Sandra Lindsay, a nurse in Queens and the first person in the United States to receive Pfizer's coronavirus vaccine, says she is not experiencing any side effects from the first dose.


What is the mechanism of action of the COVID vaccines? For how long will they protect? When will we be able to receive the vaccine? What took so long?

These are the questions that everyone has. The impact on our daily lives will be tremendous.

The various vaccines all have the same goal. It’s to make the immune system recognize and attack the spike protein of the COVID virus. The spike protein is the point of attachment of the coronavirus to our cells and it’s entry point into them. (The virus is called corona because of the spikes. They resemble a crown and corona means crown.).

The Pfizer and Moderna vaccines are both mRNA vaccines. They carry a program to instruct to make a protein that resembles the spike protein which will in turn induce immune recognition and response. Live virus is NOT injected. This immunity will hopefully jump right in when the real COVID virus is encountered.

The other vaccine approaches (live virus, attenuated virus, etc.) also work towards making an immune response that recognizes the spike protein.

The Pfizer vaccine needs to be stored at very cold temperatures, in the range of -90 F, something that is not readily available in doctor’s offices. Because of its cold storage need, it is optimal for large centers inoculating large groups of people in a short period of time.

The Moderna vaccine is similar without the need for extreme cold for storage. A household freezer is sufficiently cold to store this vaccine for months. Because of this it will be easier for smaller hospitals and facilities to administer and store.

Both seem to be equally effective. Both need two doses about a month apart. That means that a million doses will only inoculate 500,000 people. Full immunity does not seem to appear until at least a week after the second dose. Some recent data does show some immunity after the first dose and perhaps protection against being an asymptomatic carrier after the first dose. The protection may be about 50-70% vs 95% after the second dose. I would count on a 5-6 week lag from the time of the first injection until there is full benefit.

I expect that most people will have access to a vaccine by mid-spring. Their protection should last for at least several months and hopefully longer, hopefully long enough to give us herd immunity. If enough people take the vaccine as early as available, we can see herd immunity by the early summer.

Since the vaccine will not be 100% effective, there will still be some cases in people who were immunized. The number of those who will remain unprotected seems to be about 5% in the general population and maybe 15% in the over 65 age group. Hopefully, herd immunity, when achieved, will protect these people who did not mount a protective response to the vaccine and, hopefully, even those not fully protected against the virus will have a weaker form of disease if they get infected. This seem to be a reasonable assumption.

The CDC hosted a webinar this week and addressed common concerns. These are some of them. These are global answers. Individuals may need different answers. Everything  should be discussed with your doctor.

  • Should the vaccine be given to those with  previous infection?   Yes
  • Should the vaccine be given to those with antibodies?  Yes
  • Will it be given to children?  Not at the present time. The studies are under way. Pfizer is down to age 16, Moderna to 18
  • What will the vaccine cost?  It is free
  • Is it okay to get the COVID vaccine together with other vaccines?  It is not recommended to do so
  • If I have a significant, but not life threatening, reaction to the first dose, should I still take the second dose?  Yes
  • Should I take the vaccine if I have an allergy to one of its components?  Probably not

These are general answers from the CDC webinar. They do not replace a personal conversation, individualized to you, with your doctor.

One last point. Some people are afraid of the “new” mRNA technology and worry about potential side effects. While the use of mRNA in a vaccine is new, the mRNA technology is not. It has been around for years.

In fact, the vaccine could have been produced before the first wave in the spring. It wasn’t produced then because politicians and the press kept pressing the mantra of  “not cutting corners”. They wanted a full FDA review and absolute safety despite the situation on the ground. We all remember Governor Cuomo saying he needed to have his own advisors vet the vaccine because he didn’t trust the FDA and CDC. We remember the criticism of both Russian and Chinese vaccination programs because they felt the risk:benefit ratio favored early immunization rather than prolonged testing while the American press and politicians didn’t.

This attitude was not limited to New York. In our political leaders’ calculations, and in the press gestalt, the risk of fallout from “cutting corners”, of making a political decision that could be imperfect, outweighed the potential benefit of a new and previously untried  vaccine for a disease that was killing scores every day. Potential vaccine side effects were felt to outweigh the ongoing disease caused deaths.

General George Patton was a very successful World War II tactician because his mantra was: A good plan today is better than a great plan in three weeks.

The other modalities of treatment, ranging from pooled antibodies to blood thinners to anti- inflammatory drugs to non-ventilator methods to deliver oxygen are also being fine tuned . All are beneficial and will help to reduce the mortality level. They are available today.  Contact your physician to see what your current medical options are.

Dr. Marc J. Sicklick is an allergist-immunologist in Cedarhurst and practicing for more than 20 years. He is affiliated with Long Island Jewish Medical Center, North Shore University Hospital, Montefiore Medical Center, and Mount Sinai South Nassau.


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