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The long-awaited COVID vaccines are finally here, and with them comes deep feelings of relief and hope for the future for many of us. Getting vaccinated is at once a profoundly personal decision and a choice that impacts everyone around us. Nearly a year into the pandemic, this tension between individuals and community is familiar to us all.
It is natural to feel a range of emotions about the COVID vaccines, from apprehension or frustration to excitement and joy. Volunteers for In This Together Cambria have had the same emotional discussions about vaccines that are taking place across the county. We have endeavored to seek out the most reliable information possible to make informed decisions for ourselves and our families, and to share that information with you.
We hope that no matter what you’re feeling right now, curiosity and a desire to understand the facts about the vaccine will help inform your decisions.
Vaccine Q&A with Dr. Jill D. Henning
How do our immune systems work?
When we are exposed to a pathogenic microbe, our immune system has two ways to defeat it. The first is called the innate response. This response is encoded in our DNA as a human. It is nearly the same for all of us (with minor differences). This response causes inflammation. It is non-specific and only reacts to each pathogen based on its particular type. For example, all bacteria are treated the same; it cannot distinguish Streptococcus pyogenes from Staphylococcus aureus, or an adenovirus from the Ebola virus.
Most of the time, this innate response kills the invading microbe. When it doesn’t, that is when we see symptoms of a disease. When the innate response can’t destroy all of the microbes, then we see the adaptive response.
The adaptive response is specific. This response is different in every individual. We have a complex immune genetic system that takes gene segments and pieces them together to create an entirely new gene (which is super cool!). It’s called somatic recombination. Our germline DNA is pieced together to give us a new, never-before-seen gene to fight a specific pathogen. That gene is then turned into a protein and made into a specific response to that pathogen.
When the adaptive system kicks in, people who are sick often begin to feel better.
Our immune systems are not on the offensive. The point of the immune system is to defend against invasion. We are exposed to microbes daily (even when we are sheltering in place). It is a misconception to think of the immune system like a muscle. We don’t expose our immune systems to things to make them stronger, like we lift weights to strengthen skeletal muscle. The human immune system already has the ability to fight the infections. We just don’t do it unless/until we are exposed.
What is mRNA?
mRNA stands for messenger ribonucleic acid. They’re single-stranded molecules that carry genetic code from DNA in a cell’s nucleus to ribosomes, which make protein in the cells. These molecules are called messenger RNA because they carry instructions for producing proteins from one part of the cell to another.
Rather than giving the protein, the messenger RNA provides the instructions for your body to create the protein.
COVID-19 mRNA vaccines give instructions for our cells to make a harmless piece of what is called the “spike protein.” The spike protein is found on the surface of the virus that causes COVID-19.
How do mRNA vaccines (Pfizer and Moderna) work?
Both the Pfizer and Moderna vaccines are mRNA vaccines. This means that they use our cell’s own processes to make the spike protein of SARS-CoV-2, the virus that causes COVID-19. This spike protein is then broken down by the cell and shown to the cells of the immune system in a process called antigen presentation (kind of like an introduction to the body). The immune system will then mount a response to that spike protein, causing the individual to have injection site pain, tiredness, and after about a week, a swollen lymph node in the armpit closest to the injection site.
The vaccine uses lipids to encase the RNA to deliver it into the cells. Once the mRNA is inside the body it is recognized as foreign, and an immune response is made.
Since the vaccine is mRNA, a biological molecule that is nucleic acid, and not the SARS-CoV-2 virus, there is no way a person with the vaccine can be infectious. The vaccine provides instructions to make a part of the virus. Think of it like a blueprint for a building: the instructions are there, but no actual virus.
How does the Johnson & Johnson vaccine work?
