This has been a truly momentous week, as the nation started mass
inoculations against SARS-CoV-2. Up to now, all of our public health efforts
have been around containment (which failed spectacularly world-wide) and
mitigation. We should all pause to celebrate this event: the first public
health intervention taken since the start of the pandemic designed to bring it
to an end.
Mitigation is like giving chemotherapy to slow the growth of a cancer that
cannot be cured. For the first time we have a path to actually curing our
societal cancer.
When the Vaccines and Related Biological Products Advisory Committee (VRBPAC)
met last week, they considered a single question: "Based on the totality
of scientific evidence available, do the benefits of the Pfizer-Biotech
COVID-19 Vaccine outweigh its risks for use in individuals 16 years of age and
older?" They performed a risk-benefit analysis. As every probably knows by
now, that answer was "yes."
Vaccine supplies will be limited at first, and there is still much we do not
know about how it will be distributed. To get a rough guess of where you fall
in the expected allocation plans, the New
York Times published a useful widget. If you are towards the end of the
line, do not worry. Like the annual melt of the Rockies ice pack, our vaccine
trickle will soon become a substantial stream, and by the springtime, it will
be a flood.
By April, if all goes as expected, I suspect most people who want to be
vaccinated will have access to vaccine.
Suddenly, we are all faced with our own VRBPAC-like question: "Does the
benefit of vaccination outweigh the risks to me?" Today I want to share my
personal risk-benefit assessment.
First, I need to review our recent numbers. We remain in a major surge. We did
not experience a major Thanksgiving bump, and there are some encouraging
signs.
The regional R(t) dropped below 1.0 (suggesting viral spread is decelerating)
for the first time in several weeks. On an average basis over the past
week, new
community positive cases actually dropped (2,373 vs 2,040 for the
weeks ending Dec. 6 and 13, respectively). This is encouraging, especially
given this drop occurred during the time we should be seeing Thanksgiving
induced spread. However, it is far, far too early to declare victory.
Numbers are still at near-record highs, and in our June/July surge we saw
many examples of one-week dips followed by new-record highs. Our hospital
COVID-19 census continues to inch up daily, and hospitals and providers remain
on surge footing.
National daily death rates have declined
for the past three days, and hard-hit communities
like El Paso have seen their case rate numbers fall. Again – to be
crystal clear – it is too early to say we are on the declining side of the
surge.
Critically, our nascent vaccine rollout will do virtually nothing to impact
the current spread. We need to maintain our viral control practices and plan
for safe December holidays.
But, back to my personal risk-benefit analysis.
On the risk side, my personal assessment of the risk if very, very low. I will
confess, I have confidence the clinical trials process, and in our regulatory
approval processes. A collection of our best clinical and scientific minds has
looked at the available clinical trial data, put it in the context of decades
of experience with rolling out new vaccines, and concluded it is safe and
effective.
I have confidence in our own Baylor vaccine scientists and infectious disease
experts, who have independently looked at the available data and are comfortable
with the vaccine's safety profile. I have also reviewed the data myself, which
is publicly available. I
encourage you to do the same.
More than 40,000 people received the vaccine in the Pfizer trials. The subjects
included people with a range of chronic conditions - diabetes, pulmonary
disease, heart disease, hypertension and others. The most common adverse
reactions were local soreness at the injection site, headache, muscle pain
chills and joint pain. I am not even sure I would classify these as
"adverse reactions." They are signs your body is mounting an immune
response, which is what a vaccine is designed to do. There were no major
adverse reaction reported.
Once actual non-trial vaccine administration began in Great Britain, there were
two widely publicized allergic reactions. I have not seen the details reported
yet, but both individuals apparently had a history of severe allergic reactions
and carried Epi-Pens. At this point, if you have a history of severe allergic
reactions (trouble breathing, skin rash) out of an abundance of caution I would
suggest you wait to be vaccinated. I believe there will be much more clarity
regarding these reactions in the next days to weeks.
In summary, the rate of a significant adverse reaction is very, very low. There
have been no deaths, and even the two allergic reactions were easily treated. I
am personally very comfortable with this level of risk. However, I am respectful
of those who remain cautious. My advice. Wait a month or so. You do not have to
get vaccinated today. The vaccine was approved based on the experience of tens
of thousands. Within a week, our experience will expand to hundreds of
thousands. Within a month, millions. If our experience continues to hold when a
million people are vaccinated, I am probably far more likely to be severely
injured driving my car to work than I am to experience a major vaccine-related
complication.
That is my assessment of my risk. What about my perceived benefit?
Part of my motivation is – as I think it is for most early adopters – at least
partially altruistic. I have no major risk factors. I do not want to get the
virus, but I am vigilant about my distancing practices and do not necessarily
fear contracting it.
However, I do feel – especially as a physician – an obligation to receive
the vaccine. In a very small way, I am protecting the more vulnerable in our
population. It will require tens of millions of individual small decisions to
see this end.
I will confess, much of my motivation – much of my perceived personal
benefit – is selfish. I have an 82-year-old father in North Carolina I would
like to be able to visit without fear of infecting him. I have a niece and nephew
– three-year old twins – I would like to see in person rather than on FaceTime.
I have two "pandemic baby" granddaughters that I want to steal from
their mothers ever now and then to have small adventures together. I want them
to be able to meet and play with other children their ages. I want to go to
church on Sunday morning in vivo, instead of on YouTube.
As I write this, it strikes me that this is not particularly revelatory –
the pandemic has robbed all of us of something important. Health. Economic
security. Companionship. Human connection. Selfishly, I miss my pre-pandemic
life, and want it back. My individual decision to receive the vaccine will not
get us there, but millions and millions of individual decisions will.
Let's get our lives back.
Stay well.
(Note: Between June 2020 through November 2021, I
wrote weekly COVID-19 pandemic updates seen through the lens of a health
sciences university. My intent was to
provide reliable information, acknowledge legitimate concerns, console, and
encourage. Each posting reflects issues
our community was experiencing at that moment in time. I have reproduced selected examples on this
site).
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