September 10, 2020

vaccine considerations

The race for an effective vaccine is on. We have heard this week about the clinical pause put on the AstraZenica vaccine trial due to a possible adverse event. It is not yet clear if the vaccine was the cause, but concerning. The researchers will have an independent board review the data to decide if it is related. This is standard protocol for research studies.

Several websites are tracking the other candidate vaccines. The Milliken Institute has a COVID treatment and vaccine tracker that is really interesting and explains in details the types and categories of vaccines being studied. Take a look, if you are interested. The New York Times has a vaccine tracker which explains the research process. I am glad to see the variety of approaches being taken. This is pushing our knowledge to a new level. It also means we will probably end up with more than one option.

Individual vaccines have different methods of approach to stimulating an immune reaction. Some use viral DNA or RNA to stimulate a response, some use protein subunits, some use inactivated virus, some use live virus that is “attenuated” or a live virus that is weakened, so it doesn’t cause illness but induces an immune reaction. There are other approaches as well. Each approach has strengths and weaknesses.

We are still not sure an effective vaccine is coming soon. Too many unknowns exist and a vaccine for a coronavirus has never been done before. Some scientists are concerned that the coronavirus mutates quickly which may mean that a new vaccine will need to be made and given yearly to cover the mutations, like we do with the influenza vaccine. However, new data shows minimal changes in mutations when comparing viruses from different countries. This is reassuring and hopefully means we will only need one vaccine, perhaps with a booster at some point; rather than needing a yearly update, like with the yearly flu vaccine addressing the new flu mutations.

But what happens when we actually do get a vaccine that works? We need to start planning as public health entities. Some call to vaccinate the most vulnerable first, some call to cover essential workers, and some suggest we vaccinate children and college students first since that can cut down on “super spreaders”.

Of course, the other big challenge is to convince people the vaccine is worth it. So many skeptics of vaccines to begin with, so many others leery of the political influence of approval. Add in the legacy of Tuskegee and many African Americans may have more skepticism. The Tuskegee study is a stain on American medicine and our treatment of black people. For 40 years, 600 African American men were left untreated for Syphilis, so that the natural course of the disease could be documented. By the time the study ended in 1972 (!), almost 130 men had died from Syphilis or its complications, their spouses and children also infected. Monitored and not treated for 40 years in a study run by the US Government. Shameful. One of the first patients I cared for in residency had a congenital syphilis infection from that study. It permeated her whole life and effected her health. So just imagine how an African American might feel about being in a study for vaccines. Then wonder if they will agree to receiving a vaccine when approved.

We have work to do to help people opt in for vaccination. Hopefully, we can do better than we have with masks.

Wash your hands, cover your nose, keep safe six, and visualize a safe and effective vaccine.

And finally, my caveat is that this is my experience and my opinions, which are subject to change as more information is available, and not related to the organization I work for. Thanks for reading.