1. Vaccine data on preventing disease
I will start this post by summarizing (hopefully as simply as I can) a handful of studies pertaining to how well the vaccines work at preventing disease. I will start by looking at some of the early vaccine studies for the mRNA vaccines (as these are the ones I have researched most heavily). These are older studies done back before vaccine distribution really got big. In fact, I remember doing a journal club meeting on one of these articles sometime late last fall.
The first is one of the Pfizer studies. This one excluded people with compromised immunity which I understand, but angered me greatly when it came out (as a person with compromised immunity). Note that it was designed and funded by Pfizer, though when you look at the protocol and stats it appears well-designed. Like other studies discussed here, infection with COVID-19 used the FDA definition which is a positive test with at least one symptom (which can be basically anything). However, in summary, they found that a 2-dose regimen offered 95% protection against COVID-19 infection per the above definition. (SOURCE)
The second study (on Moderna) was funded by the Biomedical Advanced Research and Development Authority and the National Institute of Allergy and Infectious Diseases, and the study protocol was designed by Moderna with their assistance. This study also used the FDA definition of COVID-19 as a positive test with a symptom and excluded the immune compromised. However, it found that a vaccination was 94.1% efficacious in preventing COVID-19 infection. (SOURCE)
Now that that part is out of the way I wanted to go over some more real-world data; that is, how are these vaccines actually functioning out there? Are they working on a population level like these studies suggest they ought to? Well…
The Morbidity and Mortality Weekly Report from April through July of 2021 shows that vaccination reduces chances of catching COVID 5 fold. This report was important in examining how the vaccines are responding since the delta variant of COVID-19 has started to surge. (SOURCE)
A study out of California found in July of 2021 that COVID-19 infection rates in unvaccinated people are ~5X higher than in vaccinated people. (SOURCE) They do raise the concerns that more studies are needed on how long immunity lasts and whether it will wane.
Another study examined COVID-19 vaccination effectiveness among health care workers, a group that is heavily exposed to COVID-19. They looked at whether the vaccines would prevent disease (in their study, defined as a positive test with at least one symptom). They specifically looked at the mRNA vaccines (Pfizer, Moderna). The study found “a single dose…to be 82% effective against symptomatic COVID-19 and 2 doses to be 94% effective.” (SOURCE)
And before you say “but those were only symptomatic cases!” here is another study also looking at health care workers. This study spanning December 2020-March 2021 basically tested all of their enrollees for 13 weeks and found that those who received 1 vaccine dose had 80% lower chances of getting COVID, while those with 2 doses had a 90% lower chance of getting COVID. This testing was done regardless of symptom burden. (SOURCE)
There is ongoing data collection on how long immunity lasts with some new reports (warning - following study is not yet peer reviewed) suggests that vaccine efficacy may drop to ~85% after 6 months in preventing disease, but efficacy in preventing severe disease remains very high, at 97%. Still, though, 85% is pretty good. (SOURCE)
So here are just a TEENY TINY number of the many studies coming out regarding the vaccines. I could sit here and list so many more, but then this post would be way too bloated and repetitive because they all say the same thing: the vaccine works. This conclusion is both consistent and reproducible, which when talking about scientific studies, means there is some good research backing it up. And before anyone says anything–YES, you can still catch COVID after getting a vaccine. Nothing works 100% of the time. Just because my car has an air bag and I use seat belts doesn’t mean I won’t get injured if I crash my car. But based on the available data, it works well in preventing infection in a lot of people, and furthermore, there is one other MAJOR benefit to the vaccine which I will discuss below.
