Chief medical officer explains basics of COVID-19 vaccines

As part of ongoing efforts to encourage people to get vaccinated against COVID-19, the chief medical officer of the SouthEast Alaska Regional Health Consortium stood in front of a Wrangell audience - live and on Zoom - to take questions.

The Wrangell Cooperative Association had invited Dr. Elliot Bruhl to town, where he explained how the vaccine works, how it was developed, and answered questions from the public Feb. 4 at the Nolan Center.

As of Feb. 4, 680 people in Wrangell had received their first vaccination - almost one-third of the community - and about half of those had received their second dose. Bruhl said the goal is to achieve a 70% vaccination rate in all of SEARHC's communities, which the health care provider hopes to achieve by late summer.

Bruhl began his presentation by explaining how the COVID-19 virus works. Under a microscope, it looks something like a ball with multiple protruding points. These protrusions are called "spike proteins," he said. The virus uses these spikes to attach itself to a cell in a person's respiratory tract, he said. However, the spike proteins are also related to how a person can build immunity.

"It is also the protein that our body, when we form an immune response to the virus, our body recognizes the shape of that protein in forming the antibodies that we direct at the virus," Bruhl said. "This is all very important to the function of both the Pfizer and Moderna vaccines."

The vaccines carry messenger RNA, or a microscopic set of instructions, to the cells in a person's body. In the case of the vaccine, it carries instructions for cells to produce the spike protein of COVID-19.

"It's like a teacher," he said. "It goes into the cell, and it instructs the cell how to build little pieces of that spike protein. It doesn't teach the cell to make the virus, it doesn't teach the cell to do anything else, it just teaches the cell to produce those little spike proteins."

Once those spike proteins are produced, Bruhl said, the body responds to their presence by producing antibodies. An antibody, he explained, is the response an immune system uses to eliminate foreign intruders. Once a person has developed the spike proteins and the required antibodies to fight them, that person's immune system knows how to react if exposed to the actual COVID-19 virus.

"The patient receives two doses of the vaccine over a three- to four-week period, and the second dose of vaccine boosts the immune system's ability to produce more and more of those antibodies so the immunity lasts," Bruhl said. "We don't know exactly how long, but it certainly greatly increases the amount of immunity that the person has."

The vaccine is "94% to 95% effective at preventing symptomatic disease, he said. The effectiveness against asymptomatic disease is unknown, he said, though more research is underway.

Those who receive the vaccine can expect some side effects. Most are mild: A sore arm from getting the shot, fatigue, or muscle pain and joint aches. Bruhl said 5% or less of people receiving the Pfizer vaccine experience headaches and a fever. A severe allergic reaction has occurred in only 10 or 11 cases out of every million doses given, he said.

There has been some concern among the public about how a COVID-19 vaccine was developed so quickly, in under a year. Bruhl said work on a similar virus from several years ago gave the scientific community a good base of knowledge. Furthermore, he said there was a lot of international cooperation in developing a vaccine. Advancements in the fields of genetics and immunology helped, too. The U.S. Food and Drug Administration provided emergency-use authorization to allow the development and research into the vaccines to go more quickly.

After receiving both doses of a vaccine, peak immunity will come about two weeks after the second shot. Though a vaccinated person can increase their personal activity with caution, Bruhl said, health care providers encourage the use of face masks and social distancing.

During audience questions, Mike Lockabey voiced concerns that the vaccine may harm women's reproductive health. Bruhl said there is no evidence of such danger.

"There were women both in the placebo arm and the vaccine arm of the Phase 3 trials, of both of these vaccines, who became pregnant and who ended up completing successful pregnancies," Bruhl said.

Josh Nuckols, who was listening online, said that as a 26-year-old he was trying to weigh the risks of taking the vaccine versus going without it. As he is young, he said he is relatively low risk of having a serious bout of COVID-19 if he got it. Meanwhile, the long-term potential effects of the vaccine are still unknown. Bruhl said that was a decision only Nuckols could make, but he said from his own perspective there is an aspect of civic duty to getting the vaccine.

"We haven't had the chance to observe it for 10 years or 20 years," Bruhl said. "However, my view of that, as a physician and a scientist, is that the actual content of the vaccine is such that I feel lingering long-term effects are highly unlikely. ... With regards to what is your role in controlling the pandemic, what we know is that young people are of a strong reservoir for disease that kills old people. So I strongly recommend that young people do get the vaccine, and I recommend that they do it out of a sense of civic duty to protect the older members of our society. I recommend that strongly for all people in Southeast Alaska."

Lovey Brock asked if she should get a vaccine developed by Johnson & Johnson if she already had received the Pfizer vaccine. She also wanted to know when children would start receiving vaccinations.

Bruhl did not recommend getting another vaccine if someone already received both doses of one. They code for the exact same protein, he said. It would not be harmful, but it would not help anything.

As to when children could be vaccinated, Bruhl said it is a work in progress. The Pfizer and Moderna vaccines have been approved for teenagers but not for younger children.

"The protocols for those types of studies are quite difficult," he said. "However, they're being done. They're being done right now."