My doctor’s new post about the Pfizer vaccine: your questions answered (and you can ask the doc if you have others)

December 14, 2020 • 10:15 am

My GP, Dr. Alex Lickerman, has once again put up a coronavirus post on his practice’s website, and allowed me to reference it here. It’s timely because it’s all about the new Pfizer vaccine. (A ICU nurse in New York may have been the first to get the shot.) How effective is it, and how do we know that? Is it safe? What about kids under 16, who weren’t part of the clinical trials? And pregnant women, who also weren’t tested? Since this is a mRNA rather than a killed-virus vaccine, should we have extra concerns about safety? What adverse reactions have been reported? If you were already infected, does the vaccination also reduce your risk of getting reinfected?  When will “normal” people who aren’t healthcare workers or nursing-home patients be able to get their jabs?

Alex has kindly agreed, as he has before, to answer readers’ questions about the new vaccine, so put your questions in the comments section below and he’ll address them as he has time. Alex has read all the relevant scientific literature, as well as the data from the vaccine trials, so ask away! But do read his 4-page summary beforehand, as it has a lot of information.

I’m not going to put up his whole post; you can go to his site to see it,  which you can do by clicking on the screenshot below:

I’ll just post Alex’s recommendations, followed by his list of “unanswered questions” (indented). The short message: GET THE SHOT AS SOON AS YOU CAN!

CONCLUSIONS

  1. The vaccine is highly effective in preventing symptomatic COVID-19 infection.
  2. The vaccine is safe. Adverse reactions, both local and systemic, are mostly minor. Though the study hasn’t yet gone on long enough to prove there are no serious long-term adverse affects, such adverse affects, if they exist, are likely to be rare and non-life-threatening based on other Phase I and II studies of other RNA vaccines.
  3. We recommend everyone who is eligible to receive the vaccine should receive it when it becomes available to them.
  4. It very well may take all of 2021 to get everyone who’s willing to be vaccinated to receive the shots, which means it likely won’t be until early 2022 that life returns to pre-pandemic normal. In the meantime, continue to wear a mask when indoors with anyone you don’t live with, wash your hands frequently, and refrain from dining indoors at restaurants.

UNANSWERED QUESTIONS

  1. While suggested by the study, still left unproven is whether BNT162b2 [Pfizer’s name for the vaccine] prevents severe COVID-19 infection, whether it prevents COVID-19 infection after just one dose, and whether it prevents COVID-19 infection in subjects who’ve already had COVID-19.
  2. The study didn’t look to see if the vaccine prevents asymptomatic infection. Nor did it assess whether subjects who developed COVID-19 despite vaccination are less likely to transmit the virus. Thus, it’s not yet clear how effective the vaccine will be in containing the spread of the infection.
  3. The study hasn’t gone on long enough to tell if subjects who were vaccinated yet still contracted COVID-19 have a lower risk of long-term effects of COVID-19.
  4. We don’t yet know if the vaccine reduces the risk of dying from COVID-19.
  5. There was insufficient data to draw conclusions about safety and efficacy of the vaccine in children younger than 16, pregnant or lactating women, and patients who are immunocompromised.
  6. We don’t yet know how long immunity lasts and whether or not booster shots will be necessary.

94 thoughts on “My doctor’s new post about the Pfizer vaccine: your questions answered (and you can ask the doc if you have others)

  1. Thank you for that. Reassurance always welcome. I am going for my first 80+ shot in an hour’s time at NHS Guy’s hospital London. (Where the crusty gentleman on CNN was interviewed.) It will be a relief after sheltering for so long.

    1. I am wondering if this might have been an allergic reaction to the lipids used to stabilize the mRNA, rather than a reaction to the mRNA itself. [I worked at a company that had a lipid-encapsulated injectable in clinical trials, and allergic reactions to the injection were a known side effect.]

      1. Anaphylactic reaction is always possible (and indeed more likely due to the vehicles than the RNA itself) . If you have a history of anaphylactic reactions, I’d advise to take your shot in a facility that has resus capability.

    2. Two healthcare workers who received the vaccine had anaphylactic reactions and recovered. The CDC is saying you can still get the vaccine if you have a history of such reactions to vaccines. If more people begin having these reactions, the advice may change.

  2. Thank you for sharing and kind of your GP to produce such a detailed clarification. While it will be a while before my turn to be vaccinated comes up (probably by the summer 2021), I will be getting it. I’d rather be vaccinated than run the risk of a full blown case of COVID-19.