2. Vaccine data on preventing severe disease:
Probably the most important realization that has come out of the past few months is our understanding of how robustly these vaccines effect disease course and severity. I am from eastern KY so one of the big hospital systems in my area is Appalachian Regional Health, which spans 13 facilities. According to their latest stats, they have 213 patients hospitalized with COVID-19. Of those, 16 are vaccinated. That means a little over 92% of the COVID patients there sick enough to need hospitalized are unvaccinated. For further reference, another major hospital in the region, Pikeville Medical, today reported that 70 of their 88 hospitalized COVID patients (~80%) are unvaccinated, and 20 their 24 (83%) ICU COVID-19 patients are unvaccinated. Another regional hospital, Kings Daughters, had recently reported that 86.5% of those hospitalized with COVID are unvaccinated and 100% of COVID patients in their ICU are unvaccinated. So before I even get to national statistics, you can look at these numbers as already see a trend, and I would hope you can see that these numbers are way too high and too consistent to be coincidence. For sources on these numbers you can visit the ARH, PMC, & KDMC websites or facebook pages where they post their stats (HERE, HERE, and HERE)
Now to post a few studies backing this up:
A recent CDC Morbidity and Mortality Weekly Report (we talked about this one earlier) shows that vaccination reduces chances of hospitalization due to COVID-19 by ten fold. (SOURCE) The same report shows that vaccination reduces the risk of death due to COVID-19 by ten fold, as well!
Another recent study that incorporated delta variant data into their research has found that “unvaccinated adults aged ≥18 years are 17 times more likely to be hospitalized compared with vaccinated adults.” (SOURCE).
Another study coming out of California, also post-delta surge, showed similar results, with hospitalization rates ~29X higher in unvaccinated people. (SOURCE)
Another study looked at how the vaccine protects adults over age 65, which is going to be a more vulnerable group. It found that adults >65 who received 1 dose of a COVID vaccine saw a 64% reduction in hospitalization if they contracted disease, and those with 2 doses saw a 94% reduction in hospitalization with disease. (SOURCE)
To me, studies like these are really important. What we are seeing over and over again right now is that our health care system is being absolutely flooded by unvaccinated COVID patients who need to be hospitalized. This is stressing the health system in ways it was not built to endure. We do not have enough equipment or staff to manage the volume of patients we are seeing.
Sadly, this does not just affect COVID patients. When a bunch of unvaccinated people get sick and take up ICU beds, that means anyone who gets sick with non-COVID problems, like strokes and heart attacks, also suffer when there aren’t beds left for them. For example, your grandmother who developed a bad bacterial pneumonia and is in respiratory distress may die because an unvaccinated COVID-19 patient got there first and took the last vent in the hospital, and there aren’t any ICU beds to transfer her to nearby because the wait lists are all so long because all the ICUs are also filled with unvaccinated COVID patients. I’d argue this is the biggest problem we are facing right now regarding the pandemic even if this problem is invisible to people who don’t work in healthcare. Please believe me when I say this: we are drowning, and we are drowning because of unvaccinated COVID patients who are getting severely ill. This is completely unnecessary and avoidable when we are seeing over and over again that vaccination does wonders to prevent you from getting sick enough to need the hospital at all.
Don’t believe me still? I want each of you reading this to visit the webpage for some of your local hospitals. Most of them are posting daily or weekly COVID admission and death statistics. Just take a look at them. Take a look at who is getting admitted and who is dying.
Any vaccine, medication, herbal supplement, or what have you that goes into your body carries the risk of an adverse side effect. As a result each of us has to ask ourselves, do the potential benefits outweigh the potential risks? To answer that we need to better understand the risks associated with COVID-19 vaccination, and that means turning back to the data we have available.
According to NYT Vaccine Tracker, there have been 5.73 billion vaccine doses administered worldwide since its release. This generates an abundance of data for us to work with–more than we have for most medications you take every day–in regards to understanding safety profiles of these immunizations. Given that impressive number, we are by no means seeing widespread death or disability popping up due to the vaccine, but let’s get more specific. We have seen a couple common possible adverse effects:
Flu-like symptoms: Most common by far is going to be flu-like symptoms or redness/pain at the injection site. This is actually a good side effect because it means that the vaccine is doing what it is meant to do. I won’t talk much more about this one because I doubt flu-like symptoms are the reason people are scared of the vaccine. But for most of you, if you have any side effects at all, this will be as bad as it gets. You are more likely to have these symptoms after dose #2.
