Transcription:
COVID-19 Vaccine Update

Prakash Chandran: This COVID-19 podcast was recorded on May 5th, 2021.

We've been living in a pandemic for over a year now. And after months of anticipation, COVID-19 vaccines are now being distributed to the public. There are so many questions surrounding these vaccines, and we're going to get the most important ones answered today.

Let's talk about it with Dr. Gian Varbaro, the Chief Medical Officer for Bergen New Bridge Medical Center.   This is Wellness Waves, a Bergen Newbridge Medical Center podcast. My name is Prakash Chandran.

So first of all, Dr. Varbaro, it is wonderful to have you here today. Let's start with the basics here. Why is it so important for people to get vaccinated?

Dr. Gian Varbaro: Thank you so much for having me as well. It's really important for people to get vaccinated for a number of reasons, but I'll go through three of the biggest ones. First, it's important to be vaccinated for yourself. Vaccines help us develop immunity. That means protection against illnesses. And by being vaccinated, you protect yourself.

Second, it's important to protect your loved ones. If you're vaccinated, you wouldn't be able to spread the virus to people around you, to your loved ones, your coworkers, your family, your friends. And third, there's also a societal reason to get vaccinated, which is by getting vaccinated, you help to end the pandemic. The more people who are vaccinated, the harder it is for the virus to spread, the harder it is for variants, which you've probably heard about in the news, to develop. And it allows us to get back to normal life. And so depending on your point-of-view or what's important to you, any of those are important reasons. There's many more, but those would be the three biggest reasons.

Prakash Chandran: yeah, all of those reasons make a ton of sense to me. Still though, I think that there is definitely some hesitancy, even in my circle of friends, around if the vaccines are actually safe. So maybe you can speak to those concerns a little bit.

Dr. Gian Varbaro: Sure. These vaccines are incredibly safe and I've been a physician for over 20 years now. And these vaccines have probably the best safety profiles of any vaccine I've seen, even the ones that we've taken for years. The vaccines, while they were developed quickly, were still developed under all of the scientific rigor and guidelines that we would normally use.

So for instance, the Pfizer and Moderna vaccines have very few side effects. And even though we had the original studies and the original what's called emergency use authorization, we've now been using it for several months. And really the only big risk on it is some people, and it's very rare, have an allergic reaction to it. It's extremely rare. And because of that, we watch people after they get the vaccine.

You've probably heard about the one concern on the Johnson & Johnson vaccine, which led to a pause that lasted for a little bit. That was a very specific and very narrow concern. So, with that, it only affected women from ages 16 to 55 and it was an extremely rare event. About nine out of 8 million shots had that clotting effect. And to put that into a little bit of context, the risk of being in a fatal car accident is 10 to 100 times greater than that. And that's just something we do every day without thinking about it.

Prakash Chandran: Wow!

Dr. Gian Varbaro: Exactly. So there's risks in life that we don't even think about all the time. If you walk on the sidewalk, there's risks. You could trip and fall and break your ankle. A car could swerve and hit you. You could be hit by a bolt of lightning. But you don't think about it because those risks are so minuscule and that's the level of risk we're talking about with these vaccines.

And to go further on the bit that they were developed quickly, the Pfizer vaccine, it was just in the news this morning, is getting ready to apply for full approval, which means it's truly gone through all of the steps that we normally would. And Moderna is close behind that.

Prakash Chandran: So just unpacking that full approval a little bit, I'm assuming you're talking about FDA approval, what is the difference or the big difference between the emergency use authorization that they gave and full approval?

Dr. Gian Varbaro: It's really more of a process thing on the governmental level, on the FDA level. For an EUA or emergency use authorization, it's just a faster process. And you have to remember, we were in the middle of a pandemic that was raging and we needed a way to be able to help slow it down and to stop it and to get back to normal. So this process exists. It's been used before. It's been used for many other things. They used it to help get the vaccines onto the market.

