The images are popping up on our social media feeds: pictures of friends, coworkers, and family members proudly displaying their COVID-19 vaccine card.
One might have received Pfizer’s version. Another might have posted a celebratory confirmation of Moderna’s vaccine.
It’s one small, but mighty, tool in our arsenal to encourage vaccination among our friends and family, which is the best chance we have to put the COVID-19 pandemic in the rearview mirror once and for all, says UNLV vaccination expert Dr. Johan Bester.
“We should use every tool at our disposal to try and encourage vaccinations,” said Bester, director of bioethics at the UNLV School of Medicine. “Post when you get vaccinated and post pro-vaccine messaging. Combat the misinformation that we see so that we can help protect the well-being of people.”
Protecting the well-being of society, Bester argues, is an obligation we all share. The COVID-19 pandemic has disrupted the nation’s health, mental health, economy, and our overall way of life.
If there’s a way we can stop the pandemic, shouldn’t we try?
“The only way that we can be rid of this thing is to, as a society, come together — our institutions and our individuals working together to do what it takes to get to limit spread, to interrupt the chain of transmission, and to be able to return to normal life,” he said.
Here, Bester explains why Americans should be confident in receiving a vaccination, how vaccines work and how they can eradicate COVID-19, and why getting vaccinated should be considered a civic duty.
Why should Americans feel con
fident that the COVID-19 vaccines are safe like other vaccines for diseases like measles?
Whenever a vaccine comes to market or is approved by the FDA, it has already gone through a very long and rigorous process, where it has been tested in various stages, and tested for adverse effects in humans. They try to figure out a dose that will be most effective, and then they test it on large numbers of volunteers. These studies were pretty well done.
Thousands and thousands of volunteers received the Pfizer and Moderna vaccines, and adverse effects and COVID infection rates were compared with a placebo group. From these studies and from data from subsequent administration in the general public, we know that these vaccines are very effective and that serious adverse effects are very rare. Fevers, body aches, and sore arms are side effects you’d find in any other vaccine. They may feel very bad in the moment, but have no long-term consequences.
The most serious adverse effects we’ve seen were severe allergic reactions. Fortunately, the rate of a serious allergic reaction — anaphylaxis — is very low, and it is usually in people who have a known history of anaphylaxis.
If you have an allergy to one of the vaccine components, or you are known to have had serious anaphylactic reactions, that might be a reason to be especially cautious when you get the vaccine, or to not get the vaccine at all. You’d really have to talk with your doctor about your specific situation. But that would be the only real reason for someone who’s otherwise eligible to not get the vaccine.
One important caveat is that this is all short-term data, so we’re not sure how long the protection from the vaccine lasts. We think the vaccine is expected to provide at least a year’s worth of protection, quite possibly longer, but we have to continue studying it over time to be certain of that.
We know that a disease like measles was eliminated in the U.S. through the use of vaccines. Can you explain how it worked in that case, and what can happen if enough people don't get vaccinated?
Measles is extremely contagious - between seven and 15 times more contagious than COVID. So, if measles is spreading and you’re susceptible, you’re going to get it. But there’s a combination of things that made it possible for us to eliminate measles.
One is that the vaccine is exceptionally effective. It’s one of the most effective vaccines we have. The other is that measles doesn’t change very much. Influenza changes a lot, and each year you need a new vaccine. Measles doesn’t do that, it stays pretty stable.
Measles is also completely dependent on spreading from person to person. It doesn’t hide out in nature somewhere, it doesn’t go into hiding in people, it doesn’t go and hide in animals. It’s kept alive by spreading from one infective case to the next infective case.
So, if you interrupt that chain, you can get rid of measles — there’s nowhere else that it can come back from. If you have enough people in a population that are vaccinated or have recovered from measles — enough people that are immune to measles — measles cannot easily spread in that population, you interrupt the chain of transmission, and measles goes away. This is the effect of herd immunity: enough people are vaccinated, the disease cannot spread, and so even those people who are not immune won’t get the disease because the disease is eliminated.
Because measles is so very infectious, we need to vaccinate about 95% of people in a population. There’s always a small group of people who cannot get the vaccine, or who lose their immunity over time, and they remain susceptible to measles. But if we keep up a high enough vaccination rate, it’s possible to keep measles at bay.
The one caveat is if you get somebody visiting your population who brings in measles. In that case, those who are susceptible are going to get it. This is why we see outbreaks each year in the U.S. — with the exception of 2020 because of social distancing and limited travel. We get travelers who bring in active cases of measles and then it spreads like wildfire along those chains of susceptible people connected with one another in some way.
Do you think it's possible that the COVID-19 vaccines can help eradicate the disease just as vaccines in the past have helped with measles, polio, etc.?
I certainly think it’s possible and I certainly hope so. It seems like COVID-19 changes a little bit more than measles does, but it doesn’t seem to change as much as the influenza virus does.
So, I believe it would be possible for us to create herd immunity, in other words, where we have enough people vaccinated, which would then stop the spread of COVID. We would need to vaccinate between 65% and 70% of the population to get to that point. It’s lower than the measles count, but it’s still a pretty high number.
If we interrupt COVID spread long enough in our population, then we certainly would get rid of it. That was the whole idea with the lockdown. The idea was we take a lot of pain for a month, we all do a lockdown, we stop the spread of COVID, and when we get out from the lockdown, there’s no COVID around, and when we get an outbreak here or there as will surely happen - we identify it through aggressive testing, and we respond to it by isolating those who are sick and their contacts. And the rest of society can go on.
Now, that of course did not happen. But I’m hoping if we combine the vaccine distribution with aggressive testing and local quarantine, masking, and social distancing, it will be enough for us to remove COVID from our society.
