Today, Explained - Your vaccine questions, answered

Episode Date: December 16, 2020

The Covid-19 vaccine is being distributed in the United States, and you have questions. Vox’s Umair Irfan has answers. Transcript at vox.com/todayexplained. 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-Firm. And today we had our second ever Today Explained live show. It was a Zoom, of course. Our opener was Dr. Anthony Fauci. We talked a bunch about the vaccine, but also about the very long and very busy year he's had. We're going to bring you that conversation next week in a series we're calling You, Me, and COVID-19. We'll be digging into how our pandemic year has changed just about everything. Stay tuned for that. After my conversation with Dr. Fauci today, I spoke with Vox science reporter Umair Irfan about the vaccine. He helped answer a whole host of questions our listeners and Vox community sent

in. And since the vaccine has now arrived in the United States, we thought we'd bring you that Q&A with Umair today. So, here it is. So, let's just start at the start. How is this vaccine different from all those that have come before? I mean, the one thing to highlight is the unprecedented speed at which we have developed this. I mean, vaccine development is something that typically takes decades. The fastest vaccine ever developed was the mumps vaccine. That took four years. This was a disease we only discovered last year around this time.

And now about a year later, we already have a vaccine that's starting to be distributed. So this is something that's unprecedented in terms of science. And the other big thing to highlight is that this is also using a completely new technology. Both the Pfizer BioNTech vaccine and the Moderna vaccines are using an approach, the mRNA-based genetic material. This is something that we've never tried on large scales in humans before. How does that work? Get us into the nitty gritty. I know you love that.

Sure. So if you imagine this is something like a virus or a coronavirus. I didn't know we had props. Oh yeah, visual aids. We're doing this on Zoom. Of course, we're going to use some visual aids. So the old-fashioned way of doing virus or vaccines was you would take the virus, weaken it, kill it, or snip off a piece of it and inject it into the body, right? And then your immune system would read that and then develop a

response. They would use it as sort of a punching bag to essentially prepare for when the virus actually invades. What these new generation of vaccines are doing is essentially prepare for when the virus actually invades. What these new generation of vaccines are doing is you don't need the virus at all. In fact, all you do is you start with the genetic material, the information used to code for how to make the virus. And you don't even need to know how to make the whole virus. You only need to know how to make a piece of it, like the spike proteins, right? And so with the coronavirus, the spike proteins are really important because that's what they use to break into cells. They're kind of like lockpicks. And so what a company like Moderna and Pfizer have done is they took the instructions

in RNA, and they basically inject those into the human body, into muscles. And then your own cells will read those instructions and then manufacture their own copies of those specific spike proteins. And then your immune system will use that as target practice. And so this is, again, something that we've never done before, but it's extremely fast. The first mRNA vaccines were developed within days of the genetic sequence of the coronavirus being released publicly. And then within two months, they were tested in the first humans. Yeah. Mayor, one of the most common questions we got, though, was around getting the vaccine. So could you break down who qualifies for a vaccine and when people might actually be able to get it? Well, let's start backwards and work towards where we are now. So ultimately, we want everybody to be vaccinated against this as much as possible, because this is a disease that can infect just

about everybody. So that's the ultimate goalpost, trying to get as close to saturation. But of course, we can't do that right away. And so the Centers for Disease Control, they convened an advisory committee, and they looked at where would these vaccines be most effective. And what they looked at were not just in terms of preventing deaths, but also in terms of preventing spread. So basically, people who are most likely to spread the virus to other people, if we can inoculate them, we can control transmission. And so they found out that those people are likely going to be health workers. So the first priority on the list are logically going to be health workers, but also people who live in long-term care facilities, older adults, and particularly the people that work around them. And so the idea is that these

people can act as sort of firebreaks against this inferno of a pandemic. The problem, though, is when you add up those people just in those high-risk groups, that's 24 million people, and we're not going to have 24 million doses right away. I mean, the Operation Warp Speed estimates that we'll have just about 20 million Americans inoculated by the end of December. And that's if everything goes perfectly well, which means that there will still be some people that'll have to wait. And so it really is going to vary from state to state and even from region to region. So different states and different hospitals have their own guidelines. Some of them are developing an algorithm which sorts out who is at highest risk. Some of them

