COVID-19 vaccine: 8 queries patients ask

The approval of the first COVID-19 vaccine came at a breakneck speed in December. Inoculation started in the US, liberating pent-up hopes that virus-ravaged states could get past the pandemic that has killed over 1.5 million people across continents.

The UK, Belgium, and Canada also did not falter in its pursuit for protection as it rolled out the Pfizer-BioNTech  vaccine, BNT162b2. Singapore received its first batch of BNT162b2 doses 4 days before Christmas, making the city-state the first country in Asia to have gained access to the vaccine.

Countries should fare better at vaccinating than it did at containing the disease. Experts said for the vaccination to work, at least 70 percent of the entire population should receive the two-dose shots for maximum protection.

Yet, people are confused by the blizzard of vaccine news circulating the media platforms. At the same time, they are worried the approval process might have been rushed, botched, or politicized. And this leaves more questions thrown at scientists and clinicians.

1. How safe and effective is the vaccine?

BNT162b2 conferred up to 95 percent protection against COVID-19 in nearly 44,000 individuals aged 16 years or older tested. Safety over a median of 2 months was comparable to other viral vaccines. [N Engl J Med 2020;383:2603-2615]

The BNT162b2 vaccine is given in two injections, 21 days apart, with the second dose as a booster. Immunity starts to kick in after the first jab, but full effect can only be reached 7 days after the second jab.

2. Will the vaccine prevent SARS-CoV-2 transmission?

The vaccine is effective at preventing COVID-19, but reductions in severe illnesses and viral transmission are difficult to perceive at the moment, with limited evidence on hand.

“[A]dditional evaluations … will be needed to assess the effect of the vaccine in preventing virus shedding and transmission, particularly in individuals with asymptomatic infection,” according to the US FDA.

3. Who gets the shots first?

Healthcare workers and the elderly are first priorities.  Is it prudent for the general public to jump on the bandwagon and take the jabs this soon? Dr Anthony Fauci, director of the US National Institute of Allergy and Infectious Diseases, said: “yes, absolutely – if you have access to the vaccine.”

“A vaccine is good for us … it’s good if we want to completely crush this outbreak,” he added. “We want virtually everybody to get vaccinated, it’s a societal responsibility to do that.”

4. Which vaccine to take?

While most people would take the first jab on instinct, others would wait for more data with guarded optimism, hoping that a second or third vaccine may be better than the first.

To this, Fauci said: “As more data become available, recommendations will be made. We would likely have a choice, just the way we have a choice with other influenza vaccines.” It is important to be absolutely certain that the vaccine is also safe for “vulnerable populations, specifically children and expectant mums,” he emphasized.

5. Does having allergy makes one ineligible for the vaccine?

Fauci said some adults who tend to have allergic reactions to vaccines have had reactions to the COVID-19 vaccine. It does not mean those with a history of allergic reactions can’t take the shots, they just need “extra special” precautions when taking the vaccine, he explained.

“If you do get an allergic reaction, it is important to have somebody there that knows how to treat it,” he said.

Additionally, the US Centers for Disease Control and Prevention said this group should undergo a risk assessment with their care provider prior to taking the vaccine.

It’s not advisable to take the Pfizer vaccine for the first dose and the Moderna the second, or vice versa, until evidence supports this.

6. Do COVID-19 survivors still need to get the jabs?

Fauci’s response: “Definitely, yes! The reason is that we don’t know if how long following infection you are protected against re-infection. Just to make doubly certain you’re protected ... you should actually get a vaccine.”

Mayo Clinic meanwhile recommends  that those who have had COVID-19 delay the vaccination until about 90 days from diagnosis. People should not get vaccinated if in quarantine after exposure or if they have COVID-19 symptoms.

7. Does taking the shots have side effects? 

Delivered as a shot in the arm, the Pfizer-BioNTech vaccine has so far not elicited any serious side effects. In the trial, half developed systemic reactions, primarily headache, chills, fatigue or muscle pain or fever lasting a day or two.

Ms Kristen Choi, a nurse researcher at the University of California, Los Angeles, US revealed the symptoms she personally experienced as a participant in the Pfizer-BioNTech trial, which included chills, nausea, headache, and fever.

“Clinicians will need to be prepared to discuss with patients why they should trust the vaccine and that its adverse effects could look a lot like COVID-19,” she said. [JAMA Intern Med 2020;doi:10.1001/jamainternmed.2020.7087]

However, while those symptoms are unpleasant, those are signs that the vaccine is working, and the immune system is working on mounting a potent response to the vaccine, she added.

8. Is masking still required after the jabs?

Even vaccinated individuals need to wear masks and avoid indoor crowds, said Fauci. This is because it will take time for everyone to get vaccinated. While the vaccine may prevent people from getting sick, vaccinated individuals may  have high viral loads although asymptomatic, and may be silent spreaders. It is not clear at this time if the virus can be sneezed or breathed out, to infect others. Until more is understood about how well the vaccine works, continuing with precautions like universally wearing of masks is important. Even US President Joe Biden said he will ask Americans to wear masks for the first 100 days of his presidency to slow down the spread of COVID-19 while vaccination is not yet in full swing.