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More vaccination questions and answers

Addressing concerns about mRNA vaccines, adverse reactions, and viral mutations


A medical assistant applies pressure to a piece of gauze after Jacob Conary received his first shot of the COVID-19 vaccination in Auburn, Maine. Robert F. Bukaty/AP

More vaccination questions and answers

In the May 22 issue of WORLD, we ran a coronavirus vaccine Q&A with Dr. Charles Horton and invited readers to submit their own questions. Here’s a new installment:

You wrote in an earlier article that mask wearing led to the lightest flu year in recent history. If masks are effective against respiratory viruses, why did we have 32.5 million COVID-19 cases in the United States and more than 578,000 deaths? Do masks only work on the flu?

Multiple factors play into this. The first is that the COVID-19 virus is more contagious than the flu. Looking at its R0 (“R naught”) value—the number of people an infected patient is expected to infect—this chart shows the H1N1 flu has an R0 of around 1.4. That means each person who had the flu gave it to one, or perhaps two, others. For COVID-19, each person passes it to an average of 1.5 to 3.5 people. The R0 range represents the effects of societal responses: Only with aggressive management were we able to get COVID-19’s R0 near that of the flu.

Second, while asymptomatic transmission of flu isn’t impossible, it’s not nearly the factor that it is with COVID-19. This matters because we as a society made a healthy change in 2020: We decided that we wouldn’t go to work (or shopping, or socializing) while sick. This interfered with flu transmission far more than COVID-19 transmission.

Is it safe for my 9-month-old baby to play with his young cousins who go to daycare or school? What rules should we put in place when meeting unvaccinated relatives for the first time?

Go for it! Remember, children almost always fare much better than older adults if they’re exposed to the coronavirus. Once we understood this, restrictions on children had more to do with concerns that they’d transmit the virus to grown-ups who might fare poorly. Nowadays, the vaccine is widely available and confers good protection for adults.

We can consider the question of unvaccinated relatives from a few angles. Assuming you’re fully vaccinated, the chance of you coming to harm is very low, and the chance of you bringing the virus to your relatives is also very low. Very young children, like your 9-month-old, don’t seem to spread COVID-19 very well—but the question of interacting with young cousins who go to daycare and then visiting unvaccinated relatives does depend on each family’s level of risk tolerance.

Will the coronavirus vaccines based on mRNA change your DNA?

No. Part of the public confusion on this issue is that RNA sounds a lot like DNA. The full version sounds even more similar: DNA is deoxyribonucleic acid, whereas RNA just lops off the “deoxy” prefix. But the difference is huge: DNA is the master copy of your body’s genetic code. RNA is an intermediate step in making proteins from DNA instructions. It serves as a messenger (and yes, that’s the “m” in “mRNA”).

Are there other concerns about mRNA vaccines? Could it weaken the immune system and its effectiveness in fighting against future viruses?

Most of the concerns I’ve seen stem from one of two issues. The first is that mRNA vaccines haven’t been widely deployed before. The technology has existed, but this is its first moment on the world stage. And the second is that we don’t have long-term safety data. (One might fairly point out here that we also don’t know the long-term effects of COVID-19 infection.)

It is not impossible for vaccines to alter the immune response in undesirable ways, but those problems are better understood now: A 1967 incident with vaccines against a childhood respiratory bug (called respiratory syncytial virus, or RSV) brought those problems to light, and vaccine developers now watch for similar problems in pre-market and post-market testing.

A few scientists have hypothesized that the vaccines could weaken immunity, either against COVID-19 or against other pathogens. Their proven effectiveness against COVID-19 disproves the former idea, and there is as yet no evidence of the latter.

How can you trust a vaccine when we do not yet know what its long-term effects are?

I’ll say here what I say to my patients before a procedure: The chance of things going badly wrong is never zero with any human endeavor, but it can be very low. If by “trust” we mean absolute certainty that nothing will go wrong with anyone taking it, we’re setting an impossibly high bar: We deal with side effects from antibiotics frequently, but that wouldn’t make us withhold them from patients who need them.

This isn’t at all the same as saying the vaccines are untested, and we’ve learned a lot about the vaccines both from the phase 3 studies (the large studies done before the Food and Drug Administration’s emergency use authorization) and from the phase 4 studies (the post-marketing surveillance). Remember, the phase 3 studies started last summer: The first study patients who received those vaccines are coming up on their first anniversary of their shots. None of this completely excludes the possibility of problems cropping up later, but it makes it highly unlikely as time passes.

Are there many adverse reactions to the vaccines that aren’t being reported?

