Vaccines Vaccines and more Vaccines



Steven Novella

COVID vaccines are dominating the health news, and with good reason.

Vaccines are dominating the health news recently and with good reason. We are now more than a year and a half into the worst pandemic in a century. By now vaccines should be shutting down COVID-19 and life should be returning to normal, but instead we are in the middle of one of the worst waves yet. The delta variant is running rampant, even in countries that previously managed the pandemic well. Children are increasingly being affected, and researchers are learning more about the long term health effects of SARS-CoV-2. Experts warn the virus is likely to become endemic. What happened?

There are now 112 different COVID vaccines either available or in clinical development. There are a further 184 vaccines in pre-clinical development. Science, in short, has done its job. Two of the vaccines available in the US, Pfizer-BioNTech and Moderna, are incredibly safe and effective, with few serious side effects and efficacy in the 90-95% range. Companies are collectively cranking out billions of doses. Worldwide 24.8% of all people have been fully vaccinated, with 32.9% receiving at least one dose. Almost 34 million doses are being administered daily.

But this is not the whole picture. Despite the success of scientific researchers, politically and socially we have collectively failed. Only 1.4% of those living in poor countries have received even one dose of vaccine. This allows the virus to spread and new variants to emerge. Meanwhile, in some wealthy countries, vaccine doses are expiring on the shelves because of vaccine hesitancy. Refusal to get vaccinated, even at this stage of the pandemic, results from massive anti-vaccine misinformation spreading online, and the fact that the vaccines and COVID in general have been politicized by one major political party. Trump himself was booed by some of his own fans when he mildly recommended getting vaccinated, and quickly backpedaled.

Here are a few items of vaccine news and controversies we are dealing with currently.

Booster Shots

Since the beginning of the vaccine campaign the looming question has been – how long with immunity last (from infection or vaccination) and when will booster shots be necessary. For some vaccines that answer is now emerging. In one UK study they found that immunity from Pfizer and AstraZeneca vaccines began waning over six months. Moderna announced that immunity from its vaccine holds through six months, but they feel that boosters will become necessary in order to maintain efficacy against the delta variant.

This is the concerning combination – waning immunity and rising variants not fully covered by the vaccine. As a result, in a joint statement released by the CDC, US health experts say they plan to start offering booster shots this Fall. Those who are immunocompromised can already receive a third dose. Moderna has studied their own booster shot and report that it is effective against the delta variant.

I should note that even with waning immunity, the vaccines all protect against severe illness. Almost all hospitalized patients with COVID are unvaccinated. But there are increased breakthrough milder symptomatic infections, and this allows the virus to spread.

Meanwhile the World Health Organization is warning against booster shots. They argue that all doses should be going to the unvaccinated before anyone receives a booster. They have a fair point, both from a perspective of justice and also practicality. New variants emerging in poor countries can spread around the world. In response, in that CDC statement, US health officials pledge:

“We will also continue to expand our efforts to increase the supply of vaccines for other countries, building further on the more than 600 million doses we have already committed to donate globally.”

India Approves First DNA Vaccine

Recently India approved a new vaccine for COVID, and the first DNA vaccine approved for humans. The vaccine is called ZyCoV-D, it is a three-dose vaccine, and it reported provides 66% protection from symptomatic infection. This is India’s second approved vaccine, and they plan on producing 120 million doses per year.

DNA vaccines are similar to the mRNA vaccines in that they introduce genetic instructions to make the COVID spike protein, which will then provoke an immune response. But there are some differences. DNA is introduced as a plasmid and, unlike the mRNA vaccines, the plasmid must get to the nucleus of the cell. This has been a limiting factor in the past. DNA vaccines work well in animals, but so far have not worked well in humans because of this limitation. As a result the immunity produced, while good, is not as strong as the mRNA vaccines. The ZyCoV-D vaccine also requires three doses.

But the vaccine has one significant advantage – it keeps well at much higher temperatures, only requiring -2 to 8 degrees C for storage. It will also keep for three months at room temperature. This compares favorably to Pfizer (-80 to -60 degrees C) and Moderna (-25 to -15 degrees C). The vaccine has also been tested favorably in 12-18 year-olds. Finally the vaccine is being offered with a needle-less injection. A fine stream of water injects the plasmid through the skin where it can be absorbed by the cells. This DNA COVID vaccine is not likely to be a revolution in vaccines, and overall the mRNA technology seems superior. But it is noteworthy that this is the first human DNA vaccine, and the advantage of not needing a cold-chain for distribution might prove useful in some locations.

Vaccine Hesitancy and Mandates

In a bit of good news, the FDA has given full approval to the Pfizer vaccine for COVID. It is anticipated the Moderna’s approval is close behind (they were a bit slower in submitting all the necessary paperwork). There is also pressure to extend approval for all three US vaccine to the pediatric population, especially as the delta variant seems to be more infectious and serious in children.

FDA approval removes one of the objections that many vaccine-hesitant individuals cite as the reason for not getting the vaccine. While this excuse was never valid (often it was stated that the vaccines were experimental, but this was not true), it is expected that the approval will result in millions more people getting vaccinated. Vaccine uptake is also betting a boost (pun intended) from the severity of the delta variant. Some people are finally getting more scared of COVID than the vaccine (which they should be).

The controversy of the day is now this – to what extent should we mandate vaccines? In my opinion, mandating vaccinations is completely ethical and justified. We have done this already for decades, with children requiring vaccination to attend school. What it typically meant by a vaccine “mandate” (and what I personally endorse) is not forced vaccination, but rather granting privileges based on vaccine status. Essentially, if you don’t want to get a vaccine to protect against COVID that is your right, but society has the right to exclude you from activities that put others at risk as a result of your decision. You don’t have the right to infect other people.

In a practical sense, this would make the lives of the unvaccinated more difficult and inconvenient. Getting on a plane, going to a movie theater or other mass gathering, and going to school should all require proof of vaccination. Insurance companies would also be justified in charging a premium for those who can get vaccinated but choose not to. In essence, vaccine refusers are making the lives of everyone else less convenient and more expensive, and that burden should be turned back around on them as much as possible.

I would also note that refusing to get vaccinated (without a legitimate medical excuse) is objectively wrong. The benefits of getting vaccinated outweigh the risks by orders of magnitude, and refusers justify their decision with demonstrable misinformation. This is not a matter of opinion – their facts are wrong.

At this point we likely need a federal law, to override those states that outlaw vaccine mandates for schools or private companies. We tried to beat this pandemic with purely voluntary vaccination, and we failed. Vaccine mandates are now our best choice.