I never get vaccines. One of the reasons I see a naturopath is because I don’t like to put chemicals in my body. Why should this be any different?
Dr. Otto: I can strongly relate to the sentiments in this question. I have built my life on practicing careful selection on what I put in my body, and I’ve built my career on teaching people how to do the same to promote health. I also have a lot of respect for the body’s built-in mechanisms to deal with microbial threats and personally think it would have consequences if we routinely blocked this mechanism from taking place. With that said, after careful deliberation I decided to get the Moderna vaccine. To distill my complex views on the subject I will say this: Our bodies are under pressure every day due to the things we put into and onto bodies that actively harm us like unhealthy food, personal care products, hair dye, pesticides, cigarette smoke and alcohol. Meanwhile, this pandemic is an active threat to our lives and the lives and well-beings of our families, neighbors and communities. Of all of the times in my life I have chosen to put something in or on my body that could possibly be found to harm me in some way, this vaccine is undoubtedly the one time that there was clear benefit that surpassed any potential risks.
What should I know about the different vaccine types and is there one that’s better than the others?
Dr. Otto: In a rapidly evolving public health landscape, we essentially have two types of vaccines in circulation: mRNA vaccines like Moderna and Pfizer and viral-vector vaccines like Johnson & Johnson and AstraZeneca. Up to this point at least, the Moderna and Pfizer vaccines have been the primary options in the United States. The Johnson & Johnson vaccine is become more widely available as we speak. Both the Moderna and Pfizer vaccines require two doses about a month apart while the Johnson and Johnson option requires just one dose. The mRNA vaccines essentially deliver the instructions to a human muscle cell to actually create the identifying protein found on SARS CoV-2 (known as the “spike protein”) long enough to stimulate our immune systems to start building an army against it. It’s sort of like a CIA operation where our bodies are getting the necessary intelligence about a foreign terrorist effort ahead of time so that our defense systems can take immediate action and stop the threat before it happens. Our bodies only make the special protein unique to SARS CoV-2 for an brief period of time, but the military defense our bodies set up in response to it sticks around just the way it would after any typical infection, protecting us from that infection by keeping soldiers in circulation that intimately know how to respond to that particular threaet in the future. A viral-vector vaccine, in contrast, takes an existing run-of-the-mill virus like that of the common cold, genetically engineers it to be incapable of replicating in the body, and attaches the special spike protein to it to trigger the exact same aforementioned CIA/military response. The outcome is the same in terms of immunity, it’s just a different mechanism for getting there. I think it’s important to state that while the mRNA vaccine technology is new in terms of its use within a vaccine on a global scale, the research had been going on for quite some time prior to this pandemic and has been well-studied. The efficacy of the mRNA vaccines’ ability to prevent COVID-19-related hospitalization and death is extremely high after the second dose. This may have more to do with them involving two separate doses rather than the mechanism (mRNA) of the vaccine since the Johnson and Johnson vaccine (only requires 1 dose) confers a similar level or modestly higher level of protection that one gets after the first dose of the mRNA vaccines. The Johnson & Johnson vaccine confers a lower efficacy rate than the mRNA vaccines, BUT only requires a single dose AND was studied during a time of new variants circulating and a higher number of cases. Basically, I don’t think there’s a reason to delay getting vaccinated by one type in deference to another unless you have an allergy or other reason to discriminate among them.
Can I stop wearing a mask and socially distancing once I’m vaccinated?
Dr. Otto: No. Clear and simple. This is the reality for a couple of reasons: First - the vaccines are super effective, but they aren’t quite 100% effective. And since one of the main reasons we are practicing social distancing and mask-wearing is to prevent our hospitals from being overloaded beyond capacity, we need to continue these essential practices until the vaccine has been offered to most people. Second - we do have variants of the virus in circulation now. At this point in time, the current vaccines still seem to be largely effective against them, but if we don’t contain transmission, that may eventually no longer be true. That would mean that our vaccine tools could become less helpful and our hospital systems would again be at risk for overload. I would mention here that while we assume based on history that vaccinated people will be less likely to spread the disease due to their immune protection, we don’t yet have clear data about that for this particular disease and therefore want to err on the side of caution. Third - It would simply be too confusing. When you are out and about and not wearing a mask, people don’t know if your truly vaccinated or if you are just rebelling against public health recommendations. So we all need to practice caution for the coming months.
What are the risks associated with the vaccines? I’m worried about the things I hear like infertility.
Dr. Otto: Vaccines, just like any drug or surgical intervention, come with risks of side effects in addition to the anticipated effects. These vaccines are no different. The most common primary effects of the vaccines include local symptoms - pain, swelling and inflammation at the injection site that usually lasts a few days, as well as systemic symptoms that feel like a really bad illness including fever, chills, fatigue, muscle aches, headaches, and symptoms that often accompany fevers generally. The vaccines that contain two doses tend to pack a pretty significant punch after the second dose - especially the Moderna vaccine. Interestingly, older people most vulnerable to the actual virus tend to tolerate the vaccine more easily whereas younger people less likely to succumb to the virus tend to be sicker from the vaccine. This probably has to do with the ‘sharpness’ of a younger immune system than an older immune system, reinforcing the need for older people to have access to vaccines to protect them against the most severe presentations of COVID-19. These are the expected effects. Unwanted side effects at this point seem to be fairly uncommon, though are getting a lot more attention because of the hyper-focus on these vaccines in the media. Still, it’s important to acknowledge them. Prolonged arm pain and stiffness, rashes, and worsening of existing underlying symptoms can and do occur. I have limited anecdotal evidence to share since we are still in early phases of roll-out, but so far my patients who have had prolonged effects from the vaccine tend to be those I suspect would have harsher long-term outcomes from COVID-19 like the newly dubbed “long-hauler” post-COVID-10 syndrome. Since the natural COVID-19 disease brings with it increases of autoimmune disease risk and may also reduce male fertility/sperm health, it is important for an individual to consider these risks when deciding whether or not to get the vaccine which does not, as far as we know, carry said risks. While Dr. Jones is going to elaborate further on the infertility issue specifically, there simply is no evidence at this point that female infertility will be negatively impacted by the vaccine. The theory behind “why it could possibly maybe interfere” it is a significant stretch of science and has not borne out during the trials or in animal models. In fact during the clinical trials, the conception rate of women who were vaccinated was the same as women receiving a placebo/non-vaccine.
