A Pediatrician Answers Your Covid Vaccine Questions

As a nurse, it was very easy to get emotional while watching the rollout of the Covid vaccine to healthcare workers. When I received the vaccine myself, the relief was immeasurable. My colleague, Pediatrician Dr Eve Krief shared she had "tears of joy and relief" in her eyes when she received her first dose. While most healthcare providers understand the importance of getting vaccinated if we are to overcome this pandemic, many in the public understandably have questions and concerns. Knowing that Dr. Krief and I both shared a common understanding of the importance of vaccinating during this pandemic, I sought Dr. Krief's expertise to address common questions and concerns being seen in our community.

Can we trust a vaccine that was developed so quickly? Can the MRNA in the vaccine incorporate into my DNA? Can I get Covid from the vaccine? Will children receive the vaccine?

Let’s first review how vaccines work. The immune system is incredibly complex and super impressive. I remember years ago being in immunology class thinking how our immune defenses are so very much like an elite military force readying for battle. Every day our bodies are exposed to 60,000 germs – from what we touch, breathe and eat. Our immune systems make antibodies against these germs so they can be recognized and destroyed if we are ever exposed to them again. We are actually capable of producing a quintillion or one million trillion antibodies! Luckily most of the germs we come into contact with are relatively harmless. However some are potentially more serious and sometimes we can’t produce antibodies quickly enough to fight off deadly infections. That’s where vaccines come in . Vaccines contain weakened or inactivated forms of bacteria and viruses or just a short segment from the surface of a pathogen. Because of this they cannot transmit the actual disease. However the body makes antibodies against the components of the vaccine so it’s ready to defend us if we are ever exposed to the actual pathogen. Vaccination is one of mankind’s greatest scientific achievements and has saved millions of lives . In 1952 Polio paralyzed thousands of children and killed 3,000. In 1920 Measles killed 7,575 and Diphtheria killed 13,170. Parents today no longer dread their children being afflicted with these diseases and luckily as a pediatrician I have never had to care for a patient with these serious vaccine-preventable illnesses.

So how does the MRNA vaccine work?

The concept is the same as traditional vaccines but instead of the vaccine containing viral or bacterial particles, it contains MRNA. MRNA or messenger RNA is produced inside the nucleus of cells and is then ejected into the cytoplasm.
It contains a genetic sequence that is translated by the cell to produce proteins the body needs. The MRNA in the vaccine is synthetic MRNA that codes for only the spike protein of the Covid-19 virus, the part that attaches to the cells in our body when we’re infected. The MRNA in the vaccine triggers our cells to produce the spike protein in the cell’s cytoplasm.
After it is used to produce the spike protein, the delicate MRNA is destroyed by the cell. The MRNA can never get incorporated into our DNA which is safely secure inside the cell nucleus. The body then recognizes the spike protein as foreign and produces antibodies against it. If exposed to Covid the vaccine recipient now has antibodies that will recognize the spike protein on the coronavirus and will attack that part of the virus so it can’t attach to our cells. Scientists have been studying coronaviruses and using MRNA technology for many years and suspected that this family of viruses would be responsible for the next pandemic. It didn’t take them long to identify the entire genetic code of the virus and specifically of the spike protein that led to a successful vaccine.
The Pfizer trial had 44,000 participants. It found the vaccine to be 95% effective in preventing Covid-19 regardless of gender, race or age group 16 and over. 157 individuals in the placebo group contracted Covid-19 compared to only 8 in the group that received the MRNA vaccine. The Moderna trial was similarly effective. It had 30,000 participants. 90 individuals in the placebo group contracted Covid-19 compared to only 5 in the group that received the vaccine.

So how was a vaccine developed in such a short period of time when most vaccines take 10-15 years to get where we are?

One reason as described above is the cutting-edge MRNA technology and research into this virus that had already been taking place . Another very important factor is funding. It can cost over one billion dollars to study and produce a vaccine and trials don’t always lead to a successful vaccine. It’s an endeavor that most pharmaceutical companies are not eager to invest in. Vaccines only produce 3% of a pharmaceutical company’s total revenue; the current pandemic led to a perfect storm of factors all needed to push the process along. Top vaccine scientists around the world were focused on a singular cause. Governments and the pharmaceutical companies funded the research, and even took the risk of mass producing vaccines before the trials were over so they would be ready to go if the vaccine was determined to be safe and effective. Volunteers for vaccine trials were much easier to find. The numbers of participants in each phase and the monitoring for adverse effects took place as it would for any other vaccine trial. The process led to a more effective vaccine than most scientists even hoped for.

