Please note: Vermont Mom Contributing Writer, Mario Trabulsy, MD is a board-certified emergency physician with over 27 years of experience. She is also a renowned and award-winning educator at University of Vermont Larner College of Medicine, and University of Vermont College of Nursing and Health Sciences. Her recommendations and answers here are not intended to replace conversations with your own medical care provider.
I’ve been crowdsourcing questions and concerns my friends have about getting the COVID-19 vaccine. As a physician, mother, partner, friend, family member, and cancer survivor, I feel strongly that everyone should get the COVID-19 vaccine as soon as it is offered to them.
These vaccines are 94.5-95% effective in preventing COVID-19 related disease in people who have been exposed to COVID-19. Although the initial clinical trials did not look at whether the vaccine made it less likely for vaccinated people to carry the virus and infect others, that data should be available shortly, and, if this vaccine behaves as most other vaccines do, there should be less spread of the virus from vaccinated individuals. Until we have the data, we need to continue to be as safe as possible and assume that vaccination does not decrease virus transmission, even while it does protect the vaccinated.
Having said that, I understand that many reasonable, intelligent, and well-intentioned people are worried about a wide array of issues and might be reluctant to get the vaccine until these concerns are addressed, so I am going to attempt to explain some of the science behind the vaccine technology and address people’s common questions or concerns regarding this new vaccine. Before we start, let me assure you that I have no conflicts of interest and do not stand to gain anything (except getting back to some semblance of a more normal life, and the health and well-being of my friends, family, and patients) from people being vaccinated.
The short version of what I have to say is: GET THE COVID-19 VACCINE AS SOON AS IT IS OFFERED TO YOU. Get whichever vaccine is offered to you. Just do it. The benefits of the vaccine far outweigh the risks of COVID-19 for pretty much all groups studied except those allergic to the actual components of the vaccine (and most likely for groups not studied too- kids, pregnancy, breastfeeding, etc).
But, let’s still look at the concerns my friends raised with me:
1. mRNA technology is new and we don’t know the long-term effects (and I don’t want to be a guinea pig.)
First of all, mRNA drug delivery technology is NOT NEW. The technology has been around for about 30 years and has been tested in vaccines for SARS and MERS, which are coronaviruses like COVID-19, and are also passed from one person to another by tiny, microscopic droplets in the air. The reason these vaccines have not been used in the past has a lot to do with the fact that the components are unstable at normal temperatures and must be stored in specialized freezers. Until the COVID-19 pandemic, it just hasn’t been worth it to deploy such an army of deep-freezing facilities across the world.
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mRNA vaccines are most likely far safer than old live but weakened virus vaccines or killed virus vaccines that we have used in the past.
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mRNA vaccines do not contain ANY COVID-19 material, and CAN NOT give you COVID-19.
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The mRNA does not enter your cell nucleus or interact with your DNA.
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All components of the vaccine are quickly cleared from your system, leaving only the antibodies they were intended to generate.
mRNA vaccines teach your immune system to fight COVID-19, and can have side effects of feeling flu-like for about 24 hours as your immune system revs up, creating antibodies that recognize a specific COVID-19 spike protein. The potential side effects are short-lasting and not dangerous. They are expected in about 30% percent of those getting the vaccine. Having these side effects does not mean you are allergic to the vaccine or shouldn’t be getting it. It means your body is doing its thing to help protect you.
Most vaccine side effects occur immediately or within a couple of weeks of getting a vaccine. There is no reason to believe that mRNA vaccines are any different. In all groups studied in the clinical trials for the Food And Drug Administration Emergency Use Authorization approval, the vaccine was highly effective in preventing severe COVID-19 disease and very safe. The study groups for the two mRNA vaccines had over 70,000 participants leading to its emergency approval. As of today, 54.4 million doses of COVID-19 vaccine have been administered since the trials, mostly to health care workers, and again, there have been very few serious side effects (11 serious side effects seen per million vaccines given, mostly anaphylactic reactions which developed within 15 min of receiving the vaccine).
In other words: it is far safer to get the vaccine than to get COVID-19.
But what about the long-term? We have not found any serious long-term vaccine side effects in the nearly a year since COVID-19 vaccine trials have been going on. In the same period, we have come to know of many serious long-term consequences of getting infected with COVID-19.
But what about years down the line? What if there are side effects of the vaccine that happen then? My answer to that is we can’t know what will happen in 10 years until 10 years from now. But what we do know is that the long term side effects and illness from COVID-19 disease are severe and persistent (so far) and that, in general, vaccines have no late side effects and there is no reason to believe this vaccine will be any different. All vaccine components are quickly broken down in the body and excreted, leaving only the antibody response it was intended to generate. So although we don’t have the answers to all the questions, science would argue that it is far safer to get the vaccine than to not get the vaccine both in the short and long term.
