Stop dissing Covid vaccines!

 In December 2020, the FDA issued emergency use authorization for two unique mRNA vaccines to deal with the Covid-19 pandemic. Both the Pfizer-Biontech vaccine and the Moderna-NIH vaccine were spectacularly successful in large Phase 3 clinical trials in preventing severe disease, hospitalization, and death from Covid-19. Furthermore, the safety profile of both vaccines was impressive. This was tremendously good news. Even so, negative press about these vaccines soon followed and unfortunately continues to this day. 

In the United Kingdom, which began vaccinating before the U.S., there were several early reports of anaphylactoid reactions. Soon after vaccinations began in the U.S., similar reports occurred. CDC looked at these and found a rate of 11.1 cases of anaphylaxis (none fatal) per 1 million first doses of the Pfizer vaccine. Anaphylaxis is reported with many other vaccines and usually occurs within 30 minutes of receipt of the vaccine. It is treatable with epinephrine. The conclusion was, comparing the risk of anaphylaxis with the risk of Covid-19, the rare occurrence of anaphylaxis should not be a deterrent to receipt of Covid vaccine. Of course, the media (both established and social media) made it sound to some as though these were dangerous vaccines. They are not.

The emergence of viral variants has created the latest stir. In mid-December 2020 the U.K. reported the presence and rapid spread of a new variant, B.1.1.7 for short. The U.K was well-positioned to do this because they had a very robust system to sequence virus isolates (something the U.S. continues to lag with). Subsequent reporting of new SARS-CoV-2 variants from South Africa (B.1.351) and Brazil (P.1) made it clear that public health authorities and scientists need to remain vigilant. Laboratory testing of the neutralization of these variants by antibodies raised after vaccination does raise a red flag. The reports of the meaning of these variants for Covid vaccinations vary; in vitro, there was diminished antibody neutralization to some variants. But in today’s ultra fast-moving news world, headlines are designed to get eyeballs and clicks (everything on the Internet is monetized). So, we have “New Sars-Cov-2 Variant Could Evade Antibodies” with links to several of the multiple reports emerging on lab studies. Therein lies my beef with this part of the Covid vaccine story. First, I suspect that most people stop at the headlines. OMG, does that mean the vaccines don’t work? [followed by much anxiety]. Second, if people read the article itself, how well equipped are they to understand its nuances? And finally, if we go to the next layer, do they click and read the material that provided the story? Many of these links are to preprints; studies that have not been peer-reviewed. I guess what I am saying is that it is too easy to go negative and too difficult, for many, to fully interpret what is going on.

Here is a recent article from Scientific American, what I would call an intelligent layman’s journal. The headline is still designed to grab eyeballs, talking about “scary Covid virus variants.” (The proper name for the virus is SARS-CoV-2, but ok). But I think the tone of the entire article is positive while indicating to a layperson what pitfalls are potentially in front of us regarding work to stay ahead of Covid-19, tweaking vaccines, and the need to have an international strategy that rapidly vaccinates people while skillfully using the many nonpharmaceutical approaches that we know limit transmission of SARS-CoV-2. The author, Charles Schmidt, gets points in my book for this piece. He references another good article in Scientific American on the viral variants that would be helpful to others. 

One interesting point about the effectiveness of the current Covid vaccines that is poorly explored and poorly understood is the total response of the immune system to vaccination, including cellular immunity (T cells). It is much harder in the laboratory to assess T cell function than it is to do antibody neutralization assays; this is one reason there have been a plethora of antibody neutralization studies published, which I have noted, have generated no small amount of anxiety in laypeople trying to parse their significance. Monica Gandhi, an infectious diseases physician at the University of California San Francisco, has kept many tuned into the significance of the T cell response as an important part of immunity to coronaviruses. She has an excellent table here which I suggest you read that sums up what we currently know about Covid vaccines in one place. I draw your attention to the column in yellow. It includes a link to a recent paper that is also noteworthy. This is the summary paragraph of that paper:

“In response to the devastation caused by the COVID-19 pandemic, scientists worldwide have inspired hope through expeditious research efforts in basic and translational avenues in unprecedented fashion. It is clear that T cells are elicited to multiple viral proteins following infection and that T cells possessing antiviral signatures associated with safety and protection and can be achieved by vaccination. As observational/longitudinal studies continue, the relationships between infection status, host immunity and disease trajectory will more clearly come into focus. Although T cell durability to SARS-CoV-2 remains to be determined, current data and past experience from human infection with other CoVs demonstrate the potential for persistence and the capacity to control viral replication and host disease, and importance in vaccine-induced protection.”

One nation has taken the lead in vaccinating its population against Covid-19: Israel. The Phase 3 trials of Covid vaccines showed 95% efficacy. Efficacy is what is demonstrated under the highly controlled conditions of a protocol-driven clinical trial. Israel’s Health Ministry is reporting that vaccine prevents 98.9% of Covid-19 deaths. That is a true demonstration of vaccine efficiency in the real world. 

Every major indicator of the pandemic has been in rapid decline in the U.S., probably for multiple reasons. We still have a long way to go but the signs are more optimistic now than they have been for a long time. Eric Topol is a great person to follow as he discusses the Covid-19 pandemic on Twitter. He notes today what we see in improvement but also what we need to be aware of, that this pandemic still has many hot spots that must be addressed. We are a global species and a global community, tightly interconnected. From Los Angeles, anywhere on Earth is no more than 24 hours away. Until Covid-19 is controlled worldwide, we all will remain at risk. Don’t diss the vaccines. Make sure that all of humanity is vaccinated.