Wednesday, July 21, 2021

"I finally capitulated and got my first vaccination."

Delta means change. 


Events are changing ideas and behavior on vaccinations.



Political comment has focused on a shift in the message coming from the political right. The Republicans message had been that the vaccine was useless or risky, and not worth the risk--especially since Democrats were encouraging people get vaccinated. Events intervened to change the story. The delta variant, combined with realization that COVID hospitalizations and deaths were concentrated among the un-vaccinated in red parts of red states, made vaccine opposition seem foolish and self-destructive. 

Republican House Whip Steve Scalise just got vaccinated. Now he calls the COVID vaccine "safe and effective." Fox and Friends' Steve Doocy says to "get vaccinated." Fox's Sean Hannity now says a vaccination "absolutely makes sense."  Click: The Atlantic

There is evolution on what I consider the vaccine-skeptical left.  Some people are skeptical about high tech "Western medicine." They observe a medical industry, and are concerned with how financial incentives have shaped it.

Today's Guest Post is by Michael Shear, a college classmate, a physician, a resident of Cambridge, Massachusetts. He was a pioneer in Emergency Room specialization. He has practiced medicine in Massachusetts and Nepal, and is currently working for the Harvard Health Services. He just now got vaccinated and he shared with me his perspective on why he waited.

Photo from Michael Shear, center, with two colleagues.




Guest Post by Michael Shear, M.D.


I finally capitulated and got my first (Pfizer) vaccination last week. Harvard now requires it of all students and employees (I continue to work part-time at the Harvard University Health Services). I’m not happy about that. I don’t think an injection of a biologic agent that still only has an Emergency Use Authorization should be mandatory. The other reason I’ve capitulated is because the writing is on the wall: if you want to travel internationally any time in the near future, you’ll have to be vaccinated. But I’ll still be careful where I go and what I do, and have a low threshold for wearing a mask.

Of course I would be amazed if it doesn’t eventually get formal FDA approval, because the situation is so politicized that it would be unthinkable for it not to be approved. But as far as I’m concerned, we’re playing with fire.

I don’t have time to go into details (and the details are important). I would only say that the “science” is much more complicated than the public discussion would have you imagine.

If I felt at great risk of dying from COVID I would get vaccinated. 
As for the personal risks of COVID, I feel reasonably protected by my own behavior. The incremental benefit to me personally of vaccination I think will be small. Otherwise, I would wait. Either way, I would avoid high risk situations (prolonged exposure in small crowded spaces with strangers or anyone likely to be sick with a respiratory illness).

We aren’t going to vaccinate our way out of this. We will never attain herd immunity. It’s not possible with a highly contagious moving target, especially when you can’t get buy-in from nearly everyone (and why should you expect to when the vaccine technology has not been sufficiently vetted?). Science is undermining its own credibility with its careless messaging.

I am not an anti-vaxxer. But I know what good science is, and what isn’t. Most medical science isn’t. There is too much money and wishful thinking involved. We could do the studies that would give us the information we need, but they aren’t being done because people are impatient and most stakeholders don’t really want to know.

We still don’t really know how well vaccination prevents spread, so it’s hard to tell younger people that they have to get vaccinated, especially since they may incur a disproportion of the adverse effects (like the young women with cerebral vein thrombosis). If you come across studies that address explicitly the prevention of spread, please let me know. I just saw a preliminary report (from Qatar) in last week’s JAMA--the Journal of the American Medical Association--that suggested vaccination might be helpful, but we need more clean data without spin.

COVID could mysteriously disappear. I think it’s more likely that it will be with us for a long time, like influenza. We haven’t had much impact on influenza by vaccination. We’ve just learned to accept tens of thousands of annual deaths in the US as “normal”. We could adjust our cultural behavior to ameliorate that, but we haven’t, and from all indications, we probably won’t. I suspect it will be much the same with COVID.

The delta variant is raising many questions. And we here in HUHS are seeing more cases of COVID in vaccinated patients, though the University is keeping as quiet about it as possible and not letting us test for variants. There was an outbreak last week in Provincetown. Also an outbreak on the Yankees, all vaccinated.


9 comments:

Dave said...

The people who are getting sick are not vaccinated. As that has become more and more obvious, even Fox News has to backup from their lies. They were shooting themselves in their own foot. They could stay mad and keep shooting their own feet, but at some point they could see, maybe that isn’t a good position to take. Reality has a way of eventually winning. Remember when it was suggested smoking wasn’t bad for you? “My grandmother smoked every day of her 90 year old life.” Well you can not get vaccinated if you want. Good luck with that.

