Today, Explained - “My friend” has a question about the vaccine

Episode Date: April 2, 2021

We asked if you still had vaccine questions, and you did. We found answers. Transcript at vox.com/todayexplained. Learn more about your ad choices. Visit megaphone.fm/adchoices Learn more about your ad choices. Visit podcastchoices.com/adchoices

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Visit connectsontario.ca. It's Today Explained. I'm Sean Ramos for I was talking to a friend recently who expressed some concerns about the vaccine. He was worried about mRNA technology, said he'd personally prefer to get a vaccine that didn't use it. And that got me thinking, what are other questions people have about these shots? Not like the anti-vaxxers who are worried about 5G or Bill Gates, but people with real legitimate concerns about the science. So we reached out to you, listeners, and asked, and you answered with your questions. We got a ton of questions from you that we haven't really addressed in great detail on the show before. So that is what we are going to do today with help from Dr. Deborah Fuller. I'm a professor in the Department of Microbiology at the University of Washington

School of Medicine. Dr. Fuller has spent decades studying the kinds of vaccines we're now using to fight COVID. One of the things that a lot of people don't realize is they think that mRNA vaccines just suddenly appeared as a brand new vaccine when COVID-19 started. But there has been research going on in this field for over 30 years. And I was one of those people 30 years ago

who first started working on the idea of putting a code into your cells and express a protein that was stimulating immune response. So you're basically the perfect person to tackle a wide range of questions about all these different vaccines. Are you game? I am totally game. Absolutely. Let's give it a shot. Okay. My buddy was too shy to call our voicemail line and admit that he's scared of mRNA, but this listener was not. adverse effect in my body in, say, 5, 20, 40, or 60 years, I feel like I'm being asked to trust something that does not have published long-term medical research behind it, which is going to leave my future self at an unknown risk. What would you say to people like Jared?

Let's just start out in general with vaccines. The idea that they're going to cause some sort of issue 5, 10 years from now, that just doesn't happen. That's not how vaccines work. They get in, they do their job, they go away. The only thing a vaccine does is stimulate an immune response. And then when you get exposed to a pathogen, that immune response is going to act on it and get rid of that pathogen. So they do a very focused, directed immune response. And once they get inside your cell and they instruct your cell to do that, they disintegrate. Our body deals with mRNA all the time. We eat it, we're exposed to it, it's in our environment, and it knows what to do with mRNA. So it's not something new that your body really hasn't seen before. There's natural mRNA everywhere in our environment. And this

synthetic mRNA vaccine that we make in the lab really just mimics that. The next sort of bucket of questions we probably had the largest number of related to pregnancies. Here's a listener from Georgia. I have actually gotten the first dose of vaccine and I'm comfortable with it, but I have a friend who is really concerned that it will affect her fertility. What can I tell her and how can I approach it with her in a way that will actually encourage her to get the vaccine? Oh, this is a conspiracy theory. And this is the sort of stuff that just really makes me mad that this kind of information gets out there. But basically, this conspiracy theory got started by somebody's blog,

and I don't know who it was. People still read blogs? Or somebody's Twitter. Who knows? I don't even remember. But let me tell you a little bit about where that got started. There is a small protein in our bodies. It's called syncytin, and it's in our placenta. A small portion of the sequence of that protein is in the spike protein of SARS-CoV-2. We use a spike protein in our vaccines, right? Yeah. So somebody got the idea that, well, because there's some sort of similarity between those, if you induce an immune response, you're going to make an immune response against your placenta,

and that's going to make you infertile. Well, that's just ridiculous. So basically, there is very little similarity between the protein that's in the virus, the spike protein, and the protein that's in our placenta. And that degree of similarity is not enough to be able to stimulate an immune response. Okay. And it all kind of is absurd anyway, because if you think about it, natural infection with SARS-CoV-2, it also has spike protein. So if we were going to be making immune responses against the spike protein that are going to make us infertile, you'd start to see COVID-19 causing infertility. We're not seeing that. We're not seeing massive miscarriages. We're not seeing infertility. So you can just look around yourself

and actually see that this sort of concept is really bogus. Well, we don't want you mad right now. So we'll move on from conspiracy theories and maybe move towards something that is founded in fact, which is just that these early vaccine trials were not conducted on pregnant women. That is a fact, right? That is true. They were not, women were not deliberately enrolled. They are being tested right now. Yes.

