Physician Outlook

Artist: Manasa Mantravadi, M.D., Pediatrician

Warp-Speed Science


The Creation Of Visionary Vaccines

2020, forecasted to be “the year of clear vision,” has turned out to be many things, but clear is not an adjective that comes to mind. For the vast majority, it’s been a year filled with turbid incertitude, blind trust, solitary confinement, intense fogginess, political confusion, irrational anger, deep darkness, intense grief and visceral fear. For a lucky and blessed minority, it’s been a year of personal growth, stronger connections with family, and renewed spirituality.

For me, personally, I have very much felt like an “extra” cast in an unbelievably complex sci-fi/thriller movie that I have seen before, the kind where I miss intricate details that later turn out to be very important. Life in 2020 is reminiscent of cinematic oldies but goodies like Contagion, Bird Box, The Hunger Games and Wag The Dog. The kind of movie with complicated storylines complete with surreal plot twists, conspiracy theories, heroes and villains.

It is surreal to think that it has only been a year since we first heard of SARS-COV2 and its journey from bat to human. By the time we had learned of its virulent path, COVID19 had already caused a tragic loss of life as it spiraled out of control and spread outside of the landlocked capital city of the Hubei province in China. In a few short months every continent and almost every country on planet Earth has become host to this most unwelcome guest.

We close out 2020, however, with a ray of sunshine and prism-like focus on a brighter future as COVID19 vaccines have been developed, studied, mass-produced and sent out for distribution.  Hundreds of thousands of healthcare workers are lining up to receive a vaccine that only a year ago would have been a figment of the imagination. Never in the history of science has a vaccine or medication been released to the general public so rapidly.

I am frankly overwhelmed and pleasantly surprised by the unity that I have observed amongst fellow physicians who have embraced the opportunity to get vaccinated. I was expecting that ANYTHING related to “Operation Warp Speed” with its lofty goals to bring a vaccine to the U.S. market by year’s end would be met with the usual disdain and distrust that our President seems to incite.  Many of the same doctors who are now proudly displaying selfies and photos of their COVID vaccine certificate and bandaged arms are ironically the same ones who were very skeptical about the safety of the vaccines that the President was promising. The doctors’ masked faces express a combination of giddy excitement and tear-filled relief that science has brought a potential end to this horrible pandemic.

Physicians are not naive, however. We understand that the vaccine is not a cure for COVID19 itself, and that it will take a considerable amount of time and widespread population immunization before we see any effects. We are ALL holding out hope that the vaccines are a first important step to putting an end to the lockdowns and drastic changes in our ability to treat patients, travel, work, learn and socialize. Worldwide, public health officials have had to recommend and institute draconian measures in attempts to “flatten the curve” of COVID spread and mortality. We know that the unintended consequences of COVID-related public health recommendations are not benign. There are rising rates of anxiety, depression, suicide, substance abuse, food insecurity, bankruptcy, divorce, missed cancer and other health diagnoses, increased homelessness, child neglect and maltreatment, worsening childhood developmental delays and many other conditions that far outnumber the tragic loss of life being caused by COVID19.

As a physician, I am elated that the general public is being educated about the importance of hand hygiene, covering their coughs, not touching their noses/mouths to prevent spread of disease and the basics about transmission of viruses. Few people seem to understand that the majority of viruses are most easily transmitted to others days before symptoms become apparent.

Even fewer people understand the importance of vaccines and how they work; all of the discussions around the COVID vaccines will be a vital tool to help those who have traditionally been vaccine-skeptic and avoidant accept the science behind vaccines that they currently may be declining.

Although, I too, will soon likely be taking my own vaccine selfie with a bandage on my upper arm when I return to work at my University Health clinic in a few weeks, I have a confession to make. I am somewhat embarrassed to admit this out loud : I am secretly relieved that I was not one of the first in line to get a COVID19 vaccine. I join a relatively small subset of physicians that are willing to be patient a little longer given the speed of the roll-out of the vaccine, and my relative personal low risk for complications from COVID19 disease.

Some colleagues may accuse me of “trying to destroy the public trust in vaccination” by voicing my opinion, but the exact opposite is true. I am a staunch supporter of vaccination and will continue to remain vocal about its importance. I find that my patients are more likely to accept vaccinations when I am honest and truthful about what we know and what we don’t know. I frankly can’t wait for my own father and other elderly, at-risk relatives to get vaccinated, as they are deteriorating before my eyes from the consequences of being shut-ins. I think that ALL of our colleagues who work in emergency departments, ICU’s, operating rooms and in other high-risk fields should absolutely be prioritized as first recipients if they want to receive the vaccine(s). I think that all hospital maintenance workers should be prioritized over everyone else, as this low-income hard-working group of individuals are rarely provided with enough appropriate protective equipment as they go from one high-risk situation to another. It irks me to see hospital administrators and politicians lining up to get vaccines before those who really need them.

I am not embarrassed to express my opinion that I am appreciative that I will have some time--and more science-- to be able to critically review the pros and cons of each of the COVID19 vaccines before getting one myself. I have SO many unanswered questions! Will Moderna or Pfizer’s vaccine confer the longest-lasting protection? When will we know the long-term effects (if any) of mRNA vaccines on those with autoimmune disease, or on a developing fetus? We know that mRNA does not enter the nucleus of cells, and thus should not then be capable of altering human DNA...but do we know if there will be some unintended deleterious effects from mRNA transcribing a protein that bears similarities to the coronavirus’ spike protein? Will there be superior herd immunity from Oxford/Astra-Zeneca’s vaccine? Is the Inovio vaccine, with its reported excellent thermostability and 5-year shelf life be the most appropriate one for outpatient use? Are the more temperature-sensitive vaccines (eg, Moderna)  not going to be as effective because of temperature/storage/expiration issues? I am full of questions, and avidly scouring through research studies and pre-print papers to look for answers. Today’s answers may not be tomorrow’s, as we are living through rapidly evolving and trying times. But that is the nature of science.

Crazy times call for drastic measures, and while I am glad that Operation Warp-Speed has allowed us to have a vaccine approved under the EUA for COVID19, I think we should be administering it only to those at high-risk -particularly the isolated elderly who are suffering more from social seclusion than from complications of COVID, and I believe we should be aggressively studying through trials people on whom we have very little vaccine study data. We know virtually nothing about the vaccine’s effects on those who are immune-compromised due to their underlying conditions or due to medication (eg those on steroids or on biologic agents for conditions such as arthritis, psoriasis, inflammatory bowel disease).

Science takes time. Vaccination of those at highest risk should proceed, as should the development of better testing for disease and to determine who is immune.

You can’t hurry love, and we shouldn’t rush science.

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