee on Immunization Practices) has made recommendations for the rollout of the currently approved COVID-19 vaccines in the United States-Pfizer and Moderna.
Currently healthcare personnel and long-term care facility residents are being vaccinated. Frontline essential workers, the elderly, people with underlying medical conditions should expect to receive their COVID-19 vaccines soon. The plan is by spring/summer of next year most of the general population will be vaccinated.
There have been some hiccups so far. The government didn’t initially buy enough vaccines from the pharmaceutical companies so new orders have been placed. Each state is responsible for the allocation of the vaccines and I am aware of many physicians who still do not have access to either vaccine. Hopefully as more COVID-19 vaccines become available this will be less of an issue.
COVID-19 Vaccines Unanswered Questions:
1. What are the long-term effects of the COVID-19 vaccines? This is being monitored. The participants in the Pfizer and Moderna studies were initially followed for 2 months but they will be followed for 2 years. The good news is that most adverse effects from vaccines happens sooner vs later.
2. How long will the immunity last? Will we need a new vaccine or booster every year? Most vaccines give long lasting immunity unless the the germ changes significantly requiring a new vaccine or booster. Since this is a new vaccine, antibodies and infection rates will need to be monitored.
3. If you have had COVID-19 can you still receive one of the COVID-19 vaccines? There have been several reports of reinfection. At this time it is unclear how long immunity lasts from a natural infection although reinfection is uncommon in the 90 days after the acute infection. You should wait until until you are completely recovered from the acute infection and completed isolation before receiving the COVID-19 vaccine.
4. Do these vaccines cover the new Coronavirus strains in the UK, South Africa, United States, Japan..? Viruses are constantly mutating. There can be minor variations are major mutations. So far the new strains spread easier from person to person but do not cause more severe disease. The UK variant was found to be 70% more transmissible which caused a huge surge in infections.
Since most of the vaccines thus far are focused on the spike protein of the virus, major mutations to this area would be of great concern. The spike protein contains the receptor binding protein which is used by the virus to attach itself to human cells and gain entry into the body. The UK and South Africa variants do have mutations involving the spike protein.
However, researchers feel that the current vaccines on the market should cover the current Coronavirus strains. The vaccines may need to be adapted to these new strains in the future similarly to the Flu vaccines. The World Health Organizations and agencies such as the Centers for Disease Control regularly do surveillance and sequencing of Coronavirus’ genetic code.
Whew. You made it! I made it! I think this is my longest blog post. I obviously had a lot to say on this subject, but I hope it was helpful. I wanted to end this year with a message of hope. These vaccines give me hope that we can put an end to this pandemic and get on with our lives. I for one cannot wait to start exploring the world again. Please practice self-care and stay healthy!
Follow along on my social media channels for updates on COVID-19 Vaccines and traveling during the pandemic.