Rick Millward said...

Emergency Use Authorization implies that there is an emergency.

While the influenza has not been completely eradicated by vaccination, polio, smallpox, hep, and measles have. Perhaps with more universal vaccination we could be rid of the flu as well. Maybe the COVID experience will spark such an initiative.

Wouldn't that be cool?



Anonymous said...

The novel vaccine formulation using mRNA technology to stimulate the body’s own immune response to the virus is one of the most important medical advances in the last 50 years in the treatment of an infectious agent like SARS-CoV-2. The future application of this treatment technique is extremely promising. And I understand the reticence of your doctor classmate to be a lifetime of thinking and training in the standard drug therapies and testing trials before approval and use. We simply need to rethink our old ways and practices regarding vaccinations at this point.

Michael Trigoboff said...

I got the vaccine as soon as it was available to me. But I understood that the risks of the vaccine (especially the long-term risks) were quite unknown given the emergency authorization procedures. Despite what various advocates want us all to believe, the actual science on the vaccines is not close to being “settled.“

This is similar to the situation with climate change. It is obvious that putting more CO2 into the atmosphere will cause more heat to be retained. But we do not know how much temperature rise this is likely to cause. All we have to go on with regard to predictions of temperature rise is a set of computer climate models of significantly unknown accuracy.

Over the course of the 20th century, CO2 in the atmosphere rose steadily. Temperatures rose until the 1940s. Then they dropped significantly until the 1970s. Then they rose again. Things are more complicated than a simple, naïve understanding can explain. This is as true of vaccines and immunity as it is of issues related to the climate.

I totally agree with the author of this guest essay. Science is a great method of arriving at the truth. We should all follow the dictates of science. “The science,“ as quoted by advocates, is a rhetorical bludgeon that has very little to do with real science.

Malcolm said...

Geez, Peter, I really don’t understand why you published something so Trump-worthy!

First if all, it’s not all about how safe he feels he is. Surely, as a medical type, he must know that, if he gets covid, he'll likely spread it to others, who will spread it to untold numbers of others. Plain as the nose on his face.

Second, ALL the data I've seen says that those few people who get covid AFTER getting vaccinated get mild cases. The data also say that virtually all states experiencing huge jumps in covid cases happen to be the state’s that have the lowest numbers of people who are vaccinated.

So many other misrepresentations that I don’t have time or energy to list them all!

Malcolm said...

Geez, Peter, I really don’t understand why you published something so Trump-worthy!

First if all, it’s not all about how safe he feels he is. Surely, as a medical type, he must know that, if he gets covid, he'll likely spread it to others, who will spread it to untold numbers of others. Plain as the nose on his face.

Second, ALL the data I've seen says that those few people who get covid AFTER getting vaccinated get mild cases. The data also say that virtually all states experiencing huge jumps in covid cases happen to be the state’s that have the lowest numbers of people who are vaccinated.

So many other misrepresentations that I don’t have time or energy to list them all!

I did check the facts on the Yankees: “Yankees manager Aaron Boone said that some of the players were experiencing symptoms, but there was nothing severe. The symptoms some players are feeling are like they have a cold or just generally don't feel well.

Looks like MAYBE the vaccinations saved the day, right?

Ralph Bowman said...

Will a seat belt prevent you from burning up in a nasty car crash? No, but maybe it will save you from going through the wind shield. Buckle up. Get vaccinated.

Sally said...

“I am not an anti-vaxxer …. But”

Is generally a Big Red Flag toward rubbish..

It is true these vaccines are not “sterilizing” — I.e., they’ve reduce but don’t prevent spread. Therefore, it is also true that they won’t provide a pathway to “herd immunity.”

Most of the rest of the claims and insinuations here are not in line with the vast majority of medical thinking. No question that Delta has raised the stakes, and that most cases and deaths are among the unvaccinated.

David Landis said...

The recent positive tests by 6 already vaccinated Democratic Texas state legislators in Washington should tell us something that we're not hearing from the medical community.

Just because you're vaccinated does not mean you are immune. It means that the likelihood of serious symptoms should you be infected is drastically reduced. That's a good thing IF you continue to wear a mask!

However, what is occurring is that the vaccinated are tossing their masks aside leaving themselves open to potentially asymptomatic infection. Those people are fully contagious. Large gatherings are occurring again with most attending not masked up.

Steady yourselves because "winter is coming".