MORGANTOWN — The COVID-19 vaccines is rolling out in an environment of hope, fear and doubt. People want to take their masks off tomorrow and see their friends and family. People are afraid of side effects or long-term effects or government control. And more.
With that in mind, The Dominion Post spoke with Dr. Amit K. Mahajan – who goes by Dr. Bobby – an American Lung Association volunteer medical expert and medical director of the Interventional Pulmonology and Complex Airways Disease Program at Inova Medical Group in northern Virginia and the greater Washington, D.C. metro area.
The conversation coincided with the release of a YouTube video and print summary of the video by WVU’s Dr. Ivan Martinez, an associate professor in the School of Medicine and Cancer Institute physician.
For this report we weave some of Martinez’ comments in with the conversation with Dr. Bobby.
Dr. Bobby explained that Pfizer and Moderna use a new technology in their vaccines. A traditional vaccine uses actual elements of a virus or a dead virus to alert and train the immune system to identify and respond to an infection,
Pfizer and Moderna use synthetic mRNA – messenger RNA – to convey information about the coronavirus spike protein (the little mushroomy protrusions you see in pictures of the virus) to the immune system so the system can identify the virus and prevent the virus spike proteins from adhering to the pateint’s cells.
In other words, he said, instead of injecting a foreign virus into the body, the vaccine uses the machinery of the person’s cells to produce a non-functioning spike protein that the body recognizes and creates an immune response for.
“This makes the mRNA really effective,” he said – about 95% effective. And the technology is serving as a template for future treatments of such things as HIV and cancer.
The mRNA also degrades, he said, and never interacts with or alters a person’s DNA. DNA alteration has been one of the fears spread by anti-vaccination conspiracy theorists.
Martinez agreed: “The messenger RNA can’t integrate with our DNA, so there’s no need to worry that it will alter our genetic makeup. And it disappears after only a few days, which means it won’t linger in our cells after fulfilling its purpose.”
Injection site pain, low-grade fevers and some other minor side effects, Dr. Bobby said, show that the immune system is working and responding to the abnormal thing that’s been injected.
Some of the vaccines that will follow – such as those by AstraZeneca and Johnson & Johnson, he said, are more traditional, using dead virus. The AstraZeneca vaccine uses an adnovirus genetically altered so the body recognizes it as a coronavirus. Johnson & Johnson’s is similar.
They’re less effective – AstraZeneca’s is about 75% effective – but still exceptionally effective compared to a traditional flu vaccine which shoot for 50% effectiveness, he said. “We’re knocking it out of the park when it comes to the actual effectiveness of what we’re shooting for.”
Nationally, he said, herd immunity will require about 200 million Americans to get vaccinated. So part of the challenge is, “We’ve got to make sure people take these vaccines.”
Are there risks?
Because of how fast the vaccines have become available, people are appropriately concerned about how fast it’s moved, Dr. Bobby said.
“There are some risks with any kind of vaccine,” he said. But in the last 40 years, the majority of serious side effects occur in the first 30 days, such as tingling or facial numbness. In older vaccines, a few people develop Guillain-Barre syndrome, which can cause a transient paralysis.
“We haven’t seen any real data that is concerning with regard to the Pfizer and Moderna vaccines,” he said. “The risk is extremely low.” For the Pfizer vaccine alone, 40,000 people were tested.
Developing the vaccine in the midst of the pandemic has helped speed the process, he said. “In order for a vaccine to be effectively tested, people have to get sick.” There has to be sufficient prevalence to allow for trials. “With coronavirus it’s so different because of the fact the prevalence is so high .. you can identify if the vaccine is effective very quickly.”
Martinez similarly noted, “With the technology that we have right now, we were able to create this vaccine faster, but this vaccine went through the same testing phases as any other vaccine that was developed before.”
The development of COVID-19 vaccines did not begin at the onset of the pandemic itself, Martinez said. Scientists have researched vaccines over the years for related coronaviruses, such as SARS and MERS, and the timing and effort have now fallen into place.
“The COVID-19 vaccine could run the gauntlet of tests so quickly because scientists conducted all three phases of clinical trials simultaneously rather than sequentially,” he said.
Dr. Bobby said no one knows the long-term effects or effectiveness yet. Pfizer will monitor all test subjects for two years.
