- I never get vaccines. One of the reasons I see a naturopath is because I do not like to put chemicals in my body. Why should this be any different?
Dr. Otto: I can strongly relate to the sentiments in this question. I have built my life on practicing careful selection on what I put in my body, and I have built my career on teaching people how to do the same to promote health. I also have a lot of respect for the body’s built-in mechanisms to deal with microbial threats and personally think it would have consequences if we routinely blocked this mechanism from taking place. With that said, after careful deliberation I decided to get the Moderna vaccine. To distill my complex views on the subject I will say this: Our bodies are under pressure every day due to the things we put into and onto bodies that actively harm us like unhealthy food, personal care products, hair dye, pesticides, cigarette smoke and alcohol. Meanwhile, this pandemic is an active threat to our lives and the lives and well-beings of our families, neighbors, and communities. Of all the times in my life I have chosen to put something in or on my body that could possibly be found to harm me in some way, this vaccine is undoubtedly the one time that there was clear benefit that surpassed any potential risks.
Dr. Jones: My last vaccine was when I went to college, 28 years ago. I have committed to a lifestyle that keeps my body as free of chemicals as I can manage, striving to maintain health that will allow me to accomplish and enjoy all that is possible in my lifetime. I too, believe in the body’s innate ability to protect itself from infection and disease IF it has what it needs to do so including water, good food, nutrients, rest, balanced stressors. I believe I would have made it through a Covid-19 infection with flying colors. However, while our bodies have seen corona viruses before, they have not seen this one and its unique surface proteins. As a result, there is not an immune memory for anything similar that would allow our bodies to recognize it quickly and protect us in the way we may have been protected with other more common viruses, such as the flu or common cold. There certainly is some unpredictability regarding who is going to become sick with severe symptoms of Covid-19. We know folks with pre-existing health conditions are at higher risk, but there are several people I know who have had no known pre-existing conditions and have experienced moderate to severe Covid-19. I expect I would have had mild symptoms if I were exposed, however, I have many loved ones and friends that I worry very much about what the illness would be like for them. This was the main reason my decision to get the vaccine was quite easy to make. In addition, I have children in my life that I want to be able to return to schooling, athletics, socialization, seeing their grandparents…as I realize that if this pandemic continues, their mental and emotional health is at stake. I am concerned for other small businesses like mine, the economy, our communities, and the well-being of our patients if we are all forced to continue in the same fashion we have been for the past year. I want to see my patients all in person again… To agree with Dr. Otto, for me, the benefits outweigh the risks when it came to getting this vaccine.
- What should I know about the different vaccine types and is there one that is better than the others?
Dr. Otto: In a rapidly evolving public health landscape, we essentially have two types of vaccines in circulation: mRNA vaccines like Moderna and Pfizer and viral-vector vaccines like Johnson & Johnson and AstraZeneca. Up to this point at least, the Moderna and Pfizer vaccines have been the primary options in the United States. The Johnson & Johnson vaccine is become more widely available as we speak. Both the Moderna and Pfizer vaccines require two doses about a month apart while the Johnson and Johnson option requires just one dose. The mRNA vaccines essentially deliver the instructions to a human muscle cell to create the identifying protein found on SARS CoV-2 (known as the “spike protein”) long enough to stimulate our immune systems to start building an army against it. It is sort of like a CIA operation where our bodies are getting the necessary intelligence about a foreign terrorist effort ahead of time so that our defense systems can take immediate action and stop the threat before it happens. Our bodies only make the special protein unique to SARS CoV-2 for a brief period, but the military defense our bodies set up in response to it sticks around just the way it would after any typical infection, protecting us from that infection by keeping soldiers in circulation that intimately know how to respond to that threat in the future. A viral-vector vaccine, in contrast, takes an existing run-of-the-mill virus like that of the common cold, genetically engineers it to be incapable of replicating in the body, and attaches the special spike protein to it to trigger the exact same aforementioned CIA/military response. The outcome is the same in terms of immunity, it is just a different mechanism for getting there. I think it is important to state that while the mRNA vaccine technology is new in terms of its use within a vaccine on a global scale, the research had been going on for quite some time prior to this pandemic and has been well-studied. The efficacy of the mRNA vaccines’ ability to prevent COVID-19-related hospitalization and death is extremely high after the second dose. This may have more to do with them involving two separate doses rather than the mechanism (mRNA) of the vaccine since the Johnson and Johnson vaccine (only requires 1 dose) confers a similar level or modestly higher level of protection that one gets after the first dose of the mRNA vaccines. The Johnson & Johnson vaccine confers a lower efficacy rate than the mRNA vaccines, BUT only requires a single dose AND was studied during a time of new variants circulating and a higher number of cases. Basically, I do not think there is a reason to delay getting vaccinated by one type in deference to another unless you have an allergy or other reason to discriminate among them.
