Ask the Pharmacist -COVID vaccines

Q) I hear so much about the new COVID vaccines every day on the news but I find it pretty confusing as the information appears to constantly change. What are some of the newest developments when it comes to them?

A) It is unfortunate that the information about the virus and the vaccines seems to be in a constant state of flux. This has led some of us to stop listening to the experts under the assumption (a mistaken one in my opinion) that they really don’t know anything. It has also caused some to question whether they actually should choose to receive the vaccine when their opportunity arrives. These are regrettable consequences of ever changing recommendations, but they were also pretty much inevitable.

This virus is an original and, like any other new phenomena throughout history, it has generated a steep learning curve that takes time to comprehend. This is especially true when dealing with a living organism such as the corona virus. It evolves over time by mutating which changes the very nature of its properties.

Today, I wanted to talk about a few of the uncertainties that are generating most of the headlines when it comes to the vaccines. The question that I seem to hear most often is, whether these vaccines are safe. This is a concern for many people since the vaccines are new and were developed with an unprecedented speed. However, this short timeline can be explained by the critical nature of the situation. It is a fact that, never before, has so much money and so many experts worldwide collaborated on solving just one health care issue.

It is also important to note that none of the stages that are normally involved with the discovery and testing of a new drug or vaccine were skipped. That means that these vaccines went through pre-clinical analysis involving animal testing as well as all three phases of testing in humans to assess their safety and effectiveness before they were released to the public.

Eventually, this testing involves thousands or, in the case of the Covid vaccines, tens of thousands of people during phase three trials. These trials are geared towards safety to such an extent that the Oxford-AstraZeneca vaccine trial was voluntarily put on hold when just one recipient out of thousands passed away. It was only restarted when researchers were sure that the death had nothing to do with the vaccine. We are now at a stage where a number of different vaccines have been rigorously analyzed and released to the world.

As of January the 8th, 18.9 million doses of various vaccines have been administered worldwide in 39 different countries. I have heard the refrain from a number of my patients that they would like to wait before seeing receiving the vaccine to see how it affects others. I understand this sentiment and it is not without logic. But, as you can see from the above numbers, you could be vaccinated tomorrow and still not have been anywhere near the front of the line. If you choose to wait, then just when would you be comfortable receiving it? After 40 million doses have been given? One year after it has been released? Will a single year or a few million more doses really reassure you about the vaccine’s long-term safety?

The fact is, that if you are waiting for absolute certainty regarding the safety of the vaccines, you will need to wait years putting you in danger of getting infected and of having your activities restricted. I understand the concern about the lack of knowledge regarding the long-term effects of these vaccines. However, the fact is these vaccines are not much different in that respect than any of the thousands of drugs that have been released over the decades.

In general, new drugs do not get tested for years prior to being released. There is rarely long-term safety data. In fact, in close to 60% of new medications, safety data is collected in less than a 1,000 patients for even as long as a single year. And yet, this is still a far more rigorous process than was used in the day when drugs like Tylenol, Penicillin and Aspirin were discovered and released decades ago. Reassuringly, the safety evaluation does not stop when the drugs are finally approved for release to the general population; it in fact only gets more intense.

Thus far, the vaccines as a collective seem to be very safe. Mild side effects are fairly common and are similar to those found with other vaccines. They include swelling or pain at the site of the injection, tiredness, fever and headache as well as muscular or joint pain. Of note the incidence of fever seems to be higher after the second dose of the Pfizer vaccine has been given. These effects tend to be short-lived, as is typical with other vaccines. The incidence of allergic reactions thus far does seem to be higher than we normally see with a vaccine and of a more severe nature. This has led some experts to caution people with a history of severe allergic reactions to steer clear of these vaccines, at least for now. That being acknowledged, current data indicates that the rate of allergic reactions with the various Covid vaccines is one person per 100,000 people injected (a typical vaccine is 1 per 1 million).

Given what we know to be the risks of becoming infected with this virus and the possibility that your infection will be a severe one (remember we have had 17,510 deaths in Canada alone as of January 14th), the risks that these vaccines pose are far less than the disease itself, even if you are young and in excellent health. Another uncertainty regarding these vaccines are questions regarding just how long the protection they offer will last.

There were concerns initially that it might just be a few months or that we would need to boost it annually as we have to with the flu vaccine. I’m happy to report that while we still do not know exactly how long their effects will last, and won’t for some time, early blood tests show that immunity is likely to last at least several years. This is a hugely positive development given how difficult it is proving to be in getting the vaccines to all of our high risk individuals in a timely and efficient manner.

If we needed to repeat this several times a year or even annually, the burden on the health care system would be enormous and surely take away from care in other much needed areas. As well, experts now believe the vaccines will work against not only the original version of the virus but also against the more contagious variants that have been discovered in the UK and in South Africa.

Next week, we’ll discuss another debate that seems to be raging. Namely is it better to vaccinate more people with just a single dose of the vaccine or should we stick to the original two-dose protocol that we know works in over 90% of recipients. For more information about this or any other health related questions, contact your pharmacist.