Written by Christian Green, Carolina Public Press.
In the first of a two-part series on the COVID-19 vaccines, Carolina Public Press takes a look at common misconceptions about getting the shot.
“I can’t get the vaccine because I don’t have insurance.”
The federal government purchased hundreds of millions of doses of the vaccine that are free to everyone, regardless of insurance.
Some health care providers are able to charge a fee for administering the vaccine, but public and private health insurers are required to cover 100% of the administration cost. The federal government pays this cost for uninsured individuals through the COVID-19 Claims Reimbursement program.
“Uninsured patients will not be charged for the vaccine, and providers who wish to be reimbursed for vaccine administration must bill the federal government and cannot bill uninsured individuals,” according to the Kaiser Family Foundation
“I can’t get the vaccine outside the county where I live.”
Individuals can receive the vaccine anywhere in the United States.
“The (national Centers for Disease Control and Prevention) has instructed states that this is a federal vaccine bought with federal funding. Thus, jurisdictions may not put restrictions on administering vaccinations to nonresidents,” according to the N.C. Department of Health and Human Services. “This applies to both county and state residency.
“I can’t get the vaccine because I am not a citizen.”
Anyone can receive a COVID-19 vaccine, regardless of citizenship or immigration status, according to NCDHHS
The U.S. Department of Homeland Security said that it “fully support[s] equal access to the COVID-19 vaccines and vaccine distribution sites for undocumented immigrants,” and the Biden administration has promised that Immigration and Customs Enforcement “will not conduct enforcement operations at or near vaccine distribution sites or clinics.”
“The process of vaccine development was rushed, and the vaccine may not be safe because of the speed.”
It is true that this is the fastest vaccination campaign in history, but that does not mean corners were cut when it comes to safety.
“These were fast studies, but they were really well-run studies,” said Dr. John Sanders, who led the phase 3 clinical trials for the Moderna vaccine at Wake Forest Baptist Medical Center. “There is not a remaining question about the safety of these vaccines. These are safe vaccines,” he said.
Each of the currently available vaccines went through the same clinical trial process as any other vaccine or treatment. The development was expedited because the companies were able to simultaneously conduct clinical trials while also manufacturing the vaccines thanks to financial backing by the federal government. The simultaneous work meant that once a company received authorization from the U.S. Food and Drug Administration, it was able to move the already manufactured doses quickly.
Also, clinical trials rely on people naturally getting sick in order to study if a vaccine is effective. Sometimes, it can take years for enough people to get sick before the trial has enough data to conclude a result. In this situation, the fast spread of COVID-19 helped clinical trials reach the amount of data researchers needed to collect more quickly.
“Millions of people all around the world have already received these vaccines perfectly safely.” said Dr. Cindy Gay, who led the phase 3 clinical trials for the Moderna vaccine at UNC Health.
The strongest evidence for the safety of the vaccines is the fact that the doctors themselves want them, she said.
“All the people who are working on these studies — the infectious disease physicians, epidemiologists and staff — they’re all asking, ‘When can I get this vaccine?’” she said.
“The current vaccines are ineffective against the new strains, so I want to wait to get it.“
It is not as simple as the vaccine either works or it doesn’t.
Consider, for example, the flu vaccine, which the national CDC has found to be anywhere from 40% to 60% effective each year. This means that those who receive the vaccine are about half as likely to come down with the flu if they are exposed to it.
That reduction alone is good, even if it does not preclude every strain. But it also applies to everyone who receives the vaccine, making the possibility for transmission among a given social circle dramatically reduced by much more than 40% to 60%. The effect, herd immunity, is the ultimate goal for these vaccines.
There are three major mutations scientists are monitoring: the U.K. strain, the Brazilian strain and the South African strain. Because these are new mutations that scientists are still learning about, this information is subject to change.
Each of these strains has mutations that slightly change the shape of the virus’s spike protein, which the immune system’s antibodies latch onto in order to prevent infection. The more different the mutated spike protein is from the original, the less effective antibodies will be at covering them.
Even if current COVID-19 vaccines are less effective against some of new strains, that does not mean they are useless. Previous studies have found that people who receive the flu vaccine and still catch the flu are much less likely to end up in the hospital. The same appears to be true for COVID-19 vaccines, which protect people from developing serious illnesses.
It appears that the Moderna and Pfizer vaccines show a similar effectiveness against the U.K. strain, but they may be less effective against the South African strain. In response to these findings, Moderna and Pfizer have already begun creating booster shots that will target these new strains, but those will likely be given in addition to the original doses, so there is no benefit to waiting for them.
Other vaccines in development, such as those coming from Johnson & Johnson, Novavax and AstraZeneca, are all able to account for these new strains in their clinical trial data.
For example, in the Johnson & Johnson trial, which included participants in both South Africa and South America, “not a single person who got vaccinated and had illness after four weeks ended up in the hospital,” Dr. Mathai Mammen, the head of pharmaceutical research and development at Johnson & Johnson, told NBC News.
Both the AstraZeneca and Novavax vaccines have shown good results against the U.K. strain and are being tested against the other two strains.
While new mutations may evade the vaccines enough to cause minor illness in some people, the vaccines still protect more than half the people who get them from ever becoming sick. For those who do become ill, the vaccine protects against any severe illness, hospitalization or death.
