COVID-19 Update: Wednesday, January 13th, 2021

Vaccine resistance

UPDATED to add in an additional resource. (Times article at the bottom)

Today I am going to assume that most of you are up to speed on the news - we are still trying to sort out the vaccination process, Gorilla's in the zoo have COVID, and Disneyland (in CA) is going to become a POD (point of dispensing) for mass vaccination. Instead of recapping news today, I would like to chat a little bit about something called vaccine resistance. (not the same as vaccine hesitance).

Vaccine resistance is when a virus becomes resistant to a vaccine so the vaccine no longer has the desired impact which results in the vaccine not working anymore, similar to what we see in antibiotic resistance. Vaccine resistance is possible and while not exactly what I would refer to as rare, it is, uncommon. We have identified three primary characteristics of a vaccine that can impact vaccine resistance so today I want to discuss one aspect of the Pfizer/Moderna vaccines and why I am even covering this. I also want to keep the science and technical aspects of this information at a population level so I am including some resources for those who want to read more about this or who want a deeper scientific explanation. (see links below)

Currently, there is a good deal of debate regarding the timing of the second shots required for both the Pfizer and Moderna vaccines. Scientists are wrestling with if the shots can be delayed in order to give more people the first dose. There is currently no evidence of what effect this may have so the FDA has said no. But some are advocating strongly for it and they make some valid and impactful arguments. While those seated in high places sort that out, I would like to share just a little insight into one possible complication. Vaccine resistance.

There is a lot we don't know, but one thing we do know is that when a vaccine is designed to prevent symptoms of a disease but not necessarily prevent catching or spreading it, that is one characteristic that can contribute to the virus becoming resistant to the vaccine. Now....we don't know for sure if someone who is vaccinated with the Pfizer or Moderna vaccines (the only two we are currently discussing) can still get COVID and spread it. We know that once immune they won't develop sickness themselves, but we don't know if they can still spread it. This is why experts have advised people to keep wearing masks and socially distancing even after they have been vaccinated, because they may still be able to spread it. These precautions won't be required forever, just until enough of us have been vaccinated.

But if we delay the second dose, it is possible, note I said possible - we don't know the probability or likelihood of it, just that it is possible, it is possible that the virus will get into people who are partially vaccinated and then it can spread to others, mutating along the way to make it resistant to the vaccine. This is not something that happens immediately, (after exposure to just one person) but vaccinating the entire country/world also doesn't happen immediately. So it essentially becomes a race between us and the virus. I do not say this to cause panic or concern but to encourage those who get the first dose to follow through with their second dose and to do so according to the prescribed schedule.

In time, enough of us will be vaccinated that this threat will be somewhat less threatening. Or we may find that once you are vaccinated you can't still spread the virus, in which case that too will mostly neutralize the threat. But short term, we just don't know and it seems like we would want to take the necessary precautions to avoid contributing to vaccine resistance. For full disclosure, IF someone who has been vaccinated can still spread COVID, the threat of vaccine resistance extends beyond people getting the second dose. This threat is not simply about getting the second dose on time, it is about vaccinated people continuing to take standard precautions (masking, distancing, handwashing) until most of us are vaccinated. We may find out that those who have been fully vaccinated cannot spread COVID, in which case, once someone has immunity the threat is removed and we can redirect our focus elsewhere.

FINAL THOUGHTS: Often we have to find the balance between scientific certainty and taking a leap of faith. We all have a preference for which way we lean and more than likely it varies from situation to situation. How much risk are you willing to take, what can you do to reduce the risk to a level you are comfortable with, and then stepping out in faith. We have been navigating these balances for over a year. We have been talking about your risk tolerance and how that looks different for each of us and how we need to let each person make the decision for themselves. The vaccine is no different. There are risks. There is risk associated with Pepto-Bismol, Tylenol, driving a car, sitting in a chair, eating a sandwich, living each day in the best of times includes taking risks. Living during a pandemic involves even more and you may be running dry. Each of us must evaluate our circumstances, our risk acceptance level, and make our own decision. We must respect and love each other enough to allow people to make those decisions. Give each other time and space to make informed decisions that are right for each person. Part of that process comes from being informed. Part of it comes from scientific research and data. Part of it comes from taking a risk and part of it comes from having faith.

LINKS to further information about vaccine resistance.

This is a good option for those looking for more of the science regarding how it works and how to test for it. https://journals.plos.org/plosbiology/article?id=10.1371/journal.pbio.3001000

Another excellent technical source: https://www.pnas.org/content/115/51/12878#sec-10

This is a great option for those who want more info but not necessarily something highly technical: https://www.nytimes.com/2020/11/27/science/covid-vaccine-virus-resistance.html#:~:text=Neither%20bacteria%20nor%20viruses%20evolve,polio%2C%20despite%20years%20of%20use.

UPDATED additional resource: this is a GREAT article on how the various types of vaccines work. It includes the science in a pretty easy to understand way along with diagrams etc. It goes through each type of vaccine. https://www.nytimes.com/interactive/2021/health/how-covid-19-vaccines-work.html?name=styln-coronavirus-vaccines&region=TOP_BANNER&block=storyline_menu_recirc&action=click&pgtype=Article&impression_id=cd7a4403-55d1-11eb-b6fd-937c53afc6d4&variant=1_Show