are awarding vaccines based on a lottery system. And so really your odds of getting a vaccine or when you will get it really depends on your locale, your city, your state, how many vaccines they received and how effectively they're distributing them. Do we know what kind of health screenings will be involved before you go get it? Or is it kind of like getting a test where you mostly just show up? Well, there are some precautions that they want to take. Like with the rollout of this Pfizer BioNTech vaccine in the UK, we saw a couple of people who had some pretty severe allergic reactions. These were two health workers, and they knew they actually had a history of severe

allergic reactions. They carried EpiPens with them and they knew that this was a potential risk. And so the advice now is basically, if you are somebody who has the potential for getting severe allergic reactions, you have to use an EpiPen. You probably should hold off on getting these vaccines for a while. And there are other high risk groups as well that may have the option of not getting the vaccine. Basically people who have certain immunological conditions, also pregnant women. These were people that were not in clinical trials because you don't want to test an experimental drug on people that are already at very high risk. But on the other hand, they may still benefit from it. And so there's some discretion there in these people that they can decide whether or not to get the vaccine. But unfortunately, we don't really have good data one way or the other about how well it would work in those populations. Can you get COVID-19 between doses?

Yeah. So as you noted, these are two dose vaccines, both the Moderna vaccine and the Pfizer-BioNTech vaccine. And both of them are administered about several weeks apart. Last week, before Pfizer and BioNTech received their emergency use authorization from the FDA, they released some of their data showing their trial pool. And they showed that they had about 160-some people who got infected with COVID-19 in their placebo group and about nine people that got infected in the group that got the vaccine. But if you look at when they got infected, most of those nine people were infected just a few days after they received the first dose of the vaccine. So between the first and second dose. Building up an immune response is something that can take several days up to a

couple of weeks. And so it's likely that they were still vulnerable in that window where they were infected. Basically, the vaccine hadn't kicked in yet. and so they were able to get infected and get sick in that specific time frame you mentioned that most of the people got it between the two shots did people get it after the second shot yeah there were a couple people that i think were reported to have received the vac um to have come down with covet 19 with the illness after getting the second dose those will have to investigated further, but that's why we don't say this vaccine is, you know, 100% effective. 95% effective is still very high, but it also does mean that not every single person who gets the vaccine is ultimately going to have protection, which means we still have to take some precautions even after getting vaccinated. You mentioned that some things here still need to be investigated. We've had a lot of questions just about safety. How do we know what this thing might do to us in a year, in five years, because this thing hasn't been around for a year? What do we know about long-term health effects of this vaccine? Well, we're still learning about them. I mean, generally, we would expect most

complications with vaccines to happen shortly after you get the vaccine, right? Even though we're only getting the results of the phase three clinical trials in the past few weeks, you know, we've had phase one and phase two trial results for several months. And so we know for the most part that most people don't really have a severe reaction to this. I mean, the main side effects you get after getting the vaccine are going to be muscle pain, weakness, some redness and soreness, and a mild fever. But we don't really have good long-term safety data just simply for the fact that this virus and this vaccine has not been around very long. In order to get the emergency use authorization, Pfizer had to provide two months of safety data. But they've also committed to following their candidates in their

phase three clinical trial for up to two years, basically actively monitoring them and tracking them. And they're also going to continue paying attention to people in the general population as they receive the vaccine. Now, it's very likely that any risks associated with this are very, very low because vaccines are drugs that are tested to a very high standard. They go out of their way to make sure that complication rates are very low. And They go out of their way to make sure that complication rates are very low. And generally, they're some of the safest pharmaceutical drugs that we have ever developed. And so that tends to weigh pretty well. But again, the risk is not