I think of it like this- I’m a cancer survivor. I knowingly ran poison with lots of known long-term negative side effects into my body to stay alive. Everyone who has ever done chemotherapy has done the same. If you ever get cancer, or if your child gets cancer, you will likely do the same. In contrast, the COVID-19 vaccine is not known to have any long-term negative side effects. It may help you or a loved one stay alive or stay healthy. The known benefits far outweigh the unknown (and unlikely) risks.
2. “What if I have an autoimmune disease?”
As with every active, ongoing illness that you are under a physician’s care for, it is best to talk to your physician about your specific case.
Having said this, COVID-19 disease activates the immune system like no other illness we have ever seen, and in all likelihood, the vaccine will be recommended to you since the benefits of vaccination outweigh the risks of the disease.
3. “What if I have active cancer and am undergoing treatment? What if I’m a cancer survivor finished with treatment?”
As with every active, ongoing illness that you are under a physician’s care for, it is best to talk to your physician about your specific case.
However, patients in active cancer care with both chemotherapy and immune modulators are at high risk for severe COVID-19 disease and the benefits of the vaccine are even more clear in high-risk groups. The timing of the vaccine might be important if you are actively undergoing chemotherapy in that it would benefit you to be able to time it for a week when your white cell counts are higher so that you can mount a better immune response, but this is about the vaccine being maximally effective, not about it being safe. Cancer survivors not currently in active treatment should also get the vaccine. Having had chemotherapy in the past puts you at a higher than normal risk for severe COVID disease.
4. “What if I’m pregnant or breastfeeding?”
Although the vaccine was not studied in pregnant or lactating patients, a number of people became pregnant during the study period. Receiving the COVID-19 vaccine caused no known harm to the fetus. The American College of Obstetrics and Gynecology just released a consensus statement recommending not withholding the vaccine in pregnant patients. ACOG recommendation. Pregnancy is a risk for severe COVID-19 disease, and with no known reason to not vaccinate, the benefits of vaccination outweigh the risks of disease. Breastfeeding is also not a reason to skip or delay vaccination. Antibodies produced in the mother’s milk may even help protect the infant.
5. “I’ve heard there might be problems with future fertility with the mRNA vaccines against COVID-19.”
THIS IS A MYTH and a conspiracy theory. There is a tiny fraction of the genetic code of the spike protein on the COVID-19 virus (the protein the vaccine targets) that bears similarity to a placental protein which is the basis for this myth, but there is no reason to believe that there is any risk of infertility from getting the vaccine. There is, however, an infertility risk if you are dead from COVID-19 disease. ACOG has also put out a statement debunking this myth.
6. “If the vaccine isn’t safe for/approved for children, it can’t be safe for adults.”
The vaccine was not tested in children in the initial trials. Both Pfizer and Moderna are currently recruiting children in the 12-16 year age range. Trials for younger children will likely follow, and vaccines will hopefully be available for children in late 2021.
7. “What if I have a neurologic disease?”
As with every active, ongoing illness that you are under a physician’s care for, it is best to talk to your physician about your specific case.
However, having a neurologic disease probably puts you in a higher risk group for severe COVID-19 disease, and the benefits of the vaccine likely outweigh the risks of COVID disease.
8. “Can I get the vaccine if I’ve had COVID?”
Yes! You should not get the vaccine while sick with COVID and should wait until you are no longer in isolation, but it is safe to get the vaccine if you are no longer sick and out of isolation (at least 10 days for asymptomatic COVID).
9. “I’m worried there is a microchip in the vaccine to track my whereabouts.”
Yeah. Right. That’s called your cell phone. Again, this is a conspiracy and wholly untrue.
The above are the main concerns I have heard from friends when I asked about their concerns. If you have other specific concerns, I would love to hear from you. Hopefully, these vaccines will start rolling out to the general public soon, and I would encourage you to get the first vaccine offered to you, as soon as it is offered, unless you are specifically allergic to the vaccine components. New vaccines using more standard technology should be rolling down the pike soon.
Unfortunately, until we reach herd immunity levels (more than 75% of the population vaccinated), we will need to continue to mask and social distance.
This is another reason it is so important for people to feel comfortable getting the vaccine. The vaccine will only be effective in ending the pandemic if a majority of people get it. In the meantime, wearing a mask, practicing social distancing, and hand-washing are especially important as the new, more infectious COVID-19 strain becomes the predominant strain in the USA, which is likely to happen within 8 weeks.
We can do this! Mask! Social distance! GET VACCINATED! Let’s put COVID-19 in the rearview mirror as quickly as possible, with as few disease casualties as possible. #ThisIsOurShot #OurShotVT
