Vaccines and Pandemics: Separating the Wheat from the Chaff

It’s hard to believe that the COVID-19 pandemic started almost 18 months ago. We have all experienced hardships and many of us had family members who have suffered from the virus.

Stopping COVID-19: Reaching the “Holy Grail” of Herd Immunity

Historically, there are only two infectious diseases that have been eradicated in nature. One is smallpox, and the other is Rinderpest (a disease in hoofed animals).

Other diseases have been drastically reduced because of vaccines, such as polio, which underwent its own mass vaccination program back in the 1950s. Measles, mumps, rubella, chickenpox, various pneumonias all occur at exponentially reduced numbers because we have vaccinations available for these diseases.

Remember that during the Spanish flu pandemic almost exactly a hundred years ago, there were no vaccines available. That pandemic dragged on for three years and over 50 million people died.

If we vaccinate enough of the population, we can reach what is often considered "herd immunity," meaning almost everyone is protected. The percentage to achieve herd immunity for a given infection depends on the R-naught or R0 (a number that indicates how contagious an infectious disease is) and the vaccine efficacy.

For COVID-19, it is estimated to be between 75-85% of the population.

Falling Far Short of COVID-19 Vaccine Goal

The number of doses of COVID-19 vaccines administered so far in the United States is 318 million: enough to vaccinate about 49.6% of the U.S. population. This is a far cry from the 75-85% of the population that is required to achieve herd immunity.

Perhaps more alarming is the rate of vaccination: it’s plummeted.

It seems there was an initial rush for those who really wanted to be vaccinated at the onset, but now that this group of early adopters has been vaccinated, those remaining never wanted to be vaccinated to begin with. This vaccine hesitancy is now probably the most significant barrier to eradicating COVID-19 in the country.

Dealing With Vaccine Hesitancy

A 2020 survey showed that while 70% of respondents were asked in April 2020 if they were likely to get the vaccine once it became available said yes, the percentage dropped to around 50% by the time the vaccine actually became available in December of 2020. Based on this, we have already reached the expected number of people vaccinated in the U.S.

Vaccine hesitancy is not limited to this country.

In one study, the rates of people who stated they were likely to get a COVID-19 vaccine varies widely, but is very rarely over 75% in any country, meaning that 25-30% of the global population is hesitant, in general.

How can primary care physicians and pediatricians help get more people vaccinated?

Logically and scientifically, we know vaccines have a positive impact, particularly during a pandemic of these proportions. But many people still refused to get vaccinated. The reasons for this are unclear, sometimes difficult to understand, and may include:

• misinformation,
• a poor understanding of vaccines and their benefits and risks,
• the novelty of the technology, and others.

Dealing with vaccine hesitancy is a difficult task.

Despite the urge to make judgements, we should instead present facts and information politely and with kindness and concern. Many physicians use a multitude of techniques, including reassurance, question and answer, creating reference material, and so on. But the people we will be able to impact are generally on the fence and have not made up their minds.

There is also a sizable group of people who have already formulated their opinions about vaccinations: nothing we say or present to them will change their minds.

How can physicians educate patients about vaccine safety and efficacy?

The best we can do is use credible sources of information, understand the data, and be able to present information to patients in a meaningful way that shows vaccines are safe and efficient.

Many of us were waiting expectantly for vaccine studies to help us accomplish this. Not only have the various vaccine (Pfizer, Moderna, etc.) candidates so far shown excellent efficacy, but we also witnessed the introduction of a new technology – mRNA vaccines. To put it simply, mRNA stands for messenger Ribonucleic acid and is the form of nuclei acid that cells use as a blueprint to synthesize proteins, such as the spike protein of COVID-19.

• These new vaccines are based on the principle that given the right conditions and necessary materials; the host (a human) can translate the mRNA contained in the vaccine to a relevant but harmless protein which serves as the antigen to which antibodies will develop following vaccination.
• This new technology has been shown in randomized, double-blind, placebo-controlled clinical trials and further validated in real-life situations to be efficacious and safe.

The two available mRNA vaccines are made by Pfizer/BioNTech and Moderna.

Johnson & Johnson/Janssens vaccine, based on viral vector technology, was the third COVID-19 vaccine to be released in the U.S.