The Johnson and Johnson vaccine is an adenovirus vector vaccine. The adenovirus is the virus that causes the common cold. Science removes the genomic material from the adenovirus and inserts the mRNA from the SARS-CoV-2 spike protein into the virus. Think of it like this, you crack open a pistachio and put in a peanut. The outside looks like the pistachio, but inside it is a different nut! That new recombinant adenovirus (adenovirus on the outside and SARS-CoV-2 mRNA on the inside) is given in the vaccine. Our cells get infected with the adenovirus and our bodies make the spike protein for our immune system to then generate a response to. This technology is used in making many vaccines that have been around for decades, such as the flu vaccine. It does not contain a live COVID virus, so there is no way you can become infected with COVID because of the shot.
Unlike the mRNA vaccines, which require two doses, the Johnson & Johnson only requires one. This is an obvious advantage in reaching many populations. In addition, the vaccine is stable at standard refrigeration temperatures instead of requiring the cryogenic (deep cold) conditions needed to store the Pfizer and Moderna vaccines. For these reasons, the Johnson & Johnson vaccine will be an important tool in fighting COVID all over the world, especially in places where specialized refrigeration is unavailable.
How effective are the vaccines?
The Pfizer and Moderna vaccines are extremely effective at 95% and 94%, respectively. The reported efficacy of the Johnson & Johnson vaccine is 74% against developing COVID-19. Though lower than the observed efficacies of the Pfizer vaccine (95%) and the Moderna vaccine (94%), the Johnson & Johnson vaccine was 100% effective at preventing hospitalization and death relating to COVID-19. This is an important statistic, as vaccination aims to prevent hospitalization and death relating to COVID-19.
Common Vaccine Questions
The vaccine was developed so quickly. How do we know it’s safe?
I have had a few family members ask about vaccine timing and how “fast” it was going. Operation Warp Speed is a misnomer. It evokes thoughts of moving faster than the speed of light, and Captain Picard saying “make it so.”
The Moderna and Pfizer vaccines are mRNA vaccines, based on sound science from cancer research and other viruses like Zika, Rabies, WNV and CMV. The speed came from overlapping clinical trials and production. Most of the time, companies won’t invest in the production if they are not sure the vaccine will work. That hinderance was removed by increased funding and companies simultaneously operating clinical trials and production to decrease the amount of time until vaccines are released to the public.
This process has been extensively studied for the last 20 years. The vaccine technology is sound. It follows central dogma and cannot change our DNA or cause infertility. While this kind of therapy hadn’t been approved for infectious diseases until recently , it has been extensively studied for use with Zika, HIV, rabies, and influenza, and human trials are ongoing. The reason the COVID-19 vaccine was fast tracked is because of the severity of the illness, coupled with the global pandemic.
To add to that, mRNA therapy has been used for eight years to treat cancers like acute myeloid lymphoma, glioblastoma (which uses measles virus RNA to get the immune system to kill the glia cells), renal cell carcinoma, pancreatic cancer, melanoma, breast, prostate, and ovarian cancers.
The Johnson and Johnson vaccine is an adenovirus vector vaccine, which is a technology that has been around for decades and is used in many vaccines, including the flu vaccine. The adenovirus is the virus that causes the common cold. Science removes the genomic material from the adenovirus and inserts the mRNA from the SARS-CoV-2 spike protein into the virus. Think of it like this, you crack open a pistachio and put in a peanut. The outside looks like the pistachio, but inside it is a different nut! That new recombinant adenovirus (adenovirus on the outside and SARS-CoV-2 mRNA on the inside) is given in the vaccine. Our cells get infected with the adenovirus and our bodies make the spike protein for our immune system to then generate a response to.
Why do we need two shots?
The first dose of both the Moderna and Pfizer vaccines will provide about 50% protection against acquiring SARS-CoV-2, the virus that causes COVID-19. However, this protection takes about 14 days to develop, which means that a few (5% of those vaccinated) may still get sick after exposure. It takes our bodies about 14 days after the second dose to build up the response to the virus. If you are exposed in that time or even later, it is possible that you could be infected.
