Dropped a child off for college last weekend and ran into some old friends I haven’t seen in a while. All of us live in different states, so parental duties done, we went out one night to catch up. After covering family, Olympics, sports, and business, the conversation turned to covid. First question out of the shoot was how everyone decided whether or not to vaccinate and which course they chose if so.
John: “I’ll start. Since I did not contract covid last year as far as I know – I could have been asymptomatic and not known I suppose – I got the vaccine shortly after it came out figuring my body hadn’t produced any post-virus antibodies. I chose the Pfizer two dose regimen simply because that was convenient to where I live and not based on any preference over Moderna or J&J.”
Mark: “Makes sense to me.”
Drew: “Me, too. OK, Mark, what about you?”
Mark: “I actually did get covid last year. Felt pretty rotten for a couple of weeks and took me about six to get most of my stamina back. I considered getting the vaccine but since I had developed natural immunity – the human body is pretty amazing, by the way – I decided not to.
I have since seen a study by the Cleveland Clinic of over 50,000 subjects showing no appreciable difference between those who received the vaccine and those who had been previously infected but did not receive the vaccine. In fact, none of the previously infected individuals contracted covid a second time over the five-month duration of the study, regardless of whether or not they had been vaccinated. By contrast, over 99% of new infections during the study were among those who were not previously infected nor had been vaccinated. The implication is pretty clear – if you haven’t had a confirmed covid diagnosis in the past, vaccination is your best bet to avoid one in the future. The other implication, as I mentioned, is that the body’s adaptive powers are amazing.”
John: “Now I’m even more glad I got the vaccine, and I understand why you didn’t. I have to admit, while waiting to receive my first shot and reviewing the mandatory informed consent material – the vaccine is not FDA approved, side effects could include difficulty breathing, irregular heartbeat, nausea, diarrhea, vomiting, entire body rash, etc. – I had some second thoughts myself. I can understand why some would hesitate to get it even if they had not been previously infected and developed natural immunity.”
Mark: “I don’t have a problem with the FDA making the vaccine available under their EUA (Emergency Use Authorization) prior to approving it. In fact, I applaud them for that. Historically, the FDA’s M.O. has been that sins of commission are worse than sins of omission – meaning that it was worse for patients to die or suffer a side effect from an FDA approved drug than to die waiting for a drug that was efficacious but that the FDA had not approved.
Since there are six stages in the FDA drug development process between discovery and approval, the cumulative time to approval can take 6-12 years! I understand the FDA’s need for caution, but that’s a long time – with a lot of patients who may have been able to benefit – suffering and dying in the interim. In fact, I read a 2018 study showing that reducing the discovery-to-approval process to 5 years would save 524,000 life-years worldwide. That’s a lot of additional life, certainly in quantity, and likely in quality as well. So, I’m fine with the FDA’s making covid vaccines available now.
However, I agree with you that making something available and forcing it on someone are quite different. If I have cancer (or tuberculosis to use a communicable disease), and an experimental drug is available, I may choose to try it to extend or improve the quality of my life. As long as the risks (and ideally the probabilities) are presented, I own that decision. But, if I don’t like the odds, I may choose not to take it.
By the same token, we all come to the covid vaccination table from different places. Some of us are young, some are old; some are in great health, some are in ill health; some have no medicinal allergies, some have a history of medicinal allergies. Treating everyone the same from a healthcare perspective doesn’t seem to make sense. Especially when we have the data at our fingertips to treat everyone as a unique individual. So, while the data suggest that vaccination makes sense the vast majority of the time for those not previously infected, there may be a minority of individuals for whom vaccination is not the best option based on their history. Treating them as individuals incapable of making informed decisions is condescending and may actually increase resistance.
But enough from me. Drew, what about you?”
Drew: “I actually went a hybrid route. Like Mark, I got covid last fall with a similar path to recovery. I opted for just one shot of the two-shot Pfizer routine.”
John: “That’s random. What led you to do that?”
Drew: “No insight of my own, I can assure you. I guess it goes to Mark’s point that we’re capable of making decisions based on our own history. In my case, I’m middle aged and healthy, and knew my body had produced its own immune response after recovering from covid. As I was debating what to do, I came across several studies – New England Journal of Medicine, The Lancet, and Ziv Medical Center in Israel to name a few – comparing the response between previously uninfected subjects receiving two doses of the vaccine and previously infected subjects receiving one dose. The surprising result was that those who had been previously infected and only received one dose of the vaccine produced an immune response (as measured by the presence of various antibody titers) an order of magnitude higher than those who had been uninfected but received the complete two dose regimen. In other words, those who had previously contracted covid and received one shot produced 10x the immune response to those who had not contracted covid but received both shots. To Mark’s point, the body is amazing.”
John (whistling): “Whewww, that’s fascinating. Give me a reply to the people in the part of the country where I live who say ‘Why don’t you just listen to the CDC and do what they say? By not getting both shots you’re just being selfish and putting people in danger.’”
Drew: “I guess I’d respond like this. The CDC has some good people who are doing the best they can in a difficult situation. However, as Mark articulated well, I’m not sure one size fits all makes sense. In fact, Germany, France, and Italy recommend only one shot for those who have been previously infected. And, since much of the developing world remains largely unvaccinated – many African countries have less than 1% of their populations vaccinated – one shot for those previously infected allows more vaccines to be sent sooner to countries that need it desperately and don’t have access to vaccines otherwise. So, I think it would actually be more selfish to take two shots if I only need one.”
Kelley Williams is a Northsider.