COVID-19 Vaccine Questions Answered

• How does the vaccine work?
• Is the vaccine safe?
• Who should and shouldn't get vaccinated?

These and many more commonly asked questions about the COVID-19 vaccine are answered

Opener (0:00-0:30)
Intro (0:30-2:14)
Interview part 1(2:14-13:48)
Break (13:48-14:46)
Interview part 2 (14:46-23:56)
Segment throw (23:56-24:02)
Ending segment (24:02-27:34)
Outro (27:34-28:41)

• Frequently Asked Questions about the COVID-19 Vaccine
• COVID-19 Disinformation: How to Spot It and Stop It

Ending segment: Katy Love
Editing and music: Brian Middleton
Research and writing: Jiayu Liang and Pamela Worth
Executive producer: Rich Hayes
Host: Colleen MacDonald

Colleen: Nothing about COVID-19 has been easy. But this winter has been especially hard... with a massive surge in cases around the country and the death toll reaching a staggering, heart-breaking height. More than 500,000 lives have been lost, and our communities are hurting. But spring promises to be here soon. Literally and figuratively. In the U.S., three COVID-19 vaccines have been authorized for use, distribution is ramping up each day, and I breathe a sigh of relief with each friend or family member that gets their vaccine, one by one. But that doesn’t mean we’re out of the woods yet. Many more people need to be vaccinated before it’s safe to start hanging out indoors without masks. And it’s a long, tricky road to herd immunity. Some don’t want the vaccine. Some want it and can’t get it. And lots of people have questions about the vaccine. So today on Got Science? we want to focus on what the data says, to get you some answers based on the best available scientific information. Our guest is Dr. Jose Romero, Arkansas health secretary and chair of the CDC’s advisory committee on immunization practices. He provides scientific guidance and informs the CDC on how vaccines should be prioritized and distributed. I ask Dr. Romero some COVID-19 vaccine FAQs, and what he’d say to people who feel they don’t need to be vaccinated. We also confront the history of medical racism and discuss how public health officials must make sure vaccine distribution is equitable.

Colleen: Dr. Romero, welcome to the podcast.

Dr. Romero: Thank you. Thank you for having me. It's a pleasure to be here.

Colleen: Yeah, I really appreciate you taking time in your busy schedule to talk to us about the vaccines that are currently available and in trial, also to maybe debunk some common misconceptions. One thing I wanted to start off with is we've heard a lot about messenger RNA or mRNA vaccines and their ability to be produced quickly and easily. But when I hear RNA, I automatically think DNA, which could cause confusion and it might make folks uneasy. So, I was wondering if you could explain for the non-scientists how they work?

Dr. Romero: Sure. The vaccine itself is based on what's called messenger RNA. And the messenger RNA, exactly as the name implies, takes the message from the DNA outside of the nucleus, which is the center of the cell, and into the cytoplasm, and it serves as the blueprint to make proteins. It's circulating and it assembles the protein that you want made, we all have mRNA inside of us, inside of our cells. So, this is a molecule that is inside our cells, and there's different mRNAs for different proteins. So, what is done here is that the mRNA encodes or has a blueprint for this receptor for COVID. And when you make that protein, it then is expressed, and you have the development of immunity against that protein. So, it's not the DNA itself, it's not the true blueprint of the cell, it is the messenger from that blueprint.

Colleen: So, just to confirm for our listeners, none of the approved vaccines, or ones that will be approved later can interact in any way with your DNA?

Dr. Romero: That is correct. So, for that concern, it's very true, there is no... It's called integration. That is, there is no chance that that mRNA will form part of your DNA. And this is not a possibility at this time with these types of vaccines. So, they're completely safe from that point of view.

Colleen: Excellent. I'm glad we've cleared that up. A colleague of mine told me that his wife felt pretty bad for about 24 hours after getting her second vaccine. What sorts of side effects can a person expect? And are the side effects related at all to your general health?

Dr. Romero: So, the side effects that you can generally expect are fever, fatigue, some muscle aches, maybe some chills, some tiredness, or sleepiness, those are the general types of things that you can expect. We tend to see those more frequently in younger individuals than older individuals, especially after the second shot. And that in a way reflects the robustness of the immune system of the individual receiving it. So, just as I get older, I tend to forget things. And our immune system also gets old and doesn't respond as well. So, you don't get as robust a response. That type of response actually indicates that your immune system is responding appropriately.