With that said, the vaccines, the phase three trials enrolled 30 to 40,000 people. And when you have that many people in a clinical trial and you have both men and women, you're going to have women that get pregnant during the course of this trial. And they did. They had a number of women who got pregnant during the course of the trial. And at the end of the trial, they reported nothing to report on. Basically, pregnant women made good immune responses to the vaccine and there were no increases in adverse events or risks or anything that they could make note of. All these women got pregnant just fine and had babies just fine.

And there are a lot of listeners out there and friends. I mean, I've heard from a good friend of mine that, you know, she's a little nervous about the vaccine because she is currently pregnant. And what we've been hearing from scientists like yourself is that, you know, you should consult with your doctor. Is the vaccine safe for pregnant women? I mean, do we have a definitive answer at this point as to whether the vaccine is certainly safe for pregnant women? Until we actually have completed those clinical trials, we can't go out there and report it's

absolutely safe. We're going to have to compare the numbers. But with that said, there are thousands of pregnant women who have taken the vaccine. Here's the reason why. First of all, as I said, there's no evidence that the vaccine is unsafe in pregnant women for the women or for their fetus. What we do know, though, is that pregnant women are at higher risk for severe complications with COVID-19. So if you weigh things in balance and you look at, hey, here's a vaccine, there's absolutely no evidence that there's any risk associated for me or for my fetus in taking the vaccine, but we do know that they are at higher risk for severe complication of COVID-19.

You weigh that in balance, by far the greater risk is not to take the vaccine and leave yourself vulnerable to getting COVID-19. Okay, so we've covered people who maybe want to be pregnant one day. We've covered women who are pregnant. Let's talk a bit about people who have recently had a child. Here's Claire. Hi, Today Explained. I am currently a breastfeeding mother and I would love to get the vaccine, but I'm scared of the long-term consequences. I definitely believe in science. I'm definitely a big fan of not getting COVID, but I'm just hesitant because of the lack of long-term study. So breastfeeding with the vaccine, good, bad?

Good, I would say definitely good. So they are studying in these clinical trials, they are looking at whether or not when these pregnant women make antibodies to protect themselves, can they transmit antibodies that would protect their baby? As you know, when you nurse your baby, you are transferring immunity to your baby. Let's say you got the flu vaccine. You make antibodies against flu. Those antibodies are transferred to your baby and

they're able to protect your baby from flu. I know I nursed for like 10 months. The minute I stopped nursing, my baby started getting sick. So nursing actually is very important way of protecting your baby from infectious diseases that they would otherwise be vulnerable to because they're not old enough to get vaccines yet. So, but you are, and so you can transfer that immunity to your baby. They are finding that when pregnant women generate antibodies against the COVID-19 vaccine, they also have that in their breast milk. Now, we don't know whether it's enough to transfer sufficient immunity to the baby, but this is really promising and exciting news that if you're nursing and you get the vaccine, that you will

also be able to protect your baby. Okay, moving on from the babies for a bit here. Lots of people who called or emailed had questions about whether it was safe for them or loved ones to get the vaccine if they had a chronic disease. Here's one of those. Hi, my name is Jamel from Austin, Texas. Me and my wife are fully vaccinated, but her parents both have diabetes and are hesitant about getting the vaccine. Any advice for them? Thanks. Diabetes is a risk factor for COVID-19, as well as many other sorts of comorbidities,

like if you're immune compromised and the like. You are at higher risk for getting severe disease if you get COVID-19. So the recommendation is that you get your vaccine. They have found that people with comorbidities like diabetes and others, they don't develop any more adverse events for the vaccine or reactions to the vaccine than the general population. As we mentioned, the risk of getting those is modest. So it's really important for people with comorbidities to get out there, get the vaccine and build up their immunities so that they can be safer.

