COVID-19 Vaccination Questions

I’ve been having a few discussions with people regarding the safety of the mRNA vaccines being used to vaccinate against COVID-19.  As the pandemic has worsened, the need to combat COVID-19, especially for those people who are particularly vulnerable to this virus, has resulted in rapid development and testing of new vaccines.  Are these vaccines safe?  It’s a fair question, and I’m willing to share my opinions on this subject.

First off, I want to be clear that I am not an anti-vaxxer.  I support the science behind vaccination and recognize that with our excessively large human population and the desire of people to travel globally, vaccination is the only real defense we have against pandemics.  However, I also support the right of freedom of choice – in this case, the right to choose whether or not to get vaccinated.  But … with great freedoms come great responsibilities, and the right to choose freely must be tempered with the responsibility to “harm none” through the outcomes of a personal choice.

There’s been a lot of concern in general about vaccines lately, and I think much of it comes from incomplete and distorted data.  Vaccines have been around for quite a while now, and there are a number of ways that they are made.

One of the earliest methods of making vaccines was to use live “attenuated” virus, and some vaccines today are still made this way.  This type of vaccine includes those for polio (oral vaccine), measles, mumps, rubella (MMR combined vaccine), varicella (chickenpox), influenza (nasal spray), rotavirus, smallpox, and yellow fever.  One of the problems with this type of vaccine is that the “attenuated” virus can revert to a form capable of causing disease.  Mutations that can occur when the vaccine virus replicates in the body may result in a more a virulent strain.  This is very unlikely, as the vaccine virus’s ability to replicate at all is limited; however, it can be an issue.  In particular, mutations are somewhat common with the oral polio vaccine (OPV), a live vaccine that is ingested instead of injected.  This vaccine virus can mutate into a virulent form which may result in rare cases of paralytic polio.  It is particularly this history that has instilled such fear about vaccination in people.

In 1953, Salk was the most well-known scientific name behind the oral polio vaccine.  Some others, working on live, attenuated polio vaccines, objected both to Salk’s public profile and to his killed-virus approach.  They argued that his vaccine would fail to produce long-term protection from polio and that dangers lurked in Salk’s choice of a virulent Type 1 (Mahoney) virus strain.  In 1955, an Idaho doctor reported a case of paralytic polio in a recently vaccinated girl.  Over the next few weeks, similar reports trickled in to local health authorities.  All involved a disturbing detail: paralysis began in the vaccinated arm, rather than in the legs as was more common.   It soon emerged that most of the cases of paralytic polio occurred in children inoculated with a vaccine produced by Cutter Laboratories in California.  The full review concluded that 11 people died from the vaccine and hundreds were paralyzed.  Though the cause of the disaster was never proven, it is likely that certain production methods (which, it turns out, did not follow Salk’s instructions) resulted in a failure to completely kill the Type 1 (Mahoney) poliovirus in the vaccine.

Interestingly enough, I recently had Brennan vaccinated, and one of the vaccines was a live “attenuated” nasal spray for kennel cough.  It clearly had not been sufficiently deactivated, and Brennan actually came down with a mild form of kennel cough which lasted for about a week.  Usually, when these vaccines do cause problems, the disease that is produced is milder than that caused by the “wild” type virus, with the major exception of the polio vaccine.

Other methods of making vaccines use viral components rather than intact virus particles.  The components in these vaccines can’t replicate at all, and they can’t revert to a more virulent form capable of causing disease. However, they tend to provide a shorter length of protection than live vaccines, and are more likely to require boosters to create long-term immunity.  mRNA vaccines are an example of one of these methodologies.  They cannot give someone COVID-19 and they do not use the live virus that causes COVID.  Although they are considered to be “genetically engineered”, they do not affect or interact with our DNA.  The mRNA contained in the vaccine does not enter the nuclei of our cells, which is where our DNA (genetic material) is kept.  In the cytoplasm of our cells, our mRNA “translation” system creates viral “spike” proteins, which are in themselves harmless.  However, our body recognizes them as foreign and produces antibodies that are directed towards them, and which are also effective against an intact COVID virus.  After translation, our cells break down and get rid of the mRNA.  The main concerns with these types of vaccines are efficiency (sometimes they don’t provide sufficient immunity) and the possibility of an allergic reaction to the components contained in the vaccine for the purpose of stabilizing and preserving the mRNA and making it injectable.  However, allergic reactions can occur towards any vaccine, although they are very rare.  People who are prone to severe allergic reactions need to be careful.

