YESSSSSSSSSS! I am so glad this day is here! For me, getting a COVID-19 vaccine is like getting into college or getting a new car, it’s such a gamechanger! I am so thankful for TMH getting me in on day 1 in Tallahassee, Florida. And thank you to private industry for finding a solution to the COVID-19 Pandemic.
If you have any doubts about the safety of COVID-19 please read my previous blog posts. As a general pediatrician, I did a lot of reading, and the more I read, the more I wanted a COVID-19 vaccine. Yes, I may get a little soreness or a fever, but THIS IS PART OF THE VACCINE DESIGN. If the vaccine didn’t elicit any inflammation, then the body would not make antibodies against the COVID-19 spike protein.
Hopefully the general public will be vaccinated soon! I did not expect the vaccine to arrive until 2021!!!!!!!!
Blog 4 of the 4 Part Series: Why I Want a COVID-19 mRNA Vaccine (and why you should too).
This is the fourth of four blog posts where I share what I have learned as a Tallahassee pediatrician doing my own research, and why I am excited to receive a COVID-19 vaccine:
Sunday, December the 6th – How vaccines use our immune system to protect us against viruses, bacteria, and even cancer.
Last Wednesday – How mRNA and DNA vaccines are different than traditional vaccines.
Last Saturday – mRNA and DNA vaccine safety in animals and humans.
Today – Post Covid-19 Syndrome
For Young and Middle Age Adults, Post COVID-19 Syndrome May Cause More Suffering Than Acute Symptoms
Even though I turned 40 in 2020 (yes, I know I look 25…except for the hair), I am not as nervous about the immediate effects of COVID-19 (fever, trouble breathing, etc.), as I am about the chronic effects of COVID-19.
Very few people my age actually die from COVID-19, even though many will have flu-like symptoms for over a week or be hospitalized. But now, doctors and scientists are learning that some people will develop chronic COVID-19 symptoms for months, the most common symptom being fatigue, like having Mono, but worse. Others will suffer from shortness of breath, headaches, depression, brain fog, high blood pressure, cholesterol issue, or body aches. Some people alternate feeling fine for a week and then terrible for a week. This diverse group of chronic symptoms has been given the name, “Post COVID-19 Syndrome.”
It would suck to be sick for a few weeks, but it would be even worse to be tired and have body aches for months or years.
Post COVID-19 Syndrome May Be Caused by Damage to Small Blood Vessels
Doctors and scientists are not sure how COVID-19 causes these persistent symptoms, but they think it is from damage to small blood vessels throughout the body–in the heart, lungs, liver, and even the brain. COVID-19’s damage to small blood vessels can cause stroke and heart attacks in relatively young patients (even in patients younger than myself). As you can imagine, blood vessels are found throughout the body, so this may be why the symptoms are so diverse, ranging from depression to trouble breathing.
New Vaccine vs COVID-19 Infection
To me the answer is clear: I would rather take a new(ish) vaccine than get a COVID-19 infection (or a second COVID-19 infection). These new vaccines have already been given to thousands of people without serious side-effects, while we know that COVID-19 can cause death, make you very sick for weeks, and can have long-term side-effects for months and maybe years.
If you are skeptical about the Moderna and Pfizer/BioNTech vaccines, please read my previous posts. The more I learned about them, the more I wanted one!
Blog 3 of the 4 Part Series: Why I Want a COVID-19 mRNA Vaccine (and why you should too).
This is the third of four blog posts where I share what I have learned as a Tallahassee pediatrician doing my own research, and why I am excited to receive a COVID-19 vaccine:
Last Sunday – How vaccines use our immune system to protect us against viruses, bacteria, and even cancer.
Last Wednesday – How mRNA and DNA vaccines are different than traditional vaccines.
Today – mRNA and DNA vaccine safety in animals and humans.
This Wednesday December the 16th – Post Covid-19 Syndrome
The History of mRNA and DNA Vaccines
Starting around 1990, scientists were first able to inject genetic material (mRNA or DNA) into animal muscle AMD get the muscle cells to produce a protein based on this genetic material. This laid the foundation for mRNA and DNA vaccines, which stimulate the muscle cells near the injection to produce the antigen for the vaccine. So far, the biggest challenge with DNA and mRNA vaccines has not been safety but getting them to work. Scientists have continued to tweak the antigen code and the adjuvant effect of the DNA and mRNA. They have also discovered better ways of getting the mRNA or DNA into the cells.
DNA and RNA Vaccines in Humans and Animals
Though the new COVID-19 mRNA and DNA vaccines will be the first fully licensed vaccines for humans, there have been DNA vaccines licensed for animals since 2002. This includes vaccines for fish, dogs, cats, horses, and chickens. None of these licensed vaccines for animals have had to be pulled from the market for safety or efficacy concerns.
mRNA and DNA Vaccines were already in Human Clinical Trials
Starting 10 years before the COVID-19 pandemic, mRNA vaccines had started entering human clinical trials. This includes vaccines against influenza, rabies, cancer, Mono, and Zika virus. In fact, Moderna had already completed a successful Phase 1 Clinical Trial for an mRNA influenza vaccine in 2017. Most of the mRNA vaccines in trials have been safe and effective, but just like traditional antigen plus adjuvant vaccines, some mRNA vaccines were not effective and some had too strong of an immune response. But after a decade of conducting mRNA vaccine trials on thousands of human lives, results have been so good and promising that research and interest has continued to grow.
