Should You Take the New COVID-19 Vaccine?

The time has finally come. The vaccine is here.

Now, should you take it?

My philosophy to practicing medicine is to arm my patients with the information that I know and allow them to make their own decisions. In keeping with that philosophy, I'm going to outline below some of my thoughts about the COVID vaccine and allow you to make your own educated decision.

First, please know that our office applied for a vaccine distribution with the Ohio Department of Health within minutes of the application being open. Simplicity Health DPC is in their database to receive 100 multi-dose vials which will be offered to our members first.

As we do not have the capabilities to store the mRNA vaccines from Pfizer or Moderna which require storage at subarctic temperatures, I suspect early vaccines will be distributed to large hospitals, large pharmacies, and I've also heard Walmart. I've heard talk about different ways to deploy this vaccine to smaller offices as it can be kept refrigerated for 5 days, but I don't foresee us getting access to any vaccine for at least a month. We will absolutely keep you posted ASAP when we have more information about the vaccine's arrival.

Now, let's talk about the actual vaccine:

The topic of most of the following will be focused on the vaccine that is coming out now which is the mRNA vaccine. AstraZeneca has a vaccine coming out in a few months that is made in a more traditional way and I don't think it will be met with such safety skepticism as the process is not new.

The Pfizer and Moderna vaccines use a genetic material called "messenger" RNA. It is single-stranded genetic material that your body already naturally possesses. Since it is single-stranded, it cannot incorporate into your body's own DNA which is double-stranded.

mRNA is very unstable. Thank goodness (I'll come back to this later). mRNA is responsible for translation of genetic material so that small protein "factories" in our bodies called ribosomes can make those proteins for our body to use. Basically mRNA provides ribosomes with the genetic code needed to produce a protein.

I think a cooking illustration makes the most sense here: mRNA is the cookbook and the ribosomes are the cook. The amino acids that your own body makes on a routine basis are the ingredients. Since the cookbook isn't going into the food, just the ingredients, the cookbook itself is never ingested or incorporated into the body. Furthermore, this process takes place in the cytoplasm of the cell and DNA is stored in the nucleus of the cell. They are compartmentalized and the two do not interact. Finally, I'll circle back to my first point about mRNA and its instability. It has to be stored at ultra-cold temperatures or it will quickly be degraded and rendered useless. I said "thank goodness" before because we want that to happen. Our body doesn't want old mRNA providing sloppy recipes to the ribosomes that are manufacturing proteins. That is a recipe for mutations to occur which could result in a number of unwanted processes. Mutational defects in genetic codes are the basis for cancer, for example. So thank goodness that mRNA naturally doesn't stick around and is degraded rapidly.

mRNA vaccine technology is new to widespread human use, but the technology itself is not new. It has been around since 2005. However, the storage requirements and its cumbersome use has limited its utility until now. With typical vaccines, the viruses are either grown in egg cultures and then killed and injected or a specific protein of that virus is purified and then injected. Subsequently, this triggers an immune response. Some vaccines (like some flu vaccines), take live virus but it is significantly weakened or "attenuated." This also results in our bodies mounting an immune response. It is because of that immune response that you feel which sometimes causes patients to tell me that "they got the flu from the flu shot." This is a normal and desired phenomenon (the immune response is desired but not necessarily the mild symptoms). But to grow a virus, purify it, mass produce it, etc....that takes time. The AstraZeneca vaccine is made in the typical fashion and has lagged behind the mRNA vaccines by Pfizer and Moderna. Up until this point, we've never needed to make a vaccine fast. Enter mRNA vaccines.

SARS-CoV2 aka "Coronavirus" is composed of 25-29 proteins. 1 of those proteins is the spike protein. The virus uses this protein to bind to our receptors (ACE receptors) and enter into our cells. The vaccine is composed of mRNA with the sequenced code to provide instructions to the ribosomes to produce this spike protein. Our bodies then recognize this protein as foreign and mount an immune response to it (create antibodies against it). This process takes about 2-4 weeks. With the current vaccine, a second dose is given after 3 weeks to create a brisker antibody response. In the trial, immunity was found in 52% after 12 days from the first injection and in 95% after the second injection. Keep in mind, the mRNA is telling the ribosomes to only make ONE protein of the virus and this protein is completely harmless to us without an associated virus which is a conglomerate of 20+ other proteins. Similarly, if we provided only the instructions to automobile factory workers to produce a spark plug, we couldn't expect to drive anywhere without the instructions to manufacture the wheels, engine, seats, etc.

When a person that has had the vaccine then actually encounters the real virus, the body basically says "Oh, I've seen this invader before. Let's send out the immune system immediately to destroy this before it can take root in our cells."

I've heard concerns about long-term safety. Could this cause problems many years from now? Will this cause autoimmune disease? Will this make an actual COVID infection worse? I think many of these concerns are unfounded. We have data from the trial of nearly 18,000 people. It was double-blinded placebo controlled, meaning that 18,000 people received the vaccine and 18,000 people received a placebo. None of the participants in the trial knew if they got the real vaccine or not until the trial had ended. Of those 18,000 people, no significant long-term safety issues were identified over the 2 months after their final vaccine dose. Remember the degradation of mRNA is rapid and it's likely that the safety going forward will also be very promising. However, to say that it is 100% safe and there will be absolutely no long-term issues is also inaccurate. We just don't know. That statement is possible, and I might even argue that it is probable, but we simply just do not have the data yet to say this conclusively.

In the trial, the short-term side effects should also not be minimized and need to be known. Pain at the injection site described as "mild-to-moderate" can be expected. 83% of people younger than 55 reported the pain symptoms while 71% of those older than 55 reported pain. Fatigue and headache were reported in 59% of younger adults and in 51% of adults over age 55. Fever was reported in 16% of younger patients and 11% of patients older than age 55. The symptoms tended to last for 1-2 days.

So, in summary, it is probable that the COVID vaccine will make you feel "not so great" for 1-2 days.

We also believe that this vaccine produces a brisk immune response which is better than normal vaccines, too. We know that although you can get COVID more than once, it is extremely unlikely to get COVID after initial infection for at least 6 months and the vaccine may be even better. We don't know just how long the immunity will last at this juncture though. If COVID does become endemic, meaning that it will mutate and we may require an annual COVID vaccine, this new mRNA technology will allow for rapid changes to the genetic sequence so that we can hopefully always stay ahead of the virus.

So with all of that information, yes, I will personally choose to take the vaccine. While it's true that we don't know the very long-term safety data, I feel it is the safer alternative to getting the actual virus. With COVID, we know about many potential long-term consequences such as weakened heart muscle, blood clotting, mental fog, fatigue, and breathing issues. I think I'd rather take my chances with the vaccine.