COVID-19 Vaccines—The how and why

“Didn’t even feel the needle going in, and I thought I’d feel it because it looks like six inches long,” Joseph Enrietti, 95, said.

Enrietti, a resident of Ahmeek, got his first COVID-19 vaccine shot through the Hancock Veterans Affairs Office in mid-January. He’s scheduled for his second dose next week.

“A little sore if you touched it the next day, but if you didn’t touch it, didn’t know I had it,” he said.

He said the VA called him, and he was the second person to get the vaccine there, after a 97-year-old. He said he recommends the shot to anyone who can get it. He said his family in Marquette can’t get an appointment.

Unfortunately, Pfizer’s CEO Albert Bourla has said COVID-19 is likely here to stay in an interview with Bloomberg this week. New, emerging variants before the vaccine was distributed mean that new vaccines will be needed to be in continual development.

“But also it looks like we have the tools to make Covid like the flu,” he told John Micklethwait. “That means it will not disturb our lives or the economy. We just need to be very vigilant about [tracking new] strains. And we need to be very vigilant about vaccinating people.”

But in Copper Country, those vaccination efforts have now slowed to a crawl. Plans for vaccine distribution have changed several times, and the vaccine supply isn’t increasing, according to Kate Beer—MPA, CFPH, CPA and CGMA.

Two of those designations are certifications in public accounting, MPA is a master’s in public administration, and the CFPH is a certificate in the foundations of public health. She’s worked in different roles in Upper Peninsula health for more than 25 years, and has been the Western Upper Peninsula Health Department’s administrator since October 2014.

“So, for example, this week we got in about 1,000 doses,” Beer said. “And 750 of those doses were second doses.”

That means only 250 more people in WUPHD’s 5-county jurisdiction can receive their first vaccine shot this week, but if the second doses aren’t delivered, the first doses will be wasted.

“We’re hopeful that this next round, we might get a little bit more, because they’re almost done with the long term care facilities,” Beer said.

But the state could decide to allocate those spare doses somewhere else, too.

Beer said the state has changed their allocation strategy several times in response to the supply they’ve been receiving from the federal level. Right now, she said WUPHD doesn’t know how many doses the district will be getting from week to week, which makes scheduling and keeping appointments difficult. Beer said some care providers have had to cancel vaccination clinics because they didn’t get the vaccine they had planned on having.

She also said that care providers are working very hard to verify appointments, because many people are signing up on more than one providers vaccination list.

“We're going to run into where people just aren't going to show up for an appointment slot, because they got it somewhere else,” she said. “And that's, that's what's gonna, you know, kind of gum up the system.”

She asked that people only sign up for one list, or take their names off duplicate lists. That will help make sure no vaccine is wasted in our area.

Tight scheduling is crucial in making sure each dose is responsibly used, too. Each vial of the Moderna vaccine contains six doses of vaccine, but can’t be transported and expires within six hours of opening. If you have six bottles of vaccine, you want to be sure to have 36 arms ready for a shot in that time.

“We've actually had a few no-shows,” Beer said. “So we've had to, you know, we've kind of kept a list of people we can call on.”

This list mainly consists of people previously eligible who missed or turned down their first chance at a shot, or others eligible who might be able to travel to the vaccination site on short notice. Beer said she isn’t front-line essential and has not had her first shot.

Individuals will mostly get their vaccine shots from their regular care provider, but WUPHD has been running vaccine clinics for school staff, first responders, and other smaller, eligible groups. WUPHD advocates for local care providers with the state. For instance, the Pfizer vaccine has to be kept very cold, and in rural areas refridgeration of that level is not readily available. Pelleted dry ice can be used to achieve those temperatures in many areas.

“In the Western U.P., we really don’t have a source for dry ice that does it in the pellet form that’s required,” Beer said.

So most of the vaccines sent here are from Moderna.

