COVID vaccine: The way out of the pandemic

April 06, 2021

COVID-19 Vaccine

Three members of the MUSC family talk about the COVID vaccine and why they're encouraging friends and family to get it.

 

portrait of Ruth Adekunle 
Dr. Ruth Adekunle

The COVID vaccine rollout is a conundrum. Even as some people are scrambling to get one of the precious shots, others remain leery.

Mileka Gilbert, M.D., Ph.D., a pediatric rheumatologist, and Ruth Adekunle, M.D., an infectious disease specialist, have heard it all. And it’s perfectly fine to have questions, they say.

But they want to ensure that people are getting the correct answers to those questions. And as Black doctors, they feel a particular responsibility to get the information out to the Black community, which has been hit especially hard by the coronavirus pandemic.

Gilbert appears in the above video along with two members of the MUSC family, Neka Gardner and Aisha Vanderhorst.

Adekunle sat down for the following Q&A.

 

We are learning more each day that even patients with "mild" disease from COVID-19 can suffer from prolonged symptoms coined "long COVID," and up to 30% of patients who contracted COVID-19 continue to experience symptoms. Some patients have not recovered their senses of taste or smell a year after infection; others suffer from fatigue. So even if someone gets COVID and only has a mild infection, “complete” recovery is not guaranteed. The best way to avoid this is to get vaccinated.

No. You absolutely cannot get COVID from the COVID vaccine, because of the way that the vaccine is made – it's not a live virus.

The way that the Pfizer and Moderna vaccines work, they’re a messenger RNA, or mRNA, virus. mRNA is a piece of genetic material that helps to provide instructions about what your body should make. The vaccine delivers this piece of mRNA that has instructions for the protein that sits on the outside of the coronavirus – that's the spike protein that everyone talks about. Once this information is delivered to your cells inside of your muscle, your muscle uses this piece of information to essentially create the protein. And that piece of genetic material that is used to help create the protein is then disintegrated and broken away.

Then what your body does is, now that it's created this protein, it puts the protein on the outside of the cells so that your antibodies can recognize it and say, ‘Hmmmm. This is different. This isn’t part of your normal immune system.’ And it triggers them to remember that protein so that if you ever do actually see coronavirus, you already have an army of antibodies ready to help protect you.

The Johnson and Johnson has a slightly different delivery mechanism. What they use is something called an adenovirus. Adenovirus is a virus that causes the common cold, but they've changed the virus in a way that it cannot replicate inside your body. So therefore, you cannot get adenovirus from the Johnson and Johnson vaccine. But otherwise, the other steps are the same. So they deliver instructions so that your cells create a protein, and then you can make antibodies against it. You can't get coronavirus from the vaccine, and you can't get adenovirus from the Johnson and Johnson vaccine.

It absolutely will not. The mRNA never enters into the main part where your DNA is held – in the nucleus. It never enters the nucleus. So it never communicates at all with your own DNA.

Yeah. Great question. I think it's definitely the one that everyone is so concerned about, right? What we know is that there were all of the appropriate safety mechanisms in place in all of the clinical trials used to develop the COVID-19 vaccinations. And since they’ve gotten emergency use authorization (EUA), there's been extensive monitoring of side effects and adverse effects of the COVID-19 vaccinations.

So, within the trials, between Pfizer having about 43,000 people and Moderna having around 30,000 people, we know already off the bat, that's thousands of people who got the vaccine prior to its widespread public use, with very minimal adverse effects reported. And now, there have been over 107 million Americans who received the vaccine, and again, very minimal side effects and adverse effects have been reported. So we know that the vaccine is safe.

Now, as far as long-term adverse effects, when we look at other vaccines, other vaccines don't have long-term adverse effects. Vaccination in general is intended to be a mechanism to allow your body to build an immunity against a virus or an infection. And so, the actual delivery mechanism, the actual vaccination aspect of it is very short term, right? It's very passive, allowing your body to see the virus once so that it can develop a response. So vaccination in general tends to not have long-term adverse effects.

There's been, like I mentioned, a lot of really close monitoring, particularly of deaths and severe adverse effects after vaccination. What I saw most recently, from just a couple days ago, is that the total number of deaths that have occurred after people have been vaccinated was 0.002% of all vaccinated people – so a very tiny amount.

And there's been no patterns in these deaths to show that it's been related – at all – to the COVID-19 vaccination. And so obviously, that's going to continue to be closely monitored, but right now, there's no evidence to suggest that the coronavirus vaccination is associated with any increased risk of death.

