Understandably, there is a sea of conflicting information going around about the safety, efficacy, and reliability of all of the available COVID-19 vaccine candidates. Much of that uncertainty stems from the novel scientific methods being used to generate immunity in two of the current contenders being administered and bought on the public market. In an effort to clarify some of the complex, politicized, and occasionally conflicting information that is being so widely disseminated, I have compiled a non-exhaustive list of the most contentious points related to being vaccinated.
Before I begin, it is important to note that I am not a doctor, which I’m sure is unsurprising to most of you. What I am, however, is an ex-science student with a number of published peer-reviewed papers, who never lost my admiration for the scientific method or my fondness for statistical analysis. I have an equally unsurprising interest in health law and intellectual property, since those fields often allow me to return to my roots. That qualifier has nothing to do with my ego, and everything to do with my credibility. I am more qualified as a scientist than I am as a lawyer. My goal is to clarify the many concerns that the public has about the safety and efficacy of vaccination, and I do not present a medical opinion on the matter. While my opinion is that most people should get vaccinated, some still shouldn’t, and that decision should only be made by having a conversation with your doctor when the time comes.
If your opinion differs from mine, I welcome criticism and am always willing to support an open dialogue. Feel free to send a letter to the editor at editor@obiter-dicta.ca. Citations are available upon request to the same address.
1. The mRNA vaccine does not, at any point, enter your DNA and alter it permanently in order to make you immune. The vaccine is injected, it does its job in the cell, and it is then destroyed by the body.
Simply put, the vaccine works like this; first, your body receives the injection of the vaccine in your upper arm muscle. mRNA in all human cells works in a similar way to the mRNA being injected – all vaccination does is provide the mRNA. The “m” in mRNA quite accurately stands for messenger. This messenger RNA is essentially just an instruction manual for the building of proteins. mRNA is made of what it sounds like, RNA. RNA is similar to DNA, in that it is a chain of molecules that together make up a code that can be translated using the right machinery in the cell. Think of those molecules like the fridge-magnet alphabets many of us played with as kids. You only have a limited number of each letter available, so you have to make the most of the letters you have. Instead of buying an entirely new set of fridge magnets, when you’re done with the message of your choice, you destroy the message to make others. mRNA functions similarly – the building blocks are distinct chemicals that the body would rather not use once and dispose of. The mRNA that is injected is broken down into single units that are useless on their own, and those constituent parts are re-used.
In our cells, the message in mRNA causes the cell to produce a protein that looks almost identical to one of the proteins found on the surface of COVID-19. This protein is found on all variants of COVID-19 that have been identified so far, which contributes to the general medical confidence that the vaccines currently being administered will be effective against those novel strains. The rest of the body recognizes these proteins, which are simply identification proteins and have no pathogenic effect, and realizes they’re not meant to be there. The body’s cells then understand that they must find a way to destroy these proteins, and proceed to build antibodies that know how to target that out-of-place protein.
When you’re later exposed to COVID-19, the body has seen that protein before and can target it immediately. The body does not have to wait for you to become infected with the virus (meaning, the virus does not have to enter your cells and wreak havoc like it would in a typical infection), for it to launch an immune response.
Your DNA is never touched by the mRNA, or the proteins that are produced based on its message. DNA was roped into this conversation like an unwilling founding partner around recruitment season. It has no interest or stake in the matter. It does not care whether the proteins being produced are going to be satisfactory for the 6th year mitochondrial associate who requested them. It does not give a rat’s ass if the protein printer doesn’t work. It’s so over, like so over, talking to keen first year RNA chemicals that are interested in working in “burgeoning markets” and “innovative practices.” That’s the mRNA coordinator’s job – to talk to the people and give them what they want. DNA just built the house that the mRNA works in. Now leave it alone.
2. No, the vaccine is not 100% effective. But that should not alarm you.
At the moment, vaccine candidates currently being distributed boast a vaccine efficacy percentage of about 90%. I clearly didn’t do well enough in high school to consider 90% an inadequate grade, but I do understand individual hesitation when putting a substance that is seemingly untested into their bodies without a guarantee that it will actually do its job.
