COVID-19 Vaccination

Many people still have questions or concerns about getting vaccinated against COVID-19. The following information is intended to help you make an informed decision

1.) As things are right now, there is a very high probability that we all will come into contact with the virus or a variant at some point in our lives.

The COVID-19 (SARS-CoV-2) vaccine dramatically reduces the chances of developing a serious reaction to the virus. Most vaccine-related adverse effects are mild to moderate and temporary. According to one study, the chances of developing a severe allergic reaction to the Pfizer and Moderna vaccines were between 0.00025% and 0.001% (Shimabukuro et al, 2021). Bear in mind that allergic reactions are the most serious adverse side effects of the vaccine. There are other serious side effects, but they are very rarely life-threatening and have a very low probability.

The risk of developing severe symptoms as a result of COVID-19 increases with age (CDC, 2021). According to a Public Health Canada assessment, fully vaccinated people were 70% less likely to be hospitalized and 52% less likely to die as a result of their illness (Public Health Agency of Canada, 2021). As it stands right now, the vast majority of people developing serious reactions to COVID-19 (and variants) are mostly the unvaccinated population, accounting for ~89% of hospitalizations (Public Health Agency of Canada, 2021). Breakthrough cases in the vaccinated population generally involve much milder symptoms (CDC, 2021) and make up only 0.6% of current hospitalizations in Canada (Public Health Agency of Canada, 2021). Studies also show that the vaccinated population transmit the virus at lower rates than the unvaccinated population (Shah et al, 2021).

2.) The pandemic is not going to end anytime soon without action.

Infectious diseases do not go away on their own. Either we receive the vaccine and manage to stop or slow down the spread of infection with herd immunity, or the virus makes its way through the population, causing serious side effects and killing people in the process, which, if recent history is any indicator, would likely primarily affect our vulnerable populations. Vaccines have a historically high success rate. for example, Smallpox was eradicated due to vaccines. (World Health Organization, 2021).

3.) The longer it takes to get a large portion of the population vaccinated, the more time the virus has to mutate.           

The original vaccines were very effective for the strains that were spreading at the time of their development. There are breakthrough cases happening with vaccinated people, which is expected as the vaccine primarily protects against severe outcomes. Breakthrough cases appear to be more common with SARS-CoV-2 variants (CDC, 2021). It will take time to develop more effective vaccines for the new variants, and by that time, more variants will likely have emerged. This foreshadows a potential cycle of ongoing mutation and reinfection that may not end without a strong response from the public to get vaccinated to stop the virus from spreading and mutating via herd immunity.

To add context, mutations can change the behaviour of the virus. For example, new variants might: i.) Cause the virus to spread more easily. ii.) Cause more or less severe illness iii.) Require different treatments. iv.) Reduce current vaccine effectiveness (Public Health Agency of Canada, 2021). According to Yale Medicine, new mutations of the SARS-CoV-2 virus could very well bring it back, and it could even be stronger than before (Katella, 2021). Take the current delta variant into consideration, from July 22-29, the number of children in the U.S being hospitalized had almost doubled from the previous week (American Academy of Pediatrics 2021). The bulk of this influx is the result of the delta mutation of the SARS-CoV-2 virus (CDC, 2021).

4.) The SARS-CoV-2 vaccine has good safety data.

Vaccines in general have very good safety profiles as compared to pharmaceutical drugs. There are very few vaccines in history that have had serious adverse side effects, unlike pharmaceutical drugs (including over-the-counter medications), which many people use without hesitation, despite higher rates of adverse effects. The most severe side effect is related to an anaphylactic allergic response to the vaccine ingredients, which is reported to happen in roughly 2.5 – 11.1 people per million (Shimabukuro et al, 2021). This is why patients are asked to wait briefly after receiving a vaccine. Medical staff keep epinephrine on hand in case someone experiences an anaphylactic reaction. It is thought that these allergic reactions are to the common ingredients (e.g., polyethylene glycol (PEG) or polysorbate 80) typically used to deliver vaccines. So if you had an allergic reaction to other vaccines, then you may also have a reaction to one or more of the SARS-CoV-2 vaccines. The use of any vaccines should be discussed with your physician to rule out any pre-existing potential for additional risk.

There have been reports of myocarditis and pericarditis (inflammation of the heart muscle and the heart lining, respectively) following the mRNA vaccines in the adolescent/young adult population, affecting mostly young males. Currently, it is not clear if this was a result of the vaccine, as myocarditis and pericarditis typically happen as a result of various viral infections (including the adenovirus, which causes the common cold). The CDC is currently investigating the cause, and it is being monitored, so the exact number of cases is currently unknown. It is also important to mention that cases of myocarditis and pericarditis are estimated to occur much more often in cases of COVID-19 than post-vaccine (Daniels et al, 2021). The majority of the side effects are mild and due to the body’s immune response, like headaches and fatigue, as well as a sore arm from the injection into the muscle.