The fourth candidate, a protein subunit vaccine, will almost certainly be available in the near future.

The World Health Organization (WHO) reports that there are 287 COVID-19 vaccine candidates, of which 102 are in clinical phase, as of June 22, 2021. There are 23 vaccine candidates in either phase three or phase four trials.

• The Pfizer mRNA vaccine has been granted Emergency Use Authorization (EUA) by the FDA for children 12 years and older.
• Both Pfizer and Moderna have ongoing clinical trials in patients as young as six months of age.
• It is anticipated that the vaccine will become available for children younger than 12 years of age in the near future, although the exact date that the vaccines will be approved by the FDA for EUA is unknown.

Facts to Help You Persuade Your Patients

• Approximately 319 million doses of COVID-19 vaccines were given in the U.S. as of June 22, 2021: enough to vaccinate 49.7% of the population.
• In the U.S., the percentage of people who have received at least one dose is 53.4%, and those fully vaccinated account for 45.2%.
• In Florida, the corresponding numbers are 52.5% and 44.1% respectively, slightly below the national average.
• The number of reports received by the Vaccine Adverse Effect Reporting System (VAERS) is 9,000.
  • Symptoms most commonly reported include nausea, dizziness, fatigue and chills.
  • There are a handful of children with myocarditis reported with the mRNA vaccines, and a very small percentage of women between the ages of 18 and 48 given the Johnson & Johnson vaccine developed thrombosis related complications.

What is the risk of dying from a COVID-19 shot?

Overall, there are 196 reports of death, but it is unclear how many of these are related to the vaccine, since approximately 10,000 people normally die in a single day in the U.S. in 2020. It is highly likely that the 196 reported deaths on the VAERS probably did not die from the COVID-19 vaccine. Many of these individuals had existing diseases and underlying conditions.

Let’s assume the worst case scenario: that they all did.

• Even if we attributed every single one of these deaths to COVID-19, the maximum risk of dying from a COVID-19 vaccine would be approximately one in every 2,000,000 injections.

• Of all the 319,000,000 COVID-19 shots given in the US as of June 22, 2021, there were 9,000 VAERS reports, which gives a rate of one report per 35,444 shots.

Clearly, the rate of side effects or death is minimal. Let’s compare them to other U.S. statistics (as of June 22, 2021):

• Number of people who had COVID-19: 34,419,838
• Number of people who have died of COVID-19: 617,000
• U.S. population: 332,800,000

• This means that over the past 18 months, you had a 10% chance of contracting COVID-19.
• The 617,000+ deaths are equivalent to about one in every 540 people, or about 0.2%.
• That means the risk of dying from COVID-19 in the general population is about 65 times greater than dying from a COVID-19 vaccine.
• If you do come down with COVID-19, then the case fatality rate is 1.79%.

At Joe DiMaggio Children’s Hospital, we have cared for:

• 1,500 children with COVID-19
• Of these, 81 children were admitted
• 74 children developed Multisystem Inflammatory Syndrome of COVID-19 (MIS-C)
• As of June 2021, all MIS-C patients have been admitted to the ICU

Everyday Risks Are Statistically Higher Than a COVID-19 Vaccine

All of us perform an activity every day that is also significantly riskier than a COVID-19 vaccine.

• In 2019 there were 38,000 deaths from automobile accidents in the U.S.
• Accidents led to over 4.4 million people requiring medical attention.
• This means that in one year, we lost one in 9,000 people to an automobile accident.

In a worst case scenario, assuming all 192 deaths reported in VAERS are indeed secondary to COVID-19 vaccines, you would have a minimum of at least a 200 fold or 20,000% greater likelihood of experiencing death from an automobile accident, and yet none of us would think twice about getting into a car.

Getting Vaccinated is More Than a Privilege, It’s a Social Responsibility

Getting vaccinated is critical to stop COVID-19. Initial mass vaccination programs have helped, but we are also now faced with the emergence of variants, some of which may be more severe and and/or more contagious. Some of these variants may also be able to evade the protective effects of vaccines.

If vaccines are less effective, it means more people must be vaccinated in order to reach herd immunity. Fifty percent of the population is definitely not going to be enough.

People who lived a hundred years ago did not have the benefits of a vaccine, but we do. We all need to do our part to help eradicate COVID-19.