zero. I mean, there are some people that may experience some complications, and it's worth trying to take steps ahead of time to try to minimize them to see what risk factors lead to complications, and then also helping out the folks that do actually have any kind of trouble with them afterwards. We also got a lot of questions about mutation. What happens if this coronavirus mutates? Do we have to start all over with the vaccine? What do we know about that at this point? Well, it's important to note that mutations are happening all the time. This is a virus and viruses tend to change a lot, right? We can actually trace the lineages of where specific strains of this COVID-19 virus came from by

looking at how they mutated over time. We can see distinctly that in the United States, we saw infections come on the West Coast and from a separate strain on the East Coast. And we were able to trace basically where that virus came from that way. Now, in terms of the parts of the virus that we're concerned about, you know, the spike proteins, right? Those are the parts that the virus actually has to use to break into cells. And if that doesn't work right, then the virus can't really cause an infection very well. So that protein tends to be pretty well conserved. It's not changing very much.

So while there is a rate of mutation, that part tends to be pretty stable. And that seems to indicate that the vaccine will have some effectiveness. Now, we know from our experience with past coronaviruses like SARS and MERS that eventually immunity does fade. The virus does mutate eventually in a way that previous immunity doesn't really hold up. But that usually takes a couple of years. And so it's very likely that this vaccine will offer protection that does last for several years. But if there is another outbreak, we may need to restart the process. Yeah. Mayor, someone wants to know if you've had the virus

before and already have antibodies, should you still get the vaccine? The recommendations right now are likely going to be that you still get the vaccine. The reason is that while being naturally infected with the virus gives you some degree of immunity and protection. It's not necessarily targeted. The vaccines are optimized specifically to neutralize the virus and its infection and how it causes disease. Whereas with your own natural infection, you will produce antibodies, but they're more scattershot. They'll target some of the parts of the virus that cause infection, but they'll target other parts that don't necessarily interfere with its reproductive cycle. So it's very likely that most people, even if they have gotten sick with this, it would be useful for them to still get vaccinated.

Someone wants to know, because they heard you can still spread the virus after you have the vaccine, how does that work? Well, generally, like what we've seen with the coronavirus in general is that most people don't get seriously ill. And there's a number of people that can have the virus and spread it without showing any symptoms at all. So basically what that means is your immune system doesn't even mount a response and the virus doesn't really do much damage to you. And it's likely that even after your body gets coached to fight off this infection, the infection might be so low grade that it doesn't really do anything.

It doesn't even trigger the alarm bells in your body, but it still allows you to spread the virus to other people. And so that low level of infection or that low level of transmission, it still poses a risk. Now, there is some evidence that, especially with Moderna's data that was just actually put out today, they seem to indicate that their vaccine actually does lower transmission. So that would very likely, we would actually see a dent in transmission by getting this vaccine. But it's not as steep of a drop as we saw with reductions in disease.

So you will slightly have a lower risk of making other people sick, but not as low as the risk of keeping yourself from getting sick. Dr. Fauci noted that these two vaccines are pretty similar, the Pfizer and the Moderna. Someone wants to know if we'll get to choose which ones we get. I mean, I don't think we'll have the luxury of choice anytime soon. I mean, we're going to have to probably go get the vaccine that's most easily available to us. Right now, the Pfizer vaccine is the one that's already started rolling out, but it also has some pretty stringent cold storage requirements, which means that a large medical facilities that have these ultra cold freezers are likely going to be the ones to get it because they can actually store it on site and administer it to people. Now, Pfizer has developed these shipping containers that can ship the vaccine and keep it cold for 10 days. But the Moderna vaccine has much lower temperature,

or has much less stringent temperature requirements. It can be stored at ordinary freezer temperatures. And so that might be one that's going to be sent out to more rural areas or areas with fewer resources. And then there are other vaccines that require even fewer, you know, cold storage requirements and are even more stable. And those might be rolled out to even more, you know, far flung areas. And so eventually we'll have multiple vaccines on the market. And if we do, we can optimize them and basically see which vaccines are best suited to which people. But right now we're operating from a position of scarcity. And I think people will just have to take what they will have, what they can get for the next few months.