But like specifically with autoimmune disorders, we know the vaccine works by activating your immune system against COVID. Are there any reasons to be particularly worried if you have an autoimmune disorder? Oh, this is a great question. This is a question my sister-in-law actually posed to me about a week or a couple of weeks ago where she has an autoimmune disease and she's taking medications to dampen that immune response. Because when you have an autoimmune

disease, you're making heightened immune responses against your own body, basically. And so if you take a vaccine, that triggers enhanced immune response. The big question is that, is that going to make my autoimmune disease worse? Should I, the other question I always get is, should I stop taking my steroids or whatever I'm taking to dampen my immune response before I take the vaccine? You should go ahead and take the vaccines. There are a lot of people who have autoimmune disorders, have to date received the vaccine, and to date there's no evidence that there's any problems associated with that. So it's important to take the vaccine. It's also important not to stop your medications. You're taking those medications for a reason.

If you have a chronic disease that you continue to take your medications and not worry about that interacting or interfering with the vaccine. Here's one that's a little lighter, but I think just as serious for Nicholas from Pennsylvania, who writes that needles give me the creeps. Once that needle is in my arm, I already begin to pass out. And I can empathize with Nicholas. I've had some very bad experiences giving blood. Any advice for Nicholas from Pennsylvania?

One of the things that I have to say is that the needle is very thin, okay? So it's about as innocuous needle as possible. So they're doing their best for people like that who have needle aversions. But I totally get that. And there's a lot of people who feel the same way. In fact, my lab, we're actually developing a new technology that is a needle-free delivery of vaccines. It's not going to come out this year. It might be a year or two from now. People who have aversions to needles, we're going to be able to offer a needle-free option. And I don't know if you've seen this video,

Debra, of this doctor who's vaccinating a small child, maybe even a baby, and he's just like, boop, boop, boop, and he keeps poking the baby's skin and then all of a sudden he gives the baby the shot and the baby doesn't even know and it's just laughing. Dee-da-lee-dee-da-lee-da. Dee-da-lee-dee-da-lee-da.

Dee-da-lee-dee-da-lee-da. Dee-da-lee-dee-da-lee-da. Maybe Nicholas just needs to find himself a doctor like that Yeah, go to a pediatrician Absolutely find himself a doctor like that. Yeah, go to a pediatrician. Absolutely. More of your vaccine questions in a minute on Today Explained. Thank you. back in your pocket. Ramp says they give finance teams unprecedented control and insight into company spend. With Ramp, you're able to issue cards to every employee with limits and restrictions and automate expense reporting so you can stop wasting time at the end of every month. And now you can get $250 when you join Ramp. You can go to ramp.com slash explained,

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Dr. Fuller, I'm old enough to remember when there were just two vaccines in the United States. Now it's three, four might be around the corner. We had a listener who was wondering if she could mix and match. Hi, today's Blink and Shazib. I can get a vaccine shot from Pfizer and Moderna. And is that safe? And is it safe to mix vaccine that is made of different kinds of technology, like AstraZeneca and Pfizer, for example? Mixing brands, what do you think? Oh, what a great question. Yeah, we don't know yet how they actually work together. So obviously, the clinical trials were done with one vaccine, right? So that's what we know in terms of what's effective and what's safe is based in the clinical trials. With that said, if we look historically, we have traditionally mixed vaccines in the past. We've had, for example, two different polio vaccines, an inactivated and a live attenuated vaccine.

