By Patricia B. Mirasol
CAN immunocompromised individuals get the coronavirus disease 2019 (COVID-19) vaccine? Can those previously affected by the virus still benefit from it? These questions and other common COVID-19 vaccine-related concerns were addressed at a Feb. 23 health forum organized by the Philippine College of Physicians and the Philippine Society for Microbiology and Infectious Diseases.
Dr. Kathryn U. Roa, vice-president of Philippine College of Physicians — Southern Mindanao Chapter, discussed these questions, as culled from the guidelines of the World Health Organization (WHO) and the US Centers for Disease Control and Prevention (CDC).
Claim: The COVID-19 vaccine is not for everyone.
True, but cases are rare. The only current contraindication to COVID-19 vaccination is an allergy to a previous dose of COVID-19 vaccine and any of its components. Those who experience an immediate allergic reaction after the first dose should not receive the second dose.
Claim: I have allergies to other vaccines and injectable medications, therefore I cannot get the vaccine.
False. People who experience an immediate allergic reaction, such as difficulty of breathing, to any other vaccine or injected therapy must first be evaluated by an allergist to assess possible allergic reactions.
Claim: I have food and/or medication allergies, therefore I can’t receive the COVID-19 vaccine.
False. There are special groups who can receive the COVID-19 vaccines. Those with allergic reactions to insects and latex, and those with well-controlled asthma, can receive the COVID-19 vaccine. Patients with autoimmune diseases such as Bell’s palsy may also get vaccinated, provided they are informed that not enough data is yet available to establish the vaccine’s safety and efficacy for such conditions.
Claim: I’m pregnant, therefore I can’t get the COVID-19 vaccine.
Discuss this with your doctor. There is limited data on the vaccine’s effect on pregnant women and their babies. Among the small group of women included in trials and in animal studies, there were no safety concerns noted. Pregnant women should consider certain factors such as the level of COVID-19 transmission in their community, as well as their personal risk of contracting the virus, when making a decision about the vaccine.
Claim: If I get vaccinated, I can give COVID-19 to my baby through breastfeeding.
False, but discuss the benefits versus risks of breastfeeding with your doctor. There is limited data available, but the vaccine is not a live virus, and is thus unlikely to pose a risk to the breastfeeding child. The WHO does not recommend discontinuing breastfeeding if the mother is vaccinated.
Claim: I am immunocompromised, therefore I can’t get the COVID-19 vaccine.
The COVID-19 vaccine is not contraindicated for immunocompromised individuals, unless the individual has allergies to the vaccine or its components. The optimal timing of one’s COVID-19 vaccination must be discussed with the attending physician, however. Immunocompromised patients, or patients with diseases such as cancer and human immunodeficiency virus (HIV), may benefit from the vaccine because they are at higher risk of developing complications from COVID-19.
Claim: I have comorbidities but am not yet a senior citizen, therefore I will not benefit from the COVID-19 vaccine.
False. You will benefit from the COVID-19 vaccine. Wait for your priority group’s turn to come up. Adults of any age with medical conditions — such as chronic kidney disease, heart failure, severe obesity, and chronic obstructive pulmonary disease (COPD) — have been shown to be at increased risk for severe illness from COVID-19. If you have underlying medical conditions, you are among the persons to whom the COVID-19 vaccination is recommended and prioritized.
Claim: I currently have COVID-19, therefore I should get the vaccine now.
True, do not get the vaccine right away. People who have COVID-19 now should wait until they have recovered.
Claim: I can’t spread COVID-19 to others once I’ve been vaccinated.
We still need more information as to whether the vaccines protect against asymptomatic transmission. Unless herd immunity is reached, wearing masks, hand washing, and physical distancing are the best ways to keep everybody else safe.
Claim: If I got a recent non-COVID vaccine, I can still get a COVID-19 shot as scheduled.
Wait at least 14 days. There should be a minimum interval of 14 days between administration of the COVID-19 vaccine and any other vaccine against other conditions.
Claim: It’s okay to mix and match vaccines and use different brands.
No, vaccine brands are not interchangeable at this time. The WHO recommends that the same product should be used for both doses. The US CDC gives a stronger statement: the mRNA COVID-19 vaccines (like Moderna) are not interchangeable with each other or with other COVID-19 vaccine products.
Claim: COVID-19 vaccines are not halal (or food and items that are permissible according to Islamic law).
False. Muslim leaders in the UK have already issued a favorable fatwa (a legal opinion or ruling issued by an Islamic scholar) on the vaccines. Pfizer, AstraZeneca, and Moderna have stated that their vaccines do not use gelatin or pork products. Indonesia has certified China-made Sinovac’s CoronaVac as halal.
Claim: I already had COVID-19, so I won’t benefit from the vaccine.
It is not known how long natural immunity lasts. Early evidence suggests natural immunity may not last very long, and experts hope that the vaccination will offer a more durable immunity.
Claim: Since COVID-19’s survival rate is so high, I don’t need the vaccine.
It’s true that most recover, but it’s also true that some people develop severe complications. More than 2.4 million people worldwide have died from COVID-19 thus far. Also, it may cause long-term health problems. Getting vaccinated protects you and the people around you, as well as those who cannot be vaccinated.
Claim: COVID-19 vaccines have really bad side effects.
You may experience side effects, but they are not necessarily bad. Side effects from COVID-19 vaccines are caused as part of the immune response to vaccines. Side effects occur during the first week — but most likely one or two days — after vaccine administration.
Claim: If I don’t experience side effects from the vaccine, it means it didn’t work.
False. Many people will get the vaccine and not experience side effects. This does not mean that the vaccine did not work for them.
REAL-WORLD DATA
Dr. Roa said that vaccines can’t be compared head-to-head, because the definition of the measured outcome per study differs. “Ninety percent efficacy could mean the efficacy against hospitalization due to COVID-19, or the efficacy against death due to COVID-19, or the efficacy against severe COVID-19 infection,” she said. “The vaccine efficacy is almost the same anyway. The WHO says that, as long as efficacy is 50%, then it’s good enough to be used.”
The US CDC, in its Feb. 19 Morbidity and Mortality Weekly Report, noted that of the 13,794,904 Pfizer/BioNTech and Moderna vaccine doses that were administered between Dec. 14, 2020, and Jan. 13, 2021, in the United States, 6,994 adverse post-vaccination events were reported. Of the 6,994, only 9.2% were classified as serious.
There were 4.5 reported cases of anaphylaxis (a rapidly progressing, life-threatening allergic reaction) per million doses administered. The US CDC’s Vaccine Adverse Event Reporting System detected 21 cases of anaphylaxis, or 11.1 cases per million doses, after the administration of 1,893,360 first doses of the Pfizer-BioNTech COVID-19 vaccine. The rate of anaphylaxis for Moderna, on the other hand, is 2.5 cases per million COVID-19 vaccine doses administered.
For comparison, Dr. Roa told the forum audience that the incidence of anaphylaxis in the inactivated influenza vaccine is 1.4 per million doses administered.