COVID Transmissions for 5-13-2021

This issue will give you basic tools to promote vaccination

May 13, 2021

Greetings from an undisclosed location in my apartment. Welcome to COVID Transmissions.

It has been 542 days since the first documented human case of COVID-19. In 542, the Plague of Justinian was in full swing, and it killed 230,000 people in Constantinople before they stopped counting the dead.

I’ll reiterate from yesterday: I’m really grateful for modern medicine.

Today we are going to do something a little different that I have been meaning to create for a while. I want to help you all become better advocates for the science-supported cause of vaccination against COVID-19.

As usual, bolded terms are linked to the running newsletter glossary.

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Now, let’s talk COVID.

Vaccine uptake is slowing in the US and other high-uptake countries; we need to get the word out that it is safe and effective

As the initial, large group of enthusiastic vaccine recipients reaches full protection, the uptake of COVID-19 vaccination in the US (and some other countries) is slowing down. Specifically, the US situation is detailed in this recent New York Times article: https://www.nytimes.com/interactive/2021/05/04/us/vaccine-rollout-slowing.html

There are a lot of reasons for this. Many of them are beyond the control of each individual, but I do think together we can make impacts that are helpful, and help fight this trend. One thing we can all do is become advocates for the cause of vaccination. To that end, I’d like to give you all a crash course on basic vaccine communication. I can’t teach you everything about advocacy for vaccines, but I think there are a lot of people who just need a little extra push from a friend or family to get vaccinated, and I can help you be that push.

I’ve got a few starting thoughts on this. First, I think that most people who would, say, sign up for a COVID-19 newsletter by a virology PhD realize just how confusing the concept of vaccination is to many people. There is a lot that many of us may take for granted that is not widely appreciated. One of the things we can do is make vaccines more understandable and relatable.

Second, I think that it’s important to recognize that there are two kinds of vaccine-hesitant people. There are the kind who are dyed in the wool antivaccinationists with extreme views; you are not going to be able to convince this type of person of anything. At this point, their viewpoint is a near-theological one and rational argument will not serve you well.

The other type are people who are confused and have heard a couple of scary things about vaccines, have faced obstacles in getting vaccinated that have left them discouraged, believe they do not really need the vaccine, or some combination of all of these elements. These people can be convinced to get vaccinated, but it would require the patient and respectful attention of someone close to them. There may be someone in your life who is in this category. You might be able to make the difference for this person. I’d like to arm you with some answers for common questions and misconceptions about the vaccines, which will help with this. Here we go:

How do vaccines work?

Vaccines are designed to simulate infection with a dangerous germ without making you sick. The point of this is to make your immune system rehearse the experience of the germ, so that it can learn what to do when it encounters that germ for real. This builds an immune memory that stops you from getting sick from that germ in the future. Vaccines work by providing your immune system with an “antigen” from that germ; an antigen is a bit like a wanted poster. It shows the immune system a pattern to look out for, so that it can recognize the threat early, before it causes damage. Vaccines have been used and developed for over 200 years on the basis of this principle.

Aren’t these vaccines experimental?

The COVID-19 vaccines are not “experimental” products, not any more than a new type of toaster or cell phone is experimental. While there is still work being done to improve them and expand their use to new groups of people, the vaccines themselves have been studied extensively in tens of thousands of patients. Some people point to the fact that the vaccines are available under an “Emergency Use Authorization” (EUA) to suggest they are experimental products. This is not true. An EUA is sometimes used to approve experimental medicines, but in other cases it is used to reduce the number of bureaucratic steps in an approval process. Normal medicines are developed based on years of feedback from regulators like the FDA. Drug makers have frequent meetings with regulators, and they take feedback from these meetings to change their development plans. While this usually helps to find the right place for a product in therapy, in a pandemic emergency it slows development. The use of the EUA pathway for the vaccines helped to remove the need for many of these check-in meetings and speed the bureaucratic process involved in authorization. The actual process of the trial was not accelerated, and corners were not cut in the study of the vaccines. They were fully investigated before being authorized for use in the public.

Do the vaccines affect your DNA/are the vaccines gene therapy?

The vaccines do not alter your DNA and are not gene therapy of any kind. This is a lie that that has been spread by people who profit from undermining vaccines so that they can sell fake and unproven COVID-19 prevention strategies and cures.

Weren’t the trials too rushed to be certain the vaccines are safe?