Dr. Jones: On February 27, 2021, the FDA grated emergency use approval for a different type of vaccine made by Johnson & Johnson. This has been more recently referred to as the J&J vaccine. The J&J vaccine is a carrier or virus vector vaccine, not an mRNA vaccine like the other two Dr. Otto referenced. The J&J vaccine can be stored at room temperature and requires just one injection rather than two. It has been approved for only adults, but J&J is already preparing for testing it in children. This vaccine uses an adenovirus that has been inactivated as a shell to carry a genetic code on the spike proteins to the body’s cells. The shell and code cannot make you sick but once inside our cells, the spike protein is produced to train the body’s immune system and make antibodies and memory cells to protect again the actual Covid-19 virus. Common side effects are like the other vaccines for Covid-19 but have been reported to be milder and have been found to resolve within a day or two. According to J&J, no one suffered an allergic reaction in clinical trial. The vaccine was 86% effective against severe disease and 72% effective overall. Unlike the other two vaccines, because this one came out later, researchers were able to look at its effectiveness against the B.1.1.7 variant and found it to be well covered.
- I have always heard that the ingredients they use in the vaccines can be detrimental to my health. How is this any different?
Dr. Jones: This is a valid concern considering trace amounts of known toxins have been used in many of the vaccines people are administered daily for protection against other illnesses such as MMR, Hib, HPV, Tetanus. Unlike most of the other vaccines many of us have had in our lifetimes, the ingredients in Moderna and Pfizer vaccines are remarkably simple, J&J is a bit more complex but still cleaner than most. Unlike the MMR, DPT, HPV, Hep B, and Varicella, there is no aluminum hydroxide, neomycin, monosodium glutamate or formaldehyde – some of the ingredients that concern us most. Outside of the mRNA itself or inactivated adenovirus, these vaccines have lipids (fats) to protect the mRNA and genetic data and allow it to better enter the cell, salts to balance the acidity of the vaccine itself in your body, acid stabilizers to maintain the stability of the vaccines and sugar in the form of sucrose that helps the molecules maintain their shape during freezing. These simple ingredient lists made me more comfortable with the idea of getting a vaccine as well. If you have a history of allergies, it is still important that you check the ingredients list for any known allergens.
- Can I stop wearing a mask and socially distancing once I am vaccinated?
Dr. Otto: No. Clear and simple. This is the reality for a couple of reasons: First – the vaccines are super effective, but they are not quite 100% effective. And since one of the main reasons we are practicing social distancing and mask-wearing is to prevent our hospitals from being overloaded beyond capacity, we need to continue these essential practices until the vaccine has been offered to most people. Second – we do have variants of the virus in circulation now. At this point in time, the current vaccines still seem to be largely effective against them, but if we do not contain transmission, that may eventually no longer be true. That would mean that our vaccine tools could become less helpful, and our hospital systems would again be at risk for overload. I would mention here that while we assume based on history that vaccinated people will be less likely to spread the disease due to their immune protection, we do not yet have clear data about that for this particular disease and therefore want to err on the side of caution. Third – It would simply be too confusing. When you are out and about and not wearing a mask, people do not know if your truly vaccinated or if you are just rebelling against public health recommendations. So, we all need to practice caution for the coming months.
Dr. Jones: While I would love to…CDC recommendations are that we keep wearing them until we are closer to achieving HERD immunity. I believe we will find that those of us who are vaccinated or who have had Covid-19 already, are much less likely to transmit it. However, until we have more clarity here, I certainly do not want to be the one to share it with a co-worker, patient or family member who is not as well protected against symptoms as I am. Recently, published guidelines suggest masks are not necessary at home with other family members who have also been vaccinated or with our children who have not been vaccinated. This means vaccinated grandparents, aunts, and uncles, etc. can now be with other vaccinated adults and unvaccinated children, inside and without masks. Whole Health Concord will continue to follow CDC guidelines and while we plan to open entirely for patient visits in June and open our wellness shop in mid-May, masks will be required until otherwise notified to keep our patients, staff, and community safe.
- What are the risks associated with the vaccines? I am worried about the things I hear like infertility.
