How do vaccines work?

Pixabay

As far back as two thousand years ago, people began to take material from weak strains of smallpox and scratch it into the skin of healthy people to guard them against infection. The principal of vaccines is still the same today; introducing a weak version of an infection to the body of a healthy person in order to prepare them to fight off a full-strength infection. When you get vaccinated, your body develops an immune response to the microbe that causes the disease.

Vaccines are usually made with fragments of the microbe that causes the disease from which you want immunity (the pathogen). These fragments of the pathogen are engineered to cause your body to react and create its own immunity. That can include showing symptoms, but you aren’t actually sick. An actual sickness requires the pathogen to actively replicate and infect you. And modern vaccines are designed so that is impossible.

The active part of the vaccine (the antigen) is usually not a complete pathogen. It consists of a portion of the pathogen that your body will react to, and create its own defense. The antigen also has enough components of the pathogen so that your body can recognize it if it “sees” it again. The antigen is often inactive or dead portions of the pathogen.

In some cases, the entire pathogen needs to be present in the vaccine. If the vaccine does require the pathogen to be whole, it is in a weakened state such that it cannot reproduce itself and harm you. Or the vaccine itself contains the necessary ingredients to prevent the pathogen from being able to cause infection.

Either way, there is not enough of a living pathogen in a vaccine to replicate and infect you.

How are vaccines tested?

Vaccines are developed and tested in laboratory experiments, and often in animals. Final-stage clinical trials on humans involve a large group of volunteers, tens of thousands of people. Some will receive the experimental vaccine, others receive a treatment that seems to be the vaccine but has no therapeutic value (a placebo). Only the scientists conducting the experiment know who is in which group.

This is done for several reasons. The first is to gauge how effective the vaccine is, by comparing how those who were vaccinated fared against a potential infection vs. those who received the placebo.

Another reason is to judge the side effects or potential risks of the new vaccine. Some side effects of the new vaccine will not be obvious or immediately apparent, but any medical events that could be related to the vaccine can be compared between the two groups. For instance, if twenty people in the vaccinated group get a headache, but only two members of the group who received the placebo do, that may indicate that a headache is a potential side effect of the vaccine.

This is a basic overview of a vaccine trial process, which includes an incredible amount of careful scientific work.

Who decides if vaccines are safe?

The Food and Drug Administration (FDA) authorizes vaccines for the US, and they rely on an independent advisory panel for a recommendation. FDA advisory panels are composed of scientists and specialists who are independent of the government, which is another layer of assurance at a time when there seemed to be undue pressure on the FDA.

The vaccine advisory panel is a group of infectious disease doctors, scientific experts, and statisticians who weigh the evidence available for a new vaccine. After careful review, they voted 17 to 4 to recommend emergency use authorization for the first COVID vaccine.

The meeting was streamed live in its entirety for anyone to watch, and the entire day’s conversation is still available here:

This same panel will meet again to consider whether to recommend an EUA for a second COVID vaccine.

The FDA has granted the emergency use authorization for the first vaccine, and now it is being given in hospitals around the US to health care workers and some people living in group care facilities. This is the same vaccine that has been used in the UK and Bahrain, and that has been authorized in Canada.

Sir Ian McKellen has received the COVID-19 vaccine in the U.K.: "I feel euphoric" https://t.co/cwPgZzlcBT pic.twitter.com/mlLCP4pc14

— The Hollywood Reporter (@THR) December 17, 2020

What is an ’emergency use authorization’?

The vaccine currently in use was authorized by the FDA under an emergency use authorization (EUA). This allows a treatment to be used after less time has been spent examining it than is normally required before authorization. This happens only for an emergency, like the coronavirus pandemic, and only if an emergency is declared.

“In an emergency, like a pandemic, it may not be possible to have all the evidence that the FDA would usually have before approving a drug, device, or a test,” writes Joshua Sharfstein, MD, the vice dean of Public Health Practice at the Johns Hopkins Bloomberg School of Public Health. “When there is a declared emergency…if there’s evidence that strongly suggests that patients have benefited from a treatment or test, the agency can issue an EUA to make it available.” Sharfstein is also a former principal deputy commissioner of the FDA.

What’s this about allergic reactions?

Shutterstock

So far, there have been three people reported to experience serious allergic reactions to the first COVID vaccine. All three were treated and have been released from care.

The vaccine has monitoring guidelines for use, and all of these allergic reactions were caught at the time of vaccination. The Washington Post reports, “Those guidelines advise that people with no history of allergic responses be observed for 15 minutes after receiving a shot; those with severe allergic histories should be observed for 30 minutes.”

Two health care workers in the UK had allergic reactions, but they both had histories of severe allergic reactions. One Alaska health care worker had a serious allergic reaction, and she had no history of allergic reactions.

“Severe hypersensitivity or severe allergic reactions can happen after a vaccine,” explained Paul Offit, a pediatrician and expert on vaccines at Children’s Hospital of Philadelphia. “It’s important to stick around for 15 minutes in case you have an allergic reaction so that you can be treated with epinephrine to ameliorate your symptoms.”

Why are some people against vaccinations?

Flickr/ Paul Becker - Becker1999

For nearly as long as there have been vaccines, there have been people who fought against them. In the 19th century, some argued that preventing disease was against God’s will.

