As a year of sorrow and misery spills into 2021, health care workers and everyone in the rest of the country have at least some semblance of hope: the COVID-19 vaccines.
As of Jan. 6, the virus has killed over 350,000 people and infected over 20 million in the United States alone and has no signs of slowing down. It took the United States 292 days to record its first 10 million cases and only 54 days to double that figure. In LA County, it took 10 months to record 400,000 cases. It took less than a month to double the number of cases. LA County has become the epicenter of the virus, as about 1 in 5 people getting tested are positive of COVID-19. The region continues to pass grim milestone after grim milestone, with the latest records showing close to 900,000 cases and over 11,000 deaths.
It’s clear that every tactic that public health officials have instituted, from social distancing and mask orders, has failed to curb the virus. However, even with this hope the effects of the vaccine will not be felt until months to come.
“While the arrival of the vaccine offers us some hope for the future, we are still many months away from having enough people vaccinated to see the COVID-19 vaccine begin to diminish,” said Los Angeles County Public Health Officer Dr. Muntu Davis during a recent press conference.
The two vaccines being distributed throughout the entire country were developed by Pfizer/BioNTech and Moderna. However, with the rapid development of the COVID-19 vaccines, and the vast sea of information, many, whether justified or unjustified, have concerns about the safety of the vaccines.
“Three expert panels of scientists—one for the FDA, one for the CDC, and one convened by Gov. Gavin Newsom and governors of three other Western states—all completed independent reviews of the data from the Pfizer clinical trial and concluded the vaccine was safe for use,” said Chief Science Officer Paul Simon prior to the Moderna vaccine’s approval.
To understand the safety and efficacy of vaccines, it helps to understand how the body fights infections.
To fight infections such as COVID-19, immune systems deploy white blood cells to combat foreign viruses. The two important white blood cells are the B-lymphocytes and the T-lymphocytes.
“The B-lymphocytes are the ones that make the antibodies and the T-lymphocytes have an equally important but different job,” said Dr. Paula Cannon, a virologist at USC Keck School of Medicine. “It’s like a two-pronged attack. The B cells make the antibodies that stick to the virus and neutralize it and the T cells wipe up, kill and sacrifice the cells in the body that are currently infected to stop new viruses from being produced.”
However, when our bodies encounter new viruses such as COVID-19, there are no “custom-made antibodies” or T-lymphocytes because our immune systems have never met the novel coronavirus.
“When you first meet a virus, you often get infected because although your immune system immediately goes on red alert and says, ‘This is foreign, let’s start to make some antibodies’ it takes time,” said Cannon. “It’s like a race and the virus is racing ahead, replicating itself in your body and making you feel miserable.”
After a few days, the body finally catches up to the infection and creates enough antibodies and T-lymphocytes to ward off the infection. Once the virus is expelled from the body, the immune system remembers how to defeat the virus in case it comes back.
“Once we’ve met a new foreign virus the body then goes, ‘OK I’m not going to let this happen again, clearly it’s bad,” said Cannon.
She continues saying the body leaves “patrol cells” on standby, waiting for another bout with the virus.
“They maintain a higher level of vigilance and we call it memory,” said Cannon. “That means that if you then encounter that virus a second time in your life it doesn’t win the race. The antibody-producing machinery, the B-cells and the T-cells are already at a high enough level just patrolling the body that they can easily overwhelm the virus.”
Vaccines help the human body develop an immunity to viruses such as COVID-19 without getting the illness.
“That’s what a vaccine is trying to create,” said Cannon. “It’s fooling the body into thinking it’s being attacked and having the body mount the typical B-cell and T-cell immune response. At the end of the vaccination, the body stands down to this heightened memory state, which means you are now protected in the future.”
As the body responds to the vaccine, mounting a defense, people tend to have reactions such as slight fever, pain at the injection site, and fatigue. Cannon refers to these reactions as “Tylenol side effects,” meaning that these reactions are not bad nor are they unexpected.
“We get reactions to vaccines and it’s OK and often a good thing,” said Cannon. “It tells us that our immune system has noticed what has been injected in your arm and it is working really hard to fight what it perceives as an invader. … All these symptoms are actually symptoms of our immune system fighting something. In this case, it’s fighting a vaccine.”
