Pick Your Friends, Not Your Vaccine
Just for kicks I had my blood drawn last week.
Why? I was (needlessly) craving proof that my body did what it was supposed to after getting vaccinated: make antibodies to the COVID spike-protein.
And it did! The test result came in today. As expected, the vaccine stimulated my body’s immune system (specifically, my B cells) to build me an army of antibodies, poised to fight off coronavirus in the event of any exposure.
Did I need this proof with a blood test? Nope!
Should you check your blood for antibodies two weeks after you’ve been vaccinated? It’s not necessary whatsoever.
In fact, none of us needs to doubt the robust data from tens of thousands of clinical trial participants or question the ever-important real-life data that further proves the stunningly marvelous efficacy of the COVID-19 vaccines.
So why the hell did I test my own blood?
For one, I love data. Second, meandering over to my lab provided a break from my computer and a chance to shoot the breeze with Khadija. And last, I got this decent selfie.
But most of all, pondering antibodies helped me roam the immunology section of my brain to answer a frequently-asked question about the vaccines:
Which vaccine should I get?
Most of you have heard the party line: “Get the first vaccine you are offered." And while I still preach this gospel, if you're anything like me, you have a hankering for more nuance.
But before we talk about the different vaccines, let’s clarify something important. Our goal with widespread vaccination is not to rid the planet of SARS-coV-2, the virus that causes COVID-19. Rather, our goal is to prevent death, severe disease, and hospitalization from COVID-19. And all three vaccines—from Pfizer, Moderna, and Johnson & Johnson—do this extraordinarily well.
What’s not possible is to completely eliminate the risk of asymptomatic infection. Do the vaccines reduce transmission and help prevent spread of the virus to other people? You bet!
But do they completely STERILIZE the recipient such that no viral particle could ever inhabit the recipient’s nose? No way. That’s not even possible.
But guess what? It’s also not necessary for the vaccines to 100% reduce asymptomatic infection for us to resume normal life.
Once we achieve herd immunity—something we’re already on the path toward—it won’t matter if people have tiny amounts of the virus in their nose when a) it doesn’t make them sick and b) they can’t sicken other people.
And most of us would be willing to take on a small risk getting a cold or mild flu—which the vaccines essentially turn SARS-coV-2 infection into—to resume our regular lives over time. It’s important to remember that we lived with that risk every day before the pandemic. (More later about what societal risk is “acceptable” to fully re-enter life after the pandemic and in future flu seasons, for example.)
In short, right now it’s important to understand that we’re aiming to live with this coronavirus—like we do millions of other viruses—and to disarm it.
Make sense?
OK, so back to the vaccines. They do indeed have different efficacies. (I know you’ve been paying attention.)
This chart that I pulled with permission from Emily Oster, PhD, nicely—though only very approximately—compares efficacy numbers pulled from widely published trial data. Dr. Oster has made it clear (as I will, too) that particularly for asymptomatic infections, these are estimates only. Nonetheless this chart is quite helpful:
You can see with your own sophisticated eyes that the three vaccines are not the same.
Sidenote about vaccine efficacy pulled from my newsletter last month: When we say that a vaccine is “95% effective against any symptomatic COVID-19,” it does NOT mean that 5% of vaccinated people are unprotected. It does NOT mean that one in 20 people will get sick from COVID despite vaccination. Vaccine efficacy is about relative risk. It is not measuring the likelihood of illness in an individual person. It is measuring the risk of disease in a vaccinated population against the risk of disease in an unvaccinated population. This is a critical distinction.
(As explained in this excellent recently-published article in The Lancet, “It is imperative to dispel any ambiguity about how vaccine efficacy shown in trials translates into protecting individuals and populations.”)
Yesterday the Atlantic did a nice job comparing and explaining the vaccines here.
The upshot for tired eyes?
All three vaccines are nearly perfect at preventing death. This is important and a reason for celebration.
The J & J single shot seems to do slightly less of a good job preventing non-serious illness, but it’s difficult to say this for certain because a) there wasn’t a head-to-head study comparing the vaccines, b) the J & J data was collected during a time of widely spreading variants, and c) studies aren’t perfect—which is why we all eagerly await real-life data.
As you probably know, the real-life data on the Pfizer vaccine shows that it’s as good—and probably even better—than we thought with the clinical trial data.
The upshot of the upshot?
Get the first vaccine you’re offered. Don’t wait for a Pfizer or Moderna shot based on the percentages in Dr. Oster’ chart. Why?
Any immunity (particularly with any of these three highly efficacious vaccines) is better than none;
The more people who are immunized means the closer we are to herd immunity;
You never know if you’ll get the choice of vaccine; and,
Per the new CDC guidelines (FINALLY!!!) issued today, vaccinated people get to resume some semblance of normalcy regardless of which shot they received.
Indeed, the CDC told us today what the science has made clear for months: that vaccinated people can safely convene without restrictions—or fear.
Two weeks after their second Pfzier or Moderna shot—or 28 days after their single J & J shot—vaccinated people can remove masks and gather indoors with other vaccinated people.
Vaccinated people also do not need to quarantine or get tested after an exposure to coronavirus (if they are symptom-free).
In making this announcement, the CDC not only acknowledged the scientific evidence demonstrating the reduced risk of transmission after vaccination, it recognized our broad human needs for human connection and hope.
When it’s rooted in science, hope is healthy; it’s a great day when we can dispense it.
We are not done. We still need aggressive risk mitigation to prevent community spread of coronavirus. Re-entry will be gradual, and it’s not time yet time to hit the nightclub.
But we're moving in the right direction with case rates dropping, deaths and hospitalizations declining, and a glimpse of normalcy on the horizon.
I will see you next week. Until then, be well.