A Virologist’s Case For The COVID-19 Vaccine
Recent announcements from COVID-19 vaccine trials have sparked much interest and excitement. The first two vaccines announced from …
Why I will be getting the vaccine when it becomes available
Recent announcements from COVID-19 vaccine trials have sparked much interest and excitement. The first two vaccines announced from Pfizer/BioNTech and Moderna are mRNA vaccines, whereas the third potential candidate finishing up late-stage clinical trials is a viral vector vaccine from Oxford/AstraZeneca. Pfizer’s vaccine has been granted emergency approval in the UK and Canada, and it is very likely that it will gain this approval in the US today. Many other vaccines are in clinical trials and will likely be announcing results soon.
Although these announcements have generated much excitement, there is a significant portion of the population that is hesitant to get excited about the possibility of a vaccine. Reasons for this hesitation range from concerns about the short time spent in clinical trials to concerns about what the vaccines contain.
I am a virologist. I also tend to lean fairly conservative (whatever that means anymore) when it comes to many political issues. Since the majority of vaccine concerns are being voiced by conservatives, I wanted to take a minute to explain my perspective on getting the COVID-19 vaccine and why I plan on getting it when it becomes available. Most of this article will focus on the new mRNA vaccines as they are the leading candidates at the moment, but I will reference other vaccine platforms when relevant.
If you have concerns about whether or not you should get the vaccine, I hope these thoughts will help you as you think through that decision.
The vaccine is effective
I plan on getting the vaccine because the clinical trial data shows that they will protect against the virus.
Perhaps some of the most anticipated and exciting news about the COVID-19 vaccines in development is that they appear to be highly effective. This is the case for the two leading mRNA vaccines, at least. Pfizer announced that their vaccine was 95% effective against COVID-19 in their phase III clinical trials. The graph (figure 13 on page 58 of the report submitted to the FDA) showing cumulative COVID-19 cases in the vaccine and placebo groups, respectively, is about as clean and clear as you can get in a phase III clinical trial, showing a stark and definitive protective effect in the vaccine group.
Similarly, Moderna announced that their vaccine is 94.1% effective. These are very promising numbers. AstraZeneca was the third company to announce an effective vaccine, with one dosing regimen showing 62% effectiveness and another regimen showing 90% effectiveness. For comparison, the seasonal flu vaccine is typically 40–60% effective each year (this is in part due to the nature of the influenza virus compared to coronaviruses).
To be fair, these efficacy numbers are specific to the clinical trials environment. In the real world, vaccine effectiveness might be lower. However, these data showing very high vaccine effectiveness suggests that these vaccines work well and will protect a significant number of people. I would guess that efficacy rates in the wild will be quite similar to those reported above, if just slightly lower.
The vaccine is safe
I plan on getting the vaccine because all signs point to the vaccine being safe.
The two leading vaccines from Pfizer and Moderna are mRNA-based. mRNA is a natural molecule in our own cells, taking instructions coded in our DNA and presenting that information to proteins called ribosomes, which build proteins from the mRNA instruction. Coronavirus mRNA vaccines contain instructions that tell your cells how to make a Sars-CoV-2 (the virus that causes COVID-19) protein that is typically found on the outside of the virus. Your cells then take these instructions and make the protein, which they then present to your immune cells to recognize and make antibodies towards (this is an over-simplified explanation, but it serves our purposes).
This is actually what would happen in a normal infection, except in a normal infection, the virus would introduce instructions for your cells to make all the viral proteins instead of just the one that the vaccine has. There is therefore no possibility of infection from mRNA vaccines, because there are no instructions to make all the necessary virus components. Further, mRNA is an inherently unstable molecule, meaning that it will degrade rather quickly (and thus not stay in our cells for very long), and it cannot change our cell’s DNA. This rationale is why mRNA vaccines are considered very safe.
But do we really know that these vaccines are safe? They’ve only been in trials for a few months, and vaccines normally spend years in clinical trials, right?
From years of vaccine research, we have a good understanding of vaccines and how they work in the body, so we have a good idea of what to be looking out for as far as adverse events or side effects, both severe and non-severe. For example, typical non-severe or minor adverse events often include pain, redness, and swelling at the injection site, fever, fatigue, and headache. These symptoms have been noted in the COVID-19 vaccine trials, and although they may be uncomfortable, they usually resolve within a few days. Severe adverse events that have been seen with other vaccines include seizures, anaphylaxis, and Guillian-Barré Syndrome (note that GBS, the adverse effect with the most potential to have long lasting effects, has a prevalence of between 6 and 40 cases per 1 million people in the US, and being sick with diarrhea, lung, or sinus issues poses a greater risk for developing GBS than vaccines). We also know that typically these symptoms develop within days to months, not years down the road.