As with many vicious rumors, this one contains a kernel of truth, but that kernel is being twisted to produce a very inaccurate conclusion. Much of the concern has arisen when people misinterpret data from VAERS, or the Vaccine Adverse Event Reporting System. This system, which collects everything people submit to avoid missing important trends, is only as good as its submissions. (One researcher famously demonstrated this by filing, and later withdrawing, a report that a vaccine had caused him to turn into the Incredible Hulk.)

Keep in mind that the vaccine doesn’t provide much protection until a few weeks after the first dose and that VAERS collected submissions on millions of frail elderly people during a pandemic. A COVID-19 death one week after the vaccine could well be filed with VAERS as “death after the vaccine.” It would be a death, and it would be after the vaccine. But it’s not a death from the vaccine.

This nuance has led to one persistent theme in internet disinformation, holding that the FDA is somehow hiding large numbers of vaccine-related deaths. But supposing that this was the case, clearly people would be missing with relatives demanding answers. We’re not seeing this.

How do viral mutations and adaptations play into the picture?

The ongoing problem of a mutating coronavirus has underlined how wisely the United States acted in stockpiling vaccines early as countries around the world continue to face fresh outbreaks. Mutations spread more easily between unvaccinated people, making it harder for countries that fell behind in the fight to catch up.

The mRNA vaccines control the coronavirus variants we’ve seen so far, too. The variants may not be quite as susceptible as “original” COVID-19, but they don’t seem able to dodge the antibodies from the vaccine entirely.

What about people who cannot be vaccinated due to allergic reactions to medications and foods? Those who have inflammatory responses are advised not to get the vaccine.

According to Yale’s online COVID-19 resource pages, people who have experienced severe (anaphylactic) reactions to any component of a given vaccine shouldn’t get that vaccine, and people who’ve had an anaphylactic reaction to something given by injection should talk with their doctors first. Most would still be candidates for the vaccine after that talk because the types of medication most associated with anaphylaxis (such as antibiotics and potent muscle relaxants used during general anesthesia) aren’t found in the vaccine.

For those few people who truly can’t receive the vaccine, the path I’d recommend involves masks, distancing, and encouraging everyone around them to get their own vaccine to protect those who can’t.

Why aren’t the Centers for Disease Control and Prevention and medical providers including those who have had COVID-19 and have a positive IgG test for antibodies to be in the same category as the fully vaccinated?

The CDC had initially appeared reluctant to do that, largely due to concerns about how long antibodies remain. Reassuring evidence has recently come in from two large, well-run British studies. Yet those two studies took place before viral variants became commonplace in the United Kingdom, so questions remain. With that said, I do think that as time passes, vaccinated people and people who have recovered from COVID-19 will likely come to be seen as having a similar risk of symptomatic COVID-19 disease.

A version of this article appears in the June 26 print edition.


Charles Horton, M.D. Charles is WORLD's medical correspondent. He is a World Journalism Institute graduate and a physician. Charles resides near Pittsburgh with his wife and four children.

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BECKY KEMPF

I hope that World is planning to cover the fact that countries like Germany, Israel and Canada are concerned about the cases of Myocarditis that are appearing among young people who have received the COVID 19 vaccination.

MTEM3071BECKY KEMPF

Yes! The Myocarditis issue is significant. The CDC has even published that there are increased symptoms of this. Anecdotally, we are seeing a number of connections experiencing symptoms of myocarditis out of the blue within a month or so of being vaccinated.

Mark EP

I'm a long-time World reader and World Mover who also finds World's coverage of this topic disappointing. Dr. Horton's superficial answers are not compelling. This isn't about science versus ignorance, or "real scientists" versus "wackos"; this is about science versus science, and Horton doesn't address the quality evidence that might undermine his recommendations and change the risk/benefit calculation that we each need to make about vaccination. I'm not looking for confirmation of my biases; I'm looking for rich debate. It feels like World--atypically, I'm happy to add--is glossing over the complexity here and joining the nonchalant "just get vaccinated" chorus.

SJS

This is EXCELLENT. Thanks. This covers the things I want to know and many, probably most of WNG's readers want to know. I do not hope to hear, nor want to hear, from, so called, America's Front Line Doctors [I won't belabor this point but it doesn't take long to listen to many of these to wonder where, or how some of them got their medical license] nor others who have differing opinions. So much is hearsay, whacko or just naysayers. There is enough of that out there.

The cornerstone of Western Medicine and the breakthroughs of antibiotics and other lifesaving healthcare and medicine has been the scientific method and the RCT (Randomized Controlled Trial). This is not perfect but the results are evident. I applaud World and Dr Horton for sticking to this evidence. Of course there is homeopathy, Eastern and herbal medicine, acupuncture, Rikki and on and on. Do we need to hear all of their opinions? I say no. I hope WNG agrees.