COVID mRNA Vaccines are 90-95% Effective, in Studies of Over 50,000 People
I am so impressed with reports of 90 to 95% effectiveness. Yes, the Phase 3 Clinical Trials are just finishing, and we only have about 9 months of safety data in humans, but 95% efficacy is awesome! First, many vaccines and medications get to Phase 3 trials just to find out that they do not really work. Second, this is exceeding the CDC’s goal for 70% effectiveness (the seasonal flu vaccine is only 40 to 60% effective every year). 95% Efficacy means that if you give 100 people the COVID-19 mRNA vaccine, and then expose them all to COVID-19, only 5 out of the 100 would contract COVID-19!
COVID mRNA Vaccines have been Safe
So far, COVID mRNA vaccines have been safe. About 1/3rd of people who received the Moderna or Pfizer/BioNTech mRNA vaccines had a reaction. Normally a little redness or swelling at the injection site or mild aches or fatigue. About 2% (2 out of every 100 shots) of study participants had a “grade 3” reaction, which means that the fever, body aches, fatigue, or swelling was severe enough to keep the person from doing his or her normal activities for a day or two. There were no life-threatening “grade 4” reactions in with either mRNA vaccine trial. This is similar to what people experience after a Tdap (tetanus-diptheria-whooping cough) booster vaccine.
What Other Adverse (aka Bad) Reactions were Scientists Worried About?
Some scientists were worried about too strong of an immune response from the adjuvant part of the mRNA. This could have led to high fevers, inflammation, damage of vital organs, or too much swelling at the injection site Thankfully, even though the mRNA immune response has been strong (which is good because it stimulates the body to build antibodies), it has not been dangerously strong. Again, the experience is similar to receiving a Tdap vaccine.
Second, scientists were worried about “Vaccine Enhanced Disease,” where the vaccine makes the real infection worse rather than protecting against the infection. There were some animal vaccine studies of the 2002 SARS Coronavirus (which is similar to COVID-19), in which the experimental vaccine made the SARS infection worse, so scientists were appropriately nervous about VED occurring with COVID-19 vaccination. Thankfully this has not happened. Even when vaccinated people get COVID-19, the COVID-19 infection has been less severe, instead of more severe. More great news!
Third, DNA and mRNA are genetic material. There is a theoretical concern that a DNA or mRNA vaccine could permanently insert foreign genetic material into our DNA, leading to health problems. In the decades of DNA and mRNA vaccine experimentation, this has never happened in animal or human studies (but it could make a good movie).
In conclusion, the COVID-19 mRNA vaccines appear to be very safe and very effective, despite the rapid development and challenges of making a new vaccine. Thankfully, mRNA and DNA vaccines had been in development for decades and were ready to be produced when the COVID-19 Pandemic hit.
I hope after reading this (long) blog, you are encouraged and excited about how our country can overcome this horrible illness. Post with any questions, and read my next blog covering Post Covid-19 Syndrome.
Blog 2 of the 4 Part Series: Why I Want a COVID-19 mRNA Vaccine (and why you should too).
This is the second of four blog posts where I share what I have learned as a pediatrician doing research, and why I am excited to receive a COVID-19 vaccine:
Last Sunday – How vaccines use our immune system to protect us against viruses, bacteria, and even cancer.
Today – How mRNA and DNA vaccines are different than traditional vaccines.
This Saturday – mRNA and DNA vaccine safety in animals and humans.
Wednesday December the 16th – Post Covid-19 Syndrome
What is the Difference Between mRNA and DNA?
Our genetic code is stored in a DNA “double-stranded” spiraling helix, made-up of 4 different DeoxyriboNucleic Acids, corresponding to the A, T, G, or C of our genetic code. Think of DNA as our genetic code storage facility, and RNA (RiboNucleic Acid) as genetic copies that your body uses to make and do things. RNA copies that are used to build things are called “messenger RNA” or mRNA.
Why Use mRNA (or DNA) in Vaccines if all You Need is an Antigen and an Adjuvant?
In my first post, I explained how a vaccine basically has two parts: an “antigen” (for COVID-19, usually the “spike” protein) and an “adjuvant” to stimulate the immune system. Traditionally, vaccine companies make large quantities antigens and adjuvants and then package them into small vials for use. In fact, 5 of the 11 COVID-19 vaccines in clinical trials are being produced just like this. The problem is that takes a lot of time and money to design and build the manufacturing plants that safely and efficiently produce the antigen and adjuvant for a vaccine.
