Did you get your shot?

 

A few months ago, a friend and I were discussing the the speed with which the vaccine against SARS-CoV-2 was invented, tested, manufactured, and licensed for use. She was contemplating holding back and waiting rather than getting a dose as soon as her turn came. That we have a vaccine for a disease we only started being concerned about less than a year ago is unheard of. Remarkable, amazing, spectacular, revolutionary. But is it also scary?  Does the happiness associated with such a miracle give way to doubt, suspicion, and anxiety? I had been following the vaccine for COVID-19 story closely, and although I always have some suspicions when it comes to organized medicine and drug manufacturers, I had very little such skepticism in this case. I noticed that after a couple minutes, I started feeling a bit angry. I wanted to share with my friend my joy about the end of this horrible plague being in sight, while my friend was manifesting anxiety that if shared widely could lead to significant delays in achieving herd immunity (I like the term community immunity better). I wanted us to jump up and down together cheering, she wanted to throw a flag and bring the ball back.

A trusted superhero with a remarkable new weapon

Early in the pandemic, when it became clear that life was essentially never going to be the same, and that the City of New Orleans was going to be in a prolonged state of WTF?,  I was pretty much in favor of challenge trials for vaccines.  That’s where you give a group of volunteers either the vaccine or placebo and then expose them on purpose to the virus.  This is similar to what Edward Jenner did to his 8 year old gardener’s son James Phipps in the late 18^th century. Jenner took some cowpox pus from a milkmaid and used it to infect the child.  James was sick for 9 days but survived.  Several weeks later, Jenner infected the child with actual smallpox and nothing happened.  Success! It turned out that cowpox and smallpox were similar enough that immunity to one afforded immunity to the other. Today, just being a cool-ass doctor no longer allows you to head over to the neighbors to get a  child to experiment on, but with informed consent it can be done and I wanted it to be done for COVID-19. (I think there actually were some challenge trials done; turns out that they did get volunteers. Some people were willing to assume the risk either out of heroism or desire for money).  Some experts refused to even talk about such a heinous thing as challenge trials, totally and completely unethical they said. My thinking was (and is) that finding a vaccine would reduce the total number of deaths and serious illness due to the virus.  Therefore, even if some of the volunteers had adverse reactions to the vaccine or if they were not protected and as a result of being exposed, were seriously ill or died, the benefits would outweigh the drawbacks, since having to wait a lot longer to get a vaccine would result in more disease and more deaths than what would be caused by doing the challenge trial. As it turned out, for many reasons and with lots of blame to go around, the virus circulated widely in our country and so we got lots of vaccine trial volunteers exposed, just by virtue of being Americans living in America, a place teeming with SARS-CoV-2 virus. No need for challenging.

For several years I served as the clinical co-chair of the Immunization Committee at Group Health Cooperative, a non-profit staff model HMO in the Puget Sound region of Washington state. On our committee we had vaccine scientists, public health experts, infectious disease specialists, primary care clinicians and others.  We reviewed proposed changes to the vaccine schedule and implemented the changes that seemed appropriate.  I developed a faith in the process of vaccine approval that I still hold and feel is justified.  When parents would question vaccinating their child according to the recommended schedule, I would point out that using an “alternative schedule” might work, but such a plan would be lacking in evidence for its safety and effectiveness, since large scale studies and ongoing monitoring applies only to the accepted schedule. A scientific approach strongly favors doing what’s been shown to be effective.  Perhaps one should be allowed to use a different schedule, but doing so is essentially an experiment with an “N of 1”, like Jenner and Phipps, but hopefully without purposeful exposure to Measles, Mumps, Rubella, or any of the 12 other diseases for which vaccines are recommended on the current schedule in the U.S. (Vaccines exist for a total of 27 diseases currently, but some are not routine such as Yellow Fever vaccine).

