--:-- Sean Rameswaram: Support for Today Explained comes from the FIFA World Cup, of all things. The FIFA World Cup 26 is coming to North America next summer. It is the ultimate celebration of sports and culture. You can get closer to the beautiful game with a hospitality package, closer to the action, the best seats, the best suites, closer to match day and that world-class food and that world-class entertainment, closer to the experience of a lifetime. Book a hospitality package at fifaworldcup.com slash hospitality. Terms and more at AppleCard.com.
--:-- Sean Rameswaram: We're going to bring you that conversation next week in a series we're calling You, Me, and COVID-19. We'll be digging into how our pandemic year has changed just about everything. Stay tuned for that. After my conversation with Dr. Fauci today, I spoke with Vox science reporter Umair Irfan about the vaccine. He helped answer a whole host of questions our listeners and Vox community sent in. And since the vaccine has now arrived in the United States, we thought we'd bring you that Q&A with Umair today.
--:-- Sean Rameswaram: So here it is. So let's just start at the start. How is this vaccine different from all those that have come before it? I mean, the one thing to highlight is the unprecedented speed at which we have developed this. I mean, vaccine development is something that typically takes decades. The fastest vaccine ever developed was the mumps vaccine. That took four years. This was a disease we only discovered last year around this time. And now about a year later, we already have a vaccine that's starting to be distributed. So this is something that's unprecedented in terms of science.
--:-- Sean Rameswaram: And the other big thing to highlight is that this is also using a completely new technology. Both the Pfizer BioNTech vaccine and the Moderna vaccines are using an approach, the mRNA-based genetic material. This is something that we've never tried on large scales in humans before. How does that work? Get us into the nitty gritty.
--:-- Umair Irfan: Sure. So if you imagine this is something like a virus or a coronavirus. I didn't know we had props. Oh, yeah. Visual aids. We're doing this on Zoom. Of course, we're going to use some visual aids. So the old fashioned way of doing virus or vaccines was you would take the virus, weaken it, kill it, or snip off a piece of it and inject it into the body. And then your immune system would read that and then develop a response. They would use it as sort of a punching bag to essentially prepare for when the virus actually invades.
--:-- Umair Irfan: What these new generation of vaccines are doing is you don't need the virus at all. In fact, all you do is you start with the genetic material that is the information used to code for how to make the virus. And you don't even need to know how to make the whole virus. You only need to know how to make a piece of it, like the spike proteins. And so with the coronavirus, the spike proteins are really important because that's what they use to break into cells. They're kind of like lockpicks.
--:-- Umair Irfan: And so what a company like Moderna and Pfizer have done is they took the instructions in RNA and they basically inject those into the human body, into muscles. And then your own cells will read those instructions and then manufacture their own copies of those specific spike proteins. And then your immune system will use that as target practice. And so this is, again, something that we've never done before, but it's extremely fast.
--:-- Umair Irfan: The first mRNA vaccines were developed within days of the genetic sequence of the coronavirus being released publicly. And then within two months, they were tested in the first humans.
--:-- Sean Rameswaram: One of the most common questions we got, though, it was around getting the vaccine. So could you break down who qualifies for a vaccine and when people might actually be able to get it?
--:-- Umair Irfan: Well, let's start backwards and work towards where we are now. So ultimately, we want everybody to be vaccinated against this as much as possible because this is a disease that can infect just about everybody. So that's the ultimate goalpost, trying to get as close to saturation. But of course, we can't do that right away.
--:-- Umair Irfan: And so the Centers for Disease Control, they convened an advisory committee and they looked at where would these vaccines be most effective. And what they looked at were not just in terms of preventing deaths, but also in terms of preventing spread. So basically people who are most likely to spread the virus to other people, if we can inoculate them, we can control transmission.
--:-- Umair Irfan: And so they found out that those are people are likely going to be health workers. So the first priority on the list are logically going to be health workers, but also people who live in long-term care facilities, older adults, and particularly the people that work around them. And so the idea is that these people can act as sort of fire breaks against this inferno of a pandemic.
--:-- Umair Irfan: The problem, though, is when you add up those people just in those high-risk groups, that's 24 million people, and we're not going to have 24 million doses right away. I mean, the Operation Warp Speed estimates that we'll have just about 20 million Americans inoculated by the end of December, and that's if everything goes perfectly well, which means that there will still be some people that will have to wait.
--:-- Sean Rameswaram: Do we know what kind of health screenings will be involved before you go get it? Or is it kind of like getting a test where you mostly just show up?
