The New Year brings renewed energy in our collective efforts to win the race against a common foe. If we intend 2021 to be a year of joy and hope — we absolutely need to use all viable tools at our disposal and unite in our efforts to beat the coronavirus. One such tool is vaccines, considered one of the most important advances in modern medicine, and has been responsible for greatly improving our quality of life over centuries. Vaccines have allowed us to triumph over serious adverse diseases by reducing or eliminating many dangerous infectious diseases we don't even think about anymore.
Vaccination research and development has never stopped. Global partnerships have been formed to create faster, more efficient platforms and new technologies to help us against the onslaught of diseases like Ebola, Zika, and the coronavirus family — SARS (severe acute respiratory syndrome), MERS (Middle East respiratory syndrome), and now SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2).
The victory of vaccines, our most promising counter-pandemic measure, in our fight against a pathogen like SARS-CoV-2, the virus that causes Covid-19, relies on a critical mass of people becoming immune to the virus. This breaks the chain of transmission and, most importantly, protects the most vulnerable people in our community who cannot develop immunity through vaccination. This is called herd immunity — vaccines go beyond our individual benefit; it protects us as a community. Imagine this vaccinated community surrounding a pregnant mother who cannot get vaccinated now; she is protected through this invisible shield of the community blocking SARS-CoV-2 from reaching her.
Vaccine safety requirements are among the highest in the nation because they are widely distributed. Two vaccines (Pfizer/ BioNTech and Moderna) received U.S. emergency use approval (EUA) from the FDA. Nearly 2.8 million people in the U.S. have received a Covid-19 vaccine to date. Dr. Francis Collins, director of the U.S. National Institutes of Health, received the Moderna vaccine on December 22, 2020 — saying the two vaccines had been examined and put through more rigorous analysis than most vaccines to date. Nonetheless, some common myths are surrounding both vaccines:
Both approved U.S. vaccines contain no virus or viral particles. You are not injected with any part of a virus. The vaccines use synthetic messenger RNA (mRNA) that our cells can read to make a specific piece of the virus, which on its own cannot harm. This piece is the protein spikes on the outside of the virus, and it is what helps the virus dock onto a human cell and allows it to infect us. By allowing our cells to reproduce this spike temporarily, we teach our immune system what to look for in the face of a future coronavirus attack. This memory of what to look for provides us immunity and allows us to respond much faster.
The development of the current vaccines did not start in January 2020. Science has been paying close attention to the coronavirus family for many years. Research into the messenger RNA technology used in the Pfizer/ BioNTech and Moderna vaccines has been in development for close to 15 years. The perceived speed in getting the vaccines to the public is partly due to unparalleled worldwide emergency cooperation, free sharing of information, and new faster technology platforms. Also aiding has been billions in private and public funding, allowing vaccine firms to run preclinical and phase I, II, and III trials in parallel instead of sequentially. The FDA completed a meticulous safety review, and the independent Advisory Committee on Immunization panel scrutinized safety and efficacy data from the clinical trials.
Your cell's DNA is securely kept inside a nucleus in the cell. The snippet of mRNA that gets injected does not gain access to the nucleus and never comes in contact with your DNA. Your cell machinery translates the mRNA and manufactures the viral spike protein needed to present to your immune system. Once the instruction is read, human cells break down and get rid of the mRNA.
Currently, we don't have enough information to definitively know how long after infection someone might be protected from getting reinfected with Covid-19. Early indications suggest this natural immunity may not last very long. The CDC recommends getting vaccinated. However, if you are currently infected with Covid-19, the recommendation is to delay vaccination until the illness has resolved.
According to Dr. Anthony Fauci, Director of the National Institute of Allergy and Infectious Diseases, getting rid of public health measures like wearing a mask is only possible once there are extremely low levels of circulating virus left. For this to happen, we need 75-95 percent of people to have immunity to the coronavirus.
Both Pfizer/ BioNTech and Moderna have reported that their vaccines contain no preservatives. The vaccines are created using a novel methodology to synthesize the mRNA, encapsulated for protection in a lipid or oily shell. This technology allows the vaccine to be free from materials of animal origin, egg, and without preservatives. However, mRNA is fragile and can break down easily. Storing vaccines in ultracold environments keeps them stable and safe. Vaccines are thawed before injection.
Life and vaccines never present us with absolute safety in usage. We must acknowledge this — vaccines do carry some risks. Of the close to 2.8 million U.S. vaccines to date, very few recipients reported short-term mild or moderate symptoms that resolved without complication within a day or two. These included sore arms, redness at the injection site, headache, chills, fatigue, muscle pain, or fever — all expected indicators that your immune system is responding to the vaccine — and comparable to side effects seen with the shingles vaccine. As of December 23, 2020, the U.S. has seen 10 cases of anaphylaxis. Anaphylactic reactions can occur with any vaccine but are extremely rare. The cases occurred in people with a significant history of severe allergies and were safely managed with epinephrine, and the CDC has distributed safeguard protocols to vaccine sites.
But, compare these calculated vaccination risks to that of the virus itself — which has infected more than 83 million people globally and killed approximately 1.8 million — including more than 350,000 deaths in the United States. Now add in the devastation caused to economies and health systems. Dr. Walter Orenstein, the former director of the United States' National Immunization Program, wrote that if vaccines are not administered to the persons they are recommended for, there is zero impact. In the current pandemic, time is lives. We need an estimated 80 percent of people vaccinated to reach herd immunity to have a fighting chance to stop this pandemic in its tracks — and we need to get it done now.
We face a collective threat — a pandemic, and a moral dilemma on choosing to be vaccinated. Concerns over the vaccines' safety are understandable, but reports on negative outcomes are few and far outweighed by the benefits. This quarantine year has taught me that we are intrinsically bound to our community, only truly to thrive through community involvement and participation. We need each other, and we have an obligation to take care of one another. Getting a Covid-19 vaccine is not just about you; it is protecting your grandmother who has diabetes, your neighbor who is immuno-compromised — it safeguards everyone who is medically unable to receive a vaccine and needs you as their human shield against coronavirus reaching them. Vaccinations save lives — when your eligibility phase comes up, be a solid citizen, loving caring child, sibling, parent, and spouse…GET IT!
This column is a monthly feature of “Health & Exercise Forum” in association with the students and faculty of Geisinger Commonwealth School of Medicine.
Author: Hendrik Marais, MD, MS
Hendrik Marais, MD, MS, received his Doctor of Medicine degree from Geisinger Commonwealth School of Medicine in 2015 and his Master of Science degree in Global Medicine from Keck School of Medicine at USC in 2019. He is passionate about creating positive and empowered patient health outcomes. He grew up in South Africa and currently calls Scranton, PA home – where he enjoys cycling, swimming, and discovering the beauty of NEPA. He is a member of the American Medical Association, American Public Health Association, and the International Society of Physical and Rehabilitation Medicine. He plans to pursue a clinical career in physiatry.
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Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at Geisinger Commonwealth School of Medicine.