What about fear of big pharma and the health care system wanting to make money? Shouldn’t we be a bit skeptical of modern medicine in general? After all, there are plenty of examples where drugs are used inappropriately and surgical procedures are performed which are questionable at best, seemingly done more out of a desire for profit than to proceed carefully in the best interest of the patient. And in the case of COVID-19, isn’t this uncharted territory, a new type of vaccine?  Are we really sure this is OK?  My reply is that we should be skeptical and questioning.  Happily, in the case of vaccines, the approach  to their approval and inclusion on the schedule is perhaps the most open and bias-free process in all of medicine.  Representatives of pharmaceutical manufacturers are not on the committees.  One can never entirely separate corporate influence from the medical system, but it’s close to as good as it gets in the case of vaccines. And mRNA vaccines are not really new, what’s new is getting one marketed.

Yes, there are rainbows!

As a retired 69 year old healthy and financially comfortable white male, the personal stresses added to me by this pandemic are quite low comparatively.  In contrast, it’s hard to even imagine the challenges faced  by parents, teachers, doctors and nurses, those working in front line jobs, those out of work, pretty much everyone.  So we need for this to end and end soon.  Were the Moderna and Pfizer vaccines brought to market blisteringly fast in comparison to the usual timing?  Absolutely. Is our current situation nowhere even close to “usual”? No question.  That we have systems, scientists, and a review process to ensure the quality and safety of new vaccines is truly miraculous.  I have no doubt that the clear choice here is to get vaccinated absolutely as soon as possible. You will be protected and be much less likely to infect other people.  By following the recommendations, you will demonstrate a justified faith in our health care system that will encourage others to follow your example. 

My friend has come around and has received her first dose, which she called her "Fauci owchy". My wife and I are scheduled for ours on Feb. 22.  Not a moment too soon. 

Bibliography of Vaccine Resources

1.       Podcast: Endless Thread from WBUR Boston and Reddit.  Series of  5 episodes called Infectious, which dropped in late April of 2019.  The focus is on the phenomenon of vaccine hesitancy and refusal.  It’s chilling to listen to this production from our viewpoint now after enduring a year of an actual pandemic, which they could only worry about back then.  They feared thousands of potential deaths.  We are now close to half a million. The hosts are Ben Brock Johnson and Amory Sevirtson.

2.       A majority of US Black adults surveyed are worried about Covid-19 but only 49% plan to get vaccinated.

3.       Recently, Charles Blow commented on the survey in a New York Times opinion piece.

4.       Neeti Sanyal and Shantanu Nundy explore these issues in a Harvard Business Review article.

5.       CDC has a smart phone based tool called V-Safe to add an extra data collection method to track vaccine safety and adverse reactions.  You can sign up using the information on the card you receive after getting your shot.

6.       I really loved Eula Biss’s 2014 book On Immunity.  Bill Gates also commented on the book in his Gates Notes post in March of 2015. The New York Times review linked to above is quite eloquent. Human lives are so interesting, so complicated, so potentially tragic, and we are so dependent on one another.

7.       The NPR program On Point had an informative episode on January 5, 2021.  In the show notes linked to here there is a strong list of resources, which I am working my way through. I thought the ideas and actions of Miguel Rodriguez, who is a member of the Community Advisory Committee of the Camden Coalition of Healthcare Providers was particularly inspiring. He is featured in the podcast, and has been  volunteering going door to door to ask people in his predominantly African American community about their plans, fears, and concerns regarding COVID-19 vaccination. 

8.       How to Talk to an Anti-vax Relative: article in The Atlantic. 

9.       General immunization information sites that I used frequently while in pediatric practice:

-Immunization Action Coalition
-The Vaccine Information Center at Children’s Hospital Philadelphia I just looked at this site and there is an interesting piece there by the director, Dr. Paul Offit, on the issue of delaying the second dose of COVID-19 vaccine so that more people can get a first shot faster.

This is what it's come to down here. 

All pictures are taken in New Orleans neighborhoods, and they are part of what is being called "House Floats" since there are no Mardi Gras parades this year and no floats, and yet folks want to create nevertheless.