This is an interview I did with Daniel Seiser, a PharmD/MBA Pharmacist-In-Charge, and an immunizing pharmacist in the north western United States. Daniel is also my cousin, and one of the most intelligent people I know, so I thought I'd ask him to help clarify the myriad of concerns surrounding a potential vaccine for Covid-19. I think you'll find his information helpful in the coming months as a vaccine becomes available.
1. There has been a lot of discussion about a coronavirus vaccine, and that it will be available for mass-distribution soon. What would creating a vaccine in a short amount of time involve, from a production standpoint?
So to produce an effective vaccine it really is just a matter of real estate. First they need a lot of petri dishes to allow the replication of virus in a controlled environment to be able to produce testing that shows what level of chemical manipulation might be necessary to get viral protein antigens to make antibodies. The more they have to do to the virus to get it to set off the antibody alarms for the white blood cells, the longer it will take to have an effective vaccine. I think they might have gotten this part of the investigation done for now. Of note, knowledge about other corona viruses has also helped even though there are still no vaccines for SARS and MERS yet either. However, they now look at what makes Covid-19 unique and there is a protein that literally sticks out on the viral capsid. Soon much more real estate will be needed for mass production of vaccine, but that is a simple long established process compared with safety trials.
2. What are the potential risk factors for getting any vaccine that has been pushed to market in such a short time?
The biggest problem with a rushed vaccine is that it might not be specific enough to stop infection within diverse populations of people, but they'll put something on the market anyway. For years we had one shingles vaccine. People kept having rebound shingles because some virus always stays dormant in our bodies since the time when some of us had chicken pox. Now we have one that is ten times more effective. So it is what it is because there is a high demand to have anything as a vaccine in the beginning, and later to have something that actually works well. It is currently not known if people getting Covid twice are rebound infections that their immune system didn't finish off or if reinfection is the culprit.
Next, the much needed safety trials are the rate limiting step that we wade through. It could keep sending them back to square one, but so far so good. There are now supposed to be dozens of Covid vaccine candidates. The amount of these could either point to different numbered generations of weakened virus inside chicken embryos or inactivated virus taken through different chemical processes. There is more sophisticated genetic manipulation that they will consider later. Live weakened virus would have the most risk of causing active illness, but even inactivated virus could spawn sensitivities in different organ systems such as the lungs, which has been seen in some now discarded options resulting from Covid vaccine animal trials. Human trials are underway to screen for problems in probably both live and inactivated virus. They also use adjuvants in vaccines which are added as preservatives and facilitate better absorption and immune response. That complicates the issue by causing possible inflammation and fever known as pyrexia. They do know when too much is too much for most people, but they might not be as picky about the adjuvant load if those trials were on the more effective side of preventing Covid.
3. Are there those who shouldn't get the vaccine, and why?
People who have weaker immune systems shouldn't get a live vaccine. People who are allergic to eggs or people who have bad reactions to vaccines or the adjuvants should wait until they know the specifics and hold out for the safest option for them. It's my opinion that healthy and young individuals decide for themselves whether the time is right for them, and it will likely be fine either way. Either way provides benefits and risks under the related uncertainties.
4. In your opinion, do people need the coronavirus vaccine? What about those who've already had coronavirus?
People need a vaccine primarily in the elderly population. We'd say that the benefits of almost any vaccine would be acceptable over the virus, but inactivated vaccine should be the priority for safety. Then healthcare workers will probably have it mandated through their work places. That might give some protection to them and their contacts with older individuals.
There's a lot of speculation about people who've already had Covid. It will probably be recommended in elderly and a mandated vaccine for healthcare workers including ones that have already had it since some people have had Covid twice. A vaccine offers the potential of a higher immune response without the toxic effects of an active infection.
5. What are potential side-effects of the vaccine, in your educated opinion, since it's still in production and there are a lot of unknowns?
It'll be the same with any vaccine, which runs the whole spectrum. Typically there are injection site reactions, sore arms, and opportunistic cold virus. And the less common more serious side effects which could include swollen lymph nodes, fever and even some cases of anaphylaxis.