Dr. Otto: Vaccines, just like any drug or surgical intervention, come with risks of side effects in addition to the anticipated effects. These vaccines are no different. The most common primary effects of the vaccines include local symptoms – pain, swelling and inflammation at the injection site that usually lasts a few days, as well as systemic symptoms that feel like a bad illness including fever, chills, fatigue, muscle aches, headaches, and symptoms that often accompany fevers generally. The vaccines that contain two doses tend to pack a significant punch after the second dose – especially the Moderna vaccine. Interestingly, older people most vulnerable to the actual virus tend to tolerate the vaccine more easily whereas younger people less likely to succumb to the virus tend to be sicker from the vaccine. This probably has to do with the ‘sharpness’ of a younger immune system than an older immune system, reinforcing the need for older people to have access to vaccines to protect them against the most severe presentations of COVID-19. These are the expected effects. Unwanted side effects at this point seem to be uncommon, though are getting a lot more attention because of the hyper-focus on these vaccines in the media. Still, it is important to acknowledge them. Prolonged arm pain and stiffness, rashes, and worsening of existing underlying symptoms can and do occur. I have limited anecdotal evidence to share since we are still in early phases of roll-out, but so far, my patients who have had prolonged effects from the vaccine tend to be those I suspect would have harsher long-term outcomes from COVID-19 like the newly dubbed “long-hauler” post-COVID-10 syndrome. Since the natural COVID-19 disease brings with it increases of autoimmune disease risk and may also reduce male fertility/sperm health, it is important for an individual to consider these risks when deciding whether to get the vaccine which does not, as far as we know, carry said risks.
Dr. Jones: Beyond a sore arm, most of the side effects/reactions to the vaccine occur after the second dose with Moderna and Pfizer and with the one-time dose with J&J. These include fever, chills, fatigue, and headache for 1-3 days (unless you are me, and then it was 4 days…). But this is not a bad thing at all; this means your body is building an immune response to Covid-19. This is how your body will recognize the virus the next time you are exposed, and this will allow you to protect your body from infection, lowering your risk of severe illness. Despite the absence of evidence that the vaccines cause infertility, many women are delaying getting the vaccine due to concerns about it affecting their fertility. One common theory as to why the vaccination would influence fertility is that the antibodies we create to the virus could potentially attack a protein within the placenta during the pregnancy. There is no evidence now to support this concern. There is no evidence or reports of infertility among women who have recovered from covid-19, despite the millions who have been infected. Experts agree that the safest way to enter pregnancy right now is to be vaccinated before conceiving as pregnant females are known to be in a higher risk category of covid-19 illness compared to the average person.
- I am a healthy, low-risk person. Shouldn’t I skip the vaccine and just wait to get COVID naturally?
Dr. Otto: I am a proponent of natural immunization. The stepwise process of our immune systems to identify and respond to threats is integrated into our dynamic interconnected systems’ biology. A working principle of naturopathic medicine and the functional medicine approach is to appreciate that when you manipulate or hinder one aspect of the body’s functioning, you have untold consequences to others. Therefore, we aim to understand how to support and optimize the body’s existing systems (including the immune system) rather than replace them. However, I am willing to make an exception every 100 years when a global pandemic is wreaking havoc and putting millions of innocent people at grave risk. I just think that’s part of living in a connected world where we depend on each other in various ways for our safety. The idea of a “COVID party” like the “chicken pox parties” of my childhood is appealing except for the fact that this virus spreads so darn easily and among asymptomatic individuals. You would literally need to live in a carefully controlled bubble for a month to make it work, and that just does not seem realistic and safe to me. An additional concern is that while this disease tends to hit certain risk-populations the hardest, there is really no way to know for sure how well you personally will handle the disease. I am pro-vaccination in general, but I am also a proponent of personal decision-making when it comes to deciding what goes into one’s own body and therefore choosing whether to be vaccinated. Fortunately, we have learned that simply wearing a mask that covers the mouth and nose is extremely effective at minimizing the risk of transmission of this disease. This means that you can protect those around you from the disease you may not know you are carrying simply by continuing to wear a mask should you decide not to get vaccinated (or if you are unable to get vaccinated).
- I have already had COVID. Can I skip vaccination?
Dr. Otto: This is a category that I personally want to have more data on before I really answer it. Officially, the CDC is recommending that an otherwise vaccine-eligible person who has already had COVID wait 90 days after their positive COVID test before getting vaccinated. Their primary reason for this is to allow other people who do not have any immunity to get it via vaccination. But I wonder if we might actually have longer immunity than this. I do not necessarily think it would be harmful. Rather, I would personally rather ride out my natural immunization before jumping to the vaccine. But that is just me. I never got COVID and regularly was tested for antibodies whenever I donated blood over the past year, so I did not have to make that decision for myself.