While this is the first mRNA vaccine to be approved, there are several reasons to be confident in the safety of these vaccines. As explained above, the theoretical basis for mRNA vaccines gives every indication that they will be safe and not cause serious adverse effects. Further, mRNA vaccines have been in development for several years for other infectious diseases, such as influenza, and clinical trials had already begun.
COVID-19 vaccine trials are also under intense scrutiny, as the whole world is watching for obvious reasons (for example, Oxford’s vaccine trial results have generated questions and concerns from the scientific community). Independent review boards are being used to review the results to eliminate as much bias as possible.
Moderna has enrolled 30,000 participants and Pfizer nearly 44,000, and to date, there have been no severe adverse events following immunization. The AstraZeneca vaccine trial, which also enrolled around 30,000 participants, saw one participant develop spinal cord inflammation. The trial was immediately halted until review occured, and it was determined the patient developed multiple sclerosis and there was no evidence that this was related to the COVID vaccine.
To question the speed of development and approval of these vaccines is a legitimate concern. The development of a COVID-19 has proceeded at an unprecedented pace. This is especially true for mRNA vaccines, as the mRNA vaccine platform has yet to be approved for any disease. However, this rapid development does not mean that bad science is being done. It is indeed impossible to know all the downstream effects of these new vaccines. However, there has been no evidence to warrant any fear that these vaccines will be anything other than safe. Compare that with the known detrimental effects (both short term and long term) that COVID-19 can have on the body and I believe that the risk-benefit analysis weighs heavily on the side of the vaccine.
The vaccine will allow us to reclaim our social lives
I plan on getting the vaccine because I want us all to be able to spend quality time with our friends and families again.
This year has been difficult for most of us, not only because of the pandemic but perhaps even more so because of what the pandemic has taken away from us: our social lives. I truly believe the short- and long-term mental health effects from social distancing and isolation are underappreciated as of yet. An effective vaccine holds the potential to allow us to reclaim our social lives without the fear of spreading the virus to those we love.
Although there are some concerns that a vaccine will not fully allow us to get back to normal, I believe these concerns are overstated. An effective vaccine that is widely accepted by the public will severely limit the number of people that the coronavirus can infect, which in turn will drive down viral transmission. In the best-case scenario, there will not be enough people that the virus can infect to keep it in circulation.
But even if vaccination rates are much more modest, any proportion of the population that is immune to the virus should decrease viral transmission. Not to mention the fact that especially vulnerable populations, such as the elderly and those with risk factors, will have an option for a line of protection even if the general public is less than enthusiastic about the vaccine. We cannot let perfect be the enemy of good enough.
Two common objections
These are the main reasons I am planning on getting the COVID-19 vaccine. Honestly, for many people, getting the vaccine just seems like common sense. Why wouldn’t you get the vaccine?
Yet, there are quite a few people who are hesitant to get the vaccine. And a growing number are voicing outright opposition to the vaccine. Hesitancy that spawns from uncertainty about the safety of a new vaccine is reasonable, though there is good reason to believe that the vaccine will be both safe and effective. However, there are a couple of claims that are making their rounds that are misleading people about the vaccine, causing unwarranted fear and opposition to the vaccine. This article would not be complete if I didn’t address these concerns.
The vaccine does not contain poisons
You might come across some claims that the new COVID vaccines that they are making contain different chemical poisons. Statements like these are designed to frighten and intimidate, often using unfamiliar chemical names to frighten people. What statements like these are trying to imply is that there are chemicals in the vaccine that are toxic to our bodies.
However, this misunderstands (or deliberately ignores) the definition of poison. Poison is a vague term, and it is determined by the dose. It is true that a lot of vaccines contain small amounts of different chemicals (with long, frightening names) that are used at various stages of the production process, but the amount of these chemicals in the final vaccine products is minuscule. For example, the amount of formaldehyde, a common chemical named as one of the ‘poisons’, in a vaccine is less than the amount of formaldehyde that our own cells produce as a natural by-product of metabolism (for more information about vaccine safety, see my article, “Your Flu Questions Answered”). So, to call that poison is to misuse the concept of poison.
