Your COVID-19 Vaccine Questions, Answered
Please visit the ‘Drexel’s Response to Coronavirus’ website for the latest public health advisories.
On May 19, a trio of public health experts from Drexel University convened in a panel discussion to answer questions submitted by faculty and professional staff and to address concerns related to the COVID-19 vaccine.
At Drexel, proof of vaccination against COVID-19 will be mandatory for students in the upcoming academic year with a full return to campus, and the decision about a similar vaccine mandate for employees has not yet been made. Recently, the University surveyed faculty and professional staff about their COVID-19 vaccination status; 50% of employees responded, and 94% of them were either fully vaccinated or in process of vaccination at the time.
Still, there are many questions and concerns related to the safety of the vaccine and its health impact. For that reason, a panel was held for medical experts to address those concerns and share the most accurate and up-to-date information about the vaccine. The panel was moderated by Anna Koulas, executive director of the Drexel Business Solutions Institute. Those experts were:
- Marla Gold, MD, vice provost for community health care innovation, dean emerita and professor of health management and policy in the Dornsife School of Public Health, and director of the Return Oversight Committee informing Drexel’s response to the coronavirus. An infectious disease physician by training, Gold has been a member of the Board of Health for the City of Philadelphia for decades.
- John Rich, MD, professor of health management and policy in the Dornsife School of Public Health and co-director of Drexel’s Center for Nonviolence and Social Justice. A primary care internal medicine physician by training, Rich focuses on health disparities and the impact of those on the health of communities. He also sits on the Board of Health for the City of Philadelphia and the Vaccine Advisory Committee that the Department of Public Health has maintained, and previously was the medical director of the Health Department in Boston.
- Esther Chernak, MD, associate professor in the Department of Environmental Health om the Dornsife School of Public Health who also teaches in the College of Medicine. Chernak is also the director of Drexel’s Center for Public Health Readiness and Communication (CPHRC). An infectious disease physician and an internal medicine doctor, she sees patients in the public health clinics in Philadelphia. At Drexel, she co-chairs the Scientific Advisory Group that advises the Return Oversight Committee, and also participates in the University Travel Task Force.
Excerpts from their conversations have been consolidated and lightly edited in the transcript below. For additional information, please refer to the Faculty and Staff Q&As page and COVID-19 vaccination page on the ‘Drexel’s Response to Coronavirus’ website, and email roc@drexel.edu with additional questions and concerns.
Understanding Vaccine Development and Terminology
On what “emergency use authorization” means for vaccines:
John Rich: The head of the public health service for the U.S. has the ability to declare a public health emergency, and this is particularly critical in a circumstance where we don't have treatment for a particular disease. When a drug needs to be approved and, in an emergency, we don't have any alternatives for life-saving drugs or a vaccine, in this case, rather than take the long and perhaps protracted process of approval, the FDA is able to shorten that bureaucratic process, but it doesn't change the amount of science that's needed to stand behind it. You have to have phase one trials with healthy volunteers. You have to have phase two trials where you look at a larger population. You have to have phase three trials where you're giving it to the very people who are affected by the disease. Rather than having that take months and months for approval, once we have the evidence, we move quickly to be able to put this in place. There was an opportunity so that while the testing was going on to show that this is a highly effective vaccine, the pharmaceutical companies were actually producing it at the same time. This was a way to speed that process, but not cut corners on the science.
One of the reasons that we were able to show the effectiveness is that, unfortunately, there were so many people getting the disease out there that when you administered this vaccine to people and compared it to people who didn't get the vaccine, you saw big differences between those who got the vaccine and those who didn't.
On whether or not the vaccine was rushed into production:
Esther Chernak: I can see why people think that, because it certainly became available at a pace that is much faster than other vaccines. But I don't think it was rushed in production. I think it's just an example of how science can work quickly and be nimble when it needs to be.
With the COVID-19 vaccine, you still had the usual phases that vaccine trials go through, and those occurred as they always occur. But the anticipation was we were going to need to have these vaccines available quickly, so the planning for the phase three effectiveness trials was actually done while those phase one and two studies were happening, accelerating what usually takes years.
Generally, pharmaceutical companies don't make a lot of money on vaccines and are quite cautious about what vaccines they bring to market. But the U.S. government basically guaranteed a market by buying those vaccines, which pushed the companies to set up these phase three trials relatively quickly and to plan production. Because of that, we had an accelerated process from the perspective of manufacturing capability, but the actual trials themselves were basically run as they always are run. In fact, the FDA was very intentional about not authorizing the Pfizer or the Moderna vaccines until after several months of safety monitoring of the phase three trials.