“I have heard that some vaccines are better than others. Can I choose?“
All vaccines are required to show a benefit to be approved for use by the FDA. Because supply is limited and time is of the essence, individuals are currently unable to select a particular vaccine.
Some people have hesitance about the Johnson & Johnson vaccine, which is still under consideration by the FDA. The company reported a 66% efficacy at preventing moderate to severe infections across all trials. Moderna’s and Pfizer’s vaccines both reported that they were over 90% efficient at preventing moderate to severe infections, making many people believe they are better.
The J&J trials were conducted across the world in North America, South America and South Africa — an important distinction because there are now different mutations to SARS-CoV-2 around the world. In particular, the Brazilian and South African strains appear to be the most concerning.
In those different trials, the J&J vaccine showed 72% efficacy at preventing moderate/severe disease in the United States after 14-24 days. In South America, it was 66% effective, and in South Africa, it was 57% effective.
The Moderna/Pfizer clinical trials were mainly conducted in the United States in late summer and fall, meaning that those clinical trials likely did not include these new mutations. If they had included mutations like the South African strain, their efficacy numbers may well have been lower.
Preventing disease is not the only role of a vaccine. Even in situations where people still get sick, they often have less severe illness if they have been vaccinated. In all of J&J’s worldwide trials, the shot proved 85% efficient at preventing serious disease and 100% efficient at preventing hospitalization and death, even in South Africa. While the J&J vaccine might not be as effective at completely eradicating minor symptoms, it was very good at preventing more serious cases.
The J&J vaccine may be an improvement for logistical reasons. The Moderna and Pfizer vaccines both require two shots to achieve a high level of immunity, and they must be stored in specially built freezers to keep them at supercooled temperatures. This has led to many logistical hiccups, wasted doses and vulnerability to disease for more than a month after the first shot due to the three- to four-week wait between doses.
In contrast, the J&J vaccine only requires a single shot, and doses can be stored for up to three months at 36-46 degrees Fahrenheit — temperatures a typical refrigerator can achieve.
“I shouldn’t get it because I already had COVID.“
“If you’ve had COVID-19, you can receive the vaccine as soon as you are over the illness and symptoms have resolved,” Dr. Chris Ohl, an infectious disease expert at Wake Forest Baptist Health Medical Center, told WFMY News 2.
Scientists don’t know exactly how long natural resistance to COVID lasts after recovery. However, it is generally accepted that a strong natural immunity does last at least 90 days after recovery.
Because of that, the CDC advised that someone who has recently recovered from COVID-19 might elect to temporarily delay vaccination by a few weeks so that people who do not have natural immunity can receive a vaccine first.
The vaccines offer protection that is just as effective, if not better than, what the body produces from a real infection. Even if a person previously had COVID-19, there is no increased risk from vaccination, and there is a decreased likelihood of transmitting the disease.
“I have allergies to eggs, shellfish or peanuts, so I’m not sure I should get the vaccine.“
“People with allergies to foods, animals, environmental triggers (such as pollen), latex or medications taken by mouth, or who have family members with past severe allergic reactions, can be vaccinated with the Pfizer or Moderna vaccines,” according to NCDHHS.
The only people who are recommended not to receive either the Moderna of Pfizer vaccine are people who have had severe reactions to any ingredients within the vaccines. Find the ingredients to the Moderna vaccine and Pfizer vaccine at these links.
There have been some reports of anaphylactic reactions to both vaccines, but these are very rare (31 documented cases out of more than 6 million doses). In these rare cases, the reaction occurred very soon after the vaccine was administered, and no reaction resulted in any long-term negative consequences.
Vaccine recipients are monitored for 15-30 minutes afterward, and all vaccination providers are advised to have the necessary materials on hand to treat anaphylaxis, should it occur.
Concerned individuals should consult their doctor.
“If I get it now, I’ll just have to get it again in a few months.“
There is not enough data to know for certain how long immunity lasts after vaccination. It is possible that booster shots will be required for new strains of COVID-19 as they appear.
It is possible that SARS-CoV-2 becomes a minor disease like the flu, which we will need to vaccinate for each year, Dr. Anthony Fauci told NPR; but he said, “I don’t think we need to make that assumption.”
The best bet to avoiding future vaccination is getting shots to as many people as quickly as possible.
Mutations to the disease can only occur when it replicates in a host, so if enough people become vaccinated to stop the spread of the disease, the vaccines would effectively curtail its ability to mutate and spread.
“We live in a global community, and unless we get the rest of the world adequately vaccinated, and unless we don’t have the opportunity of this virus to mutate in a place that doesn’t have access to vaccines, we will always be threatened,” Fauci told NPR.
Christian Green is a Carolina Public Press contributing writer based in Raleigh. He obtained a master’s degree in Neuroscience at Wake Forest University’s Graduate School for the Arts and Sciences, where he worked in the Laboratory for Complex Brain Networks and used graph theory and machine learning to explore functional connectivity differences in the neural networks of individuals with Alzheimer’s disease compared to healthy aging adults. Send an email to [email protected] to contact him or other members of the Carolina Public Press news team. Carolina Public Press is an independent, in-depth and investigative nonprofit news service for North Carolina.