And the other thing to be aware of is even when things have FDA approval, we still monitor them afterwards. Any new medication that comes onto the market, even when it goes through all of the normal steps. It's still monitored afterwards. So with the emergency use authorization, they just were able to do it a little bit faster, but now they are ready to even do it through the normal process as well. So it's almost like a fast pass to get it approved.

Prakash Chandran: And just to be crystal clear, just because it had that fast pass, it doesn't make it any less safe for the public to use, right? Like it had to go through a lot of the same baseline tests and analysis and trials before it got that emergency use authorization, right?

Dr. Gian Varbaro: Absolutely. And it's also important to understand that when you hear on the news that they're applying for approval, it doesn't mean that it's automatic. It still means that people look at it, they analyze it, they go through it with tremendous amount of scientific rigor to make sure that it's safe and effective. So yes, it goes through an incredibly thorough vetting.

Prakash Chandran: Okay. So you've alluded to the different types of vaccines. There's the Moderna, there's Pfizer and there's Johnson & Johnson. Talk a little bit about how the different vaccines work and what are the differences between them.

Dr. Gian Varbaro: Sure. I'll start with the Pfizer and the Moderna. Those both use a technology called mRNA technology. I'll explain what that means. MRNA stands for messenger RNA, and it's important for people to understand that's not DNA because I think that's one thing that confuses people who are not science experts. DNA is what codes for your genetics, but people worry, they hear mRNA and they think maybe this thing can change my genetics. Maybe it could affect young people and cause problems for them to have children or other problems in the future. That's not possible because mRNA is a different thing than DNA.

Normally, in yourself, your DNA sits in what's called the nucleus of a cell and it codes for something called mRNA, which then goes out and sends out its messages, that's why it's called messenger RNA, out to your body to tell it what things to make. That mRNA,, once it's sent out of the nucleus, can never go back into the nucleus. So there's no way for mRNA to affect your genetics.

The way that the Moderna and Pfizer vaccines work is that the scientists were able to sequence the DNA of the virus and figure out which part of it coded for a piece of the protein spike. I think everybody's now seen that picture of the coronavirus with all the spikes on it. So they found just a portion of it, not even the full spike. They figured out what made it.

And they created in a lab cleanly with no other contaminants and no preservatives, a strip of mRNA that coded for that protein by itself. They inject it into your upper arm, into your deltoid muscle and your body's machinery figures out what that mRNA says. And it just makes pieces of that protein. It doesn't make a full virus. It doesn't even make a full protein spike. Just a little piece of protein that your body then sees and says, "Wait. This thing isn't part of me. This is new." And whenever your body sees something like that, it creates an immune response against it. And what this does is it changes your body so that, if the actual virus came into it, your body would know to attack it right away. It would never be able to get a real foothold into you. And that's how those work.

So it's a very clean and safe technology. It's a new technology, but it's a very exciting one for somebody like me who's been doing this for a while because it just has so many potentials. And it's been theorized for decades now that this could be done, it's just amazing they we're able to do it.

The difference between the Pfizer and Moderna themselves are mostly technical and it just has to do with how they were studied originally. Again, when they created these vaccines, nobody knew just how effective they would be. They were hoping that they would be at least 60% effective. They were way more effective than that. But when they developed the vaccines, they tested them in certain ways.

So the Pfizer vaccine, your second shot is around three weeks after the first shot; the Moderna vaccine, the second shot is about four weeks after the first shot. The reason why those are two shots is because that's how they tested it. There's nothing special about it or different. That's just what they tested because they didn't know how it was going to work when they were developing it. They code for slightly different points on the protein, but that's mostly technical. And there's some differences in how they have to be stored, what temperature they're stored at. But differences are more important for me than for a lay person.

Prakash Chandran: Okay. You explained that really well. So if I can just summarize as a lay person the mRNA technology, I would basically say that it's just a set of instructions for your body to protect itself if it comes into contact with COVID-19. And those instructions disappear, but that's all it is. It's an instructional sheet that says if you encounter this, here's what you should do to protect yourself and develop that immune response at a high level. Is that correct?