I am a healthy, low-risk person. Shouldn’t I skip the vaccine and just wait to get COVID naturally?
Dr. Otto: I am a proponent of natural immunization. The step-wise process of our immune systems to identify and respond to threats is integrated into our dynamic interconnected systems’ biology. A working principle of naturopathic medicine and the functional medicine approach is to appreciate that when you manipulate or hinder one aspect of the body’s functioning, you have untold consequences to others. Therefore, we aim to understand how to support and optimize the body’s existing systems (including the immune system) rather than replace them. However, I am willing to make an exception every 100 years when a global pandemic is wreaking havoc and putting millions of innocent people at grave risk. I just think that’s part of living in a connected world where we depend on each other in various ways for our safety. The idea of a “COVID party” like the “chicken pox parties” of my childhood is appealing except for the fact that this virus spreads so darn easily and among asymptomatic individuals. You would literally need to live in a carefully controlled bubble for a month to make it work, and that just doesn’t seem realistic and safe to me. An additional concern is that while this disease tends to hit certain risk-populations the hardest, there’s really no way to know for sure how well you personally will handle the disease. I am pro-vaccination in general, but I am also a proponent of personal decision-making when it comes to deciding what goes into one’s own body and therefore choosing whether or not to be vaccinated. Fortunately, we have learned that simply wearing a mask that covers the mouth and nose is extremely effective at minimizing the risk of transmission of this disease. This means that you can protect those around you from the disease you may not know you are carrying simply by continuing to wear a mask over your mouth and nose should you decide not to get vaccinated (or if you are unable to get vaccinated).
I’ve already had COVID. Can I skip vaccination?
Dr. Otto: This is a category that I personally want to have more data on before I really answer it. Officially, the CDC is recommending that an otherwise vaccine-eligible person who has already had COVID wait 90 days after their positive COVID test before getting vaccinated. Their primary reason for this is to allow other people who don’t have any immunity to get it via vaccination. But I wonder if we might actually have longer immunity than this. I don’t necessarily think it would be harmful. Rather, I would personally rather ride out my natural immunization before jumping to the vaccine. But that’s just me. I never got COVID and regularly was tested for antibodies whenever I donated blood over the past year, so I didn’t have to make that decision for myself.
I’ve heard that people feel really ill when they get the vaccine. If I get vaccinated, how do I prevent getting really sick from it?
Dr. Otto: Dr. Jones and I have been deep into this topic since the vaccines became available. At this point, my recommendations aren’t different from those I’d give to anyone about to get any vaccination. I recommend you get plenty of sleep both leading up to and during recovery from the vaccine. I recommend additional gut support since a lot of the immune system that gets activated involves activity in or near the intestinal tract. Gut support means probiotics, an anti-inflammatory diet and addressing any acute flares of GI disease like IBS or IBD. Otherwise, we believe that the symptoms following vaccination are largely desirable as they indicate a fierce protective force from our immune systems. Patients can take over-the-counter NSAIDs or Acetaminophen to hedge a fever and pains if they desire - though I recommend trying to use these sparingly and simply rest rather than work the day after your vaccinations. To minimize arm pain, be sure to use your arm and engage the deltoid muscle after vaccination to encourage blood and lymph flow through the area to prevent excess pain. For patients with more complex immune system issues, we will be making other recommendations. For patients who are having side effects from the vaccine that are not typical, we have been prescribing for them on a case-by-case basis.
I know this is a loaded question, but what do you think the future looks like after this pandemic passes?
Dr. Otto: I hate to break it to anyone, but this is not the last pandemic we’re going to see. I've commented/joked before that this is the type of event I’m "willing to get vaccinated for every 100 years", but truthfully I think pandemics will become more common just as extreme weather events are becoming more common. We have nearly 8 billion people on this Earth and climbing, and we are living in closer and closer proximity to each other as well as animals through agricultural practices which creates at atmosphere for some funky and scary things to happen with pathogens and how they spread. So, I hope that we are better outfitted to tackle the next outbreak when it happens by learning from this one. One thing I think very likely will be different moving forward after this pandemic is ‘over’ is the use of masks in public spaces. Our friends in Asian countries have known for several decades the benefits of mask-wearing in densely-populated public spaces, especially if you have symptoms of illness. We have now learned for ourselves how effective the extremely simple practice of mask-wearing has caused influenza cases to plummet this season along with preventing the transmission of COVID. Wearing a mask may be the easiest, most inexpensive and non-invasive way to keep our population spared from airborne pathogens while allowing us to live our regular lives. I am really excited about that and I can imagine that mask-wearing on subways and buses, for example, becomes commonplace.
I chose this style of writing for this blog post to highlight the fact that while my opinions on this topic are CDC-informed, they are my opinions shaped by current science as well as my philosophy of medicine and approach to health and wellness. The contents of this post do not necessarily reflect the official positions of the organizations to which I belong nor the medical community as a whole.