COVID-19 Vaccines and Boosters
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In a world where the known facts of the COVID-19 virus are ever-evolving, researchers use their expertise, scientific findings and the events of the past to provide an accurate viewpoint of today’s current events. Cooper Clinic Platinum Physician Michael Chapman, MD, discusses the facts and benefits of COVID-19 vaccinations and boosters.
Thankfully the majority of our patients have chosen to be vaccinated, aligning well with our preventive approach to medicine. The main concerns I hear typically revolve around the safety and long-term side effects of the COVID-19 vaccine.
COVID-19 Vaccine Technology and Safety
Individuals hesitant to receive the vaccine believe the production was rushed or not properly tested. In reality, tens of thousands of people have been enrolled in COVID-19 vaccine trials, which have proven to be some of the largest clinical trials in the medical field in comparison to other drug studies. In clinical trials, the Pfizer vaccine enrolled 43,000 participants, Moderna vaccine had 30,000 participants and Johnson & Johnson had 43,000 participants. Typical clinical trials have closer to 1,000 to 5,000 participants. The same necessary steps were taken in these clinical trials as with any other trials to gain FDA approval. The difference with the COVID-19 vaccine was due to the urgent need of vaccine, the government allowed for Emergency Use prior to FDA approval to speed up the production and availability to the public during this worldwide pandemic.
While some individuals also think the COVID-19 vaccine is “experimental,” mRNA technology has been around since the early 2000s. In regard to their safety, keep in mind more than 200 million doses have been administered in the United States and more than 4 billion administered worldwide. Results show only 13 per 1 million people who are vaccinated experience side effects. This is why it is more important to look at the risk of death from contracting COVID-19 in each age group. For example, in people ages 65-74 the risk of death is 1 in 39, which does not account for preexisting comorbidities. If you take 1 in 39 and compare it to the larger population, the benefit clearly outweighs the risk.
*Numbers rounded to their nearest round number. You can view the full chart here.
Long-term Side Effects
While we don’t know the long-term side effects of the vaccine, we also don’t know the long-term side effects of COVID-19. I always ask people who are not vaccinated what their plan is if they were to contract COVID-19. People often say they’ll take the monoclonal antibodies as treatment, which is a new non-FDA treatment. Millions of people have been vaccinated but we do not have data from the hundreds of thousands of people who have used the antibodies. While the monoclonal antibodies and other medications appear to be safe and have proven to be beneficial, I would recommend the vaccine rather than any drug that has not been FDA approved for COVID-19.
COVID-19 Vaccine Effectiveness on Delta Variant
The mRNA Pfizer and Moderna vaccines are 94-95% effective in preventing mild disease with Johnson & Johnson being around 78% effective. Mild disease is considered COVID-19 plus one symptom—this could be COVID-19 plus a fever or COVID-19 plus body aches or a headache. Now, however, the virus has adapted into what we know as the Delta variant. Viruses are smart and require hosts in order to survive. Viruses adapt over time and therefore could become more infectious, which we have seen with the Delta variant. The original COVID-19 virus had an incubation period, or from the time one was exposed to the time symptoms develop, of five to seven days. With the Delta variant, the incubation period is two to three days and therefore replicates faster, making it much more contagious. With the Delta variant in play, the initial vaccines are less effective in preventing mild illness but are still very effective in preventing severe disease and death.
In a recent presentation I gave alongside a critical care doctor, she reported she has yet to put a vaccinated person on a ventilator, regardless of the variant they’ve contracted. In fact, greater than 95% of hospitalizations in the United States right now are unvaccinated people and an even higher percentage of those hospitalized make up ICU admissions.
Early on in the pandemic older individuals with preexisting medical conditions were the ones hospitalized. Now the largest demographic of COVID-19 cases in the hospitals consists of individuals ages 30-64─it is no longer the 65+ population because a higher percentage of that age group has been vaccinated. Statistically speaking, the risk of death from infection of COVID-19 in newborns to age 34 is 1 in 24,999. However, practicing physicians have seen young people get very sick from the delta variant, making this statistic the exception and not the rule. This is why the FDA has approved vaccination for the population as young as 12 years old with expected approval for younger age groups in the next few months.
Recently, we have seen surges in COVID-19 cases in parts of the world that have embraced the vaccines, such as Israel. This is once again due to the efficacy of the vaccine decreasing as the virus has morphed. We were told getting vaccinated would enable us to live life as normal again. People began letting their guards down and not taking the same precautions as we did in the beginning of the pandemic. The fact is masks are coming off and the lack of social distancing is causing COVID-19 to spread again. Interestingly enough, Israel’s Delta variant case surge has become more controllable because they were one of the first countries to begin administering the COVID-19 boosters. It is important to differentiate that while Israel has seen a surge in infections, the country has avoided severe disease and death due to the high percentage of vaccinations.
Vaccines are meant to be spaced out to achieve full immunity. Vaccines create antibodies to different parts of the virus being targeted. In the case of COVID-19, the vaccine creates antibodies to the spike protein part of the COVID-19 virus. The antibodies hit a peak at 30 days after the final vaccination dose. The number of antibodies to the spike protein, or antibody titer, then start to fall over a period of time which can be measured through a simple blood test. Immunity also occurs through memory cells and what are called T-cells, which are not measured on a regular basis.
Since this is a relatively new vaccine, medical professionals and scientists are still learning the appropriate timing of vaccine doses. Pfizer prescribes a three-week interval between the two required vaccination doses with Moderna recommending a four-week interval. We have seen immunity levels decreasing after six months of receiving the final dose. Other countries have seen a much higher immune response when the Pfizer vaccine is extended over a three-month period.
We know there is lasting immunity from the vaccine, but we want to ensure excellent immunity through the booster by bolstering the antibodies. I anticipate people will only need one COVID-19 booster to achieve the desired level of immunity, but only time will tell. By purposefully spacing out the vaccine doses and boosters, the body has a chance to adapt and create immunity. Our ultimate goal is to create lifelong immunity.
The COVID-19 booster is forecasted to be available to the general population in the near future. The third vaccination will likely be recommended for individuals vaccinated with the Pfizer and Moderna vaccine six to eight months after receiving their second dose of the vaccine. A physician may recommend receiving the booster earlier if one is immunocompromised. Johnson & Johnson is also seeing a nine-fold increase in immunity after receiving a booster shot, but they have not officially put the production of boosters into motion.
Still on the Fence?
For someone who is on the fence about getting vaccinated, it comes down to risk-benefit ratio. Does the benefit of vaccination outweigh the risk of complications of COVID-19? If the answer is yes, I strongly encourage them to get vaccinated.
Like with any injection, some people (usually those who have had an allergic reaction in the past) can have a severe allergic reaction. Statistically, this is rare and treatable. Check with your doctor and see an allergist to ensure you would not have an allergic reaction to the COVID-19 vaccine.
While the medical field is encouraging everyone to get vaccinated against COVID-19, the bottom line is it is a personal decision between you and your physician as your physician knows you and your health profile best.
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