Let's talk about kids for a second. Are kids meant to get this vaccine? Do they need to? Is it safe for them to get it? That's really hard to say because children were explicitly excluded from these clinical trials. In fact, that was one of the big sources of contention during the meeting last week with the advisors to the Food and Drug Administration. They were looking at trial data, and they said that the youngest people in the trial were 16 years old, and there weren't that many of them. And so they were wondering, you know, is this a vaccine that we can approve for everyone over the age of 16? Or should we raise that to the everyone over the age of 18? They eventually approved language saying everyone over the age of 16. And it's very likely

that it will be safer in younger people. But with an emergency use authorization, you're balancing risk and reward, because you're looking at the potential benefit, but you're also looking at any potential harm. Now, we know, for instance, that children are much less likely to get severely ill from this virus compared to, say, adults and much older adults. And so looking at that risk reward calculation right now, it seems that it doesn't really weigh in favor of vaccinating children. That could change in the future as they do more trials and testing and as we learn more about the disease. But for now, we're aiming mainly at health workers and older adults. Is this going to be something like the flu shot where we need to get

something every year? Is there a potential for that to happen? It depends on how fast, as you noted earlier, about how fast the virus mutates. And what we've seen so far is that it tends to be pretty stable in the parts of the virus that we're most concerned about. And so what that likely means is that protection will last for a few years. Our experiences with SARS and MERS show that protection against those viruses also lasts for a few years. Our experiences with SARS and MERS show that protection against those viruses also lasts for a few years, but eventually the virus will change enough and you'll have to restart the process. You might need a booster a few years from now if there is still an outbreak or an epidemic, but it's very likely that once you get the vaccine, you'll have some room to breathe easy for a while.

Deep breath and more with Umair after a quick break. Thank you. and Aura says it's never been easier thanks to their digital picture frames. They were named the number one digital photo frame by Wirecutter. Aura frames make it easy to share unlimited photos and videos directly from your phone to the frame. When you give an Aura frame as a gift, you can personalize it, you can preload it with a thoughtful message, maybe your favorite photos. Our colleague Andrew tried an Aura frame for himself. So setup was super simple. In my case, we were celebrating my grandmother's birthday and she's very fortunate. She's got 10 grandkids. And so we wanted to surprise her with the aura frame. And because she's a little bit older, it was just easier for us to source

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gambling or someone close to you, please contact Connex Ontario at 1-866-531-2600 to speak to an advisor free of charge. BetMGM operates pursuant to an operating agreement with iGaming Ontario. We know if companies and airlines and who knows, theme parks, music venues are going to have some sort of, you know, vaccination ID to let people, you know, use their businesses to enter their venues, to enter their airlines? Is it going to be some situation where, you know, vaccinated people might be able to do stuff that the rest

of us can't? I mean, that's a very likely, you know, something that we'll have to deal with in the coming year, because, you know, if you looked at what Operation Warp Speed's goals are, they estimate that they want, they'll get about 100 million Americans vaccinated by the end of February, and that's only one third of the population. That means that we'll still have spread of this virus, but you'll also have a large group of people that effectively are immune or that are very unlikely to get sick from this. And that's going to be, you politically one of the most thorny parts of this pandemic because you'll have two groups of people held to two different kinds of standards. One group of people is going to have to aggressively socially distance and isolate and wear masks,

and others can be a little bit more lackadaisical and go back to life, something approaching normal. Now, I can't really speak to a music venue screening people or looking at your ID and asking you to turn in, you know, a vaccine receipt. But it's very likely that hospitals, for instance, will start doing this, at least for places like COVID wards, where you have doctors who are treating patients with COVID-19. They're very likely going to try to screen doctors and nurses and other health workers to make sure that they are protected against the virus before they work with patients. And similarly, people in other high-risk roles where they're meeting lots of people, people like delivery workers or maybe even people in grocery stores and other kinds of