Yeah, another really big concern. There are a couple reasons why the vaccine world was able to develop this very quickly. One is a little bit more historical. So, during the Ebola outbreak, there were a lot of vaccines as well as treatment medications that were created – but we weren't organized enough to be able to get something up and going and get it FDA-approved. And that was a really big signal to the infectious disease community, and the vaccine development community in general, that we cannot allow another pandemic to happen and not be able to quickly get something through the FDA. And so there was a lot of effort in the government to put together resources that would allow trials to occur a lot more quickly and get through the FDA process more quickly.

And, two, obviously, we were in the middle of a pandemic, and we didn’t have the opportunity to wait. There was an urgency to move development along. The other thing is, outside of a global pandemic, it's sometimes difficult to enroll people into studies. The enrollment time period can take several months to years. And so that part was significantly shortened because we were in this time when there were plenty of people who either had coronavirus or were very interested in protecting themselves from getting coronavirus. So enrollment was able to occur very quickly.

And then, I think that last major aspect of it, was there was just really great collaboration all over the world, and people being willing to share the data. Within, like, a week and a half of the coronavirus being identified, we had already sequenced the genetic material and shared it so that people could then develop their own tests for coronavirus and so forth. So there was just a lot of collaboration occurring all over the world to allow people to work on things faster. And finally, mRNA technology is not new. Physicians have been working on it for years, and the very nature of mRNA vaccine technology allows for faster development of new vaccines.

We've learned that people who've contracted COVID-19 have antibodies for different lengths of time. Some patients only have three months of protection, others eight months or greater. There is emerging data that after vaccination, immunity can last up to a year, and if you've already had COVID-19, it is possible that giving that “booster” to your immune system will extend the duration of immunity even further.

Well, hopefully, as we know more, those guidelines will start to adjust. And we've already seen some adjustments in the guidelines in the past couple of weeks, with the Centers for Disease Control and Prevention saying that people who have been vaccinated and are around other vaccinated people can decrease their restrictions. I do think we'll get to the point where, if we have a significant proportion of the population vaccinated, we can feel a bit more relaxed when it comes to the restrictions. I think that's one incentive that will get us closer to what we consider to be normal life.

Part of the caution, obviously, is because this is all so new, right? We're all still learning so much about the vaccine, the immunity that it provides and whether people who are vaccinated could still potentially be carriers of the virus. That's part of the concern, as far as maintaining mask restrictions. And because the coronavirus vaccines are not 100% effective, there's still the small chance that you could get COVID-19, even after being vaccinated. And so that's why we need to remain cautious. But I think the point is that the mask will not only protect you, it could protect other people and protect your community and protect this nation as a whole.

Yeah, absolutely. And I would say that that is one credit, for sure, that I would give particularly to the Pfizer and Moderna trials. Both of them were ethnically diverse studies. Both of them were around 9% to 10% inclusive of Black persons. And while that sounds not as robust as you would necessarily expect, it's much better, actually, than a lot of studies, which are closer to 1% to 2% being Black and African American. And so this is actually a pretty significant number.

What is recommended, and personally what I also recommend, is to get the vaccine that you have access to. Yes, there is a slightly decreased efficacy reported rate for Johnson and Johnson compared to Pfizer and Moderna, but either way, any of the three is still better than having no protection from coronavirus.

And just to compare some of the other vaccines that we have, the flu vaccine is around 50-something percent effective each year. That is still plenty enough to, in most cases, prevent you from getting the flu but most importantly, prevent you from getting severe infection from the flu. And that's what we've seen thus far in all three coronavirus vaccine studies – that there's 100% protection from death.


The vaccines do not cause infertility. Where that concern came about was that there was concern that the mRNA spike protein, or the protein that the vaccine gives your body instructions to make, was similar to a protein a woman’s body uses to create a placenta. And so, that protein, called Syncytin-1, has similar functions, but structurally, they're very different. The area that your antibodies would recognize on the coronavirus is very different and not similar at all to the placenta protein. And so therefore, there's no data right now that supports any evidence that it would cause infertility, which is certainly one of the things that's also being monitored in this EUA authorization rollout.

The obstetric society as well as a pediatric society have both recommended vaccination during pregnancy and breastfeeding, but if you have concerns, have a discussion with your provider about it first.

And I will just add as a personal anecdote, I'm currently a nursing mother, and for me, I kind of viewed it as this is my way of trying to protect my child. Yes, I can prevent her from being around other family members. But even if I'm only giving passive immunity, it's something that I'm able to give her that I otherwise cannot. And so that's how I try to explain it to other mothers, as this is one other way that you can do something to actually protect your child.

 

For information about scheduling a vaccine appointment through MUSC Health, visit muschealth.org/get-vaccine.

About the Author

Leslie Cantu
MUSC Catalyst News

Keywords: COVID-19