On the vaccines being considered experimental:
John Rich: When people ask if it’s experimental, it's important to figure out what exactly that the concern is. They are not experimental in that they have gone through all of the phases of testing that all drugs and vaccines have to go through. The people who participated in those trials were entering something somewhat uncertain, and we owe them a debt of gratitude for being brave enough to do that. But now we're out of the experiment phase. It has been demonstrated to work. That process was overseen very carefully by people from all walks of life, all walks of science. So it is not an experimental vaccine.
What we also think about is the benefits versus the risks. One of the things that we do know about COVID infection is that even if people recover and survive, which most do, many are left with symptoms that can be quite concerning and stay with people for a long time. It’s not only hospitalization and death that we're trying to prevent; we're also working to prevent these long-term effects of people who get the disease.
On why clinical trials for vaccine are still ongoing:
Marla Gold: What we have is a new, highly contagious virus that entered our global community all at once, without any immunity among us. We're going to have to get answers while we're in motion in a pandemic, and that means gathering more data. But I guarantee you, like all vaccines, we'll be reporting forever as this vaccine is in motion to gather more information.
On explaining viral vector vaccines (like the Johnson & Johnson vaccine) and mRNA vaccines (like the Moderna and Pfizer vaccines):
Esther Chernak: Messenger RNA vaccines and viral vector vaccines have actually been in the works for over a decade. A viral vector vaccine is basically a vaccine that uses a virus that would normally infect human cells to deliver a small amount of genetic material that's from the virus into a human cell, so that the human cell starts producing that protein. Then, the body basically recognizes this foreign protein and starts to produce antibodies against it. This technology has been used pretty successfully in other vaccines, including one that's been used to curb the Ebola outbreak in West Africa and the Democratic Republic of Congo.
The messenger RNA, or mRNA, vaccine is really the novel technology of this pandemic. These vaccines are basically pieces of the messenger RNA molecule that code for the spike protein, which is the key protein of the virus that needs to be neutralized by our antibodies. The segment of that messenger RNA is basically coated in a lipid coat, a fatty coat, that is injected into the skin, and then once it's in human cells, the lipid coating falls off and the cells recognize this messenger RNA and start producing the protein that looks like the spike protein of the virus. It’s sort of tricking the body into producing antibodies against the spike protein without having to be exposed to the entire virus itself.
Choosing Vaccines and Understanding Vaccine Safety
On the best vaccine to get:
Marla Gold: When vaccine first became available, we said that the best vaccine to get of the three that are currently authorized in the United States is the one that you can at first get your hands on. Now there is no longer vaccine scarcity, and so we recommend that the best vaccine is the one that fits for you. There are still people who prefer to have one injection; they may pursue the J&J vaccine. But there are others that want messenger RNA vaccine, based on the available science and what they've heard from a friend or family member. Here at Drexel, where we've been running our clinics, we use the Pfizer vaccine currently. All three vaccines work extremely well.
On whether the vaccine is safe:
Esther Chernak: The safety profile has been studied quite extensively. One of the things that's unusual about rolling out a vaccine in the context of a global pandemic is that in a short period of time, we've immunized over 150 million people here in this country, and millions more in other countries. When you study the safety profile of a vaccine, particularly for rare side effects, you find that the more people you immunize, the more likely you are to see those rare side effects. Six months into this vaccine rollout, we actually have a lot of information about the safety profile. We know that more than half of vaccine recipients have a sore arm at the vaccination site. It's not uncommon for a day or two after the vaccine to have flu-type symptoms, muscle aches, headaches, chills, perhaps low-grade fever. That’s the immune system actually responding to the vaccine.
The longer-term safety profiles are quite reassuring. The messenger RNA vaccines seem extremely safe; the viral vector vaccine — the AstraZeneca vaccine that's been used in Europe and many other parts of the globe, and the Johnson & Johnson vaccine used here — has a rare side effect of abnormal blood clotting that occurs around week two or three after vaccine and seems to occur more commonly in younger people. That's probably the most significant and most worrisome of the side effects that we're aware of. But for the most part, these vaccines are actually quite really remarkably safe.
