10-Minute Talks with Dr. Martin Today’s Topic: The COVID-19 Vaccine

DR. GREG MARTIN: Hi, I’m Greg Martin, and I’m here to talk to you a little bit today about the COVID-19 vaccines. We now have two of them out. When I first started this, we only had one, but now we’re talking really about both of them – both the Pfizer and the Moderna vaccines.

This is Dr. Padget, who is our Chief Medical Officer, and myself getting our immunizations back on the first day of this, which was about three and half weeks ago.

So, as you know, the Pfizer vaccine was the first one out, and it’s really been incredible that both this and the second one out – the Moderna vaccine – are almost incredibly equivalent as far as their efficacy, looking to be 94% to 95% efficacious in protecting people from getting COVID.

And just a little bit about what these vaccines both do is they use a thing called mRNA, which is messenger RNA. So basically, this is just taking a little piece of the genetic material that would be needed to produce a full virus, but instead of making the full virus, this is just making a little portion of it called the spike protein. The spike protein is what attaches to your cells – the antigen presenting cells in your body – and by getting a little bit of this mRNA encapsulated in sub-lipid, basically a fat thing, it kind of makes your immune system think this is a micro-organism. It gets encapsulated, it gets processed, and it starts cranking out this portion of the spike proteins that then get out and let the rest of your immune system really become activated into fighting what is known to be an invader then. The good thing is this goes on in your cell for about a week to 10 days, and then your cell just gets rid of this and stops, so it does not become incorporated into your body and it does not cause much in a way of side effects.

So reviewers in the UK, Canada, and now the European Union have all given this what’s called emergency use authorization. That’s a little different than what is given when you actually approve a vaccine. This means they’re still looking at some of the side effects that might occur down the line, but this has been given over 40,000 people for the Pfizer vaccine, and were around 30-some thousand people for the Moderna vaccine. So I wanted to talk about some of the common questions that seem to be popping up from people who are getting these vaccines.

Fortunately, almost everyone can get these immunizations. Now, I made this whole graph just to show you that the main concern is about allergies. And there’s been an incredible amount of overplay of this in the press, but these vaccines have proven to be incredibly safe. We’ve given out millions of doses by this point in the United States, and even more so in other countries, and there’s been a very, very low rate of people having serious allergic responses. In fact, you can be – even if you have bad allergies, as you can see in this chart, you really can get this immunization. The only ones who can’t are if you have a really severe allergy to a component of this vaccine, and it’s a very simple vaccine so it does not have a lot of components.

A lot of the vaccines we’ve all gotten before have a lot of preservatives in them and things to stabilize, but these being very cold vaccines are stabilized by that cold, so they don’t have a lot of other things and so they tend to not cause a lot of allergies.

There are some groups that were not tested. And when we are looking at new drugs, we test them in adults who are not pregnant, who are not breastfeeding, because we don’t want to give somebody a bad side effect and then it turns out that it’s also affecting their fetus or their young baby. So, once safety data is back on that, they then expand these out to larger groups.

The Pfizer vaccine is currently being looked at in little kids and it is being looked at in pregnant women and in breastfeeding women, but there is no reason to believe that there will be any problems in any of these groups.

The younger kids are something – they’re probably not so concerned about side effects, it’s just to make sure that it is immunogenic enough in them that it is anywhere near as efficacious as it is in adults, and we expect that this will be, and that probably later this year by late spring, we will have much more data on giving this to kids.

We are actually recommending pregnant women and breastfeeding women get this. We’ve given plenty of women here in MED, in Washington, DC – pregnant women – the vaccine and breastfeeding women the vaccines with no problems and there’s no indication that there should be any problem for their babies.

And I just kind of jumped ahead on this in saying, but there’s no indication that there is shedding of any of the vaccine components that go into breast milk, no suggestion that this would cause any harm to a developing fetus. And there’s a lot of advantages to a mom taking these while she’s pregnant or breastfeeding in that the antibodies she will develop will be passed on to her baby in uterus – the baby is born with some antibodies – and actually breast milk will also contain antibodies if the mother is immunized while she is either pregnant or breastfeeding, and those passive antibodies – we call them – are passed on to the baby and are at least somewhat protected from infections, even though we know that babies actually do incredibly well with COVID – they very rarely even have symptomatic seeds.

