James Trice of Concord is retired physician ABIM certified in Rheumatology and Internal Medicine.
To be or not to be (vaccinated) that is the question, with apologies to William Shakespeare whom I hold in the highest esteem.
Dr. Edward Jenner, a British physician, is credited with being the originator of vaccines. Jenner theorized that material from milkmaids infected with cowpox sores (a cross-species infection that would require an essay unto itself), could be protective against smallpox. Cowpox is a member of the orthopox family of viruses which includes horse pox, monkeypox, and variola which causes smallpox.
He took material from a milkmaids cowpox sore and infected 8-year-old James Phipps. The young man developed a local reaction and felt poorly for a few days and then recovered completely. Two months later he inoculated Phipps with material from a fresh smallpox sore in an attempt to challenge the cowpox protection. Phipps remained healthy. This protection was confirmed in subsequent subjects and voila, vaccines are born.
Since that time vaccines have been developed against a wide variety of infections both bacterial and viral. Diseases that have been eradicated or markedly reduced include smallpox, polio, tetanus, diphtheria, pertussis (whooping cough), measles, mumps and rubella, hepatitis subtypes A&B, varicella (chicken pox), pneumococci (a common type of bacterial infection that can cause severe pneumonia), shingles, haemophilus influenza B, papilloma (HPV) virus and COVID-19.
Vaccines are prepared using a portion of the infectious agent, generally a protein, to stimulate an immune response (Immunization Advisory Center). Sometimes these proteins (termed antigens) are complexed with an adjuvant (a carrier substance) to enhance the immune response. The immune response can be primarily the formation of antibodies (immune-derived proteins) directed against the specific antigen, the priming of specific immune cells, or a combination of both.
Vaccines can be broadly classified by how their antigens are prepared. They may be produced using live or attenuated (weakened) viruses, subunit proteins or polysaccharides (long sugar chains), viral vectors, or DNA or RNA.
Here are examples of each:
Live attenuated viral vaccines: measles, mumps rubella, varicella and rotavirus. (Varicella vaccine is required in all 50 states to attend public school).
Inactivated or whole killed-influenza, hepatitis A, and polio viruses and the bacteria that cause pertussis.
Subunit: diphtheria, tetanus: polysaccharide/protein: pneumococcal and Haemophilus influenza B.
Recombinant which contains genetic material of disease-causing germ viruses of Hepatitis B and HPV.
Nucleic acid MRNA (messenger RNA) delivers a portion of the genetic code of infectious agents to make specific viral proteins (antigens) COVID-19 (Pfizer and Moderna) and viral vector which uses viral MRNA delivered by a harmless virus to stimulate immune response. This is how the AstraZeneca COVID-19 vaccine is formulated.
Severe vaccine-related side effects can occur but are rare, generally less than 10/million doses (.00001%).
The commonwealth fund started by philanthropist Anna Harkness in 1918 was developed to better the welfare of mankind. The Harkness family from 1918 to 1959 contributed $99 million (approximately $852 million in today’s dollars) to this fund which has focused on eliminating disparities in healthcare globally.
A very recent report from this fund (found on their website) regarding the benefit of COVID-19 vaccines administered is remarkable. Since the first vaccines were given in the U.S., the program has prevented more than 3 million deaths and 18 million hospitalizations saving more than $1 trillion in medical costs.
It’s puzzling and discouraging that in 2022 (data courtesy of the CDC) that of U.S. citizens 65 years and older (a high risk group) only 36% have received the updated COVID-19 vaccine and a mere 15% have gotten the flu vaccine.
Getting vaccinated will reduce the spread of disease to loved ones, build herd immunity to help limit disease from spreading in a community and help protect those who can’t be vaccinated like newborns or those with chronic illnesses.
As we head into the new year, give the gift that keeps on giving, the best gift of all — get vaccinated.