And what happens kind of naturally in the population when you have multiple vaccines out there at the same time is that you can get a mixing of them. And today we don't have any evidence that mixing them is a problem at all. In fact, in my lab, we're doing preclinical testing on mixing vaccines and actually finding that they work very well together. So the expectation is that it shouldn't be a problem. If you happen to go back in later on, let's say, and this is a big important question because we may end up finding that with the emergence of some new SARS-CoV-2 variants that there might be a recommendation. You go back and you get a booster shot. You might go back and be offered a number of different

sorts of vaccines. By then, we will know how well different sorts of vaccines mix and match, and so to speak. But right now, it's important to understand that the recommendation is that you take the vaccine and the booster dose should be the same simply because that's what was tested in the clinical trial and that's what we know. But later on, we're going to have choices and there's going to be sort of a natural tendency for people to start to mix vaccines is my expectation. There's also this very real possibility that people will only get one shot. They'll get one shot. They'll forget to get the second one. They'll miss an appointment, something like that. How dangerous or advisable is it to get one of two shots if that's,

you know, all you have time for, if that's all you can muster? Yeah, we're entering in a zone of we don't know yet. Okay, so one of the big questions we don't know yet is how durable is the immunity? So let me tell you what we do know. We do know that the single shot, for example, the J&J vaccine, we do know that's very effective as a single shot, but they're also studying a single shot

with the mRNA vaccines. And they're finding that they're pretty effective after a single shot. But here's the caveat. For those particular studies, they only study them for a very short period of time after that first shot. So even though you may have, for example, I think that the study showed 80% efficacy even after the first shot with an mRNA vaccine, we don't know how long that efficacy persists because what happens after a first shot is you induce generally a pretty good immune response, but it's generally going

to be lower than the immune response you get after the second immunization. So with the lower immune response that comes up, we don't know how long that's going to persist. High enough to protect you, but it may not persist as long. And so the second shot brings the immunity up higher and that will theoretically allow the immune response to last longer. While we're on this sort of menu of vaccines

that are now available and maybe additional ones that'll be available down the line, it sounds like the AstraZeneca vaccine has gotten a little bit of bad press. So here's a question from my guy, David, from my hometown of Toronto, Canada. Hi, I was just kind of curious about all of this blood clotting issues with the AstraZeneca vaccine. And here in Canada, we've been told that people under the age of 55 can't get it,

but those over 55 can. It's being distributed. I don't know, it just seems confusing and weird and just would love to have that cleared up. What is up with AstraZeneca? AstraZeneca is an interesting case. First, let me just point out that the science shows that this is a very good vaccine, but it's had its ups and downs in terms of its development, in terms of its distribution release and the like. And so it's just kind of like one piece of news after another that has plagued this poor vaccine. So one of the things that did come out

is this question about blood clots. And so what's important to understand is that adverse events can occur after vaccination, but association is not causation. In other words, just because there's a blood clot after a vaccination doesn't necessarily mean the vaccine caused that. When an adverse event does occur, they are investigated intensely to determine if the

vaccine could be the cause. And so with regard to blood clots, what they ended up doing was compare the adverse event in the group of people who get vaccinated, and they compare that to how many blood clots are you getting in the unvaccinated people. And they didn't see any difference. Okay. In fact, they actually saw fewer blood clots among the vaccinated and they ended up concluding that these blood clots are not due to the vaccination. But of course the news gets out there and that's how it raises everybody's concern about that. So we just have to remember that the research continues to happen. We see any adverse events or rare events associated with a vaccine is going to be studied. But there are a lot of

different people. We have underlying conditions that, you know, could pop up after you've been vaccinated. It doesn't necessarily mean that the vaccine itself caused that. Okay. And while we're on the subject here of just all of the different vaccines, here's a question from Matt in Los Angeles who has gotten one of them. Less of a hesitancy question and more of an efficacy question. I just got the second Moderna shot and I had almost no side effects, whereas some of my friends and colleagues were pretty knocked out in a funny little way. I was kind of jealous of them because I'm like, do they have better antibodies for me? Did I just waste my time?

