Francisco R. Velázquez, M.D.: COVID-19 vaccine confidence: Let’s talk

In recent months, some of the initial reluctance to get the COVID-19 vaccine seems to have subsided around the world.

Increasing confidence, availability and information are contributing to the progress being made in addressing some of the earlier concerns. For more progress to be made, acknowledging and addressing why these concerns exist is critical as we go forward into future phases of managing this pandemic.

First, some level of uncertainty, and even trepidation, is to be expected. We have a new virus and new vaccines, both moving at a speed we have not experienced before. In addition, there are some populations that, due to historical reasons, still carry a level of mistrust for medical establishments. And some mistrust stems from more recent issues such as inequitable access, lack of communication and differences in cultures.

Let’s talk about the concerns raised. There are three questions that come up most often: Are these vaccines safe? Are they effective? Are these vaccines worse than the actual disease? These are all reasonable questions. My goal is to provide some information that may be useful in answering these questions and helping you make a decision about the COVID-19 vaccine.

COVID-19 vaccine safety

The question about safety gravitates around the technology, speed and evaluation process. One of the most common questions revolves around the messenger-RNA (m-RNA) technology and this application. The early m-RNA research goes back to the 1970s, but it wasn’t until the ’90s that progress was made. M-RNA vaccines for rabies, influenza, cytomegalovirus and Zika have been tested in humans before. But it was not until now that there was a sense of urgency matched with the unlimited resources, allowing for the m-RNA sequences to be completed quickly. These vaccines do not contain the virus, thus you cannot get the disease from the inoculation. Additionally, the synthetic m-RNA works in the cell cytoplasm, not in the nucleus of the cell where the DNA resides. Thus, there is no evidence that it can alter your DNA. In addition, both the m-RNA and the viral vector vaccines went through the same rigorous clinical trial process that involved tens of thousands of people in many countries. No steps were omitted, and no short cuts taken.

COVID-19 vaccine effectiveness

The effectiveness of the vaccines is determined initially in the clinical trials process where the efficacy in a controlled environment is calculated. This is followed by the real-world effectiveness, which by now includes more than 250 million doses just in the U.S. The fact is these vaccines are almost 100% effective in preventing severe disease and mortality. In addition, they significantly decrease the potential of transmission.

COVID-19 vaccine side effects

Most if not all drugs have expected and unexpected side effects. The former are usually identified in the clinical trials; the latter are reported after long-term use. For vaccines, the main side effects are attributable to reactogenicity, defined as the physical manifestation of the inflammatory response to the vaccination. These include pain, redness and swelling at the injection site, fever, muscle aches, tiredness or general malaise. These are all due to the body’s immune reaction, which goes into overdrive after the second shot of the two-dose vaccines.

I personally experienced a fever and muscle aches after my second dose for about 24 hours. All these symptoms typically subside on their own within one to three days. Extremely rare side effects such as severe allergic reactions and a rare clotting syndrome with low platelets have been associated to at least two vaccine types. Compare these side effects to the long-term symptoms, hospitalization and mortality rate of COVID-19, and the side effects are vastly outweighed by the benefits of the immunization.

There is a significant amount of information about all the COVID-19 vaccines available. All data, including the clinical trials data, the reviews performed by the U.S. Food and Drug Administration and others, are also available. This speaks to the transparency of the process. Frankly, I read as much of the information available as I could before I had my first shot, and more important, before I recommended it to family and friends. The bottom line for me was not only my health and safety but that of my family, friends and community. If you are not sure yet about getting one of the vaccines, ask questions, research using reliable resources, and talk to your provider. I am sure you will find all the information you need to make the right decision for you and your family.

Vaccines are the tools that will allow us to move forward, open business, visit entertainment venues and have gatherings. Ultimately, this is something that most of us can do right now to return to a more normal life.

Francisco R. Velázquez, M.D., S.M., F.C.A.P., is the interim health officer for the Spokane Regional Health District.