The real vaccine trial begins

NICK EICHER, HOST: Coming up next on The World and Everything in It: COVID-19 vaccines.

The Trump administration had hoped to have at least 20 million vaccine doses available by the end of 2020. It missed that target pretty significantly—to date, roughly four million, and these are estimates, about four million people have received the first of two doses.

But that number is growing rapidly, and health officials say we could have as many as 100 million Americans fully vaccinated in the next hundred days.

MARY REICHARD, HOST: To make that happen, the U.S. health system needs to overcome a few challenges, including logistics and persistent doubts about vaccine safety.

Joining us now to talk about these problems is Dr. Charles Horton. He’s a physician and WORLD’s medical correspondent. Good morning, Dr. Horton!

CHARLES HORTON, GUEST:  Good morning, Mary!

REICHARD: Well, this slower rollout led some national health experts to express disappointment about it this past week. Many, many factors are behind that slowness. I want to ask you about one aspect, and that’s the medical logistics.

HORTON: I’m surprised by the problems, both because we as a system have had plenty of time to prepare and because the medical world normally does pretty well with logistics. Plenty of things other than COVID vaccines need to be shipped very quickly and often on dry ice.

I do think this is a case of growing pains, because the main difference here strikes me as one of scale. The medical world isn’t trying to do something truly new here in moving very cold things, but it’s trying to move much greater quantities of very cold things than it had. Of course there’s also a healthy desire to be sure we’re not wasting any of the vaccine by letting it spoil.

REICHARD: The last time we had you on the program to talk about vaccines, you detailed how the new RNA vaccines work. We’ll link to that in today’s transcript for anyone who might be interested and missed it then. But one listener had a question about why the body doesn’t continue to make proteins in response to the virus RNA in the vaccine. The body’s normal immune response. In other words, when and why does that process stop?

HORTON: Great question. I think we do need to make a distinction here between the body making proteins directly in response to the RNA, that is, transcribing the RNA to make the spike protein that it’s stimulating the immune response against, which only lasts for a few days, and the antibody response, which of course is the goal of the vaccine and, Lord willing, will last for a very long time. Keep in mind, it’s a two-dose vaccine and the reason for that second dose is by the time you’re a few days out, that protein is already ceasing to be made in the body. So, it’s not something that you need to worry about in the long term.

REICHARD: A lot of people still have questions about how safe the vaccine is.  We continue to get emails from listeners asking about things they’ve heard or read about elsewhere. We don’t have time to address all of them, but I’d like to ask you about a few. Let’s start with the claim that the vaccine causes infertility in women. 

HORTON: First and foremost: it doesn’t. The vaccines induce immunity to a viral protein called “spike protein.” It’s named after how it looks under a very powerful microscope. Now, at risk of saying the obvious here, the vaccines accomplish the same thing in terms of immunity that catching the virus would, minus the suffering and danger that goes with actually having the coronavirus. So if immunity to spike protein were to cause infertility, then we’d be in big trouble here—all of humankind would—because catching the virus would also cause women to be immune to spike protein and, thus, to be infertile.

The theory behind this was that a protein in the human placenta could look enough like spike protein that immunity to spike protein would effectively vaccinate women against forming, or maintaining, a placenta. That would be terrible news, but, again, praise God it isn’t the case. There have been reports of miscarriages in women with severe Covid, simply because a pregnant woman who gets severely ill could lose her baby. That’s heartbreaking when that happens, of course, but there isn’t any that it’s due to spike protein.

REICHARD: I’ve seen some legitimate reports of reactions or problems, like Bell’s palsy and allergic responses. What about those?

HORTON: To take the second one first, almost anything we give a patient can at least theoretically cause an allergic reaction. Most allergic reactions are minor, more annoying than dangerous. But it is rarely possible to have a more severe one. This is why when you get any vaccine, whether it’s the Covid vaccine or the plain old flu shot, they ask you to stick around for a little while and give you a list of things to look out for.

As for Bell’s palsy, that was reported in four of 20,000 patients in the Pfizer trial. There are two important things to keep in mind about that. First, it isn’t unknown in the general public and Pfizer does argue that one in 5,000 people might have reasonably developed it in the timeframe where they monitored people. Even if that’s overstating it, the risk is plainly very low. And, of course, we need to balance it against the risk of getting coronavirus.

REICHARD: The issue of cause and effect is huge here. If someone gets the vaccine and then develops a health problem, it seems reasonable to conclude that the vaccine caused it. But we know correlation doesn’t prove causation. And the people who are first in line to get the vaccine are those most likely to have health problems in the first place.

HORTON: You hit the nail on the head, Mary, and this is especially true while a drug or vaccine is being evaluated for approval. Researchers quiz the volunteers exhaustively about anything new, medically speaking, in their lives. And, remember, the stage 3 trials included thousands upon thousands of people. If you followed that many people for weeks on end, you’re going to hear about all kinds of medical issues.

REICHARD: Dr. Charles Horton is a physician and WORLD’s medical correspondent. Thank you so much for joining us today!

HORTON: Thanks for having me!

(AP Photo/Jeff Chiu, File) This Dec. 24, 2020, file photo, shows a vial of the COVID-19 vaccine from Pfizer is shown at Seton Medical Center during the coronavirus pandemic in Daly City, Calif. 

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