This may come as a big surprise considering how adamant our teachers, parents, and health care providers have historically been when it comes to pushing us to get vaccinated annually for the flu, but as it turns out, annual flu shots are comparatively abysmally ineffective. Some estimates report efficacy to be as low as 24%, though the government of Ontario reports a 55% efficacy rate. Yes, you read that correctly. The vaccine that we’re supposed to get annually is at best only effective in preventing the flu half the time.
What is important to remember is that even at those low efficacy rates, the government and healthcare professionals still recommend getting vaccinated. Why? Because the proportion of the population that does will be protecting those that don’t. It is far better to have 50% of the population that’s been vaccinated with something that works 50% of the time, than to have no one vaccinated on the basis that the vaccine is less than perfectly effective. If there’s a chance it’ll protect you (and with COVID-19, there’s a much higher chance than usual), it’s worth getting, especially if the people around you are those you’re most concerned about protecting.
3. Long term side-effects of mRNA vaccines are unknown, that is absolutely true. But this vaccine concept has been under development for far longer than the pandemic has been going on.
I’ll get the ugly out of the way – while Pfizer is a known player in the vaccine game, Moderna has never produced a marketable vaccine before even though it’s employing the same technology. It’s essentially joining the fray with no precedent, which to us, probably sounds a lot of alarms. It rings similarly, perhaps, to the idea that a self-represented, first-time litigant is about to stand trial. Tap into your empathy, that rusty old thing. Just because they are first-timers, and are perhaps less well-seasoned than you, a freshly minted lawyer with the promise of a career ahead of you, does not make their claim less legitimate. Now, this is not an access to justice issue as Moderna has had millions behind it while self-reps don’t, but the principle is similar.
Perhaps, let’s extend this analogy. We’ve been studying law for years and interested in it for years more. Once we pass the bar, graduate, and earn our stripes, we can appear in court like anyone else. Perhaps, Moderna is just a bigger, more medical you. It’s paid its dues, too. Moderna has been doing mRNA research for years, which gave it a head start in the race to make a vaccine against this new and unruly foe. The name Moderna actually comes from the word mRNA, believe it or not.
The good thing is that long-term effects of many other types of vaccinations are very well-understood. There are no known side-effects to many, and there are many candidates for COVID-19 vaccines that employ those better-known vehicles towards immunity (i.e., they don’t use mRNA). If you’re patient, you may not need to get a new mRNA vaccine at all. If what’s going in your arm is based on the same stuff that’s in a flu shot, it should give you at least a touch more peace of mind.
4. All vaccines have potential side-effects. Those reported for the COVID-19 vaccines that have so far been made available are no different on this front.
Think of it this way. When you’re given a task at work or school to do, it takes some effort on your part to complete it. Depending on the student, the same task could take varying amounts of time and effort. Now pretend that task is in the instructions that are written into the mRNA sequence injected into your arm. Your body needs to kick its immune system into action with no warning except the feeling of that needle. For that reason, you shouldn’t be alarmed or taken aback if you experience side effects from this vaccine, even if you’ve never experienced any before. Your body is learning how to respond to the threat that the vaccine is training it to recognize, and that cannot be done without some effort on your body’s part. This is where some of the discomfort comes from when you get any kind of shot (i.e. soreness at the site of injection, lingering stiffness, fever, chills, etc.).
Immunity comes at a cost, and at least when you’re only paying the price of vaccination, you can avoid paying the same price, and then some, if your body is instead mounting an immune response in the face of an actual infection.
5. Allergic reactions are not uncommon when it comes to administering vaccines, and should not deter you from getting yours (in the right settings). If you require an Epipen, this might mean a conversation with your doctor, but does not outright mean you cannot get vaccinated.
Allergic reactions are human immune overreactions to invasive pathogens. Unlike COVID-19, medical professionals are well-accustomed to dealing with them. With the increased awareness surrounding the side-effects of vaccinations, it’s important to keep that awareness in context. People have been reacting to vaccines for years. If you’ve been told to sit in the doctor’s office after getting a shot, it’s because you’re being monitored for anaphylaxis. No one wants to have an adverse reaction, so physicians are recommending that those with a history of anaphylaxis avoid the vaccine in most cases. Still, what is important is that allergic reactions are far better understood than COVID-19, and what’s also worth mentioning is that they’re not contagious.
Ultimately, as someone with no history of allergies, I cannot speak for those who do. It will be up to those who become eligible for vaccination to choose whether they want to put themselves at risk of a known medical issue, for the sake of preventing the transmission of another. No decision is right or wrong, but the takeaway from this section is simply this: if you’ve never reacted to a vaccine before, and aren’t severely allergic to anything, you probably have nothing to worry about.
