Justin F. Thulin: The COVID-19 vaccines are a blessing

Questions and answers about the benefits of the three types of vaccines.

(Leah Hogsten | The Salt Lake Tribune) Utah first lady Abby Cox receives her first COVID-19 vaccine from Utah County Health Department nurse Amy Engle in Spanish Fork, Mar. 25, 2021.

After more than 560,000 deaths in the United States from COVID-19, it’s time to end the misery and get back to normal.  To achieve this, we need herd immunity.

Herd immunity refers to a population’s resistance to infection either from immunity acquired from national infection and recovery, or from vaccination.  The exact threshold to reach herd immunity for the Coronavirus is unknown, but recent estimates range from 70 percent to 90 percent.

If we fail to reach herd immunity, the coronavirus will continue to spread throughout our population, mutating as it does, and generating genetic variants that may evade our bodies’ natural or vaccinated-induced immunity, and cause sickness. The CDC just reported that the U.K. variant (B.1.1.7) is now the most common form of coronavirus in the United States, and currently Utah is seeing a significant uptick in the spread of this highly contagious and more lethal variant.

As of April 9, 650,000 Utahns are fully vaccinated, and 1,070,000 are partially vaccinated.  Since the 2020 U.S. census estimates that there are 3.25 million Utahns, this means that 20% of our population is fully vaccinated and 33% are partially vaccinated. With the expiration of the Utah mask mandate on April 10, this means that we are potentially setting ourselves up for another surge of COVID-19 cases if we don’t re-double our efforts to get everybody vaccinated as soon as possible.

Unfortunately, there’s a problem. A Kaiser Family Foundation poll released in February found that 28% of Republicans said they would “definitely not” get vaccinated, and another 18% said they would “wait and see” before getting a shot. The numbers in Utah are also worrisome. A Deseret News/Hinckley Institute of Politics conducted in mid-February shows that 38% of Utahns are either rejecting, waiting, or are in no rush to get vaccinated. These state and national numbers pose a real problem for reaching herd immunity.

To counter this reticence to get vaccinated and achieve this essential communal health goal, we must answer the questions and allay the concerns that these skeptical citizens have. Accordingly, what follows are the answers to questions that those wary of getting vaccinated commonly have.

Q1: It seems like the vaccine was developed and approved in about a year which is much faster than usual. Have corners been cut, and safety compromised by this speedy rollout of the vaccine?

A1:  First of all, it wasn’t a year. The mRNA technology behind two of the vaccines (Moderna and Pfizer) is based on decades of trusted medical research, not something experimental or brand-new. The Johnson & Johnson and Astra-Zeneca vaccines, using standard vaccine methodology, were produced almost as quickly the Moderna/Pfizer ones.

Furthermore, immunizations were able to advance quickly not because pharmaceutical companies had cut corners, possibly jeopardizing safety, but because the government had cut red tape in the approval process.

Citizens should take great comfort in that each of the final (Phase 3) vaccine trials had tens of thousands of participants, compared with a routine Phase 3 trial for a drug or other treatment that could include 5,000 participants or fewer.

Q2: How do you know for sure that there won’t be some long-term bad complication of these vaccines?

A2: The honest answer is that we don’t know. It’s possible that there might be a rare bad reaction to these vaccines, but because they have not been around for a long time, we can’t say definitively that there will not be one.

We do know that the vaccine will make it much less likely that you will get very sick, require hospitalization, or die from the virus.

It’s also worth pointing out that even if you don’t get very sick or die from the virus, you are much more likely to have a long-term bad effect from the virus than from vaccination.

As of mid-March, of the 69 million Americans who have received at least one dose of a vaccine, none have died of COVID-19 or the shot. A possible extremely rare caveat to this impressive safety record was reported on April 13. Six women who were vaccinated with the Johnson & Johnson adenovirus-based vaccine ages 18-48 developed a blood clot in the brain (cerebral venous sinus thrombosis) associated with low platelets (thrombocytopenia) 6-13 days after vaccination. One woman has died. The Johnson & Johnson vaccine (7.1 million shots) makes up less than 5% of recorded shots in arms in the U.S. to date. Federal health officials have judiciously called for a pause in the use of the Johnson & Johnson vaccine while these reports are evaluated. Importantly, this one-in-a-million side effect has not been reported with either the Moderna or Pfizer vaccine.

Q3: If I already had COVID-19, and am presumably immune, why do I need to get vaccinated?

A3: The problem is that we don’t know how long immunity lasts after infection with COVID-19. Natural immunity wanes over time. There is clear evidence that people can get COVID-19 again, sometimes only a few months after the initial infection. There is some evidence that vaccination will give stronger immunity than natural infection. So, since vaccination is very safe, it is recommended that even those who have gotten COVID-19 get vaccinated.

Q4:  Does the severity of infection with COVID-19 justify the risk of vaccination? After all, I know someone who had COVID-19 and it wasn’t that bad.

A4:  Over 30 million Americans have been infected with the coronavirus. In many people, symptoms are relatively mild — similar to a case of the flu. The severity of disease, however, varies with age. The older one gets, the higher the risk of severe infection, hospitalization, and death.

Individuals 50 and over account for 95% of deaths.  During the last surge, more people were dying in the U.S. each day of COVID-19 than of heart disease (the No. 2 cause of death) or cancer (No. 3).

It is also important to recognize that averages mask a lot of death and pain. While individuals younger than 30 years old account for less than 1% of deaths from COVID-19, this still is over 2,000 deaths and includes the broader agony for families that would not have happened had these individuals been vaccinated. When a 29-year-old OB/GYN resident dies of COVID-19, as happened last year, it’s shocking and tragic. The problem is that on an individual basis, there is no way to predict how one is going to react to the virus.

Q5: What large group of citizens best understand the pros and cons of vaccination?

A5:  Physicians. We spend our professional lives endeavoring to give our patients the best health outcomes possible. We are constantly evaluating the risks and benefits of medications/vaccines in light of our patient’s diagnosis, age, sex, other health conditions and medications.

Q6: Are physicians getting vaccinated?

A6: Physicians know that the evidence supporting getting vaccinated is overwhelming. Accordingly, approximately 95% of physicians either have or plan to be vaccinated.

Physicians recommend that to protect yourself, your family, and your community, that you get vaccinated as soon as you can. If I haven’t adequately answered your concerns or questions, many other questions are answered at the Utah Coronavirus website and an extensive New York Times Q & A website.

Justin F. Thulin, M.D., is a dermatologist practicing in Salt Lake City.

Justin F. Thulin, M.D., is a dermatologist practicing in Salt Lake City.