COVID Vaccine: What We Know and What We Don’t

Several months ago I posted some early thoughts on the COVID vaccine. I won’t rehash all of that information, but if you are interested you can find that article here. Since that time, a lot of water has flowed under the proverbial bridge and many things have been learned, while other questions still remain unanswered. Here I give an update on what we know, what we think we know, and what we don’t know as of August 2021. 

Effectiveness of Vaccines

Let’s talk about vaccine effectiveness. It would be fantastic (and a medical miracle) if the vaccine was 100% effective against all forms of COVID and had no potential side effects. The reality is, well, more realistic.

What we know: the vaccine is incredibly effective (greater than 99%) when it comes to preventing hospitalization and death, also known as severe disease. The vaccine is very effective (90-96% depending on the COVID variant) at prevention of mild or moderate disease (those people who get sick and miss work, but don’t have to go to the hospital). The effectiveness against the Delta variant is in the range of 88-92%

What we think we know: mRNA vaccines (Pfizer and Moderna) are partially effective in  preventing the transmission of disease by reducing the amount of replicating and shedding virus in the host human. The immunity that you get from vaccines is better than the immunity you get from surviving the virus. 

What we don’t know: we don’t know how long the immunity from vaccines (or immunity from the virus itself) will last. It is unknown whether vaccines will need to be repeated yearly, but current studies do not favor a vaccine booster at this time, even for immunocompromised people.  

Side Effects of Vaccines

Safety of the vaccine is a serious consideration. We have less than one year of experience with the vaccine and it is not yet FDA approved. The vaccines are not perfect and we should continue to monitor for new and emerging side effects. 

What we know:  Over 339 million doses of vaccines have been given to date. The mRNA vaccines especially have proven to be incredibly safe with the vast majority of people reporting minimal or very mild side effects. The most common side effects are “Moderna Arm” (Google it) and general malaise lasting less than 24 hours the day after the vaccine. 

What we think we know: while the vaccines are new, the mRNA method of delivering the vaccine is not. The likelihood of any long-term side effects is minimal, and in any case much less than the likelihood of long-term effect of the disease.

What we don’t know: As stated above, we don’t know what will happen ten years after a dose of COVID vaccine. Long-term side effects will not be known until several years have passed. 

Vaccine Hesitancy

As of this writing, about 42% of the people in our area have been fully or completely vaccinated. In order to achieve herd immunity, we will need to get to at least the 75% mark. That means we have a long way to go. Furthermore, there is a great deal of hesitancy among those that have not been vaccinated for various reasons. This has been termed “vaccine hesitancy”. 

While many of us hoped for a future in which the virus simply “burned itself out”. It is now clear that the virus will continue to circulate, mainly in the unvaccinated population, and will mutate into new variants instead of dying out. It doesn’t take a lot of imagination to realize that there is no natural end in sight to this pandemic. 

The Unvaccinated Nation, as it has been called, represents a pool of hosts (human beings) in which the virus will continue to replicate and mutate. It is not unreasonable to assume, based on our experiences of the last 19 months, that this cycle will go on for years, if not indefinitely. And yet, intelligent and thoughtful people have real concerns and valid reasons to delay or even completely refuse vaccination.  

It seems we are at an impasse. Where do we go from here? It is probably clear that I believe the only way out of this situation is mass immunity from vaccination, disease, or a combination of the two. I have found that thoughtful, one-on -one or small group discussions about the vaccine are much more productive than Facebook memes or politically charged accusations. As such, I’d like to offer some advice for those that are willing to engage in such dialogue.

        1.  Separate science from politics. COVID doesn't care whether you are Red or Blue. Neither Trump nor Biden have a monopoly on common sense or the right thing for you to do as an individual. No political party stands to gain from the disease burden or loss of life that this pandemic has created. Whatever your reasons for getting the vaccine or not getting the vaccine, don’t let political affiliation be the deciding factor. It just doesn’t make sense. 

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          2. Get your information from credible sources. Here I am on Facebook telling you not to listen to Facebook. The irony is not lost on me and is one of the reasons have not posted more. I don’t want to add to the noise. There are a very few peer-reviewed medical journals that have almost ALL of the cogent information. When you see or hear of a claim made, check for source documents in The New England Journal of Medicine, The American Journal of Medicine, JAMA, The Lancet, or PubMed. These are free resources available to anyone. If you can’t find that information backed up by articles in one of those journals, then that information is less reliable and at the very least unproven. Everything I have cited here under the “What we Know” heading came from one of these sources. 

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          3.  Meet people where they are. We’ve gotten as far as we are going to get by name-calling and demeaning our neighbors. Whether it is accusing others of not caring about others, or claiming anti-vaccination as a personal right that will never be violated, we need to have thoughtful, respectful conversations with one another about our real reasons why we believe the way we do.

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