Dr Jones: I believe that in time, we will better know just how long people are likely to make antibodies following infection and vaccination. A study came out last week confirming that the antibody levels post-Covid infection are much higher, much longer than expected. This is good news. An article was also published sharing that antibodies have been found in umbilical cord blood of babies delivered by mothers with previous covid infection. So, it appears immunity may be easier to hold onto than originally thought. As time goes on, we will have more accurate antibody testing which will be helpful in making sure folks have lasting protection. Perhaps Covid vaccine boosters will be administered based on timelines that are established after we have a few years of data under our belts. It could also be that older adults at highest risk are blood tested for antibodies so they can receive a booster if needed when/if antibody levels fall. There certainly still are several unknowns here.
- I have heard that people feel ill when they get the vaccine. If I get vaccinated, how do I prevent getting sick from it?
Dr. Otto: Dr. Jones and I have been deep into this topic since the vaccines became available. At this point, my recommendations are not different from those I would give to anyone about to get any vaccination. I recommend you get plenty of sleep both leading up to and during recovery from the vaccine. I recommend additional gut support since a lot of the immune system that gets activated involves activity in or near the intestinal tract. Gut support means probiotics, an anti-inflammatory diet and addressing any acute flares of GI disease like IBS or IBD. Otherwise, we believe that the symptoms following vaccination are largely desirable as they indicate a fierce protective force from our immune systems. Patients can take over the counter NSAIDs or Acetaminophen to hedge a fever and pains if they desire – though I recommend trying to use these sparingly and simply rest rather than work the day after your vaccinations. To minimize arm pain, be sure to use your arm and engage the deltoid muscle after vaccination to encourage blood and lymph flow through the area to prevent excess pain. For patients with more complex immune system issues, we will be making other recommendations. For patients who are having side effects from the vaccine that are not typical, we have been prescribing for them on a case-by-case basis.
Dr Jones: I tried hard to stay ahead of side effects in my own body and was disappointed with the results as I felt poorly for 3-4 days following the second vaccine. I did not feel like myself again until 5-6 days later, but certainly was able to get back to work and parenting as soon as my fever came down. I agree with Dr. Otto, more intense side effects likely mean a more robust immune system, which we see often in our patients who have lifestyles that are healthier than most people. Hydration is key during mild to moderate fever; epsom baths can be helpful for the muscle aches and pain. And do not be afraid to use ice at the injection side if needed for pain relief.
- I know this is a loaded question, but what do you think the future looks like after this pandemic passes?
Dr. Otto: I hate to break it to anyone, but this is not the last pandemic we are going to see. I have commented/joked before that this is the type of event that I am “willing to get vaccinated for every 100 years”, but truthfully, I think pandemics will become more common just as extreme weather events are becoming more common. We have nearly 8 billion people on this Earth and climbing, and we are living in closer and closer proximity to each other as well as animals through agricultural practices which creates at atmosphere for some funky and scary things to happen with pathogens and how they spread. So, I hope that we are better outfitted to tackle the next outbreak when it happens by learning from this one. One thing I think likely will be different moving forward after this pandemic is ‘over’ the use of masks in public spaces. Our friends in Asian countries have known for several decades the benefits of mask-wearing in densely populated public spaces, especially if you have symptoms of illness. We have now learned for ourselves how effective the extremely simple practice of mask-wearing has caused influenza cases to plummet this season along with preventing the transmission of COVID. Wearing a mask may be the easiest, most inexpensive, and non-invasive way to keep our population spared from airborne pathogens while allowing us to live our regular lives. I am really excited about that and I can imagine that mask-wearing on subways and buses, for example, becomes commonplace.
Dr. Jones: I agree, we likely will see another pandemic sooner than we would like to believe. But I also feel we have learned and continue to learn a lot from this experience that will allow us to better manage another pandemic when it comes up. This experience will also be helpful with managing flu and other outbreaks going forward. I am hoping that this experience will remind us all about the importance of focusing on prevention of illness rather than reacting to becoming sick – who would have thought some of our most trusted functional medicine immune supportive recommendations would become a common sight on household shelves in America…vitamin D3, vitamin C, zinc, and probiotics! We have learned how to better function when we cannot be together – remote working and remote learning have come a long way since we started a year ago and this will be so valuable for us when needed going forward. We have learned how little we really need to get by and not to take simple things for granted… such as toilet paper. We have learned how important social connection is and just how detrimental it is when we do not have it, regardless of our age. I am not a hugger and yet I cannot believe how much I miss hugging people. I am hopeful that this experience will bring a future of less entitlement and more appreciation for what we have.