The Johnson & Johnson vaccine only requires one shot because that vaccine is made of rebuilt adenoviruses that will replicate in our cells, triggering our immune systems to respond to the spike protein of the coronavirus.
How long does vaccine immunity last?
I wish I had more information to share with you on this topic. We don’t know for certain if people are immune to reinfection after vaccination simply because not enough studies have been done yet.
To learn the answer to that question would require tracking the re-exposure of a significant number of people and determining if they get sick. These studies have not been done because the vaccine has only been available since January 2021.
What we do know comes from a study published in the journal Science. This study looked at the cells involved in immune memory. Researcher examined the four cells used in immunologic memory and found that they persisted for eight months following infection with SARS-CoV-2. It is important to note that the study stopped at eight months, and that immunity may last longer.
If we look at other vaccines, it is possible that immunity may last for years. However, the variant strains must be considered when talking vaccination. Pfizer, Moderna, and the Johnson and Johnson vaccine all provide some level of protection against the variants seen at present. What that means is that vaccinated individuals may get sick, but they will have a milder case of COVID-19 than those that are not vaccinated.
Do I need the vaccine if I already tested positive for COVID?
Yes, you can receive the vaccine after being infected with SARS-CoV-2 as long as you are not experiencing acute symptoms of the infection.
Will I still need to wear masks and social distance if I am vaccinated?
Vaccinated individuals can still become infected with SARS-CoV-2, the virus that causes COVID-19. The reason is that the vaccines are 95% effective at preventing COVID-19, that means that few (5% of those vaccinated) may still get sick after exposure.
It takes our bodies about 14 days for the after the second dose to build up the response to the virus. If you are exposed in that time or even later, it is possible that you could be infected.
For now, the recommendations are to not assume complete immunity after vaccination. Even those who are vaccinated should wear a mask when in public, practice social distancing from unvaccinated people, and wash their hands regularly.
Can you still spread the virus once you are vaccinated?
The Pfizer and Moderna vaccines are mRNA, a biological molecule that is nucleic acid, and not the SARS-CoV-2 virus. The Johnson and Johnson vaccine is an adenovirus vector vaccine, which means a harmless virus is used to trigger an immune response against the coronavirus. There is no coronavirus in ANY of the three vaccines, so there is no way a vaccinated person can be infectious because of the vaccine. All three vaccines provide instructions to make a part of the virus, and does not infect the vaccinated with the virus.
Family units or individuals living together do not need to be vaccinated at the same time.
Science isn’t certain yet if those vaccinated will be unable to spread the virus or not. This isn’t because of the vaccine. As I said, the vaccines have no coronavirus in them. What is possible is that individuals who have been vaccinated may be what is called an asymptomatic carrier. They are exposed to the virus, but don’t experience any symptoms because of the protection from the vaccine.
We all know the story of Typhoid Mary. Mary was not symptomatic with Typhoid Fever herself but did infect countless people with the pathogen unknowingly. She was an asymptomatic carrier. She had no symptoms, but did infect those around her.
Science is not yet certain as to whether individuals who receive the approved COVID-19 vaccines are able to be asymptomatic carriers or not. Therefore, those that have been vaccinated still need to wear masks in public, practice social distance, and wash their hands regularly.
More studies need to be done to answer this pressing scientific question. I urge everyone to be mindful of the fact that we are in a global pandemic with a never-before-seen virus, SARS-CoV-2. Information on best practices may change (and has changed since the beginning). Look to your state health department for the most up-to-date recommendations.
What if I test positive for COVID in between shots?
It is recommended that individuals who are infected with SARS-CoV-2 in between doses (after the first does of the vaccine but before the second) should wait until their acute symptoms resolve before getting the second dose. This goes for both the Moderna and the Pfizer vaccines.
The first dose of both vaccines will provide about 50% protection against acquiring SARS-CoV-2, the virus that causes COVID-19. So, your question may be relevant for others in the same
Vaccinated individuals can still become infected with SARS-CoV-2, the virus that causes COVID-19. The reason is that the vaccines are 95% effective at preventing COVID-19, that means that few (5% of those vaccinated) may still get sick after exposure.