I think that most of the concerns that we are hearing about mRNA vaccines are the result of increased public awareness of a process that has been going on for many, many years.  All drugs being prescribed by our medical system constitute something of an “experiment” on people, as our drug research can never determine all the possible side effects, drug interactions, unique individual reactions, etc. that a particular drug can have.  That being said, I don’t think mRNA vaccines are any riskier than many of the other commonly prescribed drugs (including things like Aspirin).  Like anything, I think the choice to get vaccinated is a decision based on weighting the various risks – age, pre-existing conditions, remoteness to medical facilities, poverty, living in crowded conditions, etc.  However, I do believe that if someone chooses not to get vaccinated, they must take personal responsibility for ensuring that they do not transmit the virus to vulnerable individuals, and this may mean restrictions on their activities, wearing masks, physical distancing, etc.

Unfortunately, some people are taking advantage of the reasonable sense of caution that most people express in response to new, and possibly dangerous, situation by fear-mongering.  I just received an article, titled “Safety and Efficacy of mRNA Vaccines: Information With Which to Make an Informed Choice.” By Deborah Brakeley B.A. M.Ed (Counselling Psychology); Elizabeth Bastian M.D. BSc. MDCM.  The fact that it’s written by people with letters after their names makes the average reader think that it should be professionally and scientifically sound.  However, it is a good example of what I would call “pseudoscience”.  Nor do I suspect that this paper is the only example of this kind of material floating around in the “grey literature”.  While I wouldn’t say that everything in this paper is incorrect, it is definitely not telling the entire story either.  I would say that it is strongly biased towards encouraging people to reject or distrust mRNA vaccines.  I spent a while dissecting it, and discovered issues such as: (1) severe bias by providing only negative data (against vaccination), and not reporting newer positive statistics; (2) most references were news articles, not primary scientific literature; (3) references provided frequently did not support the paper’s statements, were misquoted, or any data supporting vaccination was not included; (4) some of the reference links went nowhere, and the references weren’t given with proper author, date, title format so they could be traced when a link was broken.  Although the paper appears to be written by doctors (a psychologist and a surgeon, whose disciplines do not specialize in immunization science), I’m not sure how much faith I’d put in “doctors” opinions.  During my 3rd year at UBC, I was taking biochemistry along with all the pre-meds.  That situation left me with little respect for the medical profession.  Among other things, I was offered money to write exams for the pre-meds, as they had to take their MCAT exams in 3rd year.  Needless to say, I didn’t assist them in any way!  I have to admit, I’m not sure why the authors of this paper are trying to bias the public.  It makes me wonder what they are getting out of it all.

Being open-minded and willing to spend the time to do the research, I did look into a few of the concerns brought up by that paper that have been making it into the news:

    • Can the mRNA in the vaccine become incorporated into our DNA?

Only if there is an available source of reverse transcriptase, which is not present in the vaccine, and not normally present in human cells.  However, cells that have already been infected with a virus such as HIV, which does carry reverse transcriptase, might have the potential to incorporate the mRNA into the cell’s DNA.  The flip side to this is that people who have reverse transcriptase in their bodies from some other source can also incorporate the RNA from the COVID-19 virus, or any other RNA virus, into their DNA.  So … this risk, which is likely fairly small, is potential for both the vaccine and the virus, making the risk of incorporation the same for either one.

    • Do nanoparticles in the mRNA vaccine damage DNA?

The current mRNA vaccines are using polyethylene glycol as the nanoparticle material.  This substance does cause allergic reactions in some individuals (easily treated, which is why they ask people to remain at the clinic for 15 minutes in case they have an anaphylactic reaction; allergic reaction is a problem with all vaccines, not just mRNA vaccines).  The papers which have reported DNA damage from nanoparticles are largely identifying metal nanoparticles as the culprits, although I can see that more research is needed to specifically identify which nanoparticle materials are issues.  A small amount of DNA damage in a healthy person is quickly fixed by our DNA repair systems (the amount of injected vaccine is very small and is injected into muscle tissue).  The likelihood of cancer resulting from such a vaccination, even if it contained metal nanoparticles, is low, probably on the same order as getting an x-ray, which also has the potential to cause cancer.