Am I protected? Please help. I love this question. Yeah, this is a great question. So we have to remember that we are all different. Our immune system responds differently or we feel our immune response differently than others. And to my knowledge, nobody has identified a direct correlation between the level of reactogenicity you get for a vaccine and whether or not you get an immune response. So we look in some of the reported data from the clinical trials, you can see quite a spectrum in terms of reactogenicity to the vaccine from absolutely no reactogenicity to high levels. I know, like, for example, my family, when my family gets sick, and they're all boys in my family, and they never feel anything. But boy, when I get that infection, I'm just, you know,

down for the count. And so it's the same way, you know, how people respond differently to getting exposed to various infections. It's just your immune system operates a little bit differently. But that doesn't mean that you're any less immune than somebody who had a greater reaction. Okay, and a final question from Colorado. Hi, my name is Kevin. Recently, I heard from a colleague saying that he didn't want to get vaccinated because he believed that nature should just take its course. And I'm wondering if you could address the idea of potentially getting to herd immunity as an individual without using a vaccine for a disease like the coronavirus. I'm sure this just feels like a violation of your entire life's work, this question.

No, but this is an important question because there's a lot of people who feel like this, and they're all people who are on the fence. And there are really two reasons that I tell them that are important to think about when you're deciding to take a vaccine. And one is a selfish one. One's very personal. One is actually more of a community one. And so the selfish personal reason is this. Okay. COVID-19 is a disease you do not want to get. Okay, we are still studying this disease. We don't know what its effects are long-term. We know that it can impact the heart. We know that it can impact the kidneys.

There are people, as you probably heard, who are getting sort of this long COVID issue where they have difficulty breathing long-term, even long after the virus has left their body. And you don't know if you're going to fall in that bucket of people who might have long-term, even long after the virus has left their body. And you don't know if you're going to fall in that bucket of people who might have long-term effects because of COVID-19. So for just a very selfish reason, for your own protection, the vaccine is going to prevent that. It's going to prevent the risk of you actually having some sort of long-term effects as a result of COVID-19 itself.

Okay. The second reason is more of an altruistic reason. But the reality is, is that even people who are not at risk for severe disease, who get a myoform or even asymptomatic can spread that virus. And you can spread that virus to a lot of people who are much more vulnerable than you to getting the severe disease. And so the idea is that with vaccination, that we're going to be able to induce a widespread immunity in your community. So you're protecting not just yourself, but you're protecting your

neighbors, your friends, and the vulnerable people that are down the street from you. Vaccination in its core is really a public health thing. Okay, it is about you to some extent, but in a bigger picture sense, it's about all of us. We need to think about getting this pandemic under control as a team, as a community, as a nation, as a world. And the only way to do that is to get as many people coming forward and getting vaccinated as possible. Yeah.

I mean, it just feels like, you know, all told, if you're thinking about where we were a year ago with this being the long shot of all long shots, it feels like we're very lucky and fortunate and indebted to science that we're here right now, that we're here asking you questions about four, five, six different vaccines and asking you questions about all these different effects they may have on us because we have the science. We have these shots to go around right now. Yeah, this is such an exciting time for as a vaccinologist to be living through this and actually seeing just the culmination of years and years of work. I would have never imagined this was possible, you know, over a year ago and before COVID-19

struck. And now we see what is possible. We can anticipate that future pandemics that we're going to get a much better grip and quicker grip on them. Well, I want to thank all of our listeners for their questions. And thank you, Debra, so much for taking the time to answer them and for all of your work. My pleasure. Dr. Debra Fuller, she's a vaccinologist, a microbiologist, and a qualified answerologist, as far as I'm concerned.

She's also a professor at the University of Washington School of Medicine. Go Huskies. Today Explained is a product of the Vox Media Podcast Network. The team includes Will Reed, Muj Zaydi, Halima Shah, Cecile Yalay, and our engineer, Afim Shapiro. Facts checked by Laura Bullard.

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