Vaccine Hope or Suspicion
As the COVID-19 pandemic approaches 350,000 deaths in the United States, the arrival of a COVID-19 vaccine the week before Christmas instilled hope in many, suspicion in others. Scientists and some of the general public are excited about this vaccine squelching the COVID-19 pandemic. However, the African American community is skeptical. The very groups that are disproportionately impacted by the virus are among the most suspicious. This is not due to scientific concerns about the vaccine, but rather memories of past wrongs in the medical environment. So, while the release of the vaccine was historic, the work has only just begun.
Tuskegee’s Lingering Impact
Black Americans, young or old cite the Tuskegee “experiment”, as a reason to be cautious. Although people often can’t give details about the study, the lore of this atrocity has been passed down from generation to generation.
What was the Tuskegee study? It was a U.S. Public Health Service study from 1932 through 1972, that studied the natural history of syphilis in Black men. These Black men, many of them sharecroppers in Alabama, were never intentionally treated for their syphilis even when penicillin was available. Public Health officials did not inject these men with syphilis, as urban myths would suggest. This was a focused effort and to this day offers an example of structural racism and blatant disregard for the Black body/Black health.
The Tuskegee experiment along with many other instances has created lingering distrust in governmental systems and health institutions. This has contributed to vaccine hesitancy among Black populations.
In Some Ways These are new Days
However, in some respects this is a different day. Though systemic racism abounds, studies like Tuskegee will not occur. Now, there are safeguards in place and watchful eyes, including African Americans that have dedicated their lives to insure this will never happen again.
We have Black scientists and medical doctors that helped develop the COVID-19 vaccines. Dr. Kizzmekia Corbett with the National Institutes of Health (NIH) is making waves in the lab and connecting with our community. While there are reports that some black community members question Dr. Corbett’s motives and whether she is pro-Black enough, I trust her. These are age-old debates in our community. Other Black professionals have cited her as an asset to the Black community.
We have Dr. James Hildreth on the Food and Drug Administration (FDA) advisory committee reviewing the data and making recommendations. The FDA is the regulatory authority that oversees the safety, effectiveness, and quality of vaccines used in the U.S. We have the National Medical Association reviewing vaccine data and advising, as well.
Also, COVID-19 vaccine clinical trials have made a concerted effort to engage and enroll Black participants. 10 % of participants in both the Moderna and Pfizer vaccine trials were Black. The safety, effectiveness, and side effect profile was the same for Black participants.
“Given all that has transpired over the last 400 years, we have got to make sure that they [Black Americans] have a sense of agency, that they are empowered to make the decision themselves. The goal is to make sure that people understand as much as we can provide them: what vaccines are, how they work, what is and is not true about them.”Dr. James Hildreth, MarketWatch interview
What About These mRNA Technology Vaccines?
Though China was criticized heavily by the Trump Administration, Chinese scientists did share the genetic sequence with the world in January 2020. This allowed scientists to begin working on a vaccine that would prevent this dreaded virus. The vaccines that are the furthest along use the mRNA, “genetic vaccine” technology. This technology is relatively new but was used in animal studies as far back as 1990. It also has been used extensively in cancer therapy. To me it is comforting that this methodology was not just discovered. There is a track record.
The mRNA vaccine contains ‘ingredients’ that are fairly well known – inorganic salts from lipids, sugars, and the mRNA. They don’t contain animal products or preservatives. mRNA vaccines can be produced more rapidly and safely than the more traditional vaccines. Additionally, manufacturing can be rapid, inexpensive, and scalable.
Moderna and Pfizer use mRNA technology for their vaccines. The CDC provides a good discussion on mRNA vaccines.
mRNA Vaccines in Brief
mRNA vaccines do not contain a live virus. The mRNA never enters the nucleus of the cell and does not affect or interact with a person’s DNA. The way COVID-19 mRNA vaccine works is that it tells the body’s cells how to make the S or spike protein of the virus. This activates the immune system which begins producing antibodies and activates T-cells (immune cells) to fight off what it thinks is an infection. The antibodies are specific for the SARS-CoV-2 virus (causes COVID-19 infection). The immune system is thus primed to protect against future infections.
Was the COVID-19 Vaccine Developed too Fast?