Dr. Gian Varbaro: Exactly. And you said another piece I should have said, which is the mRNA disappears from your body within just a couple of days. So what it really does is it's a coding that really change your body so your body knows in the future how to attack it. So it's even beyond that, it's a coding to train your body, so your body knows going forward what to do.

Prakash Chandran: Got it. And another concern that I had heard is that, as you alluded to, this mRNA technology has been researched for many years. However, the vaccine, the Moderna and Pfizer is the first official vaccine that it is rolling out with, which obviously for some people that are like, "Well, why didn't it work before? Why is it working now?" Can you speak to this a little bit?

Dr. Gian Varbaro: Sure. The reason why it didn't work before is there wasn't an opportunity to make one. They theorize this probably in the last 20 years or something. And that's really when we had the technology to do this and there hasn't been a large new infection since then that would require something like this on such a mass scale. But the implications of this are actually tremendous. I think that in coming years you'll see this used because it's so thorough and so clean against other illnesses too. I would not be surprised to see people developing mRNA vaccines against other illnesses.

Prakash Chandran: Okay. So Pfizer and Moderna, they use mRNA technology. Now, let's move on to Johnson & Johnson. Talk a little bit about that vaccine.

Dr. Gian Varbaro: Sure. So the Johnson & Johnson vaccine is more of a traditional vaccine. I'll explain how that works. What they do is they actually take a different virus, not the coronavirus, the SARS-CoV-2 virus, which is the virus that causes COVID-19. They take a different virus called an adenovirus that doesn't normally infect humans and they weaken it as well. So it's something that can't infect your body and they alter it so that it represents, again, pieces of that protein spike on that virus and they inject that into you. So this thing cannot infect you, but it, again, trains your body to attack that protein spike.

This is similar to how flu vaccines have been made the last several years. It's similar to a lot of other vaccines that we know about. So this has been around for quite a while, and this uses again a more traditional technique. So that's how that one works. It's one shot. That's probably the biggest thing about it. And again, the reason for that is that how they tested it. So it's still also a very good vaccine. Even despite the pause, it's very safe as I described before.

And the other question sometimes people ask because they see studies on it and they say, "I've read that the Moderna and the Pfizer had a 95% efficacy and the Johnson & Johnson only had a 60 something percent. That means that Johnson & Johnson must be worse." Well, a couple of things to know about that, which are they were tested at different times when there were different things happening, when there were different variants, when there were different case rates, so that's going to affect those numbers a little bit.

The second part is remember at the beginning, I said we were looking for anything that was 50% to 60% efficacious. So this was again well beyond what they wanted. It actually was around 70% against the regular and high 60s against the variant. So it's still also extremely effective and more effective than most vaccines we're used to taking.

Prakash Chandran: Yeah, this is all making a lot of sense. So I wanted to touch on something that you said earlier, you said that the mRNA vaccines don't necessarily modify your DNA, so nothing bad is happening. And the J & J vaccine gives you a much weaker strain of the virus. So it's only upside, it's only giving you that protection.

There are two things that I'd love to hear you address. The first is that for women that are pregnant or thinking of becoming pregnant, there's uncertainty and also mixed opinions around whether they should be taking the vaccine. And this kind of is related to the second point, there has been no real longitudinal studies that prove that it is safe over time. So what might you say to people with those concerns?

Dr. Gian Varbaro: So an important thing to realize is, yes, of course we don't know long-term what's going to happen with the vaccines, they're new. And we won't know until time passes what the long-term effects are. But we also don't know the long-term effects of catching COVID-19 and that seems to be much more serious than any possible effect of the actual vaccine.

We've already seen patients who are what we call long-haul COVID-19 patients. We know that some patients have some kind of long-term effects from having the illness. And that is going to be many times greater of a risk than any possible theoretical risk of vaccines. So that's one.