The COVID vaccines are going through rigorous safety trials, and the only ones that will get FDA approval will be those that can show that they are both safe and effective. And as stated above, the safety data for the mRNA vaccines is looking very good. It is true that we cannot know for certain the long-term safety profile of these new vaccines, but this is also true of any novel medicine or medical device. The vaccines will continue to be closely monitored for safety even after they pass through Phase III clinical trials. However, there is no reason at the moment, from theory or clinical trials, to believe that these vaccines will be anything but safe. On the other hand, we can be quite sure that COVID-19 will continue to harm and kill people in the absence of a vaccine.
The vaccine does not contain aborted fetal tissue
Statements asserting that the COVID vaccine contains or is made with aborted fetal tissue are increasingly becoming a common refrain in some circles opposing the vaccine. These statements are not new among those who have opposed vaccination for years, but rather have been recycled for various vaccines.
What is new, however, is that I am starting to hear this line of reasoning in the more mainstream conservative community in reference to the COVID vaccine. The reason for this is fairly obvious. Abortion is being used as a trigger word to rally conservatives that would not normally fall into to the far-right community, but already have some concerns about the COVID-19 vaccine. And it is an effective persuasion tool. However, this statement is at best a half-truth designed to mislead, and at worst an outright lie.
To begin, I want to make one thing abundantly clear: none of the vaccines currently in development contain aborted fetal tissue. The two leading mRNA vaccines contain lipids and mRNA, and the next contender (Janssen) is based on a recombinant protein encoded in a viral vector. More traditional vaccine approaches use a weakened or killed form of the virus that causes COVID-19. Any statement that asserts the new COVID-19 vaccine contains aborted fetal tissue is simply incorrect.
Now that that is out of the way, we can look into where statements about aborted fetal tissue originate. As far as I can tell, claims such as these are based on the fact that research groups and companies often use a particular cell line, named HEK-293 cells, during their vaccine development stage. It is true that the HEK293 cell line was derived from an aborted fetus in 1973 in the Netherlands. However, there are several important points that need to be discussed before we use this as a reason to oppose vaccines.
First, the reason for the abortion is unknown. The scientist who derived the cell line from the fetus could not recall the circumstances in which he obtained the fetus. What is certain, however, is that reason for the abortion had nothing to do with the scientist making the cell line with the tissue (it could have even been a spontaneous abortion — we just don’t know). There is little moral ground for blaming the scientist in this situation. As a parallel, if an organ donor is murdered, we wouldn’t say it is morally reprehensible to use his/her organs to save a life on the basis that the murder itself was immoral.
Second, the HEK293 cell line is a very popular cell line in biological/medical research (probably second only to HeLa cells, another cell line with a controversial origin story) and is used in practically every major lab and biotech company that exists today. They are widely used to study various aspects of infection, vaccine, and drug effects. They work very well in genetic assays, often playing a vital role in genetic research.
So, if research with this cell line provides grounds to not get the COVID vaccine, then it also provides grounds not to get any vaccines (which certain groups would likely agree with) or medications at all, as practically every lab that has produced modern therapeutic agents has used this cell line at some point, from cancer labs to infectious disease groups to basic biology researchers.
Finally, and relating to the original point, whereas HEK293 cells have likely been used at some point in researching a vaccine, they are not used to produce the vaccine. The cells are used in the testing process, not the development of the actual vaccine.
Actually, if you support the claims that vaccines contain trace amounts of the cells they are grown in, you should be for the new mRNA platform of vaccination. All components of mRNA vaccines can be made completely free from any animal-based products. They are not grown in human cells at all, much less the HEK293 cell line.
But even the traditional approaches to the COVID-19 vaccine would not use HEK293 cells to grow the virus. These cells simply do not work well to produce large amounts of virus. Rather, another cell line, called Vero cells (derived from African green monkey kidney cells) has proven to be the best at producing large amounts of the coronavirus, and it is likely that this would be the cell line of choice for the COVID-19 vaccine.
In sum, the vaccine itself does not contain (or use) aborted fetal tissue; however, the research process that led to the vaccine likely at some point used that cell line. Just like the research that led to most modern medicines that save countless lives today.
If you are struggling over whether or not you should get the vaccine when it becomes available, I hope this helps you think through the decision. I know that it can be a tough choice due to the different uncertainties and concerns that you may have, or might have heard about from close friends and family. However, I think the theory and data for the new vaccines are solid, showing them to be both safe and effective.
I plan on getting the COVID-19 vaccine when it becomes available. I hope you will too.