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COVID-19 Vaccines
I underestimated just how excited I was for the COVID-19 vaccines.
I want to share my experience so far and how the vaccine works. My goal is to hopefully alleviate any fears you have about this vaccine and show why as a physician I'm so excited to get the vaccine.
Each of the mRNA COVID-19 vaccines from Pfizer and Moderna are similar in their effectiveness and side effect profile. I've been asked if I had a preference. My answer has been "whichever I can get first" because the longer I have to wait the more time I'm not protected.
A beginning to the end
As I read updates and information about the vaccines as they were coming close to being authorized for use, I felt like there was finally a beginning of the end of the pandemic coming.
When it first seemed possible that COVID-19 vaccines were going to be a reality much sooner than I imagined they could be developed, I was excited, but I still underestimated how much it meant to me.
We can't safely count on natural immunity to end the pandemic - countries that tried this route are not succeeding and there's too much at risk allowing the infection to spread across the country. I firmly believe that vaccines are the way to stop this unpredictable virus from spreading.
Vaccine for healthcare workers
I was finishing up charting after work when I got a group text that a vaccine was available.
Instead of going home for dinner I texted my family to eat without me: I was getting the vaccine! I was like a little kid getting their most wished for gift - truly giddy on the drive to the hospital for my vaccine.
The energy in the area where the vaccine was being given was palpable. The text I had received was a group text among KC area pediatricians and we all left to get vaccinated about the same time, so the room was filled with pediatricians from all over the community taking pictures of one another and enjoying the moment. We were chatting and bubbling with excitement. I'm sure those who were giving the vaccines got tired of people asking if we could take pictures documenting the momentous occasion.
I was so very relieved to start my protection against this infection that has dominated my every thought and action the majority of the past year. I underestimated just how stressed I was.
A huge weight was lifted from my shoulders because I was starting the vaccine series. Protecting against the risk of infection that kept me from seeing my extended family and doing activities that I would otherwise be able to enjoy because I know I could be exposed at any time at work or doing necessary excursions was a relief. Though I know there's still risk, the stress relief is enormous.
How did it go?
I've been asked a lot about side effects.
The injection itself didn't feel like anything - usually you can feel whatever's being injected enter the muscle. But nothing with this shot.
My arm was sore starting shortly after the shot, but only when I touched it.
The next day it hurt when I touched it or lifted my arm, but only a little.
By the 2nd day all tenderness was nearly gone and it's entirely gone this morning (day 3).
I've been tired since the vaccine, but that's my new normal. I was tired before the vaccine. Sleep does feel more restful the past few nights. That's probably the lessened anxiety.
I had a few headaches at work, but that also happens fairly regularly these days. They get better if I go to my office, remove my faceshield and mask and take a few sips of water. I don't drink nearly as much water since I started wearing all the PPE - that's probably why I get headaches. This vaccine is one step to being able to work without all the PPE again one day.
I didn't take any pain relievers - they weren't needed and I don't want to interfere with my immune response if it's not necessary.
My work partners also had mild soreness to their arms but not much else.
I do expect to have more side effects after the 2nd dose. I'll explain why more below.
Update: I added a Side Effects post - check it out here.
Immune system & vaccine basics
Our immune system attacks anything that's foreign to our body, so when a virus gets into our body, our immune system gets to work.
If we've seen the virus (or something resembling the virus) before and have memory immune cells ready to fight, it can be swiftly taken care of before the infection has a chance to spread in our body.
If we've never seen a specific virus (or bacteria, fungus, or other invading thing) it can replicate and spread within our body and cause whatever symptoms and hazards that particular infection causes before the immune system has a chance to contain it.
Traditional vaccines
Many vaccines against viruses use attenuated (weakened) or inactivated (killed) viruses to introduce the immune system to that virus. The immune system doesn't know that the virus isn't a threat because it's been altered to not be able to cause disease. The immune system treats it like any other foreign invader and attacks it.
This attack can give us minor symptoms like fever, body aches, and other symptoms commonly seen after vaccination.
This is our immune system building an army of protectors.
Some of these protectors stay around so if that particular virus comes back, they're ready to launch an attack.
Most vaccines are given in a series of two or more vaccines to get our immune memory sharp.
Boosters: Think of how you learn any new information.
When you learn something for the first time, it takes time to learn the concept and you may only remember the big picture, not little details.
If you study it again later, it is easier to comprehend and you retain more of the details.
Our immune system learns much like you learn. A booster dose helps solidify the knowledge.
mRNA vaccines
The mRNA vaccines are very interesting because they don't use the whole virus. They only use the very characteristic spike protein that we've all come to imagine with all the pictures of the coronavirus - those little spikes around the central core.
