Inoculation in the 1500s...
As we move into 2021, there is no shortage of Covid related news.
1. Can a vaccinated person still transmit Covid? This is a critical question. If we learn that vaccinated persons can still catch Covid and transmit it to others, then vaccinated people will still have to restrict their travel and interactions with anyone outside of their “bubble”. On the other hand, if we learn that vaccinated persons either don’t get Covid at all and therefore cannot possibly transmit it, or might get an asymptomatic or mild case of Covid but not transmit it, we would feel liberated to travel, eat in restaurants, and mix with people outside of our bubble. I asked a good friend of mine who is a leading infectious disease physician about this and he offered the following guidance, which I will paraphrase. “We don’t know yet.” “We need to be able to determine who has been infected, and this is best accomplished retrospectively by looking for antibodies to the nucleocapsid protein.” “There are studies ongoing presently looking at rates of seroconversion to this antigen.” “It is important to look for evidence of infection in vaccinated persons, because without infection there is likely no transmission.” He went on to explain that “real proof will be epidemiologic, probably from places like Israel that will be first to have high rates of vaccination.” So, this vital question will be answered, probably in the next few months, and become more definite over time as more data comes in. I would suggest as a default that those persons lucky enough to be vaccinated should wait until the evidence is available before assuming that they cannot get infected and not pose a risk to others. Also, keep in mind that a vaccine that is 95% effective, still means that 1 in 20 people can still get infected and mild to moderately ill with Covid. It is only when herd immunity is achieved with more than 80% of the population vaccinated or previously infected will we really feel safe – and be safe.
2. Where does anti-vaccine sentiment come from? This story goes back a long way. A friend of mine who works with Chinese art and history reminded me that the Chinese were all over smallpox inoculation long before Dr. Edward Jenner in England made his “discovery” about smallpox in 1796 leading to the development of the smallpox vaccine. My friend related the following: In the 1500s, the Chinese and Indians figured out that smallpox could be prevented by blowing pus from the smallpox lesions up peoples’ noses. In 1780, the Panchen Lama traveled from Tibet to Beijing to visit the Qianlong emperor. Everyone in the traveling delegation got the smallpox inoculation, with the exception of the Panchen Lama who was expected to be immune to smallpox due to his exalted status. This did not work out well and the Panchen Lama died of smallpox in Beijing. Fast forward to 2020, wherein the Covid vaccine is around the 27th vaccination developed in history. Following is the incredibly dramatic list of vaccines that have been developed in chronological order since 1790. Smallpox, rabies, typhoid, cholera, plague, diphtheria, pertussis, tetanus, BCG against tuberculosis, yellow fever, influenza, polio, measles, mumps, rubella, anthrax, meningococcus, pneumococcus, hepatitis B, H. Influenzae, varicella, hepatitis A, rotavirus, zoster, human papillomavirus (HPV), malaria (partially effective). I present this list as it is the highest-level overview of the most remarkable medical achievements in world history and deserves far more recognition than it usually gets. I personally have great reverence for the scientists who have contributed to the development of these vaccines over the centuries. Which brings me to vaccine hesitancy. Vaccine hesitancy is part of the larger disconnection from reality and facts that we are seeing in much of our society today. There is certainly some understandable resistance to vaccines from those who have suffered mistreatment in the medical system. Nevertheless, we must fight ignorance with facts and science, and have our doctors and leaders – politicians, sports stars, celebrities, religious leaders – model publicly receiving the vaccine. I always remind the vaccine hesitant and the reluctant that taking the vaccine might save someone else’s life in addition to your own.
3. Last tidbits hot off the press. A recent review of vaccine side effects reveals 29 serious reactions – mostly anaphylaxis – out of 5.3 million vaccinations given for a rate of 0.000547% -- pretty good odds! The other tidbit is that the Moderna mRNA vaccine seems to provide at least one year of immunity against infection, which is excellent news. As we learn more about this, we will learn if people will need booster shots and at what interval.