--:-- Umair Irfan: Well, there are some precautions that they want to take. With the rollout of this Pfizer-BioNTech vaccine in the UK, we saw a couple of people who had some pretty severe allergic reactions. These were two health workers, and they knew they actually had a history of severe allergic reactions. They carried EpiPens with them, and they knew that this was a potential risk.
--:-- Umair Irfan: And so the advice now is basically if you are somebody who has the potential for getting severe allergic reactions, you have to use an EpiPen. You probably should hold off on getting these vaccines for a while. And there are other high-risk groups as well that may have the option of not getting the vaccine, basically people who have certain immunological conditions, also pregnant women.
--:-- Sean Rameswaram: Can you get COVID-19 between doses?
--:-- Umair Irfan: Yeah. So as you noted, these are two-dose vaccines, both the Moderna vaccine and the Pfizer-BioNTech vaccine. And both of them are administered about several weeks apart. Last week, before Pfizer and BioNTech received their emergency use authorization from the FDA, they released some of their data showing their trial pool.
--:-- Umair Irfan: And they showed that they had about 160-some people who got infected with COVID in their placebo group and about nine people that got infected in the group that got the vaccine But if you look at when they got infected most of those nine people were infected just a few days after they received the first dose of the vaccine So between the first and second dose Building up an immune response is something that can take several days up to a couple of weeks.
--:-- Sean Rameswaram: You mentioned that most of the people got it between the two shots. Did people get it after the second shot?
--:-- Umair Irfan: Yeah, there were a couple of people that I think were reported to have received the vaccine to have come down with COVID-19 with the illness after getting the second dose. Those will have to be investigated further.
--:-- Sean Rameswaram: But that's why we don't say this vaccine is 100% effective. 95% effective is still very high, but it also does mean that not every single person who gets the vaccine is ultimately going to have protection, which means we still have to take some precautions even after getting vaccinated.
--:-- Sean Rameswaram: You mentioned that some things here still need to be investigated. We've had a lot of questions just about safety. How do we know what this thing might do to us in a year, in five years, because this thing hasn't been around for a year? What what do we know about long-term health effects of this vaccine?
--:-- Umair Irfan: Well, we're still learning about them. I mean, generally we would expect most complications with vaccines to happen shortly after you get the vaccine, right? Even though we're only getting the results of the phase three clinical trials in the past few weeks, you know, we've had phase one and phase two trial results for several months.
--:-- Umair Irfan: And so we know for the most part that most people don't really have a severe reaction to this. I mean, the main side effects you get after getting the vaccine are going to be muscle pain, weakness, some redness and soreness, and a mild fever. But we don't really have good long-term safety data just simply for the fact that this virus and this vaccine has not been around very long.
--:-- Sean Rameswaram: We also got a lot of questions about mutation. What happens if this coronavirus mutates? Do we have to start all over with the vaccine? What do we know about that at this point?
--:-- Umair Irfan: Well, it's important to note that mutations are happening all the time. This is a virus and viruses tend to change a lot, right? We can actually trace the lineages of where specific strains of this COVID-19 virus came from by looking at how they mutated over time.
--:-- Umair Irfan: Like we can see distinctly that in the United States, we saw infections come on the West Coast and from a separate strain on the East Coast. And we were able to trace basically where that virus came from that way. Now, in terms of the parts of the virus that we're concerned about, you know, the spike proteins, right? Those are the parts that the virus actually has to use to break into cells.
--:-- Sean Rameswaram: Amir, someone wants to know if you've had the virus before and already have antibodies, should you still get the vaccine?
--:-- Umair Irfan: So the recommendations right now are likely going to be that you still get the vaccine. The reason is that while being naturally infected with the virus gives you some degree of immunity and protection, it's not necessarily targeted. The vaccines are optimized specifically to neutralize the virus and its infection and how it causes disease.
--:-- Sean Rameswaram: Someone wants to know, because they heard you can still spread the virus after you have the vaccine, how does that work?
--:-- Umair Irfan: Well, generally, like what we've seen with the coronavirus in general is that most people don't get seriously ill. And there's a number of people that can have the virus and spread it without showing any symptoms at all.
--:-- Sean Rameswaram: Dr. Fauci noted that these two vaccines are pretty similar, the Pfizer and the Moderna. Someone wants to know if we'll get to choose which ones we get.