This is helpful more than I first appreciated.
No possibility of spreading infection
One of the fears among some people with vaccines is that they can spread infections. This isn't true of other vaccines, but it cannot even be considered with mRNA vaccines.
There is no virus to spread.
The vaccine is only a blueprint for a protein. The rest of the virus doesn't play a part in the vaccine at all.
How it works
With most vaccines the immune system gets to decide what part of the virus to attack and how to prepare its fighter warriors. That can take time and might vary from person to person, but once it builds that army, some of the warriors hang out as memory cells. They are ready to launch full attack if they see that virus again.
The spike protein we've all come to visualize from media images is actually very important to the transmission of the virus. That spike is how the virus gains entry into our cells. The spike makes the virus infectious. Scientists recognized that and used that knowledge to our benefit.
Scientists found a way to show our immune system the specific COVID-19 spike protein of COVID-19 by using our cells to make the protein without using any of the actual virus in the vaccine.
mRNA is used by our cells to make proteins. The "m" of mRNA is the message of what to make. This happens in our cells all the time - different messages make different proteins.
When we're infected with the COVID-19 virus, it enters our cells and tells our cells to make the whole virus. Our own cells make many copies of the virus that makes us sick. Each of those many viruses wreck havoc in our bodies. They have the potential to damage heart, lungs, kidneys, brain, and more. By the time our immune system recognizes them, they've already had a chance to replicate and start causing damage.
The vaccine just tells the cells to make the protein. This protein is released, but it can't cause all the damage that the virus can because it's just a protein. But our immune system doesn't know that.
And the mRNA vaccine?
The mRNA vaccine is basically a blueprint telling your cells to make that specific and unique spike protein. The factories in your cells make this protein because that's what they do - they do what the mRNA tells them to do.
But the immune system recognizes that all these spike proteins are foreign and that they don't belong in us, so it launches an attack. It doesn't know that there is no dangerous virus attached to the protein, only that it isn't supposed to be in our body.
This is a good thing. Remember I mentioned above that the spike protein is the key for the virus infecting our cells? If our immune system attacks it at first sight, the virus can't infect our cells. Because the mRNA vaccine told our cells to make spike proteins, our immune system is primed and ready to attack if it sees that spike protein on the real deal COVID-19 virus. This prevents the virus from infecting our cells.
Will it change our DNA?
The mRNA never enters the cell nucleus, so it cannot change your DNA.
It just can't.
What happens to those blueprints?
The mRNA instructions given in the vaccine don't last long. They get broken down quickly by our cells, just like other mRNA. It's probably out of our body by the end of the week.
mRNA doesn't need to last long though. It gets our cells to make some proteins and our immune system gets to work learning to attack the spike protein, leading to memory cells against it. We don't need to keep making that protein once those memory cells are developed.
Want to understand more?
This video is helpful to understand how the mRNA vaccines work if you want to learn even more.
What about the 2nd dose?
We need a second dose to boost the immune system.
As mentioned above, most vaccines are given in a series so our immune system is primed and ready to go.
The booster dose response is greater
The booster dose is the one that tends to lead to more significant side effects because the immune system has seen the protein before and launches a full on attack quickly and suddenly.
Remember after the first dose the immune system had to learn how to attack, which took some time.
When our immune system sees something it's already familiar with, it can attack more quickly and effectively.
In study participants, the side effects were more significant, but still relatively minor, after the second dose of each of the mRNA COVID-19 vaccines.
Will other boosters be needed?
It's too soon to know how long immunity from the COVID-19 vaccines will last, but this isn't a reason to skip the vaccine or wait until you know when the next dose will be needed.
Studies are ongoing and you'll get a head's up if boosters are needed.
Annual flu vaccines are needed because influenza virus changes frequently. So far we have not seen that with COVID-19.
Some vaccines need a boost after many years due to falling immune levels. This may be necessary with COVID-19, but we don't know that yet.
Side effects of the mRNA COVID-19 vaccines
Yes, vaccines have side effects. But this isn't a reason to skip the vaccine.
In many ways these side effects are a good thing. They show that our immune system is doing its job. Fever, fatigue, body aches, headache are signs of fighter cells in action.
If fever is part of the attack, the fever is a sign that our immune system is taking over and fighting foreign invaders. This could be a real infection, which also causes whatever problem the invading organism could cause, or it could be from a vaccine, which can't really hurt us. Those fighter cells do what they're supposed to do - they don't realize this isn't a real threat. This is okay and expected.
