Devils and Angels — The Pro-Vaccine Narrative versus Complex Reality
Media messaging continuously stresses that good citizens who “believe in science” will get the Covid vaccine and that, for the most part, only those who are anti-science, anti-vaxxers, uneducated, or Republican men (especially Trump supporters) have concerns about the vaccine. The idea is apparently to try to shame anyone who has rational concerns into taking the shots because you don’t want to be lumped in with any of those painted as undesirables.
A news segment that I found somewhat offensive and manipulative featured a reporter in a rural Oklahoma cafe early one morning asking people’s opinion of the vaccines. Most of the folks there were not very talkative or articulate in their responses, which could have been for a variety of reasons. Some didn’t really seem to want to be on television. Most indicated they had some concerns about the vaccine or weren’t interested in getting it. In the wrap up, the metamessage seemed to be “Well, folks, look at the ignorant rubes in Trumplandia who don’t believe in science. You don’t want to be like these people do you?” Using this group as props for a vaccine promotion angle seemed unfair and certainly will do nothing to convince any of these folks to be more open to taking the vaccine.
In contrast to this media narrative about the sadly ignorant with vaccine hesitancy, it is quite fascinating that surveys reveal just shy of 50% of healthcare professionals have not taken even one shot despite being one of the very earliest authorized groups who were eligible to take the vaccine. What? How could this be? Do half of our doctors and nurses not believe in science? Of course not. On the contrary, these folks have probably read more than most of us and understand the various considerations which leaves them with some rational hesitancy.
One issue that should be of concern to everyone is the fact that all of the vaccines have only been given emergency use authorization to date by the FDA. In the earliest media coverage the entire phrase was used denoting the less than fully authorized status of these vaccines. In a short timespan, however, news coverage stopped noting emergency use authorization and simply substituted “authorized” by the FDA, presumably to mitigate any reluctance folks might feel if they were reminded of the emergency use status regularly.
Does the phrase “emergency use authorized” sound like a product that is ideal to inject into every human on the planet as fast as we possibly can? No, not really. Truth be told no one has even had this vaccine in their body an entire year at this point. Yes, early data show that it seems to be relatively safe for most folks (while a small number have had severe reactions or problematic consequences). But, we obviously cannot know about possible long term issues because there has not been time to assess these.
Most of the Covid vaccines are using an mRNA approach that has never before been used in an FDA approved vaccine. It’s brand new. It may turn out to be a fabulous success but we also might find out it creates some unanticipated issue down the line. We can’t know this in advance. We must wait and see how events unfold.
Clearly, the use of the word “safe” with respect to the Covid vaccines needs to have a couple of asterisks after it for the caveats “relatively safe for most people” and “based on the evidence we have at present”.
Then we come to the issue of the widespread use of the “95% effective” talking point. One major concern is the phrase has been misused and not properly explained. Vaccine efficacy is calculated in a manner most people may not anticipate. They compare the number infected in a placebo group to the number infected in the vaccine group. One of the Pfizer trials, for example, had one placebo group with 9 serious level infections and a vaccine group with 1. So, the vaccine group was nearly 90% better in this one instance. They average all the groups and come up with the overall efficacy figure. When the vaccine was released, the reported efficacy was 95%. However, Pfizer just announced last week that the efficacy is now at 91%.
But, again, the overall number of infections is confounded by the fact that all participants were wearing masks, distancing, and engaging in other health measures. So, you cannot say that if you took a group of 100 vaccinated individuals who were not masked and sprayed them with the Covid virus that 95% of them would not become infected.
As I mentioned in part 1, something called challenge trials would be necessary to find the real world percentage of effectiveness without the health prevention measures like masks. In these studies, vaccinated volunteers are directly exposed to the virus to determine the total percentage who are prevented from getting any level of infection. Very recently, some challenge studies have begun in the U.K. Some health leaders, like Dr. Fauci, have said publicly they are against challenge trials, in part for ethical reasons and in part due to a concern about the general public’s potential reaction to a possibly much lower vaccine effectiveness percentage when the results are released. On most topics related to Covid, I have respect for Dr. Fauci and think he provides very good guidance. However, on this topic, I am disappointed in his attitude and disagree strongly with his position.
We know that the Measles vaccine is around 97% effective at producing sterilizing immunity without any masks, distancing or other measures. People have the right to know what the true percentage of protection from the Covid vaccine will be when they try to go back to normal. I believe this is the percentage that most people want to know (and unfortunately most people currently believe is 95% due to the constant repetition of this figure in the news). If challenge trials reveal the real world protection percentage is a very high, that’s great news. If it is a lower percentage, people need to know that so they can make their choices accordingly.
In part 3, I’ll discuss variants, the recent news that the U.K. strain is now the dominant strain in the U.S., and how more harmful strains like the South African version could affect the vaccine landscape.