It takes our bodies about 14 days after the second dose to build up the response to the virus. If you are exposed in that time or even later, it is possible that you could be infected.
For now, the recommendations are to not assume complete immunity after vaccination. To be abundantly cautious, you should quarantine for at least 7 days. Even those who are vaccinated should wear a mask when in public, practice social distancing, and wash their hands regularly.
If I have COVID and I don’t know it because I’m asymptomatic, is the vaccine dangerous?
No, it will only help bolster your immune response to the virus.
What if I know I had COVID-19 but I don’t have any detectable antibodies?
Our immune systems respond to infections by mounting an adaptive response. This specific adaptive response is dependent on how severe our symptoms are, how old we are, and if we have any underlying medical conditions. After the response occurs, our immune system generates 4 types of memory cells: Helper T-cells (that help the other white blood cells), Killer T-cells (that kill cells of our body that are infected), memory B-cells (that make antibodies), and then antibodies (found in the serum of our blood).
Some individuals will have high levels of antibodies, while some will have high levels of other cells, and still some will have those cells go into a hibernation state. They will remain in the blood, but don’t activate until you see the pathogen again.
I would not be concerned about the low level of antibodies, this is normal. You have the other levels of protection and those memory B cells will come out of hibernation when/if you are exposed again.
If you were vaccinated and had a natural infection with SARS-CoV-2, you certainly have made memory cells. They are just waiting until they are needed to activate again.
What are the short-term side effects of the vaccines?
According to the FDA, the most commonly reported side effects of the Moderna vaccine, which typically lasted several days, were: pain at the injection site, tiredness, headache, muscle pain, chills, joint pain, swollen lymph nodes in the same arm as the injection, nausea and vomiting, and fever.
For the Pfizer vaccine, the FDA reports that the most commonly reported side effects, which typically lasted several days, were pain at the injection site, tiredness, headache, muscle pain, chills, joint pain, and fever.
Of note for both the Moderna and Pfizer , more people experienced these side effects after the second dose than after the first dose, so it is important for vaccination providers and recipients to expect that there may be some side effects after either dose, but even more so after the second dose.
Side effects with the Johnson & Johnson vaccine are similar to those observed with the other vaccines, including redness, pain, and swelling in the injection site, as well as general tiredness, headache, muscle pain, chills, fever, and nausea.
What are the long-term side effects of the vaccines?
Since these mRNA vaccines has only been on the market for a year, it isn’t possible to know the long term effects. However, this type of vaccine, an mRNA vaccine, has been extensively studied as a cancer treatment.
Why was the Johnson & Johnson vaccine paused?
Recent reports have linked the Johnson and Johnson vaccine to the development of “vaccine induced prothrombotic immune thrombocytopenia” (VIPT), identified by 6 people developing blood clots – literally one in a million, as more than 6 million Johnson & Johnson vaccines have been given. Obviously, this is a very low risk, but deployment was paused for 11 days to evaluate the data. As of April 24, the pause was lifted, and the vaccine is being given again in the United States. You can read more about the FDA and CDC decision to resume administering the vaccine here.
The blood clots reported in these six people result from the body developing an antibody, called anti-platelet 4, causing a strong activation of platelet production. Our bodies use platelets in clotting, and their production is perfectly normal (including leading to stopping bleeding in normal injuries). Almost anyone can develop a blood clot, also called a deep vein thrombosis (DVT). Some 900,000 people in the United States have a DVT every year.
Is it safe for people with medical allergies to get the vaccine?
Some individuals experience what is called delayed hypersensitivity.
You may be familiar with an allergy test. When this occurs a small amount of an allergen (tree pollen, cat dander, mold) is injected into the layer just under the skin surface. If an individual is allergic, the body (via the immune response) will produce a hive. It will be itchy and red and swell a bit.