The side effects after the initial vaccination are often more mild than with booster doses. This makes sense if you think about it: initially it takes time for the immune system to ramp up. With booster doses the immune system has seen the "threat" before and goes to work quickly. The suddenness of the attack is felt more than the gradual attack when it's first exposed.
What about long term adverse events of the mRNA vaccine?
Short term side effects are one thing, but what about true adverse events?
Adverse events are very, very rare, but are a risk of any vaccine. This is true of COVID-19 vaccines.
The risk of catching COVID-19 and having a serious complication is more likely than the risk of having a serious reaction to the vaccine. There have been many deaths and people with chronic serious complications from COVID-19 infections. Deaths have not been attributed to the vaccine. There have been allergic reactions, but no deaths or long term serious complications from the vaccines.
Bell's palsy is one possible adverse reaction that has been proposed. The rate of Bell's palsy after vaccination is similar to the baseline rate of Bell's Palsy and not likely to be related to the vaccine. Even if it is, it tends to be a minor event and is self limited. Compare that to the risks of natural infection, which include hospitalization, long term problems with heart, lungs, fatigue, and death.
Of course the vaccine is too new to know long term effects, but when you consider the way it works, it is unlikely to have any long term complications.
Natural immunity
There's a common argument about vaccine vs natural immunity. Is natural immunity better?
Short answer: no.
Just no.
Long answer...
Our natural immunity works.
Long before vaccines our immune system made memory cells against foreign invaders. Once people had an infection of measles or chicken pox they didn't get infected again.
But some of those people suffered greatly from the infection and others died. Some thought they recovered, but then died from SSPE or suffered with shingles years later.
Natural infection puts us at risk of the complications from the infection.
We all know people who have had COVID-19 infection and seem to have no serious complications from it.
But others do, and it's not always predictable who will have an easy course and who will struggle to breathe or have prolonged fatigue, heart complications, neurological consequences, or other significant problems.
This virus is very new.
We don't have years worth of data to see what happens 5, 10, 25 years later like we do with other viruses.
While it seems that a person recovers quickly, we don't know what is happening inside their body and if complications will show later.
Natural immunity is variable
Remember that the mRNA vaccine limits the target to that spike protein that allows the virus to enter the cell? That is very specific.
If you have natural immunity (or use one of the other vaccines that is being developed) your immune system decides what it's plan of attack will be.
It might not be to that protein.
Recognizing and attacking that protein is a huge benefit. If the virus mutates in a way that doesn't affect the protein, it doesn't matter if we attack the protein. It can't get into our cells.
If the protein is what mutates, it probably won't be able to get into our cells as well either. It's that protein that allows it to be so infectious in the first place.
Natural infections lead to disruptions
When we are sick we can't continue to work, learn and play well.
With the pandemic, even if we're just exposed to someone who is sick we can't leave our homes for work, school, and other activities.
These restrictions have a huge impact on society as a whole.
Even if we feel under the weather for a day or two after a vaccine, most of us can continue to do our usual activities. We aren't risking others like we would if we continue activities when we're naturally infected.
Are the COVID-19 vaccines safe?
There's a lot of fear surrounding COVID-19 vaccines.
The mRNA vaccines from Pfizer and Moderna are the first COVID-19 vaccines to be approved for use in the US, but other types of vaccines are in various stages of development.
Some of the common concerns include the newness of the type of vaccine, the quick development of the vaccines, and the unknown side effects.
I made a quick summary of the risks of vaccination vs infection.
COVID-19 vaccines are too new
The mRNA vaccine isn't brand new for COVID-19. Scientists have been working on this technology for a long time.
mRNA vaccines have been used to target cancer cells. They've also been studied for other coronaviruses, but research never continued because the viruses didn't cause a threat like COVID-19.
While the final stage of the vaccine trials are only conducted for 2 months, history has shown us that the majority of vaccine side effects are seen within this timeframe.
Research on COVID-19 vaccines was done "too fast"
The studies were able to be completed so quickly because they built upon previous knowledge, no time was wasted waiting for funding, volunteers were recruited much more quickly than in most studies, and there was no delay getting each step of the study approved. But all steps of the scientific process were done.
For more:
DFA COVID Vaccine FAQ Toolkit - Answers to all your COVID-19 vaccine questions.
Have you heard that the vaccines will cause infertility? If you're concerned, don't be. Read why in this great post from Edward Nirenberg.
General information on mRNA vaccines from the CDC.
Interim Clinical Considerations for Use of Pfizer-BioNTech COVID-19 Vaccine (see the appendix for a nice table of precautions and contraindications)
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