essential jobs, they may also start seeing requirements for getting vaccinated. It's going to be really hard though, because it's not like the government is going to mandate this. There's not going to necessarily be a law, but there might be some employers that start putting in requirements saying that you need to get these vaccines in order to return to work. How we deal with that, I mean, I think that's going to be something that we have to start thinking about now. People in the Q&A box and also in some questions we got before the event, seem to be hesitant about trusting a country that has not done the best job with the virus, with the vaccine. For the people out there who are wondering,

like, do I really want to go for this and get this shot when everything else has been handled so poorly? Do they have a point there? What would you say to them? Yeah, I mean, trust is going to be a big part of this, right? Like I said earlier, like, you know, the government isn't necessarily going to force people to get this. People are going to have to want to get this vaccine. Vaccine hesitancy is declining. People are

more and more inclined to get this. But it's going to be a little bit difficult right now because, you know, the FDA, for instance, has been kind of politicized. We saw earlier in the pandemic when they approved drugs like hydroxychloroquine or convalescent plasma after pressure from the White House. And so in order to rebuild the trust, they have to do things in a way to assure the public that they've done everything right. And one way they've done that is keeping their vaccine discussions public, like the approval for the Pfizer BioNTech vaccine. That was discussed in an all-day meeting. They went over the data with Pfizer officials. They presented their findings. A bunch of independent scientists weighed in.

They asked questions. They criticized them. They went back and forth, and then they voted on it, and it was all in a public meeting. And so you can understand exactly what they're working with and how they're coming to these decisions. A similar meeting is going to happen this week on Thursday, where officials are going to go over the Moderna vaccine. And so transparency is going to be one way they're going to be trying to rebuild trust. And another is just going to be basically trying to tell people that vaccines are some of the most scrutinized drugs we ever developed. They're held to a very high standard in terms of both the protection they provide and how little risk that they imbue. And so eventually, yes, I mean, the information is going to be public and people are going to have to be convinced. But I think the Food and Drug Administration public health officials are

trying to take steps to make sure to reassure the public that this is something that they can have confidence in. There's a lot of news, of course, about, you know, the first vaccines being given out in the UK. Of course, now they're in the United States. Canada's buying up a whole lot. Is there going to be some sort of, you know, vaccine inequity where the richest countries get a whole lot of shots first and everyone else is in the back of the line? Unfortunately, it is starting to look that way. You know, the first countries to approve the Pfizer-BioNTech vaccine, you know, the United

Kingdom, Canada, and the United States are, you know, very wealthy countries and other countries that have already started distributing their own homemade vaccines, you know, Russia and China, you know, they're very likely going to be going to the countries first that can pay for it, the places that actually have the resources to administer it, but also those that are willing to essentially buy their way to the front of the line. And some, there are efforts internationally to help distribute vaccines to poorer parts of the world for countries and places that have fewer resources. But, you know, that's always going to be a challenge to do because, again, we only have a finite number of vaccines that have fewer resources. But that's always going to be a challenge to do because, again, we only have a finite number of vaccines

that are going around, and this is a valuable commodity. And very likely the people with fewer resources are the ones that are going to not be able to bid as high, and we will see inequities eventually over time start to mount. And that should be concerning to everyone because unless everybody is secure, no one is secure. We saw this virus cross oceans. It travels on airplanes. And while there are hot spots in other parts of the world, even if we start distributing vaccines here, we could

potentially be at risk for another outbreak if we don't try to control this in every part of the world together. So this is something that we really do need a global effort for. And unfortunately, it seems like we are starting to see some gaps and some effort needs to be made to ensure that other developing countries and other countries with fewer resources have the means to get this vaccine and distribute it so that they can contain it and thereby protect all of us from this global pandemic. I want to talk to you a bit before we go about international cooperation on this virus and on the vaccine. Did we see, you know, about as much as we'd expect cooperation between nations? Did we see, you know, less than ideal levels of cooperation here? I know there's a Russian vaccine now and a Chinese vaccine and an American vaccine and there was a vaccine in Oxford. Are these things in competition with each other, or is this sort of the sort of inspiring international effort that we hope to see in a moment like this? I think there are two elements to that. On the research front, this has absolutely been unprecedented and completely inspiring, something that scientists have never seen before.