Two, in terms of young women and pregnancy, there's no evidence whatsoever that it would affect that. As I said before, it doesn't affect DNA. And the Johnson & Johnson wouldn't affect you. The studies are not fully published, but we have early data on them and they look completely safe in pregnancy and in young women. Young women, we know already from the regular trials, I should make that clear, in pregnancy that they're still studying it. But from the early data, it looks extraordinarily safe. There doesn't seem to be any effect. And I can tell you that I've given the vaccine to pregnant women and have had no problems whatsoever with any of those patients. So it's an extremely safe vaccine, even in those circumstances.

Prakash Chandran: Got it. That's helpful to know. Now, I wanted to also ask about vaccinating children if they need it. Because some of the things that we're hearing is, you know, if you're young, your immune system is strong, this is not going to affect you. And so maybe talk to that a little bit.

Dr. Gian Varbaro: Sure. So everybody eventually needs to be vaccinated because again that's how we help end the pandemic. For children, there's a couple of things that are kind of getting mixed together there, right? So the mortality rates or the death rates from COVID-19 definitely get lower as you get younger, but that doesn't mean that there's no effect.

In fact, now the majority of patients who are coming in with new cases, even those hospitalized are younger because we vaccinated so many of the older patients. For really younger children, and I'm talking about less than around age 12, there does seem to be less likelihood for them to catch it or spread it, but it still exists. They still are children. You've seen those cases in the news probably who've caught COVID-19 and some who've even had serious cases.

Right now, the vaccines are not available for younger ages, but again, that has to do with the studies. When they started, they had to do the studies quickly and get as much data as they could to make sure they were safe in the groups that we're launching them for as we discussed before.

So the original studies for Moderna and Johnson & Johnson were for people 18 and up. For Pfizer, it was ages 16 and up. And again, you may have seen in the news that Pfizer has already released their data from their studies from ages 12 to 16. And that is likely going to go for a new emergency use authorization in the coming weeks.

Moderna has been running those trials too, and we expect them to have their data relatively soon as well for those age groups. And Moderna in fact has already started trials in ages six months and up. And I would expect that it would probably be approved sometime hopefully this summer for younger children.

And before you ask, how safe would it be? I'll tell you that I have three young children myself, all under the age of 10. And if they were running the trials here near my house, I would enroll my children. That's how comfortable I feel with how safe these are and how effective they are.

Prakash Chandran: Yeah. I mean, that's very reassuring to hear. But I guess to that point, is there anyone at all that shouldn't be vaccinated?

Dr. Gian Varbaro: Really only if you have a severe allergic reaction to the vaccine. And unfortunately, you won't know that until you get the shot. But pretty much everybody should be vaccinated. More people getting vaccinated again helps us move forward. It protects everybody and it will help end the pandemic and help it go away.

Prakash Chandran: Yeah. So, regarding that, we've talked about the different vaccines, we talked about how effective they are and we talked about the fact that they are safe, still though I know a lot of people that are concerned with the side effects. And not only the side effects, but the potential under-reporting of the side effects, meaning that if someone, for example, goes home after getting the vaccine and has an adverse reaction, they're not going to run back to the hospital and say, "Hey, this happened to me." So what might you do? Or what might you say to people with those concerns?

Dr. Gian Varbaro: So absolutely and I understand those concerns completely. People need to understand how we described it, what the vaccine does is it makes your body have an immune response. So some people feel the effects of having an immune response. So some people get fevers or chills or body aches afterwards. You know, that's going to happen in a certain percentage of the population. For the two-shot vaccines, there have been some patients who get on the first shot, but it's more likely on the second shot, but even there, it's probably around 20% or so of people who get those kinds of side effects.

Most people, those resolve within a day and Tylenol treats them. I've had a couple of patients who've taken a couple of days, but it does pass, but that's with those. And, again, it's inconvenient, but I would say to you, it would be much more inconvenient to get COVID-19 because this is only exposing you to a piece of that virus. It's not even infecting you. So you are getting an immune response and you're feeling that. But again, a regular cold or flu would be worse than these side effects. So that's the first part to it.