People who have concerns about possible allergic reactions to one of the vaccines should talk to their provider, he said, In some cases, a different brand of vaccine may be more appropriate.
For those who’ve had COVID and are wondering if the vaccine is necessary, Dr. Bobby said immunity from having contracted the virus may be fleeting, maybe three to four months. The immune response developed by a vaccine is more effective, so if you’ve cleared it, get the vaccine.
If you’re infected, the advice is to typically wait two weeks, until you’re symptom free, to get the best response. And meanwhile, get your infection treated.
It’s important not to take COVID lightly, Dr. Bobby said. Some people see potential long-term effects. If you have underlying diseases or abnormalities, COVID can exacerbate them. At Inova, they saw previously unknown, underlying medical problems exposed by COVID.
Some had significant lung scarring because of inflammatory response, he said, Others saw neurologic changes causing dizziness and balance problems. At this point, it’s hard to know if it will be short term or not. “Only with time and research over the next couple of years are we going to see the long-term effects, if any.” And that’s why the vaccine is important – to avoid getting COVID.
Martinez said two people in the United Kingdom and one in Alaska experienced allergic reactions after receiving the Pfizer vaccine. But those three individuals make up a tiny portion of the total number of vaccine recipients.
According to the FDA, he said, only 1% of study participants who received the Moderna vaccine experienced serious adverse events, a frequency that the FDA deems “low.” It’s identical to the rate of serious adverse events in people who received a placebo.
And in a Pfizer trial, just 0.6% of people in the vaccine group — and 0.5% of people in the placebo group — had at least one serious adverse event.
“Please don’t feel like you’re a guinea pig,” Martinez said. “It’s clearly safe.”
The question remains how often boosters may be required. Martinez said, “With other types of coronaviruses — like the ones that cause the common cold — we create antibodies against them for only a few years. So, we’ll probably get a coronavirus vaccine every year, just like the influenza vaccine.”
Scientists will be able to tweak the vaccine formulation in response to the virus’s mutations over time, he said. In doing so, they can preserve the vaccine’s effectiveness in the years to come.
Martinez said scientists are confident that the vaccine keeps people from coming down with COVID-19, but they don’t yet know if it prevents people from passing the virus onto others. There isn’t enough data yet.
What’s ahead?
For those questioning the validity of the various conspiracy theories – government tracking, mind control and such – Dr. Bobby said “The concern is understandable. We’re in a cultural and political climate that there is a lot of fear out there.”
The fears are chiefly instigated by people who don’t know the data or the science, he said. “Lack of knowledge is what develops fear.” The medical and public health communities have to demonstrate the vaccine is safe and sound. As people take it and the awareness they are doing OK spreads, more will come aboard.
As we wait, many are experiencing burnout and wondering when it will be safe to take off our masks.
Dr. Bobby said, “It ebbed and flowed in a way that makes everyone exhausted … people just want to find light at the end of the tunnel.”
Some timelines have a bit aggressive; there are 320 million Americans and at least 200 million need to be vaccinated, he said. “A spring timeline of everyone getting vaccinated isn’t really that realistic.” Incoming President Joe Biden’s nominee for surgeon general has suggested late summer to early fall to see majority getting vaccinated.
“I think it’s more realistic to say that late summer, early winter of 2021 is where we’re going to start see some normalcy come back and resume,” Dr. Bobby said. There will still be some pockets of infections but we should see a more normal Thanksgiving and Christmas in 2021.
Much of the fear and misinformation, he said, stems from inconsistent and wishy-washy government leadership all across the country. “The wishy-washiness is really a problem,” he said. It often comes from government figures who don’t have the knowledge or a command of science. It is really a shame when this is politicized. The goal of science is to discover truth.”
Sometimes the inconsistency came because knowledge evolved as the pandemic progressed. But sometimes leaders chose to say what people wanted to hear, and because people chose to hear only what they wanted.
“Realism is what really drives science and medicine. You have to listen to people who know what they’re talking about. Sometimes we have to hear things we don’t want to hear, but it’s the truth.” And speaking the truth builds trust. “We need to build a regular, honest and factual-based message on a regular basis.”
Tweet David Beard@dbeardtdp Email dbeard@dominionpost.com