Colleen: I'd like to run through just a quick series of safety questions. Are the current vaccines that are available, are they safe for children?

Dr. Romero: So, at this time, they're being studied. So, we have some data already from one of the vaccines that has been looked at in children, adolescents, really down to 12 years of age, and it appears to be safe. The trials that are being done now or will go into place very shortly, looking at younger children will give us better information as to their safety in those younger children. So, at this point, we can say that at least one vaccine has been trialed to a certain degree in children 12 years and older. And in some cases, in the case of the Pfizer vaccine, it is approved for 16 years and older so they actually tested it in some of the older adolescents. But we're learning about that as we go forward.

Colleen: And what about pregnant women?

Dr. Romero: Yeah, very good question. These vaccines were not specifically trialed in pregnant women. But we have learned, as we vaccinate millions of people, there are going to be people that are pregnant or didn't know they were pregnant and then learn they're pregnant after they received their vaccine. We've learned that it is apparently safe in using in them. And we have not, that is the ACIP nor the FDA, have precluded the use of these vaccines in these individuals. It's an informed discussion between the doctor and the person receiving the vaccine, whether they should receive it or not. And so that discussion needs to be held between the physician and the woman that is about to receive the vaccine. They need to weigh the risk of having an infection with COVID while pregnant versus receiving the vaccine.

Colleen: So, what might a risk be for a pregnant woman?

Dr. Romero: Well, I think that based on the vaccines that we have now, the risk appears to be negligible, if at all. I mean, there's nothing in the vaccine itself that would be interactive with the mother or the fetus. So, I think that the risk is theoretical at this point, based on the knowledge that we have, for primarily the mRNA vaccines, and at this point.

Colleen: So, how about people with diabetes?

Dr. Romero: Yeah, so they should receive the vaccine. They are in a high-risk group, they would be considered as one of the candidates for vaccination, and clearly, should receive their vaccine when their time comes.

Colleen: I want to just talk for a second about the Johnson & Johnson trial, I believe that showed some uncertainty about its effectiveness in those over 65 with diabetes. Is that a concern?

Dr. Romero: So, I have to say that I'm not seeing the specifics about the vaccine trial in the Johnson & Johnson. So, if there is some degree of lack of efficacy in that group, then we need to look at that closely. But again, it depends on what the actual outcome is. So, I'm not sure if that's talking about vaccine efficacy, or if it's talking about hospitalization or death from COVID. So, when we look at these vaccines, we look at various aspects of it. That is the ability to prevent disease that is mild or moderate disease, the ability to prevent hospitalization, and the ability to prevent death. And so, you know, those factors are important. And really looking at the last two, that is the ability to prevent hospitalizations and death, those are very important. And I would need to see that with regard to the patients with diabetes. So, I'll have to say that I have not seen that data yet.

Colleen: Okay. Fair enough. How about people with allergies?

Dr. Romero: So, at this point, persons that don't have allergies to any specific component of the vaccines can receive the vaccines. If you have those allergies to one of the components, then it's a contraindication to receive the vaccine. If you have an allergy to a drug that you received by injection or by IV, then that's a precaution. And that means that instead of being observed for 15 minutes after a shot, you're going to be observed for 30 minutes after a shot to make sure that there isn't an adverse effect. And I know people that have allergies to other things, and severe allergies, and have successfully received the vaccine without any problems. We simply monitor them very closely.

Colleen: I would imagine if you have any of these specific allergies, you would have discussed that with your doctor most likely?

Dr. Romero: Yes, you should. You know, there is...I can say that because of my age I've received the vaccine already. But the questionnaire asks specific questions about allergies.

Colleen: Given the disparities we see in the health care system with regard to people of color, our country's history of medical racism and abuse, as well as existing racism within the health care system now. How can a person of color place their trust in a COVID-19 vaccine?