But again, I understand if people are nervous about it, and you mentioned also about the possibility people are under-reporting. Well, one, I've been running couple of large programs for some time now. We're getting close to having given a hundred thousand shots. And, you know, I typically see a lot of the people when they come back from their second shot, so I know most people have done very well with it.

The other piece you should know is that we do give to patients a place to report in electronically if they have those side effects when they leave. So there's a system. It's sponsored by the CDC where it's an electronic system you can use on your smartphone. So after you get your shot, if you do have those side effects, you can report them.

So hopefully, people are reporting them. I can't guarantee you that everybody does that. But, you know, at the end of the day, I can tell you from close to 100,000 shots, that the side effects, while they do exist, are significantly less than any of the side effects of the pandemic continuing or of getting COVID-19 or, like I said, much worse than atypical bad infection.

Prakash Chandran: Yeah. That's well said. One of the other things I wanted to ask you about was booster shots. For example, with the flu vaccine, we have to get a booster every single year. I'm assuming, because that strain mutates and we have to stay protected. Do you think we're going to have to do something similar with the COVID-19 vaccine?

Dr. Gian Varbaro: It's a great question. And real answer is we don't totally know yet. I know there's been a lot of talk in the news in the last several weeks that we're going to need them or not going to need them. So I'll tell you what we do know, because again, the problem is we don't know until we kind of know.

When they first developed the vaccines, they had done some studies in Petri dishes and test tubes that looked like the body could develop immunity that would last five to 10 years, which is great, but that's in test tubes and Petri dishes. That's not real living people. And obviously, the living beings are different and things happen. Your body changes. The virus could mutate. There's all kinds of different things. And there's other pieces that play into it.

So there's been a pandemic about every hundred years in human history, they've had pandemics before. And all of the past ones had the same natural course basically. They all lasted about five to 10 years. These were before mass vaccines, so don't be scared that we're going to be doing this for five to 10 years. But they lasted for five to 10 years and the virus would either die out, like smallpox was not a pandemic, but smallpox pretty much doesn't exist, it's been eradicated, or they would mutate and change, right? The Spanish flu 1918, that flu strain still exists in our seasonal flu, but it became less what we call virulent, it makes you less sick.

And that's part of what happens as you put pressure on it because as people develop immunity, back then you had to develop immunity by getting sick, the virus has to mutate so as not to make people change their behavior, right? Because right now, if you got sick, you'd go isolated, you wouldn't be able to spread it to other people, right? The only way for the virus to survive is to make itself become less virulent. So the vaccines push that a lot faster. So that's kind of what happens.

I should finish the thought from before, the Spanish flu strain still exists. It just is less virulent. And that's true of everything. Bubonic plague still exists, but it's not the Black Death. There's all these different ones historically you can look at. And the COVID-19 will either hopefully go away or will change over time. And the way to do that more quickly is for more people to become immune and the way to do that without having to go through getting COVID-19 is to just get the shot. Because with that, you don't get infected. All you deal with is your own body's immune response plus all the effects of being infected.

Prakash Chandran: Yeah. Absolutely. And I think another thing that is important to note is that vaccines in general are one of the greatest innovations in really our time and it has eradicated, to your point, lots of different diseases are nearly eradicated, like polio and tetanus and diphtheria and all of those things. And this is just another one of those things. We've been able to develop the vaccine faster than ever to provide us this protection and to end this pandemic fast, so we don't necessarily see it again. So I think that's an important thing to say. Wouldn't you agree?

Dr. Gian Varbaro: Oh, I 100% agree. Thank you for saying that. You're absolutely correct. Vaccines in general are one of the great scientific breakthroughs in human history. And these vaccines in particular, I would say, rank in probably the greatest innovations in human history. It really is watching history happen. What they did in creating these vaccines that were so effective and so safe so quickly is really one of the greatest accomplishments that humankind has ever had. And vaccines in general are, again, extremely safe and they are extremely effective. And, again, it's a miracle. It really is a miracle.