Some individuals who were vaccinated with the first shot may experience a reaction like what I described above with an allergy test. Their body mounted an immune response to the vaccine contents and when they get the second shot, a hive is produced at the site of infection. This may mean that they are allergic to the lipid delivery system, polyethylene glycol. It is harmless and will not cause any decrease in efficacy of the vaccine. In fact, just the opposite! The body did mount a response and it showed how willing it is to fight the pathogen.
Other allergies are not an issue with the Pfizer or Moderna vaccines.
Should immunocompromised people get vaccinated?
There are so many ways a person can be immunocompromised. It is recommended that immunocompromised individuals get vaccinated as long as there are no contraindications for their specific condition.
Will the vaccine be effective against the new strains we’ve been hearing about?
This virus is continually changing (all of the variants you may be hearing about) and a vaccine will prevent you from having severe disease. That means it will keep you out of the hospital. In addition, vaccination will increase the immunity of our community (herd immunity).
When you choose vaccination, you are helping those in our community who cannot get vaccinated due to cancer or other illness. I realize that the science around whether someone who is vaccinated can transmit the virus to others unknowingly can be confusing. The mRNA vaccine is called a genomic vaccine. It uses the mRNA to make a protein. Like using a blueprint to build a building. The mRNA used in both approved vaccines was recovered from the SARS-CoV-2 virus that was circulating at the beginning of the pandemic. mRNA viruses have a specific, mathematical, rate of mutation. Variants were always expected. This is known. So, when the mRNA in the Pfizer or Moderna vaccines is injected into someone, it will stimulate the body to make the viral spike protein from the beginning of the pandemic. Again, normal. Our bodies take that protein, and our immune system will generate antibodies to that protein. Each section of that protein will have an antibody that can bind to it.
The mutations that have occurred in the UK, South African, and Brazilian variants all occurred in the spike proteins. Some of the protein is the same, some is different in the variants. Think of it like you having long, curly hair one day and then cutting it the next. Some of your hair is the same in both cases. Antibodies generated from the vaccine will provide some protection for the variants. The goal of vaccination is always stop clinical infection. In some cases, stopping clinical infection stops transmission (like with bacterial vaccines). With viruses it is sometimes not possible to stop all cells from being infected (because they are so small, 80nm or less, and individuals may be exposed to varying amounts of the virus during exposure). Think of it like you trying to find Waldo in a sea of red and white shirts. It becomes hard to find just Waldo. That is what you immune system does every time you are exposed to something — it tries to find Waldo.
The goal of these vaccines was never to stop transmission — that is why we all still have to wear masks. The goal was simply to keep people from getting clinical symptoms that put them in the hospital. To that end, choosing vaccination will reduce your likelihood of being hospitalized if you are infected with one of the variants.
Can I take a Tylenol or another anti-inflammatory drug before I go for my vaccination?
NSAIDS, or non-steroidal anti-inflammatory drugs, are designed to suppress the innate immune response. Our bodies have two basic types of immune responses: the innate response (which we are born with) and the adaptive response (that happens after exposure via natural infection or vaccine). For the adaptive response to work best, it needs to have a strong innate response.
Think of it like this: you need to lift lighter weights when starting to train for heavy lifting. You work your way up to lifting heavy weights with time and training. The innate response is like those light weights, it helps prepare the adaptive response to do the heavy lifting.
If we take drugs like NSAIDS, acetaminophen, or ibuprofen, they can hinder the innate response. This won’t stop the adaptive response, but it can slow the process of the adaptive response.
If you can handle the minor side effects associated with the vaccine, don’t take any anti-inflammatory drugs.
The Moderna mRNA vaccine is approved for ages 18 and up. But the Pfizer vaccine, which was originally approved for ages 16 and up, is now available for ages 12-15, too. So adolescents and teens aged 12 and up can receive the Pfizer vaccine. The vaccine is safe!