“Vaccine hesitancy”, or resistance to taking the vaccine, hasn’t been too much of a problem, but isn’t uncommon, either. Beer said that the goal is at least 70% of the population taking the vaccine, but some groups they’ve scheduled with have had as low as 50% acceptance. She said a lot of people are coming around as distribution continues, though.

“I think there's a lot of, of mistrust around the safety of the vaccine, because nobody's been upfront to say, ‘Hey, we did actually do all the studies that would normally be done, we just did it in a way that compressed the timeline,’” said Dr. Kelly Kamm.

Kamm has a doctorate in epidemiology from the State University of New York at Buffalo, and a master’s degree in microbiology from John Hopkins School of Hygiene and Public Health. She works as assistant professor of kinesiology and integrative physiology at Michigan Technological University. Among her research foci are rural health, hand hygiene, and the social determinants of health.

Johns Hopkins University of Medicine has put together a really great interactive explanation of the accelerated trials process the vaccine went through. I highly recommend checking it out, because I’m not going to try to duplicate it.

A screenshot captured from coronavirus.jhu.edu/vaccines/timeline

A short explanation of the timeline acceleration is that trials are normally done one after another, but in the compressed timeline, they overlapped the phases, and started preparing for the manufacturing process under the assumption it would be successful.

COVID-19 vaccine research wasn’t slowed down much by an ethical issue that slows down other medical research. A “challenge trial” is when a placebo is given to half the participants instead of the preventative being tested, and then all participants are exposed to the disease. Those that catch the disease are then treated.

“You can only do those kinds of studies with things that we can treat, it's completely unethical to do it with a disease that we have no treatment for,” Kamm said.

With no proven treatment for COVID-19, once the trial participants are given a vaccine, researchers have to wait for enough of them to be naturally exposed to do mathematical comparisons.

“You pick a population to run your trial and of people who are already at high risk, because they're going to be more likely to be exposed. And unfortunately, some of them will develop the disease,” Kamm said. “COVID—we have lots of people who are at high risk.”

She said allergic reactions that have been observed since the vaccination of the public began are not a sign that the testing wasn’t thorough, or that the vaccine is unsafe.

“If you have a reaction that occurs, one in a million people—you don't do the phase three trial in a million people,” Kamm said. “So you wouldn't see that reaction until you release it into the public.”

Beer said a handful of reactions have been caught during the vaccination process in the Western U.P.. Providers have been keeping patients under observation for at least fifteen minutes to monitor for a reaction, and keep medication on hand to treat the anaphylactic shock that has been observed.

“And, and we see that with flu too. So you know, even with flu, if you've not had a flu shot before, or you've had any kind of reaction, they won't let you just get the shot and go, they make you sit there,” Kamm said.

Kamm said the idea of herd immunity without vaccines is an impossibility.

“Herd immunity is in terms of vaccines,” she said. “I mean, we really don't talk about it as a public health methodology of letting the disease rampage through the population to develop herd immunity.”

She said trying to do so puts a lot of people at risk of long-term impacts, even if they don’t die.

“And I think we have to remember, we don't know the long term impacts,” Kamm said.

Strokes, long-term breathing trouble, heart weakness and cognitive difficulties have all been reported by people who have ‘recovered’ from COVID-19.

“If you had an infection that led to that, you know, that led to all sorts of systemic inflammation—We don't know if 20 years from now, that's going to be a contributing factor to cardiovascular disease, we have no idea,” Kamm said.

The well-known initial symptom of loss of smell and taste has also been reported to be long-lasting to some.

“The quality of life impact on that is, you know, it's not something to to dismiss lightly,” Kamm said.

She said even those people who initially only showed mild symptoms could have long-term effect that might impact quality or length of life.

Beyond that, Beer said that research is starting to show a person’s immunity after having COVID-19 seems to only last between 90 days and 5 months at the most, which means a person can re-catch COVID-19 several times a year, new variants or not.

“And so this idea to ‘just let it rip’ is, is very problematic in my opinion,” Kamm said.