What are some challenges we currently face in terms of eradicating COVID?
The rollout of the vaccines has been a lot slower than I anticipated or had hoped for. I understand there needs to be an initial period where we ration and make sure it gets to the frontline workers, but it should not take us too long to open it up to the general public. We should really start transitioning in the near future to a situation where there’s no barrier to getting vaccinated.
At the moment, if you want to be vaccinated, you have to go through an onerous process to make sure you’re in the right category and the right tier. I understand that it’s a scarce resource now and we need to make sure it’s distributed wisely, but we should get to a point where everybody has access to the vaccine without difficulty, and should be encouraged to get it. I’d like to see that happen within the next couple of months, but it may end up taking more like six months.
Also, we still have some unanswered questions about COVID. One is, we’re not 100% sure of where it came from yet. If there’s some sort of animal reservoir, or a place where it’s hiding out, it can keep coming back.
The second thing is that we don’t know yet if COVID will be around for multiple years and whether it’s going to start changing more than we have seen up to this point and developing different protein subtypes.
But based on everything we know now, I’m certainly hopeful that we can get rid of COVID — especially the hospitalizations and deaths. If we can get to a point where we can protect the most vulnerable — thereby bringing down the hospitalization and death rates — that would be a big deal.
Why is it important to eliminate barriers when distributing a vaccine?
When it comes to decision making, people often opt for the default and avoid things that seem too difficult.
If we want people to buy healthy food, for example, we have to put the healthy food in the front of the store, with easy access. We must make it easier for people to make that choice. If we want people to save for their retirement, we must make saving for retirement the default — take money from your paycheck automatically for retirement — but you can opt out if you don’t want it.
Vaccine research has shown that in states where the default is that your children will be vaccinated, and you must register an objection and go through some process to say no, the vaccine rates are much higher than in states where you have to opt in.
Right now with the COVID vaccine, we’re in a place where you have to go through a process. I understand we’re in an early phase, and that we want to make sure we use what we have responsibly. But we cannot stay like this for too long. We need to slowly but surely move to a place where barriers to vaccination are removed.
Why might some Americans who have received common vaccines (i.e. childhood vaccines like the measles, or the annual flu shot) be hesitant to receive the COVID-19?
Even though there is a vocal anti-vaccine movement in the U.S. and in all of the Western world, the vast majority of people are actually pro-vaccine. They’re fairly accepting of vaccinations and the idea of vaccinations. We know this because many, many people get vaccinated or vaccinate their children.
But, there’s a number of reasons why some people who have generally accepted vaccination in the past might be hesitant about the COVID vaccines.
One is the perception that this is a new vaccine, so “I don’t want to be a guinea pig. I want to be sure this thing works before I get it.” There are all kinds of horror stories in film and in popular media about vaccines that go wrong. People want to be sure that this vaccine works. They want to be sure it’s not being tested on them. They want to make sure it’s gone through the process, that experts have looked at it, and that it actually is safe before they inject it in their bodies.
That is a legitimate concern, and that is why I think everybody working with vaccines or in vaccine ethics and policy, was clear on the need for rigorous trials and rigorous study to ensure safety of these vaccines. The data should be out there, should be open, it should be clear. I think that has been done — though the work is still ongoing — so we can have confidence in the process.
The second reason is that, unfortunately, right before the presidential election, there was some political discourse that politicized the vaccines. There was some worry that elected leaders may rush the approval of COVID vaccines for political purposes. There were also some lawmakers making statements that they weren’t going to get it unless it was vetted properly. These kinds of messages undermine confidence in vaccine safety. COVID should not be a political issue at all. Masking, social distancing, and getting the vaccine should be seen as a civic duty — actions that bring us all together in the interest of the common good. It should not be a thing of, “I’m this political party, I’m that political party,” and it should be led by sound policy based on science and facts.
In order to get buy-in from the public, it will always be necessary for the process to be rigorous and transparent, and unimpeded by political considerations.
Are those feelings of hesitancy on the part of some Americans valid? Why is it important for Americans to push through those feelings of hesitancy, and commit to getting the vaccine?
I completely understand feelings of hesitancy. But quite simply, the vaccine is the best hope we have for getting rid of COVID and for a return to a normal life.
There are a number of good reasons to get vaccinated; one is to protect yourself. COVID is a pretty frightening disease. Most of us will get very minor symptoms, but if you’re one of those unlucky few who get serious illness, it’s no walk in the park. You might experience lingering symptoms months after. You might end up in the ICU. These are all frightening possibilities. To protect yourself, the best weapon we have right now is the vaccine. The other best weapon that we have is to participate in the preventive activities of masking, social distancing, testing aggressively, and quarantining if you’re sick.
The other reason to get the vaccine is that if you contract the disease, you might inadvertently cause other people to suffer injury or complications. Of course, you wouldn’t do that on purpose. But if you have a way to prevent the spread of a serious disease, and you can foreseeably do so, then maybe you have an obligation to do so.
We, as a society, have an obligation to respond to threats to the well-being of the members of society. COVID is obviously a threat to the well-being of the members of society. It does so through the disease that it brings, but it also does so through the economic impact that it has on society. It also does so through feelings of fear and dread and isolation that accompanies a pandemic. All of us are suffering under the impact of COVID on our society.
Beating COVID depends on all of us doing our bit. And because we’re members of society and have obligations to each other to refrain from negatively impacting each other’s well-being, we have a civic duty to comply with vaccination and preventive measures to get rid of COVID.
I would say we can be confident in the vaccine’s safety and effectiveness. I will get the vaccine at the first opportunity I can do so. And I would encourage everybody to do the same.