--:-- Umair Irfan: I mean, I don't think we'll have the luxury of choice anytime soon. I mean, we're going to have to probably go get the vaccine that's most easily available to us. Right now, the Pfizer vaccine is the one that's already started rolling out, but it also has some pretty stringent cold storage requirements, which means that a large medical facilities that have these ultra cold freezers are likely going to be the ones to get it because they can actually store it on site and administer it to people.
--:-- Sean Rameswaram: Let's talk about kids for a second. Are kids meant to get this vaccine? Do they need to? Is it safe for them to get it?
--:-- Umair Irfan: That's really hard to say because children were explicitly excluded from these clinical trials. In fact that was one of the big sources of contention during the meeting last week with the advisors to the Food and Drug Administration They were looking at trial data and they said that the youngest people in the trial were 16 years old, and there weren't that many of them.
--:-- Sean Rameswaram: Is this going to be something like the flu shot where we need to get something every year? Is there a potential for that to happen?
--:-- Umair Irfan: It depends on how fast, as you noted earlier, about how fast the virus mutates. And what we've seen so far is that it tends to be pretty stable in the parts of the virus that we're most concerned about. And so what that likely means is that protection will last for a few years. Our experiences with SARS and MERS show that protection against those viruses also lasts for a few years.
--:-- Sean Rameswaram: We know if companies and airlines and, who knows, theme parks, music venues are going to have some sort of, you know, vaccination ID to let people, you know, use their businesses to enter their venues, to enter their airlines? Is it going to be some situation where vaccinated people might be able to do stuff that the rest of us can't?
--:-- Umair Irfan: I mean, that's very likely something that we'll have to deal with in the coming year because if you looked at what Operation Warp Speed's goals are, they estimate that they'll get about 100 million Americans vaccinated by the end of February, and that's only one-third of the population.
--:-- Sean Rameswaram: People in the Q&A box and also in some questions we got before the event seem to be hesitant about trusting a country that has not done the best job with the virus, with the vaccine. For the people out there who are wondering, do I really want to go for this and get this shot when everything else has been handled so poorly? Do they have a point there? What would you say to them?
--:-- Umair Irfan: Yeah. I mean, trust is going to be a big part of this, right? Like I said earlier, like, you know, the government isn't necessarily going to force people to get this. People are going to have to want to get this vaccine. Vaccine hesitancy is declining. People are more and more inclined to get this.
--:-- Sean Rameswaram: There a lot of news of course about you know the first vaccines being given out in the UK Of course now they in the United States Canada's buying up a whole lot. Is there going to be some sort of, you know, vaccine inequity where the richest countries get a whole lot of shots first and everyone else is in the back of the line?
--:-- Umair Irfan: Unfortunately, it is starting to look that way. The first countries to approve the Pfizer-BioNTech vaccine, the United Kingdom, Canada, and the United States are very wealthy countries. And other countries that have already started distributing their own homemade vaccines, Russia and China, they're very likely going to be going to the countries first that can pay for it.
--:-- Sean Rameswaram: I want to talk to you a bit before we go about international crop cooperation on this virus and on the vaccine. Did we see about as much as we'd expect cooperation between nations? Did we see less than ideal levels of cooperation here? I know there's a Russian vaccine now and a Chinese vaccine and an American vaccine and there was a vaccine in Oxford. Are these things in competition with each other? Or is this sort of the sort of inspiring international effort that we hope to see in a moment like this?
--:-- Umair Irfan: I think there are two elements to that. On the research front, this has absolutely been unprecedented and completely inspiring, something that scientists have never seen before. Basically, they took down barriers between research groups. Scientists can be pretty competitive. They want to be the first to advance something. And yet, we saw scientists all over the world sharing their data, publishing their findings.
--:-- Sean Rameswaram: Historically on our show, Umair, you've joined us to talk about the environment, but this year, it seemed like your role sort of, you know, you pivoted to vaccine, to virology. What did you learn covering this coronavirus this year? What were your biggest takeaways from this year?
--:-- Umair Irfan: I learned a great deal about the science. I mean, I studied biology back in college, but that's been years out of date. And so I had to kind of brush up and retake classes online and going to webinars and trying to figure out.
--:-- Sean Rameswaram: Umair Irfan is a science reporter at Vox. You can find all his work at vox.com. Again, this was the second half of our live show today. The first was a conversation with Dr. Fauci, and we'll be bringing you that conversation next week in our series You, Me, and COVID-19. This is Today Explained. Bye.