So … there’s a bit of science.  I’m still willing to take my chances with the mRNA vaccine rather than catch COVID.  There have been only a few reported cases of issues with the vaccines to date, and most of them have been allergy related.  On the other hand, there is an increasing amount of data about the long term effects of COVID, especially on us older folks!

So, how do we balance freedom of choice with the needs of the larger community to develop some type of “herd immunity” against COVID without unnecessarily exposing vulnerable individuals to COVID?  That’s the question we really need to be asking.  Additionally, how do minimize the risks of vaccination?  If I could design a better system than what we are doing right now, it might look something like this:

    • First, test everyone for presence of antibodies to COVID. This test exists, but is not being developed or used to its full potential.
    • Assume, for the moment (this needs further confirmation through studies), that anyone with a sufficient level of antibodies to COVID, probably as a result of exposure to the virus, is at least as likely to be immune to further infection as anyone receiving the vaccination. However, we already know that some people who have received two shots of the vaccine and some people who have been previously infected with COVID are not completely protected from getting COVID a second time.
    • Don’t vaccinate people with a sufficient level of antibodies. This is a waste of vaccine that can be used to better purpose elsewhere, and any likelihood of triggering antibody-dependent enhancement is avoided.
    • People without sufficient levels of antibodies to COVID would be given the following options:
      • Take the vaccination unless contraindicated by a pre-existing condition. People who are in high risk categories or who live remotely or in crowded or poor living conditions should seriously consider taking the vaccination, as the risks for them of having serious complications from a COVID infection are much higher than the risks from the vaccine.
      • Don’t take the vaccination, either for fear that the risks of the vaccination are greater than catching the virus, or because of a pre-existing condition which increases the vaccination risk. However, these people would then be responsible for the situation in which they may become carriers of COVID and infect vulnerable people.  They would have the following further options:
        • For people in low risk categories, to purposefully expose themselves to the virus and wait out the infection period until they were no longer contagious.
        • Otherwise, to be required to maintain physical distancing, mask wearing, etc. until the risk of infection for vulnerable groups had been reduced to a tolerable level. This may mean being identified in some manner so that vulnerable people could avoid association with potential carriers.

On a personal note, we ended up getting our first vaccination March 23rd, much, much earlier that I had originally expected.  As it turned out, Island Health, our regional health authority, had decided to take a “Whole Community Approach” for communities where there was a small population, and there were barriers to accessing larger immunization clinics (i.e., requiring ferry, air or 3+ hours of ground travel).  Sayward was one of these communities, and our first clinic for people aged 18+ was on March 23rd.  I’m guessing that this sudden moving up of the vaccination schedule was due to a number of factors, including: (1) recognition of the costs and risks involved with medivaccing people with COVID out of remote areas, and there are a number of small remote clusters of people who commute into Sayward from the surrounding “islands”; (2) a local First Nations village in the Sayward area; (3) several logging camps in the area; and (4) the fact that Sayward is a “retirement” village with lots of seniors.  Anyways, the whole of Port Neville, all 5 of us and one dog, went to Sayward to get vaccinated.  I was pleasantly surprised by the process.  Everything was well organized and sanitary at the vaccination clinic, people were polite, wore masks, and kept their distance.  It turned out that they gave us Pfizer and not Oxford-AstraZeneca, as I had thought they might (the province had been using Oxford-AstraZeneca for “younger” people in high risk environments, although with the risk of blood clots in people under 55, this has now been suspended), quite likely because there was not a “young ‘un” in the crowd waiting to be vaccinated.  I think I was probably one of the youngest!

There were no significant side effects for either Ken or I.  We both had sore shoulders starting a few hours after the shot and lasting for a couple days.  We might have been a little tired the day after the shot, but that’s not terribly unusual after a long boat trip either, especially as we’d had a rather athletic launch, as we’d misjudged the tide height a bit for our departure time and had to push/pull the boat off its grid into the water.  I have a few stiff muscles from that!  Otherwise, the shot was not much worse than any of the flu shots I’ve taken in the past.

Adrian Raeside cartoon, Dec. 24, 2020, from the Times Colonist