To vaccine, or not to vaccine, that is the question.

So I have a question for you. Based on what we know so far and the history of speedy vaccination efforts in the United States, is it reasonable to wait on getting the vaccine?

Well this is a very personal question to answer and I do not believe a broad “one size fits all approach” really works here. There are many reasons for some people to get the vaccine now and there are also many reasons to not get the vaccine right away. So let’s go through some of these.

And I will try to answer both sides based on if the person was myself, but I may have to change who I am in order to answer the question in the appropriate context. Let me explain.

Let’s say I was an eight-year-old child with no pre-existing medical conditions, such as some sort of autoimmune disease, cancer or immune-suppression. Basically the run-of-the-mill healthy kid. Does it make sense to vaccinate a child in this age group? Well, when you look at the data, a young child with no worrisome pre-existing conditions, have a survival rate from the virus at close to 100%. This is even if they contract it, which for some reason, they may be less susceptible to in the first place. The actual number is really something along the lines of 99.99995% or in that ballpark, but for all practical purposes, let’s say 100%. So then, why would a patient such as this need the vaccine? Good question. Maybe they don’t need it.

OK now let’s try someone else. Let’s say I am 75 years old with high blood pressure, diabetes and heart disease. As we now know, age is the biggest risk factor for mortality with this new coronavirus. And when you add in certain medical conditions, as I just mentioned, your risk of mortality goes up. Goes up to what? No one really knows, but let’s just assume your risk is considerably higher. Well if this was me, I would certainly get the vaccine. So people like this and my parents for that matter, who aren’t the healthiest humans on the planet, are all great examples of patients who should strongly consider getting the vaccine.

Now let’s say I am someone in the mid-40s who exercises, eats well and generally takes care of himself and has no worrisome medical conditions. Should someone like this be getting the vaccine? Well, based on risk factors and their underlying healthy condition, someone like this is very unlikely to have a bad outcome from the coronavirus. However, what if this person is a front line medical worker and repeatedly gets exposed to sick patients who actually have the virus, perhaps with a high viral load. That certainly changes things a bit now, doesn’t it? The average healthy 45-year-old who is unlikely to get exposed to the virus, practices social distancing and does the mask thingy, may opt NOT to get the vaccine and that would sound perfectly reasonable to many people. However, if you are in the scenario of being potentially exposed on a daily or weekly basis, to sick patients with confirmed Covid-19, well then someone like this may decide that the vaccine is a great idea.

Now to make matters more confusing for you, I’m going to throw in some additional information which you may not know about or haven’t given much thought to.

Point 1: So apparently in England, a warning was issued to people with severe allergies to not get the new vaccine. There is always the potential of an allergic reaction to pretty much anything in life (i.e. shellfish, peanuts) and there seems to be an increased risk for an allergic reaction with this vaccine as well. If you are one of those people who can’t walk by peanut butter without getting wheezy, it might be best to avoid the vaccine at the moment.

Point 2: We have no data at all on the long-term efficacy or safety of this vaccine. Well obviously, this is a given. There can’t be any long-term data on these sorts of things because the vaccine just became available. You would need to study it for years in order to produce some sort of opinion about this.

Point 3: Although the vaccine has been deemed safe by many authorities, the safety profile has not been completely studied for all different age groups and with multiple pre-existing medical conditions. It seems logical to think that giving the vaccine to a very healthy person versus giving the vaccine it to a pretty sick person could make a difference in how they react to the vaccine. Something to consider.

Point 4: The history of rushing vaccines to the market hasn’t always gone so well in the United States. There was an issue at one time with the original polio vaccine where the vaccine itself caused people to develop polio, which is a debilitating disease. There was the swine flu vaccine in the mid 70s where it was rushed to market because some people (politicians, bureaucrats and so-called experts) thought the swine flu was going to be the next Spanish flu and kill millions. But this vaccine was eventually withdrawn because it caused a neuro-degenerative disorder in some people called Guillain-Barre syndrome. Guillain-Barre (gee-YAH-buh-RAY) is a rare disorder in which your body’s immune system attacks your nerves. Not fun to have needless to say. And then there was the rotavirus vaccine in the late 90s which was known to cause intestinal obstruction in infants. Rotavirus certainly can be deadly in children, but, the vaccine with its known complications was approved by the FDA and US government agencies anyway. This vaccine had to be withdrawn as well, after several infants developed intestinal obstruction and died. So, as many of you certainly know, this new vaccine has been produced in less than a year, which is the fastest a vaccine has ever been produced in the history of vaccinations. A penny for your thoughts now.

So now what do you do with all this information? Well as I said in the beginning, I believe this is a very personal question which everybody needs to answer individually. A broad, top down dictate/approach is really inappropriate in my opinion. For some people, the risk of the vaccine, the potential side effects from the vaccine, probably carry higher risk to the patient than the virus itself. Where as, in other patients, the risk of a poor outcome from the viral infection itself may be worse than the risk of potential vaccination side effects.

If you were looking for a definitive answer from me, I’m sorry to disappoint you, you’re not getting one. I think you need to consider everything I have said and weigh your own personal risks and perhaps the risks of the people you are in contact with.

In general, only after making an individual risk benefit analysis, should you consider doing something that could be harmful. If there was no harm whatsoever and only benefits, easy answer, just do it. But because there is some potential for harm, the benefits should outweigh the risks in your calculation.

How can we tie this in with being a CT technologist? You can use this same thought process for giving a patient contrast. IV contrast does carry some risk. That’s why we check the kidney function; that’s why we check the allergies. If there was no risk, then everyone would get contrast and we wouldn’t worry about it. If you would like to learn more about the risks of intravenous contrast and how to mitigate them, how to assess the patient’s kidney function and how to recognize and deal with a contrast reaction, then go to www.CTcontrast.com and take a look at my course covering all these important details.

So now we have come full circle back to the title. To vaccine, or not to vaccine, that is the question.