Vaccine Diaries is a series of dispatches exploring the rollout of COVID-19 immunizations.
I got my Pfizer COVID-19 vaccine on Dec. 18—a date I think I’ll remember forever—at a clinic with rooms full of balloons. When I got home, I opened a bottle of Champagne. But perhaps a Negroni would have been a more appropriate celebratory drink. The occasion is historic but also bittersweet.
The day I was vaccinated, America saw a record high of hospitalizations, with deaths continuing to climb. The numbers in our communities will not fall because health care workers like me are getting vaccinated, since we are not a significant source of spread. It will be months before the general public has access to doses. Even then, a complete rollout of the vaccine in wealthy countries will not mean the end of the pandemic: the logistics of vaccinating the entire planet seems like an impossible task. (The Biden administration has not yet said if it will join COVAX, the alliance whose goal it is to provide vaccine to the developing world.)
Vaccine hesitancy could mean that even people who do have access to the vaccine will, when their turn comes, choose not to be vaccinated. There is rampant mistrust of a system that has—even if unintentionally—misled the public during this pandemic. (Do masks really work? Is the virus airborne? Is it spread by surface contact? Too often the answer was, “We aren’t sure, so we can’t tell you what to do.”) The public health response has failed minority groups, whose historic mistrust of health care is not exactly misplaced.
For now, America is still facing the dauting task of vaccinating everyone who is on the front lines. While every patient-facing health care worker is qualified to get a vaccine right now, there are not yet enough doses for all of us. Since each state and each hospital were left to figure out distribution on their own, inconsistencies in prioritization have led to chagrined health care workers and the possibility of people falling through the cracks. As an ER doctor, I got the vaccine this week—I have my spot rightfully, but also I’m lucky to work for a hospital system that has prioritized my place in line. For others, the nuances of who could be considered high risk are applied inconsistently. In my own home, my husband, a hand surgeon who performs emergency surgeries on trauma patients—some of whom might well have COVID—doesn’t yet know exactly when he’ll get a vaccine. Some of the EMTs and paramedics I work with are still waiting to hear from the department of health about when they’ll get their first doses.
Having the vaccine will not immediately change anything I, or any of my vaccinated coworkers, do. We will continue to wear PPE at work. The Pfizer study only looked at how well the vaccine prevents disease, not how well it prevents infection—that is, it’s possible that one can have the vaccine, still get infected, and spread the virus. We hope this is not true, but we don’t yet know for sure. There is a suggestion in the Moderna data that rates of asymptomatic infection will be lower in those vaccinated. Given the uncertainty, I will not be hosting unmasked dinners in my home, visiting my parents, or hugging my friends until we know more.
And yet, for a beleaguered medical workforce, the vaccine really is the cliched light at the end of the tunnel. As my friend and fellow emergency physician Andrew Matuskowitz described it to CNN: “I felt so overcome with this almost ecstasy about this idea of there is actually an end in sight.” To be sure, the tunnel is one from a horror movie, to paraphrase Lauren Mazzurco, a geriatric physician and friend of mine. The tunnel is long, narrow, with a low ceiling; it is populated by hordes of grasping zombies. But, as we claw our way through, I will feel more confident that I won’t get sick from COVID or die from it. That means a lot.
The simple fact of being one of the first to be vaccinated for a new disease feels special. It’s important to note, even with the caveats, the COVID-19 vaccines—plural!—are a historic scientific achievement. In under a year we’ve gone from discovery of a new infectious agent and sequencing of its genome to the development and testing of a successful vaccine. That’s unprecedented. Some of the first vaccines were for smallpox and rabies—diseases that have plagued humans throughout recorded history. Vaccines for relatively new diseases have either taken decades to develop (as is the case with Ebola) or evaded scientists entirely (HIV/AIDS). There’s reason to think that we’re entering an era of fast vaccines: the mRNA technology used by Pfizer and Moderna is new, hugely scaleable, and holds promise for a quick response to other infectious disease threats in the future. (Which we certainly will have to contend with: The poor stewardship of the planet that may well have given us COVID-19 is showing no signs of stopping.)
We have not one but two vaccines that are effective even beyond our highest hopes. When the Food and Drug Administration said they’d approve a vaccine that was at least 60 percent effective, I hoped that one would at least make it to that, but both Pfizer and Moderna have data that shows their vaccines to be 95 percent effective at preventing disease in clinical trials. The safety data from the Pfizer trial , with more than 40,000 participants, is very reassuring: Vaccine reactions were rare and mostly involved headache, fatigue, and fever—all signs that one’s body is reacting to the vaccine and mounting an immune response. There weren’t any truly weird side effects linked to the vaccine. Moderna’s full-length paper has not been published yet but will likely look very similar, given the FDA panel’s recommendation to approve it. The much reported Bell’s palsy in both vaccine trial groups is lower than the incidence in the general population. And anyway, I’d take my chances with a reversible facial paralysis over a disease that might put me on a ventilator. A few anaphylaxis-like reactions are being reported, but are very rare, easily treated, and not unheard of with other vaccines. One of the reasons vaccines in general are so safe is because of the ongoing monitoring of even rare, manageable side effects. Since getting the vaccine, I get regular texts from the Centers for Disease Control and Prevention’s automated checkin system asking me how I feel.
I am over 36 hours out from my vaccination as I write this, and beyond some mild fatigue, I feel very much my normal self—albeit more positive than I have felt in a long time. What the vaccine has given me is renewed faith in the potential of science to help save us. America has failed at every aspect of controlling the coronavirus. Finally, there is a way out of the pandemic I can believe in.
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