What side effects might we expect from the vaccine?

The trials found the vaccine to not only be effective but also safe and 31 million people have received a dose so far in the U.S.. Early safety data is showing the vaccines are as safe as the studies suggested they would be. Mild side effects including vaccine site tenderness, fatigue, headache, body aches, diarrhea and fever can be seen 1-3 days after vaccination. 20% of vaccine recipients developed fever. These findings are more likely after the second dose which is given 21 days after the first dose for the Pfizer vaccine and 28 days after the first dose for the Moderna vaccine The second dose boosts the body’s antibody response to reach that 95% protective level. These side effects are an indication that the immune system is having a robust response to the vaccine. The body is reacting to being exposed to a small but not dangerous component of the virus and the reaction is not nearly as severe as the potential response to the actual virus.
There have been reports of serious allergic or anaphylactic reactions to the vaccine. These reactions are exceedingly rare, occurring in 2.5 per million of Moderna vaccine recipients and 5 cases per million of Pfizer vaccine recipients. All patients have recovered. The anaphylaxis is believed to be due to an allergy to one of the vaccine ingredients and therefore anyone with a previous anaphylactic reaction to a vaccine or the vaccine ingredients should not receive the Covid vaccine. Individuals with this type of allergy had been excluded from the trial. People with food or medication allergies can safely receive the vaccine with 30 minutes of observation after receiving the vaccine.
Immunosuppressed individuals were included in the trial and the vaccine is safe for that Covid vulnerable group to receive as it is not a live vaccine. Although this was not seen in the trial, the theoretical risk of a flare up could be seen and the risk vs. benefits should be discussed with your physician. Pregnant women were not specifically studied in the trial. This is another situation where someone’s potential risk of contracting Covid due to the type of job you have might outweigh any theoretical risk of vaccination. Vaccination is safe for nursing mothers. The claim that the Covid vaccine could cause infertility has no basis in science and is patently false. People who have already had Covid and were either sick or asymptomatic from the virus should still get the vaccine as reinfection with Covid is possible .
There are several mechanisms in place to report any adverse effects people may experience. In addition as a further safeguard the CDC is implementing the V-Safe program where vaccine recipients will be actively contacted periodically via smartphone to ask about symptoms they may be experiencing.

Will children need to be vaccinated against Covid-19 ?

Children do not get as sick as adults from COVID-19 and some wonder why they should be vaccinated. Over 2.5 million children have contracted Covid-19 since the start of the pandemic, 10,182 have been hospitalized and 191 children have died, many with no underlying medical conditions. 1,569 children have suffered from MIS-C, multi system inflammatory syndrome in children, that attacks multiple organs, often requires ICU hospitalization and has killed 26 children. We do not know the long-term consequences Covid infection may have on children but there are indications that there may be long term cardiac and neurological effects for some. There have also been reports of ‘long haulers’ in the pediatric age group. In addition we know that children can transmit Covid to others. As they make up 22% of the US population it would be difficult to achieve herd immunity without the vaccination of children . Although there is no reason to believe that a child’s immune system should react differently to the vaccine than adults there must be further vaccine trials in children to ensure it’s safe use in that population. Typically vaccines are not tested in children until they are proven safe in adults. Pharmaceutical companies have started testing children 12 and older and later trials will include younger age groups.

Will we still need to wear masks and social distance after we're vaccinated?

For now, the answer is yes. The reason for this is that although we know the vaccine prevents symptomatic infection with Covid, it is still not clear whether a vaccinated individual who came into contact with Covid might still be able to transmit the virus to others. Ongoing studies will provide more guidance.

What about these new variants? Should I wait for a better vaccine ?

No! Don’t wait to vaccinate. If you have the opportunity to get a vaccine, get vaccinated! The vaccines do show some protection against the new variants circulating and can prevent risk of hospitalization and death. Viruses need unvaccinated people to infect or they can’t survive. The more infected people there are, the more likely it is for the mutated virus to spread or mutate further.

As people continue to receive the vaccine, the safety and efficacy data continues to be reassuring . Hopefully this will encourage more people to feel confident in their decision to vaccinate when the time comes.

Melody Butler, BSN, RN, CIC
Executive Director,
Nurses Who Vaccinate

Eve Krief MD, FAAP
Legislative Advocacy Chair
Long Island, Queens, Brooklyn Chapter
American Academy of Pediatrics