A "wait and see" approach to COVID-19 vaccines may derail our recovery

The first clinical trial administration of an mRNA COVID-19 vaccine took place over a year ago, on March 16. An annus horribilis of masks, remote schooling, unemployment, loneliness, and depression ensued, leaving in its wake more than a half-million deaths in the U.S. — 2.9 million globally. Will vaccines save us? We have ample reason to hope so—unless we derail our deliverance by adopting a “wait and see” approach.

A recent Kaiser Family Foundation poll indicates that about one in five people will still delay getting the COVID-19 vaccine to see how it works for other people first. This is decreased from prior polls, but when combined with the 20% who say that they will definitely not get the vaccine or only do so if required, this more than a third of adults.

I admit to entertaining similar thoughts last spring, even while treating patients with COVID-19 in one of the nation’s hardest-hit communities. Among my friends and medical colleagues, I feigned enthusiasm, but in truth, I worried how safe and effective the new vaccines would be. By the end of 2020, I had not fallen ill — perhaps I could afford to “wait and see” before getting vaccinated.

The data from randomized clinical trials, or RCTs, were published on the two mRNA vaccines (Pfizer-BioNTech and Moderna). RCTs are large human studies conducted in a manner that minimizes bias. Such trials provide important evidence that determines how we practice medicine. The data were impressive: Vaccinated individuals were 95% less likely to get COVID-19 disease than the unvaccinated. More recently, the Johnson & Johnson vaccine RCTs demonstrated the capability of preventing 85% of severe disease and 100% of hospitalization or deaths due to COVID-19.

Since real-world data, or performance of the vaccine outside of RCTs, have since shown similar strong performance. Israel, which has vaccinated more than half its population, reported a 97% reduction in disease, hospitalization, and death in those vaccinated, as well as a 94% reduction in asymptomatic transmission, that is, the spread of the virus from people who appear well. Similarly, the U.S. has shown mRNA vaccine real-world data of 90% reduction in infection regardless of symptoms.

As of April 8, 2021, more than 175 million doses of COVID-19 vaccines had been given in the U.S., with 112 million people receiving at least one dose (1/3 of the total population). No deaths have been linked to the vaccines; the deaths reported after vaccine administration (~2,800) do not follow any pattern to suggest they were due to the vaccine.

So, what are these vaccines’ downsides? Despite the fears of some, it is impossible to get COVID-19 from any of these vaccines. The most common — fatigue, fever, muscle aches, headache, and pain and swelling at the injection site — can be quite uncomfortable but last only a few days. Anaphylaxis, a severe allergic reaction, has occurred at a rate of 2 to 5 cases for every million mRNA vaccine doses administered, usually within the first 30 minutes. These rare reactions are treatable, and no one has died. To protect yourself, check with your doctor if you have a history of anaphylaxis or a history of allergy to polyethylene glycol, also known as PEG, used in some products such as laxatives and intravenous medications. Also, let your doctor know if you’ve had an allergic reaction to polysorbate, which has a similar structure to PEG.

Long-term side effects from COVID-19 vaccines are exceedingly unlikely based on the science and on the history of vaccines. In general, most vaccine complications occur within a few days to a few weeks of administration. All our COVID-19 vaccines use technology that has been studied for over 10 years and has shown no significant complications.

Fears of the COVID-19 vaccine should be weighed against the known outcomes of COVID-19 disease. In addition to the staggering tragedy of millions of deaths, roughly 30% of survivors of the disease become “long-haulers” — patients who suffer from long-lasting symptoms after COVID-19, now known as post-acute sequelae of SARS-CoV-2, or PASC.

Perhaps these facts convince you that the COVID-19 vaccine is infinitely less risky than the disease, and there is no need to “wait and see.” However, the “wait and see” approach is worse than unjustified. It’s dangerous.

To begin, it’s unclear how long protection lasts after either the vaccines or contracting COVID-19. Some survivors evidence of immunity flags within a few months, and some have even contracted the disease again. This is consequential because we need protection through immunity at the same time as each other (“herd immunity”) so that the virus cannot find susceptible hosts in which to replicate. Estimates are that we need around 70 to 90% of the population in the immune herd to thwart the virus. Delays in getting vaccinated may mean that we stagger our immunity lowering the proportion of those protected at any point in time. This allows the virus to find a host more easily and thus survive and spread. Moreover, this survival lends to mutated variants against which the vaccines may be less effective.

You might think, “if everyone else gets the vaccine, then I won’t have to.” That could be true except that many other people are thinking the same thing, in which case our herd will remain too small. More than ever, our society needs to work together.

Coordinating vaccine delivery in an efficient, fair manner is a difficult logistical challenge, but soon the U.S. will have enough vaccine for nearly everyone. Though there are unanswered questions — the duration of immunity, optimal timing of vaccine doses — we are learning. How we manage this disease will constantly be refined. Scientists are already working on vaccines to address the variants. But waiting for perfection is a dangerous game.