Monday, November 23, 2020

Why I want to be first in line for the Covid-19 Vaccine

I was talking to some educated reasonable people in the last few days, after Pfizer released the basic results of it's phase 3 Covid-19 vaccine trial and Moderna released the interim results of it's phase 3 trial. Both had efficacy of about 95% against the virus with no major side effects. For people in the know, that's a slam dunk, a hole in one, an 80 yard touchdown pass, a sub 2 hour marathon. So I want the vaccine, either one, as soon as possible, and I'll try to explain why in laymen's terms for you doubters.

First, there are two sides to a vaccine, how effective it is, and how dangerous the side effects might be. There is also the option to not get the vaccine. I made the table below to summarize the available data as simply as possible for the two options.

Not Getting a Vaccine and Getting the Disease

Getting the Vaccine

How Effective at Preventing Covid-19



Chance of Dying after Two Months



So, obviously the discussion is more nuanced than that, if you don't get the vaccine, maybe you won't get the disease either. For starters, what are the long term possible health implications of the vaccine? Before I answer that, we need to answer at the same time what the long term possible health implications of getting the disease are. So first, we don't know for the vaccine. We really have no idea if there are any negative effects from either the Pfizer or Moderna Covid-19 vaccines that show up more than 2 months after getting the second shot of the vaccine. Who knows, maybe people will keel over dead exactly six months after the second shot. Highly unlikely, that sentence was sarcasm, but the point is, we really do not know. To answer the second part of that, what are the long term consequences of not getting the vaccine and instead getting Covid-19, well for starters there is about a 2% chance of death, and that's an average, if you are over 60 or have any comorbidities like obesity, your risk of death is much higher. To give an anecdote, one person I know that contracted Covid-19 in July still has not fully gotten back her sense of taste like she had four months ago. There are no reports of that with the vaccine. In other words, we know that getting the disease you could die or have months long health problems, but getting the vaccine seems to have no immediate negative health effects. Again, this is a hole in one.

Second, still on the risk side, what are the short term risks to getting the vaccine or not getting the vaccine? For the Pfizer vaccine, you have a 2-4% chance of a fever or a headache... boohoo. Get over it. For Covid-19, again the average in the USA across all populations is about 2% chance of dying. Personally, I'll take the headache and a fever for the day or a few days. I would enjoy the extra day working from home... and being alive.

Finally, there is the efficacy aspect. Quick clarification, efficacy is basically how effective the vaccine is under lab controlled administration of the vaccine, in the real world, the effectiveness will be a little lower because some people will not get the second dose of the vaccine and others will get them spaced much farther apart than the prescribed 21 days or 28 days. So 95% effective is about as good as it gets. Frankly to definitively raise the official effective percentage higher than 95% there needs to be many more sick people than just the 170 that Pfizer had get Covid-19 (of those 162 were in the placebo group). Also, we don't know the circumstances of the eight people who had the vaccine and then got sick. Maybe some of them got Covid-19 between the first and second shot. Maybe some of them are healthcare workers who were working in Covid-19 wards and on accident received a high dose of the virus. 

Additionally, for those that still don't know how vaccine trials work here is a summary. First there is a pre-clinical phase where the vaccine is basically tested in animals to make sure it creates antibodies and does not kill the animal. If you watched the movie I Am Legend with Will Smith, that's the phase he's injecting the vaccine in rats. Phase 1 is a small group 10-80 people and the purpose is to make sure that it does not harm humans. A vaccine that crippled or killed humans would hopefully be obvious at this stage. Phase 2 trials are something like 100-2000 people to determine what the appropriate dose is to produce the desired antibodies while minimizing side effects. Finally phase 3 vaccine trials are 20,000-60,000 people where the statistics become real. Half are given a placebo and half are given the actual vaccine. Then, we all wait for a predetermined number of people to get sick from that particular disease, in the case of Pfizer and Covid-19 it was about 150 people that needed to get sick to determine how effective the vaccine is. 

This all comforts me because I'm not confident enough to sign up for a phase 3 vaccine trial, although I thought about it, but given the data that is currently available, count me in for either one of these. 15,000+ people have each had these two new vaccines and they seem to be working without major side effects. Long term, I'd much rather take my chances with one of these vaccines than with an actual case of Covid-19.

With all of this said, I'm bullish on these two vaccines for the above reasons and I'm also optimistic that in the future mRNA might be a key to making dozens of other vaccines for diseases that have confounded scientists for decades.  The US government has thrown billions of dollars through Operation Warp Speed at vaccine manufacturers, and let's be honest, it looks to be a huge success! 

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