Understanding Vaccine Side Effects
On whether vaccine could make ailments, including those from pre-existing conditions, worse:
Esther Chernak: I would certainly recommend having that conversation with their primary care physician. In terms of people with underlying medical conditions, those are generally the very conditions that predispose them to having much more severe COVID. In almost all scenarios, the recommendation would be to get the vaccine so you don't suffer severe complications. In terms of people's underlying conditions, the biggest concern is that they're going to develop COVID and have a very severe complication. I think that the concern with the vaccine is that people who have underlying immunosuppressive conditions may not muster the immune response to the vaccine that someone with a normal immune system would muster.
There are very few absolute contraindications to this vaccine, and they basically include having an anaphylactic reaction as a component of the COVID-19 vaccine. Even a history of prior allergic reactions to other products are not contraindications to this vaccine.
Understanding Vaccine Protection Against Variants, Infection and Spread
On the effectiveness of vaccines against the various strains:
Esther Chernak: It's sort of a work in progress, because with each strain, this spike protein of the virus, which is that key exterior protein that's so important for antibodies to neutralize to get rid of the viral infection, can vary or change. There's a lot of study of the variants, and in particular the spike proteins of these variants, that seem to be emerging in all parts of the world, particularly where there's lots of active viral replication, because that's how these variants emerge. The most common strain other than the original one is B. 1. 1. 7, which emerged in the United Kingdom and is now the most common strain in the United States. The country of origin doesn't matter, but the bottom line is that people have done studies looking in laboratory settings, taking serum from people who have been vaccinated to see how well they neutralize these strains. It's pretty good and even more promising in real world settings.
It looks like vaccinated folks, particularly with the messenger RNA vaccines, seem to be protected against infection from these novel variants, certainly against severe disease. Maybe they get a mild infection, but overall, the efficacy is pretty good against these variants. Every variant is going to be different, so it's going to be important to do the tests and we'll have to see how well the current vaccines protect against the variants.
Marla Gold: The longer this virus is out there, the longer it circulates, the more time there is for variants to emerge. Variants are really accidental genetic errors that happen. So that's all the more reason for us to be vaccinated because the faster that we can get people vaccinated and the more immunity we build, the less virus that's circulating, the less chance that we're going to see any variant.
On whether you can transmit the virus after being vaccinated:
Marla Gold: In studies so far, it appears that vaccinated individuals who still somehow acquire infection and are asymptomatic have a low amount of virus and probably are not able to transmit it. But it's too soon to say for sure based on available science. For that reason, we often say to protect the unvaccinated person, there are situations where vaccinated individuals may find themselves wanting to mask. Unvaccinated persons should mask to protect themselves.
Esther Chernak: Studies so far are promising and seem to suggest that the vaccine prevents against asymptomatic infection — probably not 100 percent, but maybe somewhere between 50, 60 to even 90 percent. It does seem to even reduce viral shedding, so even if you develop so-called “breakthrough disease,” meaning that you actually get the infection after being vaccinated, which appears to be quite rare, it appears that the amount of virus that people shed is much lower. This is something that people are looking at very closely and very carefully, and our understanding is still evolving.
Marla Gold: If you've had COVID, you do get an antibody response. Originally, we thought maybe three months or so until you could be reinfected, but now it may be a little longer than that.
When the vaccines first came out, there was vaccine scarcity. So, in the beginning, we first said if you had natural COVID, you could wait three months before going to get vaccine. Now it's recommended that as soon as you come out of isolation, and you meet the CDC guidelines, you can be vaccinated. The response that you get from vaccination appears to last longer and it is better. The vaccine appears to have actually better coverage against variants originatingin other countries where the virus is under poor control and hence has time for genetic variants to appear.
On understanding and tracking vaccine side effects:
Marla Gold: There is something called VAERS, the Vaccine Adverse Event Reporting System, where reactions collectively are looked at in a database. If you look at VAERS, you will see countless things that have been reported, and scientists look and see what reactions would have happened anyway, unrelated to the vaccination. So, for example, if we are getting vaccinated during what is one of the worst pollen seasons, then we may relate allergies to vaccination. The job of the CDC and other scientists in interpreting the science here is to determine which reactions actually have to do with vaccine. So more recently, for example, when rare and severe blood clotting was connected to the J&J vaccine, maybe seven per million, the VAERS system picked up that it was related to vaccine. As soon as it looks like something's lighting up on the board epidemiologically when we study it, we hone down and figure out who it affects most. The J&J experience shows us that VAERS is working.
On mixing and matching vaccines, and receiving non-approved vaccine:
Marla Gold: This has particularly come up from our international students, so we're constantly looking at this information and updating it on our coronavirus website. We’re advised from our Scientific Advisory Group, as well as an outside expert on global vaccine, on how to advise folks that had access to other vaccines that may not be authorized or approved in the United States.