Alternatively, mRNA vaccines (and DNA vaccines) use our own human cells’ built-in protein making ability. The mRNA (or DNA) stimulates our own cells to make the antigen! So instead of having to manufacture a new adjuvant and antigen for every new vaccine, scientists can simply alter the mRNA (or DNA) code so that a different antigen is produced by the cell. And as an added bonus, RNA and DNA generally do not need added adjuvants, as they have built-in genetic code that triggers an immune response.
mRNA and DNA Vaccines Stimulate Cells to Make Antigens and Stimulate the Immune System to Make Antibodies.
In Summary, the mRNA in COVID-19 mRNA vaccines both stimulates human cells to make the COVID-19 spike protein AND stimulates the immune system to make antibodies against the COVID-19 spike protein. This saves both time and money, because scientists and engineers do not have to design and build manufacturing plants to produce large quantities of antigen and adjuvant. Instead, scientists can simply change the mRNA in a mostly ready-to-go system to rapidly manufacture a new vaccine.
In my next post this Saturday, I will review this history and safety of both human and animal mRNA and DNA vaccines. There will be a lot of good information! For example, did you know DNA vaccines have been licensed for use in animals since 2002?
Like most of you, I have been encouraged by reports of 90% efficacy of both the Moderna and Pfizer/BioNTech mRNA vaccines. After all the human suffering from COVID-19, it would be great to end the pandemic with a human success story. Distribution of the vaccines could start next month in the U.S. and maybe next week in England.
And I will be the first in line to receive the vaccine! I was initially nervous about receiving and recommending a vaccine made with new technology against a new virus. But, I’ve done my research, and I really want to get one of these new vaccines.
This is the first of four blog posts where I share what I have learned, and why I am excited to receive a COVID-19 vaccine:
Today – How vaccines use our immune system to protect us against viruses, bacteria, and even cancer.
Wednesday – How mRNA and DNA vaccines are different than traditional vaccines.
This Saturday – mRNA and DNA vaccine safety in animals and humans.
Wednesday the 16th – Post Covid-19 Syndrome
Part 1: How Vaccines Use Our Immune System to Protect Us Against Viruses, Bacteria, and Even Cancer
Our Immune System is Constantly Exposed to “Antigens”
Our body is constantly exposed to foreign material, which scientists call “antigens.” Every day, THOUSANDS of antigens make it into our body through the air we breathe and the food we eat. Our immune system is alwasy on the look-out for these foreign antigens, because some are dangerous (live viruses, bacteria, parasites, and cancer). Most of the time these antigens are harmless. They are quietly recognized and gobbled-up by our immune cells, not creating any noticeable immune response.
Our Immune System Makes Antibodies Against Dangerous Antigens
But sometimes an antigen will begin to damage cells in our body (like bacteria damaging your skin). The damaged cells send out alarm signals to the immune system. These alarm signals do many things, one of which is to activate the “humoral immune system,” which produces “antibodies” to this new, dangerous antigen. Antibodies are small proteins that float around in our blood (and the lining of our lungs and GI tract) that are custom made to stick to a specific antigen. If effective antibodies are produced to an antigen, the next time this dangerous antigen enters the body, these antibodies will quickly stick to the antigen and label it as dangerous This will trigger the immune system alarms, so that the antigen can be quickly destroyed before it damages too many cells (like it did the first time).
Vaccines Contain an Antigen, Designed to Make Antibodies
A vaccine basically puts a safe antigen into body, which stimulates the immune system to make effective antibodies against a dangerous disease (like COVID-19). It sounds simple, but there are many challenges to making an effective vaccine to a new virus. First, scientists had to decide which part of the virus to use as the antigen. Remember, the antibodies produced by the antigen would have to work against the real COVID-19 virus. Many experimental vaccines fail because they don’t create effective antibodies. And, you can’t just use the whole live virus as the antigen, or the virus will make people sick! Thankfully, scientists had already learned from previous Pandemic Coronaviruses that antibodies against the “spike” protein of the virus’s fatty cover seemed to work, and they already had experience making a spike protein antigen.
Scientists Must Use the Right Adjuvant to Stimulate the Immune System
But, if you inject someone with the spike protein alone, it probably won’t cause any damage (since it’s just one part of the virus), and it will just be gobbled-up by our immune system without producing any antibodies. So scientists must also include an “adjuvant” along with the spike antigen, that “tricks” the immune system into thinking that the spike antigen is dangerous and therefore the stimulating the immune system to turn on the alarms and make antibodies against the spike protein. Adjuvants are made of many compounds, including synthetic DNA resembling bacteria DNA, aluminum, and even proteins from the Chilean soapbark tree that the immune system thinks are dangerous bacterial proteins.
It Takes Time to Manufacture Safe Antigen and Adjuvant
So, at the most basic level, a vaccine is composed of both an antigen that can be used to make effective antibodies, and an adjuvant that stimulates the immune system to make antibodies. In fact, five of the eleven COVID-19 vaccines in stage 3 clinical trials are simply antigen-adjuvant vaccines. In my next blog, I’ll explain how mRNA and DNA are different (spoiler alert—they get our own cells to make the antigen).