Some people are concerned that this vaccine was developed too fast! The quickest a vaccine has ever been developed was four years. Which, of course, raises concerns about how quickly these vaccines were developed. To facilitate development, manufacturing, and distribution of the vaccine, the U.S. government started Operation Warped Speed. However, “warped speed” implies to some Americans that corners may have been cut. This is definitely not true. The COVID-19 vaccines went through the same rigor as other vaccines. The main reasons these vaccines were developed more rapidly is because phases were overlapped, there were already platforms in place, and there was heavy monetary support.
Vaccine Development Process
The FDA provides more detailed information, Vaccine Development 101. I have included a brief summation here:
- Research and discovery– Scientists develop a case for a vaccine based on how the infectious agent causes disease. In this case SARS CoV-2. Once a scientific finding is thought to have practical application the research moves forward.
- Preclinical – Before testing a vaccine in people, scientists perform additional lab research and testing in animals. They determine whether it is likely to work well in people.
- Usually these phases progress sequentially, but given the severity and devastation of COVID- 19 some of the phases overlapped or occurred simultaneously.
- Phase 1 – The emphasis is on safety. Usually 20-100 volunteers without COVID-19 are studied. They record any adverse reactions with increasing doses and also determine how well the vaccine works to create an immune response in people.
- Phase 2 – If no safety concerns from Phase 1 the trials move onto this phase. It includes additional safety information, common short-term side effects and risks; the relationship between the dose administered and immune response; and effectiveness of the vaccine to generate an immune response. There is usually a control (receives vaccine) and placebo (receives injection of salt water) group.
- Phase 3 – Vaccine administered to thousands of people. This generates critical information on effectiveness and additional safety data. Comparison is made between those that received vaccine versus placebo. Safety considerations and assessment for less common side effects.
- Phase 4 – Conducted after a vaccine has been approved for use in the general public. Provides information on long-term risks and benefits, and how well the vaccine works when used more widely.
Once developed, the vaccine has to get approval from the FDA and CDC. These bodies review the information and make a determination.
COVID-19 Vaccine Deployment
While these new vaccines have great promise, they present some challenges. The cold hard facts about the Moderna and Pfizer vaccines are that they need refrigeration or freezer conditions. Pfizer’s vaccine requires ultra-low freezer temperatures. Both types require two shots, weeks apart.
The First Wave of Vaccines Have Been Delivered
The Pfizer vaccine was the first vaccine delivered. The priority plans have been developed by CDC and they are depending on states to enact. While Black Americans may be reluctant to get the vaccine, there are concerns that an equity lens will not be applied to vaccine distribution. Black health professionals, other health organizations, and some social justice organizations want to make sure that distribution is equitable. They feel that Black people should not be last on the list to receive the vaccine.
Vaccination Saves Lives
We have about 330 million Americans. COVID-19 vaccination can save lives, but we need about 70-75% of the U.S population to get jabbed. It will take months to vaccinate all the people that need it. Medical providers with direct patient contact will be the first to be vaccinated followed by residents of nursing homes. The COVID-19 vaccine is not mandatory at this time.
The Choice is Yours
You can exercise your right to have a vaccine when the time comes. You also have the right to say no thank you. Some people may say, “hell no!” I have some of my patients sending a note weekly to get on the list for the shot. Still others are crossing their fingers and hoping that COVID-19 will just go away.
At times I have procrastinated on getting vaccines, but this one I will be timely. Move out my way! I plan to get the vaccine next week. Even as a doctor I have questions that will be answered as time goes on. A lot has happened in our world this year that has consumed my energy and zapped my reserve. I have fear, because I am human and this is so new. What if I have one of the rare side effects? I just want to make it to retirement in one piece.
I Won’t Plead but we Need Vaccination
COVID-19 is devastating and people of color are disproportionately effected. I have seen Black patients and others not sick enough to be hospitalized, but sick enough to know they are very sick. This illness can last more than a minute. I have seen people with assorted residual symptoms from a modest COVID-19 infection that has lasted for months. This is not a pretty disease and COVID-19 does not play.
We need this vaccine, but I won’t plead with you. Our lives as we once knew it, is pleading for relief. We need to get back closer to how we like to live and interact. We are social people and getting vaccinated for COVID-19 will get us all closer to a sociable existence.
COVID-19 Vaccine Offers Hope
I think the mRNA COVID- 19 vaccine offers HOPE. It has been deemed safe and 95% effective. We have seen vaccines eradicate diseases in the past. Vaccines have saved millions of lives. I will say that you don’t have to be the first to get the COVID-19 vaccine, but don’t be at the back of the bus on this one!
What are your thoughts about the COVID-19 vaccine?