The Great Vaccine Debate Part 1

Preventing Transmission vs Sickness and Death

Vaccine mandates have become one of the most controversial topics during the COVID pandemic and the science behind vaccines has become lost in the political ruckus. The rapid rollout of SARSCov2 vaccines, especially the successful use of mRNA technology to do so, is nothing short of a scientific masterpiece*, but that is not an argument for forcing them on the population at-large. It goes without question that the availability of vaccines has been a lifesaver for many individuals because there are clearly demographics in which the risk of serious complication and death from a COVID-19 infection is much higher than the risk of adverse events from the vaccine. Clearly defining these groups, and encouraging vaccinations for those individuals, would be good public health policy*.  However, for those who do not fall into a high-risk category with respect to COVID-19, the risk to benefit ratio becomes much harder to define and it is irresponsible to overstate the benefits and downplay the risks in order to achieve a more streamlined public policy. While there may be individuals that benefit financially from mandatory vaccines, I would argue that greed is less of a motivator in this public health-pharma partnership of authoritarianism than self-importance. People who imagine themselves godlike often have good intentions, but of course we all know what road those can pave. I will do a multi-part series on different aspects of the vaccine debate with a dissection of studies; today’s essay is an editorial overview of the topic.

Vaccines were invented to prevent people from becoming sick and dying of infectious diseases. By virtue of preventing people from getting sick, a second benefit of reducing the spread of disease became apparent, with the icing on the cake being the eradication of some diseases that plagued society in past centuries. While most people get vaccines to avoid disease (thus, the ready compliance with early vaccinations for childhood diseases that involve a rash covering one’s body), public health officials have long sought a loftier goal with their vaccination programs-the eradication of disease-causing viruses.  They have pursued this goal tirelessly, even though it is not always an achievable one. This mindset has seeped into the mainstream, and the message has been convoluted along the way, so that people now hold the irrational belief that the main goal of a vaccine is not to prevent YOU from getting infected, but rather to prevent YOU from infecting someone else-something that can only happen if you do not become infected. If the vaccine efficacy wanes, so does its ability to prevent transmission.

 For some reason, the public health officials have been separating infection, illness and death, and transmission as if they are three distinct actions of a vaccine. They are separate endpoints one can assess, but they are all physiologically interconnected. If the vaccine is working to prevent you from becoming infected, you are both protected and unlikely to transmit the virus. If the vaccine stops protecting you from becoming infected, you are now able to transmit the virus. See how that works? The endpoints of sickness, transmission and death are ALL dependent upon becoming infected. The only argument for believing the unvaccinated are somehow increasing the risk for the vaccinated is if you believe that the virus could be eradicated and that, by remaining unvaccinated, people serve as a reservoir for the virus, such that when the vaccine efficacy wanes it is still there to infect people who were “kind enough” to get their shot. That eradication of a virus is difficult when there is an available reservoir (human or animal) to infect is supported by the existing paradigms in virology, but there is scant evidence for the first part of that hypothesis-i.e., that a respiratory virus of the influenza or coronavirus families can be eradicated. Even if we could keep birds, pigs, bats, and pangolins from serving as reservoirs, it is difficult to eradicate a virus that is mild in most people (e.g., the common cold). Given that viruses tend to become less lethal as they become endemic, one could argue the unvaccinated are doing a public service by serving as the reservoir in which this ineradicable virus can become more innocuous. (I know there are now a host of articles attempting to argue by exception the validity of virus becoming less lethal as it becomes endemic, and I will discuss those in a separate article. It remains the predominant tendency of endemic viruses.) Folded into this irrational argument of the unvaccinated being a threat to the vaccinated is a probability equation. If the vaccine prevents infection, the probability that you will encounter an infected person is lower if everyone is vaccinated. But if the vaccine prevents infection, it doesn’t matter if the person you encounter is infected. You need to work in the declining efficacy and the frequency of boosters into that probability equation. How many mandatory boosters a year, and for how long, are needed for any lasting efficacy?  The bottom line is that it is unethical to force a medical treatment with waning efficacy on people based on an unsupported hypothesis. There is no question that the vaccines “work” to the extent that they are lifesaving for some people, but they simply are not necessary for everyone.

There are nuances within this basic explanation of how vaccines work that are less obvious. If the vaccine results in the production of neutralizing antibodies that prevent the virus from entering cells, a person will have a greatly reduced chance of becoming infected, which means they have a reduced chance of transmitting the virus and of becoming very sick. However, if the vaccine primarily results in production of antibodies that recognize infected cells and suppress the infection before it becomes full blown, you have a reduced chance of becoming very sick, but you may still have a mild infection and transmit it the same way any other mild infection is transmitted. In either scenario, the vaccine is protecting you from the ill-effects of the virus and it is your choice to decide you prefer to have this protection regardless of any possible side effects. The little semantics trick that the public health establishment keeps pulling with respect to these immunologic responses, is implying that transmission is somehow separable from infection. ‘Oops, our bad, when we said the vaccine prevents transmission, we meant it prevents you from getting really sick.’  Once again- infection leads to both sickness and transmission. It’s the ability to prevent infection that allows a vaccine to prevent transmission. I will post another essay, in which I delve into the basic science underlying these differences and how different types of vaccines and natural immunity may favor one over the other response.

Footnote:

*I am updating these asterisked points with a comment in response to a direct message I received about those statements. I incensed someone with these two sentences because she thought I was one of the narrative-spewers, masquerading as someone trying to offer an alternative interpretation, trying to insidiously push the vaccine. I am not, but I understand the reaction because I have it sometimes, too. First, my reference to the mRNA vaccine as a “scientific masterpiece” comes from my perspective as someone who has spent decades at the bench trying to get difficult experiments to work. Getting mRNA to be taken up by cells in a human body and express a protein and then trigger an immune response is just hard to do. It’s impressive to get it to work. That’s all. That doesn’t mean I think it being a “masterpiece” makes it safer. There are things that, as a scientist, are just cool. Tagging proteins with green fluorescent protein so that cells glow green everywhere it is expressed is cool, too. That doesn’t mean we should inject people with GFP-tagged mRNA so we can fluoresce. It’s really hard to transfect mRNA into cells, much less into people. It is a scientific feat.

As for encouraging those who are vulnerable to take the vaccine, I personally would be irritated by anyone encouraging me to do it. I can make my own decision. But if an effort is really made to identify those who would benefit-individually-it is sensible public policy to encourage them to take a medical treatment. Not force it and not encourage with a constant bombardment of sanctimonious ads and billboards and road signs. I mean in a personal doctor to patient setting. That’s all. I wanted to clarify those two statements.