By Dave Ongie
Monday, April 5 was a red-letter day in the state of Tennessee as the COVID-19 vaccines became available to everyone 16 years and older. With over a million Tennesseans already vaccinated – the vast majority of them 65 and older – the eyes of medical professionals and health experts now turn toward younger folks who have previously been unable to get one of the three vaccines that have received emergency approval by the Food and Drug Administration.
It stands to reason that those most at risk of dying of COVID-19 were eager to get the vaccine. According to the CDC’s vaccination tracker, around 73 percent of people ages 65 and over had received at least one shot as of last Friday. But the quest for herd immunity will depend greatly on young people, and that has some medical professionals concerned.
Dr. David Moulton, director of quality at State of Franklin Healthcare Associates, pulled up the CDC site on his cellphone last Friday and started to do some quick math. As of now, 38 percent of individuals between the ages of 18 and 64 have received at least one dose of the vaccine, leaving roughly 200 million who are now facing a choice that will greatly impact our ability to reach herd immunity.
“So we’re really highly at risk right now with this age group that seems apathetic,” Moulton said.
Dr. David Morin, director of research at Holston Medical Group, is picking up that same sense of apathy, and he isn’t just finding it among young people who are just now getting the opportunity to get vaccinated. Morin sees primarily older patients, and they also have concerns about the vaccines.
“I’m not seeing a tremendous amount of enthusiasm among individuals for the vaccine,” he said. “My impression when I talk to people is there’s skepticism. I still see some individuals who are involved in the healthcare profession who have questions about it.”
Morin understands people may have reservations about taking the new vaccines and says they have the right to determine what they put into their bodies. All he asks is that patients examine what their specific concerns are and go to trusted sources like the CDC website or their medical provider to address those concerns.
“Your decision to not get the vaccine may be based on information that’s flawed in some way,” Morin said. “In any case, it could end up costing your life or costing the life of somebody you care about.”
The flurry of misinformation that can be found on social media is particularly frustrating to Morin, who was one of the leads on a clinical trial for the Pfizer vaccine that was conducted in our region last summer. Morin was part of a team that put in countless hours to test the Pfizer vaccine on hundreds of volunteers. He witnessed the meticulous process of testing the vaccine, which was governed by some of the strictest regulatory bodies in the world, including the FDA.
“I hate to think that process, which is so heavily governed with so many experts involved, is trusted less than a social media post,” Morin said. “It tells me we still have work to do with what we do to make sure people can trust this process.”
With that in mind, Morin, Moulton and other medical professionals from our region weighed in to address some common reasons younger people may have for not receiving the COVID-19 vaccine.
The speed at which the COVID-19 vaccines were developed was unprecedented. The novel coronavirus didn’t even reach the shores of the United States until early last year, but the vaccines developed by Pfizer and Moderna were already being administered before the year was out.
Needless to say, some folks are hesitant to get vaccinated because they’re afraid corners were cut in order to get the vaccines to market so quickly. Instead, Morin said advances in technology coupled with unprecedented cooperation between the federal government, the medical community and competing pharmaceutical companies allowed the vaccines to be developed so quickly without sacrificing quality.
“Primarily what was shortened was identification and development of initial vaccine candidates,” he said. “Whereas it might have taken months or years to develop that, they were able to start to do that by computer modeling and start to use this technology called messenger RNA (mRNA) technology which was actually first postulated for vaccine development back in 1999.”
Dr. Andrea Long, a clinical pharmacist at SoFHA, said an eager pool of volunteers also helped complete the trial phases in record time.
“With a normal disease that is not as urgent, it may take a company a long time to recruit enough patients to have a robust trial,” Long said. “But in the setting of a pandemic where everyone is desperate for a treatment, you can meet those numbers. Yes, it’s a condensed timeline, but the actual study itself was not half done. There were no shortcuts.”
What’s the hurry?
Given the concern about the speed of vaccine development, there might be a natural inclination among younger folks to wait to get the vaccine until more data is gathered on the safety of COVID-19 vaccines. After all, the risk of adverse reactions among those in their 20s and 30s is almost negligible without comorbidities, and any potential long-term risks associated with the vaccines are unknown.
“The question there is, instead of a 12 percent risk of complications (with COVID-19), you’re at about half a percentage point,” Moulton said. “How do you get to them?”
Dr. Whitney Aultman, a clinical pharmacist at SoFHA, said the outcomes experienced by patients in our area should be enough to get everyone’s attention even if they aren’t likely to die of COVID-19.
“The aftereffects we’ve seen from the disease, the long-term disability of patients – I’ve seen new-onset uncontrolled diabetes, a patient come out with clots in both of his lungs, cognitive effects they’ve found from having the active disease – that’s the part I think is scary,” Aultman said. “You won’t die, but you’ll have all of these complications.”
While younger folks may feel like they have all the time in the world to make up their mind about getting vaccinated, Moulton and other medical professionals are concerned the clock might be counting down on our window to achieve herd immunity. Variants of the virus are already popping up, and the fear is a nastier version of the virus that isn’t covered by the current vaccines could put us back at square one.
“If we mess up and don’t get herd immunity, and don’t get rid of (COVID-19), the next (variants) that are coming, it starts the clock back at zero,” Moulton said. “All of us have to get totally revaccinated again.”
Morin said up until now, there have been two primary motivators for folks to get vaccinated. The first, obviously, is to protect yourself, which has been an easier sell among those in the older age brackets as well as among the population with medical conditions and comorbidities that make them more susceptible to dying of COVID-19.
The second is to protect others around you, such as family members, co-workers and folks you attend church with who may be at risk. But Morin said there is now a third reason, which ties in with Moulton’s concern that time is running out to reach herd immunity.
“If you don’t want to do it for yourself because you’re low risk, and you don’t have the mindset to do it for somebody else, you’ve got to also think about this third level that this virus could continue to mutate into something that becomes more dangerous, and we don’t want it to turn into something like that,” Morin said.
But I’ve already had COVID-19
For young folks who had COVID-19 last year, the call to get vaccinated might be falling on deaf ears because of the belief they have immunity to the virus moving forward.
According to Moulton, studies don’t offer conclusive proof that is the case. He cites one study that shows 80 percent of people who have been infected with COVID-19 have antibodies for up to three months. A second study out of Finland showed that those antibodies lasted in the majority of those people for up to eight months. The Finnish study also indicates antibodies are more likely to fade faster for those over 65.
While Moulton said more data is needed to know for sure, he added that someone who had the virus last year can boost their immunity for the next eight months by getting the Pfizer vaccine.
“Even though you’ve had COVID-19, the antibody level is dropping, and the coverage with the variants is in question,” he said.
Hands off my DNA
Both the Pfizer and Moderna vaccines rely on mRNA technology as the delivery mechanism for eliciting a response from the patient’s immune system. While Morin didn’t want to give voice to the misinformation about mRNA technology, a quick search online will turn up concerns about mRNA vaccines altering recipients’ DNA, causing infertility in women, autoimmune diseases or other health problems.
These fears are fueled by the notion that mRNA technology is being used on a wide scale for the first time, but Morin said the technology is actually 20 years old. With over 130 million doses administered, Morin said early returns have been promising when it comes to vaccine safety.
“Messenger RNA is really not brand new, but on this scale it is because we haven’t had a pandemic like this in recent memory,” he said.
With COVID-19 numbers beginning to inch up after a sustained decline in recent months, Ballad Health’s Jamie Swift said there is no time like the present for people of all ages to get vaccinated.
“The positive rate and the number of COVID cases in our region have increased over the last two weeks,” Swift said. “Now is the time to do this. Now is the time to get your vaccine.”