It is the biggest public health crisis of our lifetime and while new data suggests brighter times might be on the horizon, tens of millions of Americans remain unsure about taking coronavirus vaccine shots.
A wave of misinformation and centuries of medical malpractice have led to wariness around the COVID-19 injections primarily in the Black community. The need to address the issues of vaccination acceptance and hesitancy is imperative to save lives, health leaders say.
UMOJA Magazine reached out to one of Madison’s top infectious disease specialists, Dr. Sheryl Henderson, for her expert guidance regarding vaccine-related questions about safety, effectiveness and related issues. The hope is that this article will reinforce how important it is to know the facts versus the widespread rumors, claims, and general worries.
Henderson earned her medical degree from Johns Hopkins University School of Medicine and completed her internship and residency at Johns Hopkins Hospital. She completed her fellowship in pediatric infectious disease at Emory University, with emphasis in the study of Human Immunodeficiency Virus (HIV) and its effect on children and adults living with the disease. Henderson is also board certified in pediatrics and pediatric infectious diseases.
“I am very familiar with working with RNA and DNA,” said Henderson, whose doctorate is in molecular biology. “While at Emory I participated in several vaccine trials. … So, when COVID-19 vaccines came up I thought, oh, I’m very familiar with these trials.
“Now that COVID has been here for the past year, myself and many of my colleagues have been involved with this understanding of this virus and its impact, how it’s transmitted and how to treat it and how to prevent it,” she added.
SARS vs COVID-19
Severe acute respiratory syndrome (SARS) was called the first pandemic of the 21st century. It appeared in 2002 and quickly spread around the world. The Centers for Disease Control (CDC) reported that 8,098 people were infected in 26 countries and that 774 died.
COVID-19 is proving more virulent and more deadly.
Since Chinese officials first reported the COVID-19 outbreak in Wuhan on Dec. 31, 2019, the virus has spread to virtually every nation on the globe. The new Severe acute respiratory syndrome coronavirus (SARS-CoV-2) named coronavirus disease 2019 (COVID-19) is responsible for 500,000 people dying and counting, in the U.S. alone.
“In a way this was like, here we go again and let’s get this thing under control,” Henderson said. “But then we started to notice things were different this time. And the biggest thing that was different is that you could have no symptoms and spread the virus.
“Another difference is that it’s not limited to just the lungs. We’re seeing, because of this inflammatory state, people are affected in all different organs and even people who get moderate disease may not be hospitalized, but may have symptoms for months,” she explained.
The U.S. Food and Drug Administration (FDA) is the regulatory authority that has oversight of the safety, effectiveness and quality of vaccines that are used in the United States, including the COVID injection.
“The purpose of a vaccine is to mimic the virus,” said Henderson, who received her vaccine just before Christmas. “But it only mimics a part of the virus. It cannot replicate. … When the body sees the vaccine, it will rev up the immune system and start making some specific antibodies against it so that if the virus does come along it’s not going to take days or weeks to build a response. It will be quick.”
Vaccines teach the body to recognize and destroy disease-causing agents. Typically, weakened pathogens or fragments of the proteins or sugars on their surfaces, known as antigens, are injected to train the immune system to recognize an invader.
Messenger RNA vaccines—also called mRNA vaccines—are some of the first COVID-19 vaccines authorized for use in the United States. RNA vaccines, however, carry only the directions for producing these invaders’ proteins. The aim is that they can slip into a person’s cells and get them to produce the antigens, basically turning the body into its own inoculation factory.
COVID-19 mRNA vaccines are given in the upper arm muscle. Once the instructions from the mRNA are inside the immune cells, the cells use them to make the protein piece. After the protein piece is made, the cell breaks down the mRNA instructions and gets rid of them.
That immune response, which produces antibodies, is what protects us from getting infected if the real virus enters our bodies. These mRNA vaccines have been studied before for flu, Zika, rabies, and cytomegalovirus.
After vaccination, the immune system is prepared to respond quickly and forcefully when the body encounters the real disease-causing organism.
“It’s like a sheep in wolves’ clothing,” Henderson said. “It’s looking like that virus, but inside it’s enough to stimulate an immune system response, but it can’t do the damage of the real virus.”
Henderson said the side effects she experienced following her second COVID shot included a low-grade fever, chills, body aches and fatigue. Tylenol and a good night’s rest was the cure, she said.
Moderna and Pfizer
By mid-summer, Moderna and Pfizer had established themselves as the leaders in the race to develop a COVID-19 vaccine. Both companies were also the only to take the mRNA vaccine approach, publishing initial Phase I/II clinical trial data on July 14 for Moderna, and on Aug. 12 for Pfizer. Although sample sizes were small—as they typically are in early phase clinical trials—the results demonstrated promising safety measures and antibody production against the spike protein from those who got the vaccine.
Both the Moderna and the Pfizer vaccines proved to be effective against infection. The promising results lead to Phase III trials, enrollment began immediately with Moderna focusing their efforts within the U.S. and Pfizer taking a more global approach. Between the two trials, more than 70,000 people were enrolled to receive either a placebo or a real vaccine and were subsequently sent out into the real world where their COVID-19 status was monitored for approximately 10 weeks, with hopes that the results would be available before the year’s end.
And they were.
Early in the pandemic, an erroneous claim widely circulated that people of African descent were immune to the COVID-19 infection. There was also a conspiracy theory that COVID-19 was a virus created by the federal government which was widely circulated on social media platforms. Not to mention the longstanding, deeply-rooted racism towards Black Americans in health care.
This lack of confidence along with erroneous information may have led to a false sense of security and inadvertently placed a large number of African Americans at risk.
“The reasons for mistrust are fully justified,” Henderson said. “There are justifiable reasons to say I don’t want to take this vaccine, or I want to wait and see. The biggest concern I have speaking as a scientist and a physician is measuring the risks of getting this virus and the risk of passing the virus to others in the community.
“We really need to try and slow the spread of this virus because even healthy people can spread it if they’re infected and have no symptoms,” the doctor added.
For many, the vaccine development happened at a breakneck speed, raising eyebrows and doubt. Some argue that they aren’t opposed to the idea of a vaccine but feel anxious about the fast-tracked process that delivered Pfizer and Moderna’s shots to the market.
The FDA approved their usage with an emergency use authorization, which is different from the much lengthier standard approval process that other products must pass before entering the market, Henderson explained.
“Because of the very nature of the pandemic ꟷ the scope and the size and the number of people ꟷ it wasn’t difficult to recruit for the phased studies,” she said. “Plus, coronaviruses aren’t new. I went back and it was January 20th of last year that the sequence to this virus was already known. The technology was there to start making it in the lab compared to 2003 with the first SARS.”
Clinical development is a three-phase process. During Phase I, small groups of people receive the trial vaccine. In Phase II, the clinical study is expanded, and vaccine is given to people who have characteristics (such as age and physical health) similar to those for whom the new vaccine is intended. In Phase III, the vaccine is given to thousands of people and tested for efficacy and safety.
“In standard clinical trials, Phase III usually enrolls up to about 3,000 people before it goes to the FDA,” Henderson said. “Between the Pfizer and Moderna studies there were over 70,000 people enrolled. … We had information in a controlled setting and since then it’s been distributed to tens of millions of people. There have been no deaths by anyone who has received the vaccine.”
(editor’s note: Days following this interview, the FDA has authorized a third COVID-19 vaccine for public use. The agency granted an emergency use authorization for a one-dose COVID-19 vaccine developed by Janssen Pharmaceuticals, a Johnson & Johnson company.)