Dr. Romero: Yes, as a person of color, you know, I am very attuned to this issue. These vaccines have been trialed, that is in the pre-approval phase, have been trialed in high-risk groups, and specific pharmaceutical companies have specifically sought out individuals from ethnic and minority groups that are hard hit by this virus. And they've been shown to be effective and safe in these groups. So, in African Americans and Latinos, in those groups and others, there has been a specific effort to include them in these studies and to show that the vaccine is safe. There is a history, unfortunately, of abuses in our system targeted to minority populations. And that has led to skepticism and doubt about vaccines. But I can say, and I've stated many, many times, that this vaccine is safe and it has been trialed in those groups at highest risk for adverse event. I said that I would take the vaccine when my time came, and I did, because I mean that this is a very safe vaccine.

Colleen: On a personal note, can you tell me anything about your family and your community if there is a reluctance?

Dr. Romero: Yes, I can speak generally to that. And so, in my family, there has not been reluctance to the vaccine that I know of at this time. In my community, yes, among Latinos that I know, and among African Americans, their friends, and colleagues, I have heard them mount concerns about this vaccine. But, you know, I've seen this change over time. When I've talked to some of my colleagues early on about this, about the possibility of vaccines, and would they accept them? Their comments were interestingly, not in favor of receiving the vaccine, but as more and more and more information came out about the vaccine and its safety, I've seen them completely change and accept the vaccine, and have taken the vaccine. So, education is key in this issue, that is presenting the data in a way that is easy to understand and presenting it by people that are trustworthy in the community to each of these groups can foster confidence in the vaccine.

Colleen: If there's one thing that you wanted to say to people to really convince them that getting the vaccine is a good thing to do. What would you say?

Dr. Romero: I think I'd have to say two things. First of all, we know that the vaccine is effective in preventing hospitalizations and death. And we also believe that the vaccine will protect you from developing severe disease, even if you get infected. So, you're preventing the spectrum of disease that can be caused by this virus. And so, it gives you a better chance of not having an adverse event or a death from this virus.

[Break]

Colleen: Once you've been vaccinated, can you still spread the virus?

Dr. Romero: That is the question I think we're all asking ourselves right now. And it's a very, very good one. So, we know from other vaccines, even... Let me give you an example, the polio vaccine that we initially used would protect us, that is the recipient, from getting polio but you could still spread polio. So, we know from history of vaccines, that this is a possibility. And so we are currently looking at whether these individuals that receive vaccines, and it depends on the vaccine type, because it doesn't necessarily apply to all of them if you have protection from one, but we're looking at it. And it seems that these vaccines do limit the ability to transmit the virus, even if infected. So, let me give you an example. If the vaccine works in a perfect way, that is the recipient, the person that receives the vaccine is protected. And at the same time, if that person comes in contact with a virus later on, they won't develop disease, and that virus won't be able to grow in their nose or their respiratory tract, and they won't be able to spread it. That's the perfect vaccine, that prevents the transmission into the community. And that's what we're looking for right now to see if those vaccines, if the current vaccines are able to do that. And some of these vaccines are showing promise in that area.

Colleen: And I suppose it's really almost too soon to tell. As I'm thinking of my next question, you know, can I be reinfected?

Dr. Romero: Well, actually, we're beginning to learn. So, we're beginning to learn now whether these vaccines do protect against reinfection. And this is where the issue of variance enters. Will the vaccines protect against those variants? And can you be reinfected with a variant, not the same, we would say the parental strain of the COVID virus, but an offspring of that virus? That virus, the offspring, would be a little different than the original, and may be able to escape the immunity that you deliver from the vaccine. So, we're looking at that now. That is a possibility. And our programs here are designed to identify individuals that have been vaccinated, and then subsequently develop infection with COVID. We want to look at those isolates those viruses, sequence them and see how different they are from the original one. So, the question is very good. We don't think that you'll get reinfected from the original strain, the strain that you have a vaccine against, but there is a possibility that you may get reinfected from a variant strain.

Colleen: So, will this potentially unfold somewhat like the flu vaccine where you have to get a vaccine every year because you've got sort of mutations or variants?

