The Great Covid-19 Vaccine Race

The Great Covid-19 Vaccine Race

The first of six potential candidates for COVID-19 vaccines should be hitting the market in late December or early January. It’s not surprising that many people are on the fence about whether they should take the vaccine, given how fast the vaccine was developed. Two vaccines are currently emerging as strong candidates but how does one choose a “winning horse” in a race like this?

Vaccines as a Solution

As a physician, I have always been a strong vaccine advocate and with literally years of research and data, there is no question that vaccines are the most potent weapon against infectious diseases ever invented. So one might assume I’d say “Yes! Get the in line for the vaccine!” But wait… I might surprise you.

As a self-proclaimed advocate of change (I even named my DPC practice after the Greek letter for “change”!) I welcome the innovation and ongoing advances in medicine. In the medical community, COVID-19 has created quite a healthy debate around our approach to vaccine development and usage. On that basis, it’s imperative that we have a serious discussion about the benefits and risks of this vaccine before weighing in on whether or not to take it.

The Vaccine Face-Off:  Pfizer vs. Moderna

At the time of this writing, there are two companies emerging as potential leaders in the great COVID-19 Vaccine race.

  1. The first is Pfizer’s vaccine. It was developed in partnership with BioNtex, a German biotech company. Pfizer’s vaccine was developed without the help of the government’s Operation Warp Speed and was likely not influenced by pressure from government agencies.
  2. The second is Moderna’s vaccine. This is a US-made product and seems to be the National Institute of Health’s(NIH) favorite.

Both companies are using messenger RNA, or mRNA, to trigger the immune system to produce protective antibodies without using actual bits of the virus. The mRNA vaccine injects a form of genetic information into immune cells to produce a response that kills the virus.

This technology is relatively new and very exciting. One advantage seems to be that it can produce a vaccine much faster than traditional methods. Those traditional methods include injecting the dead virus or live virus that has been damaged so it cannot spread.

By injecting proteins from the virus surface the immune system produces antibodies that soak up the infecting virus and removing it from the body. These traditional methods are incontrovertibly safe, with less than 1 in a million serious side effects.

Unfortunately, many scientists believe that since Coronaviruses as a group are so common, most humans already have antibodies and maybe so tolerant that they do not respond to the COVID-19 virus parts.

The Conundrum

The technology that produced the mRNA vaccine has only two examples on the market; Ebola and MERS (Middle East Respiratory Virus.) Under normal circumstances the stages of testing a vaccine that takes years to develop also give us a track record for any given vaccine, providing insight into potential risks several years down the road.

The new mRNA vaccines have less of a track record in the general sense, so for me, that heightens the risk. Moreover, there is the fact that this vaccine explicitly alters genetic material, although it is not the heritable form that is DNA. Several scientists have recently pointed out some deficiencies in the testing process that agencies like the FDA use to determine safety. These agencies continue to do a lot to secure the safety of all these new products so it’s critical we keep monitoring these efforts.

Weighing the Risks

Innovation always carries a degree of risk. And in advancing medical research and treatments we hold ourselves to a VERY high standard. That said, any new product has a non-zero chance of producing an adverse event. The solutions and treatments are evolving and improving over time.

Most widely used vaccines are built on incremental improvements in technology that are at least 300 years old. We know they are safe. But new vaccines built on modern technology evaluated by a safety protocol that is not as safe as it could leave a fair amount of uncertainty. We have been pouring over the data and it seems that they are reasonably safe and seem to work well. The most serious effects have been related to fever and viral symptoms, which are the most common side effects of any vaccine.

Against this uncertainty, we have to consider the risks of COVID. The current consensus is that approximately 0.5% of people die from the infection. Deaths are mostly amongst the elderly, but many other age groups are affected. Of those infected who don’t die, many report long-term symptoms and disabling syndromes about which we still know very little.  For example, about 10% of COVID survivors face continued lung and heart problem know as “long-hauler’s syndrome.”

To Get the Vaccine or Not to Get the Vaccine?

It’s human nature to seek out definitives – “yes or no”, “right and wrong”, “good and bad” or “black and white.” The reality is, when it comes to innovative solutions, there are several shades of gray. This mRNA vaccine innovation breeds healthy uncertainty on both sides of the risk and benefit equation.

The best way to get a better sense of balance is time. You can’t cut corners with time. But the problem is we don’t have time. Some of these risks, both of the vaccines and of the disease are impossible to know at this point.

There will be great controversy socially, politically and in the medical community fueling the desire to get to a “yes” or “no.” But in the end (potentially several years) we will find many points of agreement.

Where Do We Go From Here?

So who gets it first?  Health-care workers are at the highest risk and must be vaccinated first; starting with hospitals and followed by outpatient doctors, nurses, and caretakers of the elderly. Next to be vaccinated should be folks who are known to have factors that put them at high risk of complications of COVID (diabetes, heart disease, obesity, etc.) People who are not in contact with high-risk individuals should follow. And personally, if you spend a lot of time with grandma, I suggest you should at least consider the vaccine.

It remains uncertain, in my view, if we should offer the vaccine to young people without risk factors or significant contacts with high-risk individuals. In some ways, the biggest benefit would be to vaccinate the people who don’t seem to develop severe symptoms and appear to be the primary source of the spread. On the other hand, they are not at high personal risk.

This seems to come to the crux of many arguments about vaccines in general. Should you take a vaccine when it is more likely to help others than it is to help you? One thing for certain, the American people are not likely to tolerate a mandate to be vaccinated, so hopefully, this will not come up.

Will I Get the Vaccine?

For my personal choice, I need to wait until my hospital colleagues get their vaccines. If it looks like a non mRNA vaccine will come to the market quickly, I will take that one instead, but if not, I need protection. We’ve already had too many contacts with potential COVID patients that have disrupted our schedules and impaired our capacity to provide care.

For my readers, colleagues, and patients, I hope this read has helped you inch closer to embracing the unknown and making your own choice amid uncertainty, unresolved data, and ever-changing information.

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