A young man sits down at my Covid-19 immunization station at Maine Medical Center and stares resolutely ahead, focusing on the far wall. He looks nervous. I make sure the needle and syringe are outside his field of vision. That should help. I pick up a Band-Aid from my box of supplies. It’s a Band-Aid large enough to cover a shark wound, and I wave it in front of his nose. “This is what we’ll use after the shot. You need to keep it on for one year.” He cracks a smile. I deliver the shot. A moment later he gives me the thumbs up sign and literally skips down the hallway.
I am a volunteer Covid-19 vaccinator, overjoyed that after more than 335,000 deaths in the United States and 1.7 million deaths worldwide, two vaccines, one from Pfizer, the other from Moderna Pharmaceuticals, have been approved by the FDA to prevent Covid-19 infection. Legitimate questions remain regarding the safety and effectiveness of the vaccines, but let’s put these important issues into perspective and celebrate a remarkable achievement: After only 11 months since the first patient was sickened with Covid-19 in the United States, there is hope that the worst of the pandemic will soon recede.
How unusual is it to have a vaccine developed and approved by the FDA in less than a year? In the case of HIV, in 1985, when I was a visiting internal medicine resident rotating through the department of Rheumatology and Clinical Immunology at Yale Medical Center, HIV-1 was universally fatal. Decades later, we have effective medications for suppressing the virus, but to date, no vaccine has been approved for general use (although several vaccines are in clinical trials) (1).
Or take malaria. In 2019, there were 409,000 world-wide deaths due to malaria (2/3 of them in children under the age of six) (2). A recently completed trial last year demonstrated that a new vaccine, Mosquirix, prevented approximately 4 in 10 predicted cases (3). It is a welcome beginning, but relatively ineffective compared to traditional vaccination against polio or measles or rubella.
Why has science struggled to develop vaccinations to prevent HIV-1 or malaria? There is no simple answer. There may be some truth to the assertion that because malaria and HIV often infect the poor or those at the margins of society, that vaccine funding has been insufficient. But this view dismisses the work of countless, talented scientists who spent their entire careers in vaccine research and failed to unravel the mystery of HIV-1 or malaria. With recent advances in technology, the genetic blueprint of the Covid-19 virus was determined in record time, and novel strategies developed to produce new vaccines.
And what of risk? Are the vaccines safe? Most of us accept risk within reason. Each day, we make an effort to avoid unacceptable risk. We move indoors when a thunderstorm races across the sky. We check our clothes for ticks after a hike. If we have elevated blood pressure, we consider medications to lower the risk of stroke or heart attack. Even with the risk of side-effects, the majority of us choose treatment over avoidance, action over inaction.
In the studies leading up to approval by the FDA, the Pfizer and Moderna vaccines safety records were good, not perfect. Minor side-effects: local discomfort, muscle aching, and low-grade fevers were relatively common. By Christmas eve, after more than a million Americans were immunized against Covid-19, reports of serious side-effects have been extremely rare.
I think briefly about the challenges of malaria and HIV and the risk verses benefits of vaccination, as I draw up my next dose of vaccine. An older nurse sits down and rolls up her sleeve. A look of contentment spreads across her face. “It’s been 8 months since I’ve been able to see my mother. She’s 94 and lives alone, and I’ve been terrified that I could be the person who infects her with the virus. I believe that the vaccine will let us get back to the business of hugging. My mother needs that; I know I do.”
The line is long, but it’s moving along. 2021 will be a better year. It won’t be long before we can hug again.
- Burton DR, Advancing an HIV vaccine; advancing vaccinology, Nature Reviews Immunology. 2019; Vol.19: 77-78.
2. World malaria report 2019. Geneva: World Health Organization; 2019.
3. Draper SJ, Sack BK, King CR, et al. Malaria Vaccines: Recent Advances and New Horizons. Cell Host Microbe. 2018;24(1):43-56.