COVID-19 Vaccine Q&A with Dr. Velma Scantlebury
Dr. Velma Scantlebury
America's First African-American, Female Transplant Surgeon
How do mRNA vaccines from Pfizer and Moderna work?
COVID-19 is known for its spike proteins on the surface of the virus. Messenger RNA (mRNA) is the genetic material that tells your body how to make proteins. Both Pfizer and Moderna vaccines are able to create an exact copy of the genetic material that codes for the spike protein of the virus. This genetic code in the form of mRNA is encapsulated in a lipid or fat particle and injected in the form of the vaccine. This mRNA gets into the muscle cells of our arm and immediately gets to work to tell our body to make spike proteins. These spike proteins are recognized as invaders and signal our body to respond. Our immune system responds by making attack proteins (antibodies) that will destroy any spike proteins that come back to our bodies in the form of a COVID-19 infection.
How does the Johnson & Johnson vaccine work?
J&J uses the same mRNA but it delivers it to our body by encasing it in the shell of a common harmless cold virus called adenovirus. This shell delivers the mRNA to the cells of our body, and the shell disintegrates once the genetic material is delivered. The code, once inside the cells, produces the spike protein to train the body’s immune system and produce antibodies in a similar fashion. The shell and the code CANNOT cause you to develop the viral infection.
How did the vaccines get to market so quickly?
Due to the pandemic, the US government was able to put forth billions of dollars to get the manufacturers to start working on the vaccine process. The mRNA technology has been around for decades, and the initiative to bring vaccines to market was called “Operation WARP speed”. The time to develop the vaccine occurred faster than normal for several reasons, including:
Significant funding to jumpstart the process
Recruitment of clinical trial volunteers from existing networks
Employment of thousands of people to manufacture, test, and collect data etc.
While testing a new vaccine can take years, sufficient funding allowed multiple steps to occur at the same time, overlapping early phase testing and recruitment with various volunteers in many countries. The final steps of Phase 3 studies enrolled over 70,000 patients and followed them, for 2 months to determine how the vaccine worked - half got placebo and half received the vaccine
Are the COVID-19 vaccines safe?
All vaccines have been shown to be safe, as presented to the FDA for emergency authorization. There were no deaths in any of the studies that were felt to be caused by the vaccines.
Are they effective?
Vaccines are very effective. When we compare the flu vaccine which is only 60-70% effective, the Pfizer vaccine is 95% effective in preventing symptomatic disease. Moderna is 94.1% effective similarly, and Johnson & Johnson has 72% overall effectiveness and 86% efficacy against severe disease in the U.S.
What are the side effects of the vaccine?
All the vaccines have similar side effects such as pain, redness or swelling at the injection site, soreness of the arm, chills, headache, fatigue and tiredness, and swelling of lymph nodes.
On rare occasions the vaccine may trigger anaphylaxis, a severe reaction that is treatable with epinephrine. For this reason, the CDC requires
those vaccinated to be monitored for 15 minutes after receiving their COVID-19 shot and for 30 minutes if they have a history of severe allergies.
How can I trust vaccines that were developed by a healthcare system that has wronged my community in the past?
It is important to own the fact that there is an element of distrust based on past data that validates the hesitancy. However, we also know that from the beginning stages, there were people of color involved in the roll out of these vaccines. The lead doctor who developed the mRNA vaccines, Dr. Kissmekia Corbett, is an African American woman. Additionally, leaders from Black institutions involved in the recruitment process.
Did members of the African American community participate in clinical trials? Yes. All vaccine phase 3 trials took steps to enroll African Americans in the trials. Moderna also slowed down their clinical trials when told about the lack of adequate representation of African Americans in the study.
While still not great, both Pfizer and Moderna had 9.8% and 9.7% Black enrollment by race, which is higher than the 3-5% generally seen in other clinical trials.
Do the vaccines work differently in people of color?
No. There is no difference in how the vaccines work based on race or ethnicity. The only factor that affects the ability to work is the strength of your immune system. People with a compromised immune system may not be able to respond as well to the vaccine, and hence may be less effective in such persons.
What are the top questions and concerns you hear from the African American patients you work with?
Patients are concerned about trusting the process, but once explained, they are less reluctant. For transplant patients, the population I work with, they also want reassurance from their doctors that it will not interfere with their transplanted organ and not cause rejection.
How do you address these concerns?
Education is key as well as looking at the data. There are several studies looking at the response of transplanted patients to the vaccine, and the level of antibodies that are developed. It is important if you're a transplant patient to consider monitoring your level of antibodies to establish if you were able to develop an adequate response to the vaccine.
What would you say to someone who is unsure about getting the COVID-19 vaccine?
It is important to get vaccinated if you do not have a contra-indication (severe allergic reaction to a previous vaccine thought to be life-threatening). The more people are vaccinated the less the virus will mutate, as we are facing more and more variants as the virus passes from one person to another.
Getting COVID 19 disease carries more risk of dying if you're within that group with co-morbidities, and immunocompromised. There are no direct deaths related to the COVID-19 vaccine, but 2.6 million people have died across the world, and over 550,000 persons here in the U.S. from the coronavirus.
With all the variants appearing in this country, any protection from any vaccine is better than no protection at all.
