The Covid-19 vaccines: Our health and our future

02/10/2021

This week I had a fascinating experience. In the hours following my second Covid-19 immunization—the Moderna version—while I cheered my immune system on, I moved through various stages of discomfort: achy arm, neck and muscles, then chills and profound fatigue. I napped-—twice in one day. I went to bed early. I awoke refreshed, energized and immune.

I fervently hope that you, dear reader, will have some version of this experience in the coming months.

I’ve been doing a lot of learning, thinking and talking about the vaccines and the technology they employ, the concerns people have and the implications of working together toward collective immunity. I’ve peeked down dark rabbit holes of fear and followed threads to unwind valid concerns from conspiracy theory. I want to share what I’ve gleaned, and my reflections on where we go from here.

Let’s start with a brief description of how the immunizations currently in use work. Vaccines train our immune system to recognize a virus, so that if we get exposed to it we can fight it off immediately and we won’t become infected. Some work by showing our immune system weakened viruses, while others show little pieces of the virus. These new immunizations work by delivering to our cells the “instructions” for making the SARS-CoV2 spike protein; our own cellular machinery “reads” the instructions, makes the protein and shows it to our immune system. After the mRNA message has been read, it is quickly broken down. It is a clever and nimble way of approaching immunizations, and it has been in development since the early 2000s, when it was employed to make a SARS vaccine. This is one of the reasons the vaccines were able to be developed at “warp speed.”

As a lover of science and human physiology, I am delighted to witness the active inquiry around how these immunizations, and the immune system, work. I am also sensitive to concerns about unbridled human ingenuity and how it plays out. I’m not in favor of genetically modified anything, for example. It is from a place of circumspection that I offer this analysis: the mRNA Covid vaccines appear to be quite safe, they are not able interact with our own genetic material, they will not change our DNA, and they pose no genetic risk. It is not possible to catch Covid from this vaccine. Like many, I have been curious about the lipid “nanoparticles” being used to deliver the mRNA to our cells. I am comforted to know that this technology has been used in cancer therapies for a couple of years at least, and that the components are recognizable to our system. Many readers will be reassured to know that this immunization does not contain preservatives or the sort of “adjuvant” immune-boosting materials that many other vaccines contain. 

As with anything in medicine, there is a “risk-benefit” calculation to consider when deciding whether to take a treatment or undergo a procedure. In a global pandemic of an increasingly contagious virus that has killed hundreds of thousands of people in our country alone and crippled our economy and so many people’s livelihoods, even a vaccine with a greater risk of side effects or lower efficacy might look like a good idea. Yet the reality is this very safe and astonishingly effective treatment option makes the case for receiving the Covid immunization clear. Doing so could very well save someone’s life, if not your own. 

Now, the hard part: waiting patiently for your turn. Immunization supply is very limited, though it will be increasing. Once you have made the decision to receive the vaccine, sign up to be notified when a slot is available. Residents of Marin County can sign up at their webpage found at coronavirus.marinhhs.org/vaccine. We at the Coastal Health Alliance are about to begin immunizing our most vulnerable patients above 75 years old; our supply is also extremely limited. Please be patient, and continue to take extra care in mask-wearing, social distancing and refraining from gathering in groups. It will take many months before our most vulnerable elders and people with chronic health conditions have had the opportunity to be immunized. Now is the time to lean into patient persistence with public health precautions. Ultimately, everyone who would like to receive an immunization will have that opportunity.

What will post-immunization life look like? For a while, probably pretty similar to pre-immunization. Because we don’t know yet if immunized people can still carry and transmit the virus, for now we all still need to wear masks. Theoretically, if two or more fully immunized people are sharing a space, taking off masks would pose low risk to each of them;  however, we don’t yet know what sort of lingering risk is posed by an immunized person carrying and silently spreading the virus. We will know more in coming months, no doubt. 

I am most curious about what we will collectively choose to return to after we achieve so-called herd immunity. Once a certain percentage of our population has become immune, the virus is thwarted in finding susceptible people to infect and the pandemic will wane. Experts estimate this percentage is somewhere between 75 percent and 85 percent for this virus; for some extremely contagious viruses like measles, the number is even higher. Herd immunity will probably not be achieved until late 2021 or beyond. So we have time to reflect.

It does feel like a truly sacred question of the rarest form. Humanity has had the brakes applied to so many of our endeavors, those that are beautiful and good as well as those that are destroying our planetary home. A study by the Global Carbon Project showed that fossil fuel emissions fell by 7 percent in 2020; in the United States they fell by 12 percent. As we contemplate when things will return to normal, perhaps at the front of our minds should be a vision of what a new, life-supporting normal could be. One that celebrates the arts, music, community celebrations and experiences, convenings and gatherings for the good of all beings. One that allows us to find balance between work and home, liberates us from our vehicles and commutes whenever possible, and optimizes the way we spend our time. Lots of touch, lots of being with one another. Conscious use of the energetic currency that is money. A rejection of the notion that we are, first and foremost, consumers, and an elevation of our identity of stewards and collective caretakers. 

In my post-immunization reality, I am holding this new normal in my heart. I invite you to join me here. 

 

Anna O’Malley, M.D., is a family and community medicine physician with the Coastal Health Alliance. She founded and directs the Natura Institute for Ecology and Medicine in the Commonweal Garden. She holds regular Community Medicine Calls on Zoom, and focused on the Covid vaccine on the Jan. 27 call. Recordings of this call and others can be found at naturainstitute.org/communitymedicinerecordings.