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FAQs with an ID expert on COVID mRNA Vaccines

Manie Beheshti, MD and Matthieu DeClerck, MD
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21:35

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In this Hippo Education bonus, Dr. Matthieu DeClerck and Dr. Manie Beheshti, an infectious disease specialist, answer common questions that clinicians have regarding the new mRNA vaccine, including how mRNA vaccines work, concerns about what we know and don’t know, and how to best approach patients.

Published 12/14/2020

References: 

  1. Kaur SP, Gupta V. COVID-19 Vaccine: A comprehensive status report. Virus Res. 2020 Oct 15;288:198114. doi: 10.1016/j.virusres.2020.198114. Epub 2020 Aug 13. PMID: 32800805; PMCID: PMC7423510.

  2. Dong Y, Dai T, Wei Y, Zhang L, Zheng M, Zhou F. A systematic review of SARS-CoV-2 vaccine candidates. Signal Transduct Target Ther. 2020 Oct 13;5(1):237. doi: 10.1038/s41392-020-00352-y. PMID: 33051445; PMCID: PMC7551521.

  3. Lowe, Derek. “Get Ready for False Side Effects.” In the Pipeline, 4 Dec. 2020, . blogs.sciencemag.org/pipeline/archives/2020/12/04/get-ready-for-false-side-effects

  4. Abbasi J. COVID-19 and mRNA Vaccines—First Large Test for a New Approach. JAMA. 2020;324(12):1125–1127. doi:10.1001/jama.2020.16866

  5. FDA Briefing Document Pfizer-BioNTech COVID-19 Vaccine Sponsor: Pfizer and BioNTech.; 2020. https://www.fda.gov/media/144245/download

  6. Widge AT, Rouphael NG, Jackson LA, et al. Durability of Responses after SARS-CoV-2 mRNA-1273 Vaccination. New England Journal of Medicine. Published online December 3, 2020. doi:10.1056/nejmc2032195

Rachel S. -

Dear Mr. Beheshti, thank you very much for this piece. I have a few questions about the mRNA vaccines. 1.How long does it take for out body to develop an appropriate response to the transcribed mRNA once developed. 2.How do we know that the vaccine is safe in the long run and our own immune system won't 'over react' to the mRNA we are introducing to our cells? What if the virus mutates, is the spike protein effective for all strains? Since the vaccine just came out how can I assure the long term safety of the vaccine to families if there is no data on this?
Sincerely,
Rachel

Solomon B., MD -

Hi Rachel- here is what Dr Beheshti said:

"Hi, Rachel. Thanks for your great questions.
1.How long does it take for out body to develop an appropriate response to the transcribed mRNA once developed.
The Pfizer/BioNTech mRNA COVID-19 vaccine study data found that the vaccine efficacy was 95% seven or more days after the second dose.
The Moderna mRNA COVID-19 vaccine study data found the vaccine efficacy to be 95% fourteen or more days after the second dose.
2.How do we know that the vaccine is safe in the long run and our own immune system...
Long term safety is the only component that keeps these vaccines from being fully approved (instead of the current EUA). Those studies are typically carried on for 6 or more months after vaccination. Because we are in the middle of a pandemic, there would be ethical issues if these vaccines were withheld from use. That being said, most vaccine adverse events occur in the 2-6 weeks following vaccinations. Plenty of time has passed in that regard. In fact, many of the vaccine participants in these trials were vaccinated starting around 6 months ago. These should be very reassuring to us. Taken together with the high efficacy and safety data we currently have, this is the reason all experts are very motivated to get vaccinated.
3. What if the virus mutates, is the spike protein effective for all strains?
This virus can certainly mutate. However, it is not to the same degree as, for example, the influenza virus. Currently, there are no SARS-CoV-2 strains that would render this vaccine ineffective. The good news is that these mRNA vaccines could be rapidly altered and produced if there were to be a major mutation that would lower the vaccine's effectiveness,
4. Since the vaccine just came out how can I assure the long term safety of the vaccine to families if there is no data on this?
Like anything else in medicine (and in life!), the decision hinges on risk versus benefit: what is the risk of not getting vaccinated and possibly contracting COVID versus the risk of having a very rare vaccine event that we do not yet know about? While it is true that when we vaccinate a very large number of people, a few unexpected adverse events could surface, most experts would agree that the risk of waiting could be too great. As of this writing, over 3000 people in the US are dying daily with close to 250,000 daily infections with no let up in sight. For all the reasons above, it is far safer to be vaccinated than it is to risk infection."

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