One amazing fact about younger individuals is that the younger we are, the better our immune system responds to any infection. This has to do with a small organ located just above the heart and under the breastbone called the thymus. As we age, our thymus degenerates. It’s entirely gone by the age of 65. Our younger children are better equipped to mount an immune response because they have their thymus. That is why we see the Pfizer COVID-19 vaccine showing 100% effectivity at preventing serious COVID-19 in children ages 12-16.
Let’s talk about risk benefits.
COVID-19 is in the top 10% of deaths among children in the U.S. There were 42,429 deaths from all causes among ages 0-17 from 2020-21. Of those deaths, 282 were confirmed COVID-19 deaths, while 1,116 were pneumonia, influenza, or COVID-19 – this is a total of 1,398 deaths that were caused by or contributed to by COVID-19. That is 1,398 too many – and now, we have the power to stop this because science shows that the Pfizer vaccine is 100% effective at preventing serious COVID-19 in children ages 12-16.
If enough adults don’t get vaccinated, the virus will move to our kids and young people – and that could be much worse.
We have the power to stop this through vaccination.
Data show that young kids who have not gone through puberty are more likely to have symptoms no more serious than a cold with COVID-19, but after puberty … that is when the long-haul starts. We know that COVID-19 can leave lasting effects on an individual’s body. The virus has the key to get into cells of our brain, heart, blood vessels, lungs, and digestive system. This can leave recovered individuals, at a rate of 1 in 4, with long-haul symptoms such as cardiovascular disease, mental illness, confusion, and labored breathing while doing everyday activities.
Just because the illness in mild in children does not mean that they will escape the long-haul issues seen in patients who have recovered from COVID-19.
Please consider promoting vaccination your patients ages 12 and up and if approved in younger children as well.
Getting the Vaccine
How is Pennsylvania distributing vaccines?
Each Pennsylvanian that receives a COVID-19 vaccination puts us one step closer to beating COVID-19. As of now (May 18), the vaccine is available to any Pennsylvanian aged 12 and up.
Am I eligible?
As of now (May 18), the vaccine is available to any Pennsylvanian aged 12 and up.
Are vaccines free?
Yes! Vaccines are free — you do not need to have health insurance to be vaccinated. Some providers will ask for your insurance card , but you do not have to have insurance to receive it.
What if it takes longer than two weeks to get my second shot?
If you are unable to get the Moderna vaccine exactly 28 days after the first dose or your Pfizer shot 21 days after the first dose, you can delay the second shot. The vaccine will still provide protection to you. These intervals are the earliest you can get the second vaccine based on clinical trials. Receiving the second shot a bit later is acceptable. (Johnson & Johnson does not require a second shot).
What’s the difference between the Pfizer, Moderna, and Johnson & Johnson vaccines?
The difference between the Pfizer and Moderna vaccines is in the recipe. Think of it like this — you make chocolate chip cookies with your grandma’s recipe, but I make them with my dad’s recipe. Both are chocolate chip cookies, they were just made a bit differently. The two mRNA vaccines are using the same Spike protein, just slightly different recipes to make it.
The Johnson & Johnson vaccine is what is called an adenoviral vector vaccine. It uses a technology that has been used for vaccines such as the flu shot. The adenovirus is the virus that causes the common cold. Science removes the genomic material from the adenovirus and inserts the mRNA from the SARS-CoV-2 spike protein into the virus. That new recombinant adenovirus (adenovirus on the outside and SARS-CoV-2 mRNA on the inside) is given in the vaccine. Our cells get infected with the adenovirus, and our bodies make the spike protein for our immune system to then generate a response to. The Johnson & Johnson vaccine is also a “one-and-done” vaccine, which means you only need one dose — your immune system will continue to mount a protective response without a booster.
Can I get the Pfizer vaccine for my first shot and the Moderna for my second, or vice versa?
No. You must get the second shot from the same company. The way the immune system works if you were to get the second shot from a different company, your immune system would not recognize it as the same pathogen.