  3. Here is one I heard the other day. After they get some of this vaccine out and distributed there may be a period of waiting for more. Why the wait? Because testing has increased a whole bunch in some places and the materials used for most of the testing are the same used to create the vaccine. So the manufactures are likely to experience some shortages.

    1. Initially, I was worried there might be a shortage, but my (one conservative) facebook friend posted a simple poll: “Will you get the vaccine? Yes or No?”

      Save for my vote, not only was it entirely “No,” almost every one was a HELL, NO! Complete with lengthy responses as to why.

  4. I’ll soon be 74 years old and wonder if that gives me some kind of priority over all the younger whipper snappers. 😜

    Also, I’ve learned that a recent MMR vaccine is strongly correlated with milder symptoms if you contract COVID. I recently obtained an MMR booster at Walmart (no prescription necessary) to carry me over until I get the vaccine. Any thoughts about this for the general population?

    1. I do believe we old folks are ahead of the young in the queue. But I’ve been wondering if that is best. The young need to work and go to school, not to mention that they are more likely to flout the rules and go out. Perhaps they should be vaccinated before the old since they are more likely to spread. As an old person, I view my biggest risk as being infected by a young person, so vaccinating them helps me too.

      1. The young are much less likely to die from it. That’s the calculus behind this.

        But you do have a valid point IMO. You would probably be quite well protected if they made sure that They should really be targeting the groups more likely to spread it at the moment (and health workers who are risking their lives to treat people who have got it).

      2. I think the idea is vaccinate the more vulnerable population to prevent death as they are more likely to die and also more likely to have a more serious bout that requires hospitalization. Reducing this reduces the strain on the health care system. Next, vaccinate others that are more likely to spread it. Some government policies hopefully reflect that. I think the Moderna vaccine will be better for all those who can’t travel to sites because it has such a vulnerability to spoilage with its temperature requirements. For this reason, where I am in Ontario, Canada, Long Term Care providers are being vaccinated ahead of the LTC residents (who will be first in line for the Moderna vaccine when its available). It also means we can’t really transport it to remote locations easily so Moderna will be used for remote communities as well.

          1. I don’t think it rewards bad behaviour. You’re more likely to spread it if you work on an assembly line and social distancing is difficult, you take public transportation where social distancing is impossible (street cars in Toronto are a nightmare), you come into contact with lots of people (teachers, doctors, emergency workers), you have to go to work in any place where ventilation is not all the great for preventing viruses (everywhere). None of those things are going out to parties….they are just part of living that some people are not able to avoid.

            1. You’re right, of course. I was actually thinking of the suggestion of giving it to young people as they are more likely to ignore the precautions, such as wearing a mask and avoiding parties. This has been suggested by some. A similar argument could be made to give the vaccine to Trump supporters as they are more likely to spread the disease than Biden supporters. It might be good science but …

      3. Having been vaccinated against it, the virus won’t reproduce in your bloodstream and tissues.

        But you can still carry the vaccine from point A to B on your skin, objects, food …
        So there is little benefit to vaccinating those less likely to suffer severe disease. They can still kill their granny/ neighbour’s granny by bringing the virus into contact with them.

        1. Anyone, infected or not, can carry the virus on our skin etc., but that is not the main way the virus spreads. It spreads by the exhalation of virus laden droplets by infected persons.

    2. There is a notion that the BCG (Bacillus Calmette–Guérin ) vaccine, a TB (mycobacterium) vaccine that does not prevent you from getting TB, but reduces the chances of TB meningitis in infants, and protects against leprosy and is used as a treatment for bladder cancer, might also be useful in preventing post flu and post Covid dementia.
      So, if you like your shots, this is one to consider.

  5. I’m hoping that we get back to normal faster than that. My guess is that the logistics and production problems will get solved as they are what business is good at and there’s money involved. And, of course, a huge amount of pressure to get our economy and life back to normal. The related question is how fast will the case load drop after the vaccine starts to penetrate the population. How many people have to take it before herd immunity makes it sufficiently hard for the virus to spread?

    I suspect the biggest issue six months from now will be what paperwork does someone have to have to take an airplane flight to another country? Enter a hospital? Etc. Etc.

    1. Depends on your definition of “normal”. As the population is vaccinated, we are still going to need to mask and maintain distance especially since we don’t know if the vaccine prevents spread as well as prevents illness….so it will be all of 2021.

      1. We will learn more along the way including, with luck, that vaccine prevents spread. I’m hoping that mask use becomes unnecessary before the end of ‘21.

        1. Yeah I suspect end of 2021 for mask use. I sort of like it though. Sick bastards that want to breath all over me will have less chance of making me sick. Despite getting flu vaccines I almost always get a flu from some contagious jerk at work or other public location.

