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Vaccine Hesitancy? The Devil’s In the Details: Part 1

Updated: Apr 21

My husband and I spend a considerable amount of time talking with patients about COVID. Recently, our discussions have been centered around vaccination. To date, approximately 128 million people have received their vaccination for COVID in our country, representing about one-third the US population. With cases still on the rise, however, the race to protect is very much at the forefront of our efforts to curb the pandemic. However, at this point, we have more supply of vaccine than actual demand. Why have two- thirds of individuals chosen not been vaccinated at this point and what is the reason behind this vaccine hesitancy? Perhaps it’s the operation warp speed at which these vaccines were developed. Or the question of degree of protection or lack thereof- this effort will provide. Some may be waiting because of unknown risks involved with the COVID 19 vaccines. Or distrust in this entire process. These concerns are all valid—there is not one that is more or less important than the other. Our conversations and current understanding about the vaccine efforts are included in this two-part series. Part 1 will explain Emergency Use Authorization and mRNA technologies. Part 2 will discuss long- and short-term safety and efficacy concerns from vaccination.

In order to validate any rationale for or against vaccination, one must first understand how our immune system works as vaccines are designed to trigger an immune response. The immune system is highly complex and can be divided into two parts: innate immunity and adaptive immunity. Innate immunity is our body’s introduction to a foreign visitor, like a virus. Made up of different cells that meet and greet the virus for the first time, our innate immune system’s job is to label that visitor as if you might put a name tag on people attending a large party. This highlighted name tag serves the purpose for the second adaptive part of the immune system to easily recognize this unwanted visitor and take care of it. The adaptive immune system uses B-cells to make antibodies, memory cells so that it remembers that unwanted guest, and T cells, both that help fight and suppress the virus from taking over. We’ll come back to this understanding as we walk through some of the reasons some are holding off on being vaccinated.

Questionable delivery?

Recently we spoke with a well-educated engineer who was holding off on vaccination because of questions related to mRNA technology. While the Pfizer-BioNTech and Moderna vaccines are the first vaccines to utilize mRNA technology for COVID, using mRNA for immunization delivery has been studied for decades. Historically, vaccine delivery was by injecting a dead or inactivated virus to stimulate the body’s immune system to recognize this foreign invader should it appear in the future. But look, things change. We don’t treat cancer in the same way we did thirty years ago and the way we introduce vaccines has changed as well. Unlike traditional vaccines that use a weakened or inactivated virus to elicit an immune response, this new type of vaccine utilizes mRNA to “tell” the cells in our body how to build a protein that looks like the spike protein of the original COVID-19 virus. Once the protein is made, it triggers an immune response (like being able to recognize that particular nametag at the party and becoming armed and ready to escort that unwanted guest out). The mRNA genetic instruction does not enter the nucleus of the cell, which is where our genetic material is kept nor does it alter DNA in any way. Once the mRNA teaches our bodies to make the antibody to the spike protein, the immune cell breaks down these instructions and eliminates them, so the vaccine does not remain in the body over time. Importantly though, the antibodies produced from this process remain and will protect from serious infection when someone is exposed to the actual COVID virus. One advantage of using mRNA-based vaccines is that they can be developed in laboratories using readily available materials, and is much faster than traditional methods of making vaccines.

Questionable approval?

Some folks we’ve talked to are hesitant to become vaccinated because of the speed and process by which these vaccines were approved. Operation Warp Speed set in motion massive scientific efforts to produce a vaccine that would change the course of the pandemic. In emergency situations like the global pandemic we’re experiencing, the FDA can issue Emergency Use Authorization (EUA). This process is more timely but less stringent than the typical FDA approval process but importantly allows medicines, tests, or vaccines to be of help when there are no adequate approved or otherwise available alternatives. In order for EUA to be granted, the benefits of the treatment or vaccine must outweigh the risks during the human study phase of the clinical trial, so rigorous study design is still required. But because of the quicker approval timeline longer-term follow-up evaluation plays out in real time. [An example of real time follow-up includes the FDA pausing the administration of the Johnson & Johnson vaccine so that the incidence of blood clots in six women could be investigated further]. Both Pfizer and Moderna vaccines have received EUA and the efficacy information on both vaccines is very strong. Both Pfizer and Moderna vaccines are extremely protective of hospitalization and death from the COVID virus. Because we don’t know how to anticipate the severity of COVID illness in those who become positive, protection from hospitalization and death is life-altering. At present time more than 70,000 individuals are hospitalized each new day. This number could be drastically altered with vaccination.

Without a doubt, the decision to be vaccinated is one that has been highly publicized and debated. The decision to vaccinate or not is often discussed as one of personal choice. But the decision to wait affects more than just the person deciding to wait. As infection continues to spread, mostly in those not vaccinated, variants to the virus can form and make the virus more resistant to our current vaccine and treatment options. The Devil's in the details. If we can help answer your vaccine related questions, please contact us or call 901-701-7010 and speak to our providers at ZüpMed.

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