Prakash Chandran: So let's say that someone has listened to our conversation and is convinced that they want to get the vaccine. If they decide to do so, where can they get it? And what can they expect going through the process of getting one?

Dr. Gian Varbaro: So, I mean, it's good we're talking about this now, as opposed to a couple of months ago where, you know, it was a lot harder to get an appointment. Now, it's available to everybody who's above the ages. Most places now, at least here where I am, are taking people even for walk-ins. We're doing that as well. So you can pretty much look at the local places and go at a time that they're open and it's convenient for you. You can see if you need an appointment or not, but again, a lot of places are now taking walk-ins.

As for what to expect it's relatively simple. I mean, all of us have probably had shots at some point in our life. Again, they'll clean the part of your arm with an alcohol swab. They'll give you a shot. It's very quick. It's pretty much painless. Again, most people have very little side effects on the first shot. And if they're going to have them, they have them on the second shot.

I'll tell you personally, on my first shot, I didn't have anything. I just was a little tender where the shot was like for a day, but I wouldn't have known it if I didn't bump into that spot. On my second shot, my arm was sore. I'll be honest with you. And I had some pain in my armpit. I'm a doctor, so I understand that's my axillary lymph nodes. But I didn't have any fevers or chills.

That being said, if you're nervous about the side effects, you can take Tylenol before the shot too. So you could say, "Hey, I'm going to take some Tylenol around the time of it." It won't affect the efficacy of the vaccine on you and it could prevent you from having some of those side effects almost preemptively.

Prakash Chandran: Okay. So just as we close here, I wanted to ask you about what life looks like after you get vaccinated. Are you able to hang out with people that you haven't seen in a long time? Do you still have to wear a mask? Talk a little bit about how life changes for someone post vaccination.

Dr. Gian Varbaro: So I think that there's a lot of things that you can do once you're vaccinated. And I think that's really important for people to understand that and feeling comfortable that it's safe to do. So if you're around even people who are unvaccinated, if it's not a large number of people, you probably could be unmasked even inside. Outside, definitely could be.

If you're vaccinated and with other vaccinated people, then obviously you can feel very comfortable, kind of in normal conditions again. If you're vaccinated and you're around people who might be a higher risk, again, an older person who hasn't been vaccinated, then maybe you should wear a mask. But for right now, we're learning more day by day. And as we learn more, we're giving more and more instructions on stuff that you can do.

Prakash Chandran: Very helpful. Well, I really appreciate your time, Dr. Varbaro. Just before we leave, anything else that you'd like to leave our audience with regards to the vaccine?

Dr. Gian Varbaro: Again, I think I can't say it enough. These are one of the great breakthroughs that I've ever seen in my career. And these are one of the most safe and efficacious medicines that I've ever seen. It's really important. We live in a society together and in order to be able to move forward, to get out of all of this craziness of the last year plus, it's really important for everybody to get vaccinated. Not just for yourself, but for the people you love and for us all as a community to be able to live our lives the way that we did beforehand.

And we will be able to get back to normal again. I truly do believe that. But we can do it much faster if people go out and get vaccinated. So just to anybody listening to this, please, if you haven't already, please go out and be vaccinated. It's really important and it's really great if you do.

Prakash Chandran: All right. Well, Dr. Varbaro, thank you so much again for your time. I learned a lot. We covered a lot and I hope this really helps the audience understand why it's so important that we all go out and get vaccinated. That's Dr. Gian Varbaro, Chief Medical Officer for Bergen New Bridge Medical Center.

For more information, head to NewBridgeHealth.org. If you found this podcast helpful, please share it on your social channels and be sure to check out the entire podcast library for topics of interest to you. Thanks for checking out this episode of Wellness Waves. My name is Prakash Chandran and we'll talk next time.