6. Yes, this is the fastest a vaccine has ever been successfully produced and disseminated, but there are many good reasons for that.
Many of us know that pharmaceuticals are a lucrative area of business. Competition between companies is just as good of a reason to change the direction of your research as the presence of a new strain of virus to vaccinate against. Normally, the vaccination market moves based on both of those factors, and there is no real reason for corporations in this massive field to collaborate in any meaningful sense so long as there is no health crisis that requires the entire field’s attention. There are a number of different companies making different flu vaccines that wind up in your arm every year (that you bother to get the shot), and most of the time, you have no idea what company you’re getting the shot from. Finally, in the US at least, drugs take a long time to go from their experimental stages to being administered – on average, it takes 12 years for a drug to be used clinically, and only about 5 out of 5000 candidates make it that far. Vaccines are nominally faster, taking about 2-5 years to go from benchtop to bicep.
In the context of the COVID-19 pandemic, there was no way the world was going to wait that long. For the first time, pharmaceutical companies had the technology, financial backing, and pressure to work towards a viable solution for a global problem.
When it comes to some of the technology being used to fight COVID-19, mRNA-based vaccines were never as necessary as they are now. Coronaviruses in the respiratory tract are especially hard to vaccinate against; the human immune system has a hard time protecting our respiratory tract at a baseline, so preparing our immune systems for what’s coming, using methods we’ve already tried out, can only go so far. This means that novel technologies were placed on an even playing field with other known technologies in the hopes that one would work better than the other. While other types of vaccines are on their way to clinical success and to the marketplace, for the moment, the newcomers are in the lead.
In terms of financial backing, well, that one is easy to explain. The world wants to go back to normal, and if Dolly Parton can find a spare million to hand over to Moderna, then you can bet that wealthy stakeholders with slightly less well-known names have been lining up to pay what they can to advance the effort. I won’t belabour this, but there’s money to go around on this one.
Finally, collaboration is key. The world wants a fix for this. Lots of people have put aside their pride, and their chances for exclusive profit, in the interest of collaboration for the sake of our global return to normalcy. There has never been this much focused work on a single cause before.
Finally, emergency use authorization has further expedited the process. Normally, vaccines don’t have the same pressure to be in our arms as fast as they are being produced. There is time and opportunity to test out the vaccines being developed thoroughly and effectively. If someone told you that you’d have to wait 2-3 years to receive your shot due to administrative hurdles, I don’t think you’d be particularly pleased. This is all that the emergency use authorization provided by our governments is circumventing.
All of this taken together has made for a recipe for success. The speed with which the world has solved this viral problem should therefore not alarm you simply by virtue of that.
7. Racial and ethnic groups are regularly, undeniably, and inexcusably underrepresented in clinical trials. Thankfully so far, those vaccinated have not had adverse reactions based on race or ethnicity.
This conclusion only rings as true as it can when there has been so little opportunity to observe the long-term effects of these vaccines on the human body. Research as of the date of this publication has not shown any evidence that racial or ethnic background has contributed to the likelihood of an adverse reaction to any of the vaccines currently being administered. This article is not meant to focus on the failings of the pharmaceutical industry, but it was worth noting that there are significant opportunities for improvement in the racial and ethnic composition of large-scale clinical trials.
8. For you young folks reading this, we’ve got a while to wait. That should give you a lot of time to see that no one who receives this first round of shots will grow an extra limb, keel over on the spot, or suffer a later consequence of being vaccinated.
Obviously I am being dramatic, but if that’s the kind of comfort you need, then rest peacefully in it. We have a long time to wait, considering we work in a profession where we can probably work from home, and where the majority of people reading this are under the age of 60. Regardless of your profession or age though, the longer you have to wait to get the shot, the better idea we’ll have of the consequences of getting it. We will also benefit from the herd immunity afforded to us by all of those who are vaccinated before us. While that won’t remove the need for us to be vaccinated ourselves, it will alleviate some of the urgency. It’s your body, and no one can tell you what to do with it.
I hope this was an informative read, and that it will help you make a more informed decision in the future. Stay safe, stay healthy, and use protection (over your mouth and nose, duh).