My Black Doctor Perspective On The COVID-19 Vaccine.

I honestly have more questions than answers, but I will begin with a financial disclosure. I also challenge other analysts, commentators and proclaimed experts to do the same. I am not compensated by any companies involved in manufacturing vaccines. I do invest in stocks linked to manufacturing vaccines. 

I am a medical doctor, board certified anesthesiologist. I also have years of experience in science and medical research. In my newly appointed role as the Chief Medical Correspondent for Kluster Radio Media Group, I am duty bound by the ethics of medicine and journalism. 

I am not a conspiracy theorist. I do not align with anti-vaccination ideals. I have received all vaccines recommended by my healthcare provider, including the flu vaccine. My first and foremost recommendation is that individuals should always consult their healthcare providers. I furthermore advocate for Black people to seek out Black doctors. According to Stanford School of Medicine and Stanford Health Policy, research has shown minority patients have better outcomes when treated by minority physicians. 

How does a vaccine work? Briefly, I am going to try my best to explain a vaccine. (I solicit your prayers). A pathogen is something that enters your body and makes you sick. A virus is just one example, but I will speak on it because that's what we are dealing with currently. Part of the virus is made of a protein that is called an antigen. The antigen is what triggers your immune cells to make antibodies and neutralize the virus. Again this is a very simple description of a very complex process. Historically the scientist would use a deactivated antigen, or viral protein, in a vaccine that would trigger your immune cells to make antibodies and an immune response. 

The current front-runners for COVID-19 vaccine production are not using weakened or deactivated viral proteins to trigger an immune response. They are using messenger RNA (mRNA). RNA, akin to DNA, consists of genetic material. The mRNA is a genetic sequence used in the vaccine to trigger immune cells to make antibodies that will neutralize the virus. This new technology had only been employed in animal models, not human trials, until the current public health crisis.  

Science has proven viruses mutate and their antigens change. This phenomenon is called “antigen instability.” This means antibodies may not be effective at neutralizing the virus after it has mutated over time. Also, please note that public health experts are not clear on what percent of the population needs to be vaccinated to establish herd immunity. However, we are clear that it would take more than the percent that recent polls reveal are willing to be vaccinated.

Does the vaccine work? Again the front runners in the race for a vaccine boast a 90% efficacy or higher. Are you aware of what that really means? This 90% efficacy only means that the manufacturer can say with confidence that patients given the vaccine will have an immune response, not immunity. Did you catch that last part? These companies are saying that if you receive their vaccine, your immune cells will be triggered to produce antibodies, an immune response. According to the World Health Organization (WHO) no one knows the quantitative amount of antibody production needed to protect someone from COVID-19. 

What are they not saying? They are not saying that everyone vaccinated will produce a level of an immune response or antibody titres that will protect them from contracting COVID-19, getting sick, having complications or even dying. They are not saying that those who receive the vaccine can not transmit the virus. They are not saying how long an immune response will last or be effective due to antigen instability. (Read again, please.) 

Is the vaccine safe? I can not answer this question. I am not sure how well anyone can answer this question. One might feel we have been in this pandemic a very long time, but this virus just turn one year old and vaccine production has only been underway a few months. No one knows the long term effects of something that has only been around a short time.

It has been admitted that minority participation in clinical trials were low. Does a lack of minority volunteers limit the ability to assess the safety profile in minority patients? Minorities have been disproportionately affected during this pandemic for many reasons. Could some of those reasons, such as a large prevalence of preexisting conditions, make the vaccine less effective or safe?

"I am a doctor that believes in science, and I am a black woman that does not trust a government and healthcare system that continues to disenfranchise people that look like me."

One of the vaccines has to be kept at extremely cold temperatures. How will they ensure these parameters are kept in transit from manufacture to actual injection to the patient? Is the vaccine less efficacious if not kept at this extreme temperature? Does it make it less ideal for distribution in warmer climates like where I am in Texas?

What are the side effects? Both vaccine front runners report mild symptoms similar to acquiring the actual virus (muscle aches, chills, headaches, rash, pain at injection site). The New England Journal of Medicine reported side effects correlated with maximum and repeated doses of the mRNA vaccine. Subjects actually dropped out of the study due to side effects. Experts and analysts have been forthcoming about their fear of side effects deterring the general public from being vaccinated, as well as remaining compliant to receive the second vaccine dose required for optimal immune response. Today, Reports of anaphylaxis-like reactions required the administration of epinephrine, but did not result in fatality. While writing this piece, an official statement has been issued that patients with a history of allergies should not receive the vaccine. Dr. Leana Wen, a contributing columnist for the Washington Post, stated on CNN that people should not be alarmed or discouraged that some will die after getting the vaccine. Yet, I am alarmed. Transparency would be more appreciated than political fodder and media “spin.” 

What has history taught us? Do not assume, I will use the historical Tuskegee Experiment to bolster mistrust of the vaccine. I am actually of the culturally unpopular opinion that those circumstances do not apply to this vaccine narrative. The Tuskegee Experiment represents this country’s longstanding and deceptively cruel arm of systemic racism that knowingly withheld treatment from Black Americans. This vaccine narrative is more akin to the very recent discovery of immigrants being unethically and unlawfully sterilized in deplorable conditions at an ICE facility. This travesty did not take place decades ago, but just weeks ago.  

Also as recent as 2010, scientists boasted advances in adenovirus (Ad5) vectors for vaccinations that were later found to increase susceptibility to Human Immunodeficiency Virus (HIV). Currently, I am alarmed to read in a peer-reviewed scientific journal that CanSino Biologics and ImmunityBio are in clinical trials for their COVID-19 vaccines using adenovirus (Ad5) vectors. 

Do I plan to get the vaccine? At this time, I do not plan to get the vaccine. My risk-benefit assessment and discussion with my healthcare provider does not warrant me taking known/unknown, short term and long term risks. The risk profile of this vaccine is too uncertain for little benefit. This vaccine is not guaranteed to keep me from contracting or even spreading COVID-19 to my family. Per Dr. Fauci, the vaccine will not eliminate the need for masks and social distancing. 

I have worked with COVID-19 positive front-line workers, and I have taken care of COVID-19 positive patients. I wear my mask and PPE. I decontaminate after leaving work and before entering my home. I socially distance and limit my comings and goings to just the essentials. I have been tested for both the virus and antibodies. All of my tests have remained negative. Thus, I conclude I can remain safe and keep my family safe with my current masking practices and vigilant social distancing. Thus far, this decision has only increased my risk for acne, or mask-ne. With excellent medical advice from my dermatologist and modification to my skincare routine, I find the risk manageable and of greatest benefit to those I care about most. 

Takeaways: 

1. Consult your healthcare provider. 
2. Do your own research and risk/benefit assessment.
3. A vaccine will not eliminate the need for masks and social distancing.

Quote me. “I am a doctor that believes in science, and I am a black woman that does not trust a government and healthcare system that continues to disenfranchise people that look like me. Calling me ‘Doctor’ does not stop me from being more than three times more likely to die in childbirth. My degree does not make me immune to racism or healthcare inequalities.” -Dr. KaNisha L. Hall