      2. “since we don’t know if the vaccine prevents spread as well as prevents illness”

        So “all of 2021” is perhaps the worst-case scenario. I will cling to my hopes for a faster recovery.

    2. How many people have to take it before herd immunity makes it sufficiently hard for the virus to spread?

      From other diseases like measles, you’d start looking for that effect at vaccination percentages in excess of 90%. In a world of decreasing vaccination rates, you start getting outbreaks of measles at about 85%, with some histerisis So, I suspect that in Britain and America you’ll never approach “herd immunity”. Hopefully the rest of the world will have a more rational response, but from the restiveness of Australian anti-vaxxers, I can’t claim optimism on that.

      I suspect the biggest issue six months from now will be what paperwork does someone have to have to take an airplane flight to another country? Enter a hospital? Etc. Etc.

      I’d go and check the contents of my vaccinations and inoculations booklet (also known as the “Yellow Book” in deference to one or all of yellow fever, the yellow flag allegedly flown by ships entering harbours requesting suplies to quarantine with, due to plague on board, and the colour of some people’s booklets), but I know it would tell me that I’ have several vaccines out of date (definitely TBE and rabies prophylaxis, and that’s like getting kicked in the arm by steel-tip boots) and I’ll need to get them updated before going back to international work.
      I keep the vaccinations passport in the same wallet as my other passports, frequent flier cards, etc. I’ll have to remember to take it with me when I get called for the shot – which won’t be for several months yet if things go to plan.
      You’ll probably be expected to carry your proof of vaccination with you. Or to quote a Beninose immigration officer to the guy in front of me, “No Yellow Book, no entry. Next!” Or was it Gabon? I forget.

        1. The ‘yellow book’ is a kind of internationally accepted vaccination card, if you travel a lot, especially to tropical and equatorial countries, sooner rather than later you’ll need to produce it. So no, it is not a UK thing.
          And I guess the yellow colour may indeed have been inspired by the ‘yellow fever’.

  6. There’s lots more we don’t know, including whether or not the vaccine will prevent colonization of the nose by the virus and transmission of the virus to others by protected vaccine recipients (meaning that mask wearing will still be necessary even after one has been vaccinated to prevent further transmission). That said, I’ll get my vaccination as soon as I can.

    1. You raise what I think is an extremely important question about the vaccine: can or cannot a vaccinated person still transmit the virus to others? Obviously, a vaccine cannot prevent the virus molecules from entering the body. If I understand correctly (perhaps I don’t) what a vaccine does is that it prevents the virus molecules from harming the person so that the person infected with the virus experiences no disease. But now my area of confusion arises. Does the vaccine alter the virus in some way so as to render it harmless or does it merely create some sort of barrier (perhaps through creation of antibodies) that prevents the unaltered virus from harming the body? It would seem that if the former is the case then it would be unlikely for a vaccinated person to transmit the virus to another. If it is the latter then a vaccinated person could transmit the virus to others. But, I confess my total ignorance as to how this vaccine works. I would appreciate clarification.

      1. Even if the vaccine-prepared immune system only prevented the virus entering the cells, there would still not be enough virus to infect others. It is the massive replication of the virus inside cells that makes someone infectious.

        No one really knows yet how many COVID-19 virus particles are needed to make someone sick but, whatever the number, only a tiny fraction would be expelled by an immune person who had recently breathed a dose from someone else’s infected breath. The chances of that infecting someone else have to be vanishingly small.

        As always, I await correction by infectious disease experts.

          1. Please could you explain why the vaccine , which I understand prevents symptomatic infection to a high degree, may not prevent asymptomatic infection.

            1. The study didn’t evaluate its subjects for asymptomatic infections. We don’t know that it DOESN’T prevent them. It probably does. But the study wasn’t designed to answer that question. We’ll learn that later.

      2. No, the vaccine doesn’t alter the virus; it prevents the virus from “colonizing” your cells and spreading to other cells in your body as it colonizes ever more. When rapid colonization happens, you get sick. You cough and sneeze, your body’s response to expel the bads. These expulsions then infect others. Those infected but not sick may be (are) able to spread virus, but they are less likely to (altho more likely to be out and about). (I was a lawyer, not doc or scientist.)