Anaphylaxis: Anaphylaxis can occur in anyone when you encounter a substance you have a try allergy to. This is going to be a rare side effect (2 to 5 people per million, or 0.00025%), but is also why you are asked to wait 15-30 minutes to be monitored after receiving your vaccine. That way if you show any signs of distress you can be given immediate treatment. Any time you get a vaccine or start a new medicine a severe allergy is a possible reaction, but if you already KNOW that you are highly allergic to something in the vaccine, you should not receive it.
TTP: This is a disorder that causes abnormal clotting or bleeding. It seems to be associated exclusively with the J&J or AstraZeneca adenoviral-vector vaccines based on current data trends. While rare, this is going to be the most serious adverse effect from the immunization. Data suggest the highest risk is for women under 50, but it is still remarkably rare with only 45 confirmed cases of TTP after over 14 million vaccine doses given. This is an incredibly, incredibly low incidence. Of note, however, patients with the actual COVID-19 virus have a SIGNIFICANTLY increased risk of clotting, especially in severe disease. This increased risk may be due to the production of auto-antibodies in response to COVID-19 infection. Summary: your risk of a blood clot is much higher with the actual virus than the vaccine.
Myocarditis/Pericarditis: These are conditions involving inflammation around the heart tissues or heart muscle. There does appear to be an increased rate of myo/pericarditis after vaccination. This is more common in teenaged males who received an mRNA vaccine (such as Moderna or Pfizer). This is also very rare. According to VAERS, 1404 cases of possible myo/pericarditis were reported after vaccination through September of 2021, though only 817 were able to be confirmed. A CDC report from June 2021 estimated about 60 cases of myo/pericarditis may develop per 1 million vaccine series completed (if you are male aged 12-17; otherwise the rate is lower). However, that same report also estimated the prevention of 71 ICU admissions, 2 death, and 215 hospitalizations among that same group per million vaccines given. Again it is a risk-benefit discussion, but here the numbers definitely point to a benefit overall. Vaccine-induced myocarditis and/or pericarditis are generally one-time events with an excellent prognosis, so rarely represent a threat to life. As the authors of the study linked above stated, “The absolute incidence was extremely low, cases were mild, and all patients recovered. Fear of myocarditis or pericarditis should not influence COVID-19 vaccine decisions.”
Guillain-Barré Syndrome: This is a disorder of the nervous system that can cause temporary weakness and paralysis. It is commonly seen after immunizations or infections with various pathogens. It has been associated with adenovirus-vector vaccines (J&J, AstraZeneca) at a very low rate (about 0.0008%) with J&J reporting ~100 cases per 12.2 million doses per VAERS data, and 227 cases out of 51.4 million doses given per EU/EEA to the EMA again through June 2021. People with a history of Guillan-barre are more likely to get it again, so your risk is probably slightly higher if you have had issues with this before, so people with this history may want to opt for an mRNA vaccine which has not been associated with this.
4. Addressing Common Concerns
If the vaccine works, why do you feel unsafe if I don’t get it? A vaccinated person is more protected from you than if they were not vaccinated, but no vaccine (or medical treatment in general) works 100% of the time, so there is always a risk of spreading disease no matter what. This is true for every single vaccine in history so COVID shots aren’t special in this way. The data supports indisputibly that the vaccine reduces the RISK of getting COVID, but does not protect against it perfectly, so people should still use common sense. Also, vaccine works much, much better when everyone gets them, which is why vaccinated people enourage others to get the shot too. Think about it. Most of the studies I linked said the vaccines were in the range of 90-95% effective at preventing disease. If everyone in the room is vaccinated, the chances any of them (with their 90-95% protection) are infected and spreading COVID is going to be lower than a room of unvaccinated people, who have no protection against disease. Think now of yourself as a vaccinated bystander inside each of those rooms. In room 1, there is a low rate of COVID-19 being spread around, so your vaccine-induced immunity is now bolstered by the fact that there is also low spread in the community, making your overall chances of getting sick extremely low. In room 2 there is likely moderate to high spread of COVID-19 virus, meaning that even if you are vaccinated, because your vaccine can never be 100% effective, you sadly still have a chance of getting sick (even if it is lower than it would be if you were not vaccinated). Does that make sense?