Basically, they took down barriers between research groups. Scientists can be pretty competitive. They want to be the first to advance something. And yet we saw scientists all over the world sharing their data, publishing their findings. We saw a huge spike in these preprint journals where scientists were publishing their findings before they were reviewed to allow other people to scrutinize them and to build off of their work. That's part of the reason why we were able to develop mRNA vaccines so quickly, because the data around the virus was published online and other researchers were able to use that to develop their own vaccines. So that has been completely unique and I think, frankly, heartwarming to see researchers around

the world cooperate on this. The thing that's going to be a little bit more difficult is in terms of actually manufacturing and distributing these vaccines. As we talked earlier a little bit about how developing countries and countries with fewer resources are going to have a harder time getting these. There are initiatives around the world. There's the Global Alliance for Vaccines and Immunizations, and there are programs like COVAX. These are where

countries are pooling resources to try to ensure that everybody has equitable access to a vaccine. But those need to be strengthened. And we've also seen some countries kind of go it alone, like China, as you noted, has started distributing their own vaccine, and so has Russia. And other countries are now bidding on vaccines from China. And so they're going to be one of the major suppliers around the world. And so there may be some sort of competition brewing between these major vaccine manufacturers around the world as people are jostling to try to fight this pandemic. So it's hard to see where that shakes out right now.

Unprecedented cooperation, but also a lot of brewing competition now as the vaccines start to getting rolled out. Historically on our show, Umair, you've joined us to talk about the environment, but this year it seemed like your role sort of, you know, you pivoted to vaccine, to virology. What did you learn covering this coronavirus this year what were your biggest takeaways from this year i mean i learned a great deal about the science i mean i i studied biology back in college but that's been years out of date and so i had to kind of brush up and retake classes online and going to webinars and trying to like you took classes where i had no idea what you take i took this uh virology lecture uh that's on YouTube taught by a professor at Columbia.

And then so basically tried to remember everything that I had forgotten over the past decade. I've been out of school. But beyond that, I mean, I think in terms of reporting this, I mean, health is a very unique beat and public health in general, but it kind of shows you not just the science, but also like all the social elements are playing such an important role. And really, you can't have one without the other. Like I tend to focus on research and development, but it's hard to talk about that without talking about access, equity, and also like, you know, the historic injustices and inequalities in our society, because all of those are affecting it. We can't simply invent our way

out of this pandemic. We have these resources and technologies, but unless they're applied in a uniform and equal way, that's not really going to help us get back to normal. And so, you know, having that appreciation, you know, after researching this for a while and understanding just how much there is to know and how much I don't know myself and how much there is left to learn, it teaches you a lot of humility and gave me a lot of new appreciation for the people that do the hard work in this field. And now that the year's winding down, what do you think it's most important for people to remember now that this vaccine is out there, but we're also in this terrible position where we hit this record of 300,000 deaths yesterday? Yeah. I mean, I think the thing to remember is

that our actions do matter. Like I said, I use the firebreak analogy. The vaccines are like cutting firebreaks or cutting clearings in a forest so that the fire doesn't spread. But that really doesn't do much if there's already a huge inferno that's blazing. And so our goal right now is to reduce transmission as much as possible so that when a vaccine does roll out, it becomes that much more effective. You know, there's this herd immunity threshold of 80 to 90% of people being immune in the population where the pandemic starts to fizzle out. But we start to see reductions around 30 to 40%. And that can happen if we do a good job of controlling transmission. So our actions right now to try to limit the spread of the virus will make it easier

and more effective for when a vaccine does start being administered to us, for people who are in the low-risk pools, maybe next spring and maybe in the early summer. umair irfan is a science reporter at vox you can find all his work at vox.com again this was the second half of our live show today the first was a conversation with dr fauci and we'll be bringing you that conversation next week in our series, You, Me, and COVID-19. This is Today Explained.