The mix and match phenomena is mostly still being studied. We strongly recommend that if you've had one Pfizer vaccine, that you get the second Pfizer vaccine; if you've had one Moderna, that you get the second Moderna.
An example of a question that we're beginning to get is about AstraZeneca, which is not authorized in the United States but is authorized in other countries. “If I've had an AZ shot one in my country, can I then come and get Pfizer or Moderna in the United States?” That question is currently under study in a large trial in the United Kingdom. One of the reasons it's purposely being looked at is not just because of vaccine scarcity or changes in countries, but because there's a thought that if we combine the vaccines that we have spoken about, the viral vector vaccine and the mRNA vaccine, that might produce a more broad and robust immune response so that we'll be stronger against different variants.
Understanding the Future of COVID-19 Vaccine
On whether a booster shot will be required:
John Rich: I think it's prudent for the pharmaceuticals to anticipate looking at these variants as they emerge to see if there is an opportunity to improve upon the vaccine and make some determination about whether we're seeing breakthrough cases. I don't think we've arrived at a conclusion about whether boosters will be needed. We only have a year under our belt to be able to measure that, and that's why the clinical trials will continue to go on and follow the people who were in that initial cohort.
On whether the COVID-19 vaccine will become an annual vaccine:
Esther Chernak: I do think COVID-19 is here to stay. I think it will likely not be as extreme as the first few years of its emergence on the planet have been. I think it will settle into a sort of a seasonal respiratory virus pattern. Hopefully, as immunity builds up in the population between natural immunity, but also aggressive vaccination, we'll see much less severe disease than we are seeing now.
There’s a very good chance, particularly since it's likely to become a seasonal respiratory virus, that we will see some kind of annual boost or biannual booster. It may depend on what we learn about the duration of immunity and how long the immune response lasts for and also the emergence of new variants. That's the story with influenza. We have new strains every year, so we scramble every year to come up with a vaccine that matches what's circulating. We'll have to see what happens with this novel coronavirus and whether how quickly we need to adjust our vaccination strategy based on what's circulating.
It's not uncommon for vaccines to have to roll out a booster a few years after they've been administered. For example, the chicken pox vaccine was initially a pediatric immunization given in childhood, and then we realized five or 10 years later that we were seeing breakthrough cases, so we needed to give a booster at age five to improve immunity. Same thing with measles.
On whether a booster or annual vaccine could be combined with the flu shot:
Esther Chernak: A lot's going to depend on the technology and what you can combine in an injection. The pharmaceutical companies that manufacture influenza vaccine are looking to see how these vaccines can be combined. Is there a way to sort of combine them all to minimize the number of shots? We see that in pediatric care all the time.
Understanding Vaccine Hesitancy and Ensuring Vaccine Access in the Community
On how Drexel is ensuring vaccine access for the broader communities and working with the local community:
Marla Gold: Drexel has two ways that it can distribute vaccine. It's mainly been working as a collaborative partner with a pharmacy: Sunray Pharmacy, which is community-based and very dedicated to areas of the city, particularly West Philadelphia. In addition to making vaccine available, it’s working collaboratively with us. A number of us — all of us that are here, student volunteers, vaccinators from the College of Nursing and Health Professions and the College of Medicine, people who do medical oversight — are working with them. We have a lot of experience standing up a vaccine clinic in Behrakis Hall, and we've administered over 7,000 or 8,000 vaccines.
Behrakis and the vaccination schedule is open to community members. Please know that through the Dornsife Center for Neighborhood Partnerships and what is known as the Promise Zone, which extends all throughout West Philadelphia and other areas, we are listed there. Neighbors are welcome to come, and they do. But in addition, there's a committee spearheaded by a group working with the Dornsife Center for taking the vaccine to the community and making it available.
We also have been in touch with the A.J. Drexel Autism Institute and we're working with their autism van to convert it and use it for a vaccination. And there's an initiative being looked at to make a clinic available for families with kids on the autism spectrum.
We are also a certified distribution center so that we can order vaccine and distribute it ourselves. Sunray is an incredible partner. We don't have a school of pharmacy. We don't have a lot of pharmacy staff here. Working collaboratively with Sunray has given us extra reach and that's been really great for us. We continue to make the vaccine available to our neighbors and more programs are coming to get ourselves into the neighborhood working with our various colleges, colleagues and student volunteers.