How about immunocompromised patients?

And there’s many of you, or many of your families who are immunocompromised. And fortunately, since this is not a live vaccine, we can give this to even very seriously immunocompromised people. And in fact, it’s probably important that they do get it, because they are more likely to have severe COVID if they were to be infected, so we like the idea of giving this vaccine to them. There’s no suggestion that it causes flare-ups of autoimmune disease. It’s been given to some people who were in the studies who had things like Crohn’s and Multiple Sclerosis. If you’ve had a history of Guillain Barre in the past, it’s also safe to be able to get these vaccines.

Now, of course, we’re following these after we’re giving these millions of doses to see if there’s any untoward side effect, but we have not at this point seen this on any of the patients taking either one of these two vaccines.

How about people who have had COVID-19 already?

Well, we know that if you actually had COVID, you got tested and you were positive, that’s kind of an immunizing event. You have some antibodies that are there. And, generally, the CDC and WHO have been saying that you’re protected probably for about 90 days, and then that may go down and you might be able to get infected again, and there have been some cases of people documented to get infection like this.

So if you have had COVID already, you should be re-immunized. We don’t push you getting immunized if it’s been less than 90 days, but certainly if it’s been more than 30 to 60 days and you have an opportunity to be vaccinated, you should be vaccinated.

If you actively have COVID, we generally wait until you are over your actue COVID and then you can get the vaccine, although if it were me, I would probably wait a couple months afterwards until my immunity came down, and then it’s almost like getting a booster dose when you get the vaccine and its second dose.

So you would talk to your provider about this if you’ve had it. We’ve immunized a lot of people here in MED – over 6,500 people – many of whom have had COVID already.

We’ve also had some people who got COVID in between their first and second dose. In other words, three days after they got their first dose they got a bout of COVID that we’ve proven, and we still end up giving them their second dose as they clear up their infection. So it is still important to be able to get this even if you’ve had it.

How about those people who have really bad allergies?

Now, I’m a person who has – you know, I’m allergic to shellfish and I’m allergic to some environmental things. I don’t carry an EpiPen or anything like that, but even if I did, you can still give these people immunizations.

Now, people who tend to be allergic tend to be allergic to other things, so you do have a somewhat more risk of having an allergic event if you’ve had severe allergies before. So what we’ve done is the people who say they’ve had severe anaphylactic reactions where they’ve been hospitalized, some have even been intubated from other things they’ve been exposed to, whether it’s bee stings, or foods, or allergies, we watch them for a little longer – we keep them for 30 minutes in the clinic and watch them. We have not had a single person have an allergic reaction to this vaccine at this point.

So, almost everybody can get this. And I as I mentioned, it’s only the ingredients in there, and you could see I put this slide on here so you could see the ingredients, which are, you know, basically not a lot in here. If you look at – most vaccines have a lot more stuff in them than this. Most of these are basic chemicals that are already in your body and not going to give you some problems. The one thing is the polyethylene glycol, which is essentially antifreeze. Believe or not, there’s a little of that in there, and it looks like that might be the one thing that could cause people to have problems. Now, plenty of people take polyethylene glycol when they take – laxatives have this a lot more. And there’s a minuscule amount of PEG in this vaccine, so I think almost everyone can feel confident that this is a safe vaccine as far as any kind of allergic reaction.

So there’s also this story on the internet that this will alter my DNA. You’re giving me this mRNA and it’s going to get in there and change that. Well, that is completely untrue. This is absolute balderdash. As much as you think you want to be genetically modified, this is not going to make you into a genetically-modified organism. This, as I mentioned before, it gets into your cell, it takes some of that cell’s innate ability to produce proteins and makes that spike protein for a while, and then the cells eradicate what is left from that. It never gets incorporated into the host cell genome. In other words, it’s never passed down from cell to cell when this vaccine is used – any of the mRNA vaccines. So, you do not have to be concerned about that you will be a GMO after we have given you either one of these vaccines.

How about, will it make your test positive before I travel?

Well, I put in here no and yes.