Dr. Romero: That is a definite possibility. And so we don't know what will happen with COVID-19 or the virus itself, SARS-CoV-2. That's the virus name itself. But if SARS-CoV-2 becomes endemic, that is that it's around and it's always circulating like flu every year and will change, then there is a possibility that we'll need to get yearly or maybe every few years a booster or another vaccine in order to cover for. But we will learn over time. I mean, this virus, really if it's taught us anything, it's taught us that we know nothing and that we're learning as we go forward since this pandemic has begun.

Colleen: What can we expect after becoming vaccinated? Can I shed my mask and reengage with society right away? What will our lives look like in the next six, eight months?

Dr. Romero: So, I think that a lot of that is going to depend on the uptake and the acceptability of the vaccine in the public at large. So, we've talked about herd immunity, and we've heard that before, where you have to have a certain number of individuals in a society or in a closed environment, protected in order to prevent a virus from entering into that society or enclosed environment and causing disease. If there is uptake of the vaccine by 70% to 90% of the American public, and we develop herd immunity, I believe we will be able to get rid of the mask.

Another factor in determining whether we can get rid of it is, of course, you know, does the vaccine prevent transmission? And that will allow us to shed the mask. I don't think we're there yet, you know, it will depend on how fast we uptake and how fast we get new vaccines out there and supply to meet the need. So, possibly towards the end of the year, if everything goes well, we can go that route of shedding our mask. We've heard Dr. Fauci state that we may even have to continue wearing the mask into next year. So, I would be cautious and saying that we're going to get rid of it, and I would advocate continuing to use it whenever you go outside of your house, and whenever you're not with your family, your immediate family.

Colleen: So, if I'm young, healthy, and have no risk factors, and I'm thinking that I don't need to be vaccinated, how could you convince that person to get the vaccination?

Dr. Romero: Sure. There are a number of things I would ask them to think about. First of all, they're not immune from having an adverse event, that is from getting severe COVID disease. We know of a number of very healthy individuals, athletes that have wound up in the hospital, and, you know, some have died because of COVID. So, although your risk is low, you still have a risk, the second of all, the issue of those around you. So, you may be fine, but your parents may not be fine, and maybe an older group, and you want to protect them by not being able to hopefully, not shed the virus and not allowing the virus to propagate in your community. In addition, there is the secondary societal issue, that is that we live in a society where we all interact and our actions affect everyone in that society. And we have, I believe, an obligation to protect others and to take this vaccine in order to prevent others who have a weakened immune system or who are elderly, or have other conditions that placed them at greater risk for adverse outcome or death. We need to protect them by protecting ourselves. So, I think those are the things I would try to stress to young people, it's important that they take the vaccine, even if they are perfectly healthy, athletic, and really see themselves not in a risk group.

Colleen: So, I know that you worked on the framework for an equitable distribution of the COVID-19 vaccine. And while data is limited, it seems to be showing that white people are receiving the vaccine at rates double or triple the rates for Latino and Black people. Do you have any final advice, specifically for communities of color about the COVID-19 vaccine?

Dr. Romero: My advice would be that those that are influencers in our societies, that have this knowledge transmitted to everybody in our minority populations, that they can serve as educators and as promoters of this vaccine. We should also encourage from a public health point of view, and I'm putting on my public health hat here, is that in an effort to vaccinate as many people as possible, we cannot let inequity in distribution of the vaccine occur. And so we have to make sure that we put programs in place, and that we monitor the ability of the vaccine to enter into these communities and address these problems with confidence that they may have in the vaccine. We here in Arkansas, are specifically looking at uptake of the vaccine in different minority groups to make sure that we are targeting those groups with appropriate information and providing the vaccine in areas where they can receive it. So, that is up to us as public health individuals. And as public, we should attempt to make sure that our elderly right now, because we're primarily dealing with 65 and older, that our elderly population who don't have computers, for example, or aren't computer savvy, can have access to these vaccines by helping them arrange for appointments, taking them to mass or large vaccination venues. So, we can do what we can to help. And as public health officials, we need to keep our eyes on these groups to make sure they're receiving adequate supplies of vaccine.

Colleen: Dr. Romero, thank you, first for your tireless effort and leadership, especially in being an advocate for the most vulnerable and underserved people. It's been a real pleasure speaking with you.

Dr. Romero: Thank you. It's been my pleasure. Thank you for having me.
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