Currently, there are three main types of vaccines for COVID-19: protein subunit, vector and mRNA vaccines. The first two vaccines—Pfizer/BioNTech and Moderna—are both mRNA vaccines, which is the technology that has allowed these companies to develop the vaccines so quickly.
According to the Centers for Disease Control and Prevention, mRNA technology has been in development for decades. In the past, scientists have studied how mRNA vaccines could be used for the flu, Zika virus and rabies.
While mRNA technology has been developed for decades, both the Pfizer and Moderna vaccines are the first to be approved.
In the past many vaccines used either an inactive or weakened germ into the body to trigger an immune response. However, with mRNA vaccines no germs are injected into the body; instead, a recipe is injected.
“The mRNA vaccines are literally just the instructions for the body to make a little bit of the spike protein itself—it’s like a recipe,” said Cannon.
The spike protein is a harmless piece of the COVID-19 virus found on its surface. Once the body has the recipe, it begins to create the spike protein and identifies it as a foreign entity, triggering an immune response. After receiving the vaccine, once the body encounters the COVID-19 virus all it has to do is identify the spike protein and it will launch an attack on the virus.
The Pfizer and Moderna vaccines both require two doses spaced several weeks apart to ensure over 94% efficacy.
The quick development was enabled when the genetic sequencing of the virus was discovered by Chinese scientists at the beginning of the pandemic. Other scientists across the world were able to begin the development of the vaccine once given this information. However, just like most great ventures, the researchers required funding to create the vaccine quickly.
“Normally, when you’re developing a vaccine or a drug, there are two ingredients in the recipe: There’s time and money,” said Cannon. “It takes a huge amount of money to develop a drug.”
In the effort to quickly create the vaccine, the U.S. government launched Operation Warp Speed—a nearly $10 billion backing of six companies developing vaccines. Companies such as Moderna accepted the money for the development; Pfizer/BioNtech did not take funds to help development but to assist in the manufacturing and distribution. Many other private companies and individuals also donated money to help the development of the vaccine.
This has allowed the timeline for creating vaccines to be compressed as all of the tests happen simultaneously. Typically, vaccines take a long time because if the vaccines fail a trial it would cost millions of dollars. However, with the backing from governments and private individuals, losing money was not a worry.
“Things got kind of compressed in terms of time, but shortcuts weren’t taken and the only risk of doing that is money,” said Cannon. “We’re doing things sort of simultaneously, but it doesn’t mean they’re not getting done. The only risk it introduces is the risk such that if things fail, they will fail in an expensive way rather than in a cheaper way.
“The only reason we don’t normally make vaccines within 12 months is because what we’ve done with the coronavirus is hugely expensive. Drug companies would go out of business if this was how they made vaccines.”
The backing allowed companies to quickly develop the vaccine and submit an Emergency Use Authorization (EUA) request to the Food and Drug Administration (FDA). According to the FDA, a “EUA is a mechanism to facilitate the availability and use of medical countermeasures, including vaccines, during public health emergencies, such as the current COVID-19 pandemic. However, even with EUAs the FDA still conducts rigorous trials to ensure the vaccines are safe.
“Although the timeline for developing and evaluating the vaccine has been greatly condensed, all of the essential steps in the vaccine approval process have been maintained,” said Simon.
According to the FDA, phase one is when “the vaccine is given to a small number of generally healthy people to assess its safety at increasing doses” and also shows how the vaccine induces an immune response in people. phase 2 adds hundreds of more people from different demographic groups and varying health statuses to further prove the safety of the vaccine. It also provides a snapshot of the effectiveness of the vaccine. Finally, phase 3 again tests the safety and efficacy of the vaccine by incorporating thousands of people from different demographics. Also, some participants will receive the vaccine; others will receive a placebo to test the effectiveness.
Because Cannon is not a front-line health care worker and has no underlying health conditions, she has yet to receive the vaccine, but she still recommends everyone to take it.
“I would (take) the vaccine in a heartbeat,” said Cannon. “I have absolutely no qualms. I recommend it for my family, for my elderly parents, for everybody. I suppose that should tell you what I think about it in terms of safety but also necessity."