6. Do you think the virus will mutate, as most viruses do, and how will that impact the efficiency rate of the vaccine?
They have said that it mutates, but it doesn't mutate as fast as the the flu. Some scientists are regretting putting out there that it mutates at an "alarming rate." It's a relative thing. Clinical significance of any mutation creating a brand new threat is a much lower probability. Flu has been easy to make new vaccines on a yearly basis, but more or less predictable because those mutations come from such a broad genetic background in multiple virus types. Because of the experience with other flu types, the swine flu vaccine was simply added into the flu shot as one of the more virulent types to protect against. The swine flu was a common type of flu that mutated for a time in animals before it went back to human beings. The coronavirus will mutate, but a vaccine could still be effective for many variants of this new bug.
7. Discuss 'herd immunity.' Do you think herd immunity is possible with a coronavirus vaccine? Why or why not?
A well tested, well used vaccine can lead to herd immunity. Or imagine if the vaccine doesn't prove effective it will lead to faster herd immunity, but more loss of life would unfortunately be a part of it. Swine flu was an easy target for vaccine years ago and now there is substantial herd immunity that suggests even though it also mutates, many people around us are used to what is being spread either by getting vaccinated or surviving a sickness with it. At the stage we are at with Covid, it would be easier with the live vaccine to achieve herd immunity because it presents a stronger threat through deliberate exposure, that the immune system can detect, but inactivated virus will be safer after the matter of perfecting it. Other vaccines based on viral genetic manipulation will eventually out do these efforts.
8. Do you plan to get the vaccine? Do you think your children should have it?
I don't want the vaccine yet. It could be mandated by my employer. I would rather have an actual exposure to the real virus. That's what my immune system is meant for. Or they can give me live attenuated Covid-19 vaccine as the next most simply done option. I think I take good care of my physiology. For someone who is exposed to a lot of sick people, the sickness comes and then it comes less and less often. And I know how not to spread virus at my work place. Of course, if I come down with Covid-19 I will self quarantine.
My children will not be getting the vaccine. I will fight any mandate for them to get it. Children are more resilient to this exotic bug. Children face bigger consequences from certain potent vaccines with their adjuvants. I'm sure they would be fine in either case. I'm not an anti-vaxxer. They've had many other vaccines. We don't think about the yearly flu vaccine for them yet. That's a take it or leave it vaccine. They will not be getting the HPV vaccine and they won't be getting the Covid-19 vaccine. I reserve the right to have modern medicine tailored to their needs as children.
For someone else who would be afraid of this exotic strain, they should get the vaccine and have that feeling that science has given them all the protection they need. Even if it turns out not to be a perfect vaccine. The availability of a vaccine and idea of herd immunity will fix public perception that any kind of extinction event is upon us. I wouldn't support a mandate. They can't mandate vitamins, diet, and exercise either because those are about lifestyle. But sometimes the lifestyle is more important than the magic bullet.
I'm the pharmacist that actually tells patients that right after getting a flu shot or any shot, you have an increased chance of getting a cold. Maybe even a bad cold. It's not the flu though. Because the flu is more virulent, it peaks and then it has to finish its business. What's in all of my shots is dead dead flu virus. But cold viruses hide in the body for a long time. Maybe up to a year. When the immune system gets irritated by a vaccine, then it sort of flushes out a cold virus that we were unaware was in our lymphatic system. It also happens when the throat area gets chilled for extended periods of time in the colder wintering regions of the country. Lymphatic areas in the neck expand and contract with their blood supplies. Then the whole country gets sick with a flu epidemic as individuals travel. There are no studies of this phenomenon and there never will be.
Okay, so here's my prediction. The medical professions will embrace the first vaccine based on human trials. There won't be a widespread mandate because groups that flaunt their influence will wait to see how results fit their own interests. There will be benefits with the vaccine, but it won't offer complete protection. The media will inflate the failures of the vaccine with true tales of tragedy and make political statements. Many citizens will still support shut downs and many will say, okay but if it helps most of the people then let's move on. Most importantly, healthcare professionals will be given back jurisdiction over this dilemma. I think more people will be ready to move on.