As the science of vaccinations advanced, people who had previously made a living on claims that they could cure these same diseases using less proven methods did whatever they could think of to hold on to their clientele. One of them, Benjamin Moseley, spread stories of made-up side effects of the smallpox vaccine, including a story about women who received it wandering in pastures, acting like cows.

In the US, some considered mandatory vaccines to be an intrusion on personal freedoms, and anti-vax movements were sometimes successful in getting mandatory vaccine laws repealed or banned. In many cases, outbreaks of disease followed the anti-vaxxers success. (Does this sound eerily familiar?)

In 1998, world-renowned medical journal The Lancet published a report by a British doctor named Andrew Wakefield. Wakefield claimed to have linked the combination vaccine for measles, mumps, and rubella (MMR) to autism in infants. No one could ever duplicate the results claimed to have gotten (even in studies as recent as 2019). By 2004 it was revealed that Wakefield had faked his original results.

The Lancet withdrew the report and Wakefield lost his medical license, but the damage had been done. His report had become fodder for conspiracy theorists, and Wakefield moved to the US to whip the American anti-vax movement into a frenzy. The movement has grown to cast doubt in the minds of as much as 20% of the American public.

Has fake science really been used against minorities? (Hint: yes)

Those involved in horrors like the Nazi Holocaust or American slavery often pointed to pseudo-science to justify their actions.

“Historically, prejudice and discrimination have been legitimized through arguments that inequality was the product of natural differences between groups of people,” writes Dr. Eve Shapiro in Gender Circuits. “For example, eugenics movements sought a scientific basis for the racial superiority of Whites…Eugenics drew on Darwin’s concept of ‘survival of the fittest’.”

Of course, the most powerful members of these societies conveniently defined ‘fittest’ in their own image. It is easy to understand why minorities might be suspicious of scientific communities when the language of science has been used so effectively against them.

We still leap to racial conclusions that sound science-y

Early in the coronavirus pandemic, when it became clear that minorities were dying at a disproportionate rate, people began to look to the physiologies of Latino, African American, and Indigenous peoples for reasons why. That’s where Dr. Gbenga Ogedegbe, the director of the division of health and behavior at New York University’s Grossman School of Medicine, expected to find answers.

But after reviewing over 11,000 medical records, Ogedegbe found that statistically, “Black and Hispanic patients were no more likely than white patients to be hospitalized,” the New York Times reports. In fact, “If hospitalized, Black patients had a slightly lower risk of dying.”

“We hear this all the time — ‘Blacks are more susceptible,’” says Dr. Ogedegbe. But the reason has nothing to do with race. “It is all about the exposure. It is all about where people live. It has nothing to do with genes.”

Trust between the black community and the medical field has been fractured due to the lack of value placed on black bodies. For more information on the COVID vaccine and what to expect during and after receiving the vaccine, go to my instagram highlight @theou_md #MedTwitter pic.twitter.com/x4WUEvIUIV

— Theodor (Uyi) Uzamere, MD (@TheoUmd) December 17, 2020

Has REAL science been used against minorities? (Hint: also yes)

One of the most powerful reasons for mistrust of medical science among African American people is the infamous Tuskegee Experiment. From 1932 to 1972, doctors working for the US Public Health Service (PHS) conducted experiments on 600 African American men in Macon County, Alabama. Doctors from PHS promised free medical care and told the participants they were treating them for a variety of conditions. But they lied: the study was to monitor the effects of syphilis on any of the men who contracted the disease.

Most of the men were sharecroppers, many had never been treated by a doctor before the experiment, and none of them were equipped to discover what was being done to them. Over the course of forty years, none of the men in the study who had syphilis were offered actual care for the disease, even after penicillin was discovered to be an effective cure. “In order to track the disease’s full progression,” History.com writes, “researchers provided no effective care as the men died, went blind or insane or experienced other severe health problems due to their untreated syphilis.”

By the time public outcry following an Associated Press news story forced the study to close, 128 men had died of syphilis or related causes, 40 had infected their spouses, and 19 children had been born with the disease. All while doctors sanctioned by the US government stood by and lied to them.

Such a deadly betrayal of trust by the government has understandably left deep-seated doubts about government sanctioned medicine. And this mistrust weakens many African American people’s confidence in a new government-sanctioned vaccine.

What will make people trust the new COVID vaccines?

screenshot ABC News

The FDA’s independent panel reviewed all of the science from the first vaccine’s manufacturer and voted 17 to 4 to recommend emergency authorization. They are about to give another vaccine the same careful scrutiny this week. Meanwhile, the FDA, which has maintained its standing in the face of political pressure, has granted the first vaccine emergency use authorization.

Now caregivers and elderly people around the US are excitedly lining up to receive their first doses. And this may be the most effective tool to show people that the vaccine can be trusted, bearing witness to other members of our communities benefiting from the vaccine.

Dr. Anthony Fauci spoke directly to the concerns of African American people in an hour-long video conversation. Discussing the development of the second vaccine, he pointed out the involvement of, “Dr. Kizzmekia Corbett, or Kizzy Corbett. Kizzy is an African American scientist who is right at the forefront of the development of the vaccine.”

“The vaccine that you’re going to be taking was developed by an African American woman. And that is just a fact.”