The immunization will not make any of the RT-PCR tests that we commonly use for pre-travel positive. So if you were to develop symptoms after you are tested – I mean, after you are inoculated, we would actually work you up to make sure you don’t have COVID, and if you’re testing back positive, you almost certainly would have COVID. This is not from the vaccine.

Now, there are other tests. There are antibody tests that we generally don’t recommend in the U.S. and Europe because they’re very variable, and if you had the immunization, then there is a possibility that you will have a positive antibody test depending on what test is being used. So we would have to talk to your provider about this if for whatever reason you needed an antibody test. And now this has been in some countries, like China and Morocco have both been countries that have required antibody tests. We have to make sure you get the right antibody test before you go so you do not have any confusion based just on your immunization history.

This has been approved really quickly, and people are nervous about this and the internet has made a big noise about this, and I think, you know, it’s really been presented the wrong way. This has been something the NIH has been funding these novel vaccine technologies, like mRNA, for decades to replace the antiquated methods that are used in most of our vaccines. Most of our vaccines are using really 19th and 20th century – early 20th century – technology and have not been updated. They are highly effective so there’s really not been a big push to try to change them. But the NIH and CDC have known for a long time we might have something like this come up – a new influenza, new respiratory virus, a new diarrheal illness, who knows – and that we need to have something that is ready to go that we can very rapidly fix this.

So when they identified the full genome of the SARS-CoV-2 virus, which causes COVID, they were able to take that sequence and within weeks start doing animal studies with this. This is unprecedented at how quickly we’re able to do this. And this is the wave of the future. So this has not only been just moving along very quickly because of the funding that’s gone along with it, but it has really been a test and a testament to the great job that our scientists have done in the U.S., and Europe, and Australia, and Japan, and China in being able to come up with new vaccine technologies for precisely this kind of problem. So, you should not be afraid that this is some crazy new thing and that it has not been well tested. It has been tested quite well in many different platforms, in lots of different animals, and this is just the first one to make it into humans.

So this cycle is really important and, you know, we’re all the way up through all of the left side up here, past the blue side into the purple side. So we’re now in the thing where it is out on the market. Millions of doses have been given. There is safety things being done where we’re following people after they’ve been immunized to see what side effects they might have, so we’ll be able to collect ever more data on this. But everyone feels quite confident that these are really safe and efficacious vaccines, fortunately.

So, side effects are mild to moderate side effects and only during the first seven days. What we have found is that most people get their side effect the day after and it lasts for about a day, and that sore arm was by far the most common one that we saw. Now, this is more so with the second dose than the first dose. The first dose, when I got it, I barely could tell where I had it. I had a slight sore arm the next day. The second dose was even less so for me. Some of the other patients had a bit more of side effects with the second dose, and these are not concerning other than you might feel lousy enough. We’ve had a couple people who spent a day at home after their second dose, but nobody’s had to have anything close to being hospitalized, or even come in to have medical attention during the side effects. So again, relatively mild and very short-lived, if you get those side effects.

So this is what the CDC has put down here, and I think it’s an important slide to remember that if you start to develop cough, shortness of breath, runny nose or sore throat, loss of taste or smell, that is not from the vaccine. Those would be signs that you have either COVID or another respiratory illness, and you would want to go back to your provider and tell them about that so they could work you up for COVID and other things, and not attribute that to the vaccine.

So, will people get this vaccine?

This is a survey – many of you may have seen this before. We asked this a couple months ago, and we found that the vast majority of State Department people do want to get this vaccine. As you can see in these blue bars, most of the people really felt that they wanted to get this. And we have found in our more recent things of people taking it, around 85% of people are accepting it. This is far higher than we find in the general population where it’s really been more in the 65% of people have been willing to be vaccinated. I think as people get more familiar with hearing about other people getting the vaccine, and that they did fine, and that they are protected, then more people will choose to get the vaccine down the line. But certainly, we hope so.

So that’s all I have for today. I hope this is helpful for you. You’ll be hearing more about both the Pfizer and the Moderna vaccine, and some of the other ones that will be coming out. Hopefully, in the month of February, we are going to see the Johnson & Johnson Janssen vaccine, which is a single dose coming out as well. And whatever we can get in MED, we will be getting and getting it out to post to hopefully get everybody vaccinated in the next few months. So with that, thank you for your attention and enjoy the rest of your winter.