Pandemic Perspective #41  March 27, 2021

Vaccine reluctance by healthcare workers. Why? Do they know something?

            The media reports are unsettling.  A Medscape article just a few days ago noted that fully 30 percent of those who care for patients stated that they were still undecided (12%) or did not plan to receive the vaccine (18%).

            Consider four different elements of this issue:

1. Are manufacturers using experimental, i.e., untested methods to develop these vaccines?

2. Do the vaccines work?

3. Are the current vaccines effective against the rapidly-emerging variants, (mutations)?

4. Are vaccinated persons subject to a paradoxical response to later infection by the wild virus?

            This short blog can’t possibly adequately address each of these issues but here are some comments that might help those who are still agonizing over this decision.

1. Some methods of manufacturing vaccines have not been used on a large scale but they are not really new. mRNA technology was developed more than thirty years ago and was effective in helping to control the Ebola virus. Carrier adenoviruses have been used in several veterinary vaccines. We have less experience with these innovative vaccines because there has not been a need for such new variants until now.

2. The three vaccines released to date do produce an appropriate immune response and appear to prevent infection. For example, in one trial there were 30 subjects who required hospitalization for COVID-19 infection but all 30 were in the placebo arm of the trial. It’s true that some vaccine recipients have become infected but almost all of these were exposed within a month of receiving the second dose and at least in some reports, shed non-infectious virus particles.

3. Will these vaccines work against newly-emerging variants such as the B.1.1.7 strain that is rapidly spreading in the U.S.? That appears to be the case at the moment but this wild and woolly virus has been full of surprises and it’s quite likely that some of today’s vaccines (there are 73 vaccines in clinical trials and a total of 308 in various stages of development) will have to be tweaked or replaced by the end of this year.

4. The problem that many healthcare workers – including myself – fear most is a paradoxical immune response in which later exposure to a naturally-occurring SARS-CoV-2 virus will cause even worse disease. This happened a few decades ago with a vaccine that was designed to prevent Respiratory Syncytial Virus lung disease in very young children. If that does occur we’ll probably see it by the end of this summer. I’m keeping my fingers crossed.

            Perhaps a publication in on March 24th will put this concern to rest. In San Diego and Los Angeles a pooled study among hospital staff showed that positive tests fell to 0.2% in the second week after the second dose of either the Moderna or the Pfizer vaccine. In Dallas’ Southwestern Medical Center there was a 90% decrease in the number of employees who were in isolation or quarantine. In spite of a surge in cases in Texas the number of infections was only 0.05% among fully vaccinated employees and 2.61% of those who were unvaccinated – a whopping 50-fold difference!

            The old cliché, the perfect is the enemy of the good, applies in this case. As of this week more than a half-billion doses of the vaccine have been administered and there have been very few serious side effects. Of course, some might show up later – perhaps even a year or more from now but the initial results are reassuring. I will receive my second dose of the Moderna vaccine in a couple of days; the first was a nothingburger. I hope I can report the same next week.

            In case you wonder why vaccines don’t always work, remember that prescription drugs don’t always work either and neither do surgical procedures. I’ll explain why in the post for April 1.

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