I hope these points explain my thought process. After much investigation and research, I based my decision using statistical probabilities to quantify the risks. From the data I collected, the chance of a severe adverse effect from the vaccine was between 0.00025% and 0.001% (Shimabukuro et al, 2021). The chance of coming into contact with SARS-CoV-2 throughout my lifetime was estimated to be high, and the chance of developing severe symptoms from COVID-19 varied by age group and personal health profile; however, the numbers were significantly higher than 1% for ALL age groups. As an added bonus to protecting myself, I am also helping to protect my family and community.

Some additional concerns that I have been asked about are as follows:

THE VACCINE WAS DEVELOPED TOO QUICKLY. CAN WE REALLY BE SURE THAT IT IS SAFE?

This actually is not the case for the Pfizer and Moderna vaccines. Jason McLellan and Barry Graham had been developing mRNA vaccines for ~12 years with the RSV and MERS viruses that share similar characteristics with the SARS-CoV-2 virus (they have a surface protein). The technology used in the MERS and SARS-CoV-2 mRNA vaccines stabilizes the virus’s spike protein, preventing it from changing from its prefusion state into its post-fusion state, so it does not fuse with human cells and remains a harmless immune target (Kramer, 2021). The safety of this technology has been tested with these other two viruses, and while the response may not be exactly the same, they provide a pretty good indicator of the human body’s reaction.

WHAT IF THERE ARE LONG-TERM SIDE EFFECTS OF THE VACCINE THAT WE DO NOT YET KNOW ABOUT?

Side effects generally happen during your body’s initial immune response. For the Pfizer and Moderna vaccines, the mRNA quickly deteriorates in your body. Your immune system begins to develop an adaptive immune response fairly soon after your body builds the augmented spike protein, and this process is typically completed within a few weeks of taking the vaccine. Since you are not getting the virus and just a modified ‘locked-in’ spike protein, it is highly improbable that long-term side effects will appear outside of the initial immune response. Historical vaccine monitoring has shown that side effects generally happen within six weeks of receiving a vaccine (CDC, 2021). Long-term side effects of the SARS-CoV-2 virus itself are another story. Some viruses have been known to cause long-term health issues for some people; only time will tell if this will be the case for COVID-19.

REFERENCES

American Academy of Pediatrics. (2021). Children and COVID-19: State-level data report. https://www.aap.org/en/pages/2019-novel-coronavirus-covid-19-infections/children-and-covid-19-state-level-data-report/

Centers for Disease Control and Prevention. (2021). CDC COVID data tracker. https://covid.cdc.gov/covid-data-tracker/#variant-proportions

Centers for Disease Control and Prevention. (2021, August 5). COVID-19 breakthrough case investigations and reporting. https://www.cdc.gov/vaccines/covid-19/health-departments/breakthrough-cases.html

Centers for Disease Control and Prevention. (2021). Possible side effects after getting a COVID-19 vaccine. https://www.cdc.gov/coronavirus/2019-ncov/vaccines/expect/after.html

Daniels, C. J., Rajpal, S., Greenshields, J. T., Rosenthal, G. L., Chung, E. H., Terrin, M., ... & Big Ten COVID-19 Cardiac Registry Investigators. (2021). Prevalence of clinical and subclinical myocarditis in competitive athletes with recent SARS-CoV-2 infection: Results from the Big Ten COVID-19 cardiac registry. JAMA Cardiology, 6(9), 1070–1077. https://doi.org/10.1001/jamacardio.2021.2065

Katella, K. (2021, August 12). 5 things to know about the Delta variant. Yale Medicine. https://www.yalemedicine.org/news/5-things-to-know-delta-variant-covid

Kramer, J. (2021, May 3). They spent 12 years solving a scientific puzzle. It yielded the first COVID-19 vaccines. National Geographic. https://www.nationalgeographic.com/science/article/these-scientists-spent-twelve-years-solving-puzzle-yielded-coronavirus-vaccines

Public Health Agency of Canada. (2021, May 28). COVID-19 daily epidemiology update. https://health-infobase.canada.ca/covid-19/epidemiological-summary-covid-19-cases.html

Shimabukuro, T. T., Cole, M., & Su, J. R. (2021). Reports of anaphylaxis after receipt of mRNA COVID-19 vaccines in the US—December 14, 2020–January 18, 2021. JAMA, 325(11), 1101–1102. https://doi.org/10.1001/jama.2021.1967

Shah, A. S., Gribben, C., Bishop, J., Hanlon, P., Caldwell, D., Wood, R., ... & McAllister, D. A. (2021). Effect of vaccination on transmission of COVID-19: An observational study in healthcare workers and their households. MedRxiv. https://doi.org/10.1101/2021.03.11.21253275

World Health Organization. (2021). Smallpox. https://www.who.int/health-topics/smallpox#tab=tab_1