The COVID-19 vaccine trials were not “rushed.” Certain steps were taken to make them move more quickly than normal clinical trials, but these steps did not impact the actual length of the trials. Normally, in a clinical trial, it takes a long time to enroll patients, and each patient is enrolled at a different time. If you need 40,000 patients who are studied for two months, and you can only enroll 1,000 patients each week—a rather good rate of enrollment—it will take 40 weeks for your trial to be “fully enrolled.” After that, it will take 8 more weeks for the last 1,000 patients you enrolled to complete the trial. That is a total of 48 weeks; almost a year for a trial that generates only two months of data. The enrollment process can be very slow, because there is a lot of information that needs to be recorded about patients in a clinical trial, and it needs to be recorded accurately at many different study sites, each run by medical professionals. All of this requires administrators who are highly trained and specialized as well. Most trials do not have the money to enroll patients very quickly, because it is a very expensive process. To accelerate the COVID-19 trials, the trials themselves were not rushed, but the bureaucracy, researcher training, administration, and enrollment process were sped up using a universal lubricant: money. The government and the companies that developed these vaccines threw an enormous amount of money at hiring a huge number of staff to enroll patients rapidly and to make sure that many study sites were available to take them. This was a truly heroic effort, and it made it possible for these trials to reach full enrollment with incredible speed—without compromising the actual length of time that scientific data were collected. So, no, the scientific aspects of the trial were not rushed. The messy paperwork parts were accelerated and the red tape was cut, so that we could get to the data collection and analysis faster.

Also, the length of that data collection and analysis period was totally appropriate. While the safety results are still being followed out to 6 months, this is not because any new signal is expected. It is because the researchers wish to see if rare safety events, like allergies to vaccine ingredients, have any lasting consequences. Usually they do not, but we still study this kind of thing in order to be certain. This is because, frankly, safety is the most important thing studied in any clinical trial.

But these additional months of study are not expected to find anything new. When the vaccines were first reviewed by the FDA and CDC, the experts participating in these review panels engaged in an extensive review of past vaccine trials to determine if there had ever been a past situation where a new safety event was discovered more than 6 weeks after vaccination. They determined that this had not happened in the history of vaccine trials, despite the many hundreds of vaccines that have been through clinical trials since we started doing those sorts of studies. Since there were at least 8 weeks of follow-up for all patients in the vaccine trials being evaluated, they felt that this was an appropriate amount of safety monitoring to approve vaccination. I feel that way too.

I have heard the vaccines can impact fertility. Is this true?

This rumor has developed from some limited evidence that COVID-19 can affect fertility. That may not be 100% correct, but even if it is, it is clear that the risk of an effect like this is much greater from getting the virus, something that the vaccine can prevent. Still, let’s think about what the vaccine can do. It is not injected into the bloodstream. A very small dose is given. It does not spread throughout the body and stays localized to where it is injected, lasting there for only about two weeks. There is no reasonable way that it could travel from the arm to the reproductive system. These suggestions that the vaccines can impact fertility are rumors that are not supported by any evidence whatsoever.

I am young, with no comorbidities, and COVID-19 is not a threat to me, do I really need a vaccine?

Right now, there are more hospitalizations of young people for COVID-19 in the US than ever before in the pandemic. People of any age can die of COVID-19 or be seriously harmed by it. Also, treatment for COVID-19 can incur huge medical bills that may not always be covered by government programs. The vaccine is the only thing that can prevent these situations with reliability, and it is 100% free to recipients in the US. Additionally, while you may feel you are not at a great deal of risk, or you may not personally care if you die of COVID-19, there are certainly people around you who are at risk. By getting the vaccine, you help to protect them from the harmful impacts of this terrible disease. It is not just about you; but at the same time, the vaccine still provides you, personally, with protection against the risks I just mentioned.

That’s the end of the questions section.

This is just a starting point, but I wanted to provide some tools that I think can help with getting the message out. One thing I wanted also to mention is that while it is good to provide educational answers like the above, one of the best endorsements that a vaccine can get is this: “Well, I got it, and I’m totally fine.” When you’re talking to someone who trusts you, it matters to them what happened to you the person who they personally know. Your story matters, and you should emphasize your experience.

That’s why I shared my own vaccine story with this newsletter. I got two doses of the Pfizer vaccine, I experienced a little fatigue after each one, and then I was fine. Now I have almost nothing to fear from COVID-19.

Another important thing is to offer help. Vaccines involve needles, which many people viscerally dislike. I know I dislike them! This already makes people uncomfortable, and if getting the vaccine is difficult because of a confusing website or a long line, people will get discouraged. I recommend you offer to help your hesitant friends and relatives find appointments and get their vaccinations. Your help could be enough to make it easier for them.

Most importantly, remember to be patient, kind, and respectful. No one will get vaccinated from being yelled at. Calm answers, offers of help, and patient encouragement won’t work in every case, but even it works 1 of out of 10 times, that’s a huge win. Each vaccination is a victory in the fight against COVID-19, and we can all help make them happen.

What am I doing to cope with the pandemic? This:

Planning training and education

A big part of my new job is training our science field force on the subject matter of our clinical work. I’ve been thinking a lot about educating busy adults this week—perhaps that came through in the subject of today’s newsletter. It’s an interesting topic. Adult audiences want to learn, but they often don’t have a lot of time for it, even when it’s required for work. It takes some creative solutions to make these things happen. Feel free to let me know if you have any :)

You might have some questions or comments! Send them in. As several folks have figured out, you can also email me if you have a comment that you don’t want to share with the whole group.

Join the conversation, and what you say will impact what I talk about in the next issue.

Also, let me know any other thoughts you might have about the newsletter. I’d like to make sure you’re getting what you want out of this.

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