I am as skeptical as the next person and am greatly annoyed at the politization and polarization of this topic. But as a health care worker of nearly 50 years, someone who has been involved in RCTs, seen the good and the bad of the FDA, argued for and against certain protocols and results, seen bad research even in respected journals, I again heartily endorse Dr Horton and WNG for this and related pieces.

Deb OSJS

100% agree. Thanks for being a voice of reason. On any other topic, the skeptics on this page would readily accept Dr. Horton's perspective and evidence-based answers BECAUSE World endorses him.

MTEM3071SJS

Here is a very reputable doctor who is shedding some concern. https://articles.mercola.com/sites/articles/archive/2021/06/07/vaccines-depopulation.aspx

BECKY KEMPF

I love World but, just as many others have commented here, I have been frustrated with the lack of a diverse coverage from medical professionals concerning COVID 19 and the vaccines for it. Please World let's hear some other opinions from the many reputable doctors and scientists out there who have differing thoughts than those of Dr. Horton.

Joshua

There is far more that individuals can do to protect themselves. Based on well-established risk factors, losing excess weight would be the first on that list.
But the deeper implication is what is troubling here: the implication is that immunity is a community enterprise, that it is my responsibility to keep my neighbor healthy. If we work this forward logically, we can see the paternalistic society that many intend for us—a society with less individual responsibility and far less freedom for all.
-Sarah Clifton

MKUG9630Joshua

There is a sense that we are our "brother's keeper" and should feel responsibility not only for ourselves but also the community we live in. Think of all the venues that ban smoking, because of the harm of second-hand smoke, or the laws against driving under the influence of drugs or alcohol. They are meant to protect the community at large from the consequences of risky behavior that individuals (smokers or drinkers) may choose to engage in themselves without regard to the health of others. I think few of us would want to go back to the days of smoky work places or restaurants, and we certainly don't want to see more drunk drivers on the road than there already are.

JoshuaMKUG9630

True—no one lives in a bubble. But, there is a sweet spot between anarchy and tyranny. 

There isn’t a significant philosophical divide over the benefit of traffic laws or smoking-restrictions in publicly-owned facilities, but there is an enormous philosophical divide on the matter of vaccines.

And it’s the tyrant who has no problems coercing or forcing individuals to go against their conscience/worldview in order to accomplish his own desired ends.  

*(It would be unloving to cough on my neighbor if I am sick; but it would not be unloving of me to refuse a vaccine. The philosophical divide—which involves matters of conscience for some people—demands that the issue be a matter of personal freedom.)

David Russell

I too would like another opinion. With due respect to Dr. Horton, there is ample evidence that the masks are ineffective and shutdowns caused more harm than good. In addition, the vaccine process of development and effectiveness against disease can be very questionable, particularly when a vaccine is rushed to market. What about the blood clots, the physician whose platelets disappeared after getting the vaccine and he died three weeks later? These are real facts that should be part of his explanation.

And what about the math? If two healthy people are in a room, why should they be wearing masks or not meeting in the first place because the government won't allow it? What about natural immunity, which I've read at least 20% of the population should have? Is it right to isolate that many people who are healthy?

I trust WORLD to bring me all the facts, not just one side. Please contact Del Bigtree, the reporter behind The Highwire, or a physician / scientist with an alternative view.

PNIC9738

I find it interesting that even a doctor writing at a Christian publication is quick to discount/discredit natural God-given human immunity while brushing off any evidence as to the efficacy and safety of manmade vaccines.

MTEM3071

Charles Horton always seems to answer things in a non-dramatic way. I appreciate that he took the questions that are in controversy right now. I would appreciate if WORLD would consider getting a second opinion from another reputable doctor with different opinions just to give scope and the other side. Most of what this article says is CDC party line. There are intelligent and well-researched doctors who see these things very differently. One organization of those doctors is Americas Front Line Doctors. The medical beat is the one area where I feel like WORLD could do some additional investigative work.

My Two Cents

Dr. Horton does an admirable job answering questions in a way a lay person can understand it. I appreciate that. We are warned of the VAERS data that is available on the CDC web site, and the anecdote of the Incredible Hulk. However, the fact that VAERS is available on the official CDC web site indicates we should be able to trust the information. (You know, follow the science, and all that.) I'm still convinced that deaths AFTER the vaccine are as much related to the vaccine as are deaths following a positive COVID diagnosis related to Covid. The data clearly reported anyone who died with Covid died a "covid-related death." I have not seen the same data applied to "vaccine followed by death," regardless of the official cause.
Thank you, World, for another installment. I have not been able to get any update like this from my local news reporters and medical authorities.