If vaccines work, why do I have to wear a mask? Same reason as above. We can get into masks later, but point is, both offer protection against the spread of COVID-19, but neither is 100% surefire perfect immunity. Human bodies just don’t work that way, sadly. By using both, you increase your chances of preventing catching or spreading disease more than if you did either one in isolation. Bringing back the car example, a seat belt is good, an air bag is also good, but I’d definitely prefer to get a car that has both a seat belt AND an air bag.
Why is the vaccine not approved for kids? Lacking data on safety and efficacy, as young children were excluded from many of the trials that looked at these vaccines.
We don’t have long term safety data. It is unprecedented for an immunization to cause new side effects years later. These shots work by activating your immune system. Any problems they are going to cause will occur surrounding that period of immune activation (meaning, at most a few weeks after you get it). That is why this vaccines typically have any side effects show up within days to weeks of administration. The idea that novel side effects will pop up YEARS later is unlikely. Now, a vaccination may have cause side effect that has long-lasting health implications, such as developing TTP and having a stroke from it, but my point is that will start within weeks of vaccination, not randomly 5 years later after the vaccine has long since left your system. As a result, any side effects from the vaccine are things we will already be seeing right now. The virus, though… I can tell you that scar tissue in lungs doesn’t magically vanish, and brain damage from hypoxia doesn’t vanish. I can tell you that those who develop a generalized COVID inflammatory response are dealing with symptoms months post-infection. I can tell you that the virus itself is causing irreversible health problems and disability, and we KNOW that right now without waiting another 5 years. And we know that being unvaccinated increases your risk of getting sick enough to have these permanent disabilities. We also don’t have time to wait 5-10 years on more data to deal with this problem. Action has to be taken now, or a lot of people won’t be alive in 5 years to talk about the long term effects. I wish none of this had ever happened, but it did, and we have to do something or it won’t get any better. This is a global pandemic; we have to cooperate with each other to eradicate it.
Vaccines should not be mandated by the state or companies. I don’t really disagree. I do not think authority figures should be able to tell any person that they have to put any substance into their body against their will or else face starvation or homelessness, which is a real threat if people get fired over their vaccine status. HOWEVER neither your nor my beliefs on this topic change the fact that the vaccine works and is VITAL to keeping our health system from collapsing, and you really should be choosing to get it on your own based on the available data regardless of what your boss is saying. Please don’t refuse to get the vaccine just to “send a message” or take a stand against your boss or whoever, because I promise you they will fire you without a second thought, and the only person you are sending a message to is that little grandma we talked about earlier who needs intubated but can’t find a free vent or ICU bed, so dies in the emergency room while unvaccinated people take up all the space in the hospital.
There are risks associated with COVID-19 vaccination, as with any vaccine or medicine, but they are remarkably, remarkably low. The potential benefits of vaccination are significant, with a decreased risk of infection, hospitalization, and severe disease among those who are vaccinated. This benefit extends to the community as well, in that it means you are less likely to catch (and therefore spread) COVID-19, increase the rate of herd immunity in your area which protects everyone (especially the medically vulnerable), and reduces preventable, unnecessary COVID-19 admissions that are weighing down the health system and clogging up hospital beds. If you look at this purely from a risk-benefit standpoint there is no mathematical reason not to favor getting the vaccine, and I strongly urge everyone who can safely do so to schedule it.
I suppose my take-away statement is this: I am a physician. If you are willing to trust my advice when you show up to the hospital in respiratory distress, trust my advice now in trying to prevent you from getting to that point.