On acknowledging and addressing vaccine hesitancy in the community:
John Rich: The more that we can get input to learn about how to make sure that vaccine is not only accessible and how we can address the concerns of the community, the more success we'll have in making sure that people can get vaccinated. We don't want to overestimate or talk too much or use too broad strokes about vaccine reluctance for people of color. Many people of color were eager to get this vaccine because we were seeing people in our communities who were getting sick or dying or have seniors in our homes and our families who need to be protected. While there's been a lot of talk about reluctance, there's been also a lot of eagerness in community to get this vaccine.
We have to take seriously people's questions and concerns. Maybe it's good to be a little bit skeptical and cautious. We acknowledge that. And there are a lot of people who want to wait before getting the vaccine, because in the past there have been inequities and abuses where Black and brown and Latinx people have really gotten left behind or treated in a way that was damaging and inhumane. We have to hear that and listen to it and understand that. Having said that, for those who were waiting or might be, I think you've waited enough. I think that the evidence, the information we now have about the effectiveness of the vaccine, is apparent and across all populations.
It's also important to know that this process was overseen at every level by Black and brown and Latinx researchers and community members who watched the whole process go. That's different from the past. I have confidence in people like Valerie Montgomery Rice, MD, who's the president and dean of the Morehouse School of Medicine, and Sheryl Haron, MD, who's an emergency physician at Emory University. I've talked to folks who were involved in that process, and I have confidence that the process had equity involved.
Now, we haven't done as good a job at getting access in Philadelphia and other places for Black and brown people and Latinx people. We need to continue to do that. But we have to hear what people's concerns are, and we're not shaming people about this. We have to acknowledge those concerns as legitimate and at the same time bring facts about the process.
Understanding the State of Vaccination and Drexel’s Ongoing COVID-19 Response
On asking if someone is vaccinated:
Marla Gold: It's inappropriate to be asking that, even though I understand why people want to know. The risk is to the unvaccinated individual. The more vaccine that rolls out, the more of us that become immune because we are vaccinated — the risk shifts now to the unvaccinated person. We do not, in Drexel policy, ask if someone is vaccinated.
On what’s currently being done at Drexel:
Marla Gold: First, let me say we'll be communicating more of this to everyone. [University President John Fry] and I both signed a message that went out yesterday asking everyone for their patience as we look over occupancy standards in all spaces, event planning based on the latest science, what the CDC is doing and what the health department will tell us. But I will say this: in our buildings, at this time, you must still wear masks. Masks are mandatory in all Drexel buildings and continue to be so at the time, whereas particularly for vaccinated individuals, and in many cases unvaccinated individuals, masks outdoors are no longer necessary.
We've had thousands of students vaccinated right here on campus who chose vaccination. And I do want to say many of them are still in mandatory testing programs because we're beginning to wrap that up. One of the reasons we're wrapping it up is because for the first time in 14 months — now we're on our second week — we have many a day where hundreds of students undergo mandatory testing and there are zero cases. It was so startling when it began to happen two weeks ago that we double-checked multiple times! But we are seeing an incredibly low rate of infection among our students who are routinely tested, and that gives us a lot of information about the power and the freedom of these vaccinations.
Understanding the Vaccine for Expecting or New Mothers
Esther Chernak: I would encourage a woman who is pregnant to have a discussion with their obstetrical provider, because that's a highly personal decision. One of the most harmful rumors, I think, that I've been aware of in terms of misinformation in this pandemic and the use of vaccine has been the rumor that somehow the messenger RNA vaccines have some impact on fertility or child-bearing capacity, which I think is very dangerous.
What we do know is that pregnant women who develop COVID are at higher risk of having severe complications than non-pregnant women. In my view, a woman who is of childbearing age, certainly one who is considering getting pregnant, if at all possible, should want to get this vaccine before becoming pregnant to avoid the problem of developing COVID-19 during pregnancy. We know this is true with a lot of other respiratory viral infections, much more severe in the context of pregnancy. It does appear based on the most recent data, which is a relatively small study, that at least the Pfizer vaccine appears to be safe when administered in pregnancy.
To my knowledge, there is no data that suggests that these vaccines are linked to infertility or fertility challenges or to birth defects. That's why these early studies or these studies of vaccines in the context of pregnancy and in this important age group are so critical. So far, to my knowledge, the data does not bear that there's any link at all. These vaccines do not enter ovarian follicles; there's no biological plausibility for this.
Marla Gold: In terms of pregnancy and the data that is available, while all of it suggests safety in women who are pregnant or breastfeeding, we nonetheless would consider pregnancy or breastfeeding to be a medical exemption for our students.