      3. Reminds us of the Salk vaccine vs the Sabin vaccine for polio. The Salk vaccine is injected and gives a great and -it is thought- life long protection, while the Sabin vaccine is oral and prevents spread via the GI tract (read: shit). It is obvious that with the latter a much smaller percentage needs to be vaccinated than the former in order to get some kind of herd immunity.
        Although the notion of 90% needed for herd immunity with measles, a lower percentage may do for Covid. Measles is about the most contagious disease we know with a R0 estimated well above 10 (meaning one person would infect more than 10 others), I’m not sure about Covid, but I’ve heard numbers of up to 3-4, never over 10. The lower the ‘natural’ R0 the lower the percentage of immunity in the population needed. Of course the R0 is influenced not just by vaccination, but by all measures we take, such as avoiding mass gatherings, wearing masks, systematic hand sanitising, social distancing, etc.

    2. This may be a duplicate posting. My original posting of over a half hour ago has not appeared.

      You raise what I think is an extremely important question about the vaccine: can or cannot a vaccinated person still transmit the virus to others? Obviously, a vaccine cannot prevent the virus molecules from entering the body. If I understand correctly (perhaps I don’t) what a vaccine does is that it prevents the virus molecules from harming the person so that the person infected with the virus experiences no disease. But now my area of confusion arises. Does the vaccine alter the virus in some way so as to render it harmless or does it merely create some sort of barrier (perhaps through creation of antibodies) that prevents the unaltered virus from harming the body? It would seem that if the former is the case then it would be unlikely for a vaccinated person to transmit the virus to another. If it is the latter then a vaccinated person could transmit the virus to others. But, I confess my total ignorance as to how this vaccine works. I would appreciate clarification

      1. The vaccine causes the body to create antibodies which destroy the virus. Vaccines don’t directly attack viruses. I don’t personally see a way for a vaccinated person, whose body is destroying the coronavirus when it detects it, to pass it on. But I’m not an immunologist and am at the limits of my understanding of the transmission mechanisms.

      2. As I understand it, the vaccine prepares the immune system of the recipient to deny the virus access to the body’s cells. The prepared immune system can detect the virus’s spike proteins and destroy it.

        When a vaccinated person breathes in a viral dose, those virus particles will try to enter cells and most will be turned away. The virus particles won’t be able to multiply their quantity by many orders of magnitude like they would in an unvaccinated person. My guess is that such a person might expel some virus particles, perhaps just the ones they breathed in originally, but not often and not enough to worry about. A vaccinated person is effectively going to stop the spread.

        But I’m not a doctor!

    1. I disagree with the notion that we should allow anyone to contract the disease naturally if we can prevent it. Never mind the risk of death. We’re learning there are many other serious adverse consequences to contracting COVID-19 (e.g., loss of taste and/or smell, which is some may be permanent, increase risk of blood clots that can be limb or even life threatening, and so on). I’m not taking a stand on lockdowns here. Just saying that the notion that we should allow herd immunity to occur by supporting policies that increase the likelihood of anyone acquiring immunity through infection strikes me as a poor policy choice.

    2. I think I’m with Dr Lickerman on this one (with no disrespect to the er… illustrious Dr Johnny Bananas et al. who signed the Resolution)!

    3. Oh, that thing. I am no expert on how this pandemic is going in different countries, but I think Sweden came pretty close to trying this approach. It seemed pretty good for a time, but… now they are getting a significant surge, as is Germany who tried it similarly. They are paying a price. It does not work.
      Countries that have done the best had hard lock-downs and a compliant population and effective contact tracing and a compliant population.

        1. Very unlikely. The vaccine is directed at the spike protein, the part of the virus that enables it to infect cells. It’s already evolved to be highly efficient, so any wild types that mutated the spike protein enough to render it resistant to the immunization would, I would think, make those virions less infectious not more, and therefore likely irrelevant. The structure of the spike protein is highly conserved across most species of coronavirus because it’s so good at infecting cells.

            1. My understanding is that it takes more than just the spike protein for a virus to enter a cell. I think the spike is just a way that a virus can lock on to a cell.

  7. As a side-note, the Pfizer/BioNtech vaccine underlines the international character of the biotech and pharmaceutical industries. The German firm BioNtech, which has specialized in mRNA-based immunotherapies and vaccine development, was founded by Uğur Şahin and Özlem Türeci , two Turkish-German physician researchers in Mainz. The CEO of Pfizer is Albert Bourla, a Greek citizen from Thessaloniki. Dr. Bourla, (appropos of another WEIT thread), started out in Greece in veterinary medicine and rose through Pfizer’s animal health division. The other mRNA-based vaccine was developed by Moderna, which is headed by Stéphane Bancel, a Frenchman, and Board Chairman Noubar Afeyan, an Armenian-American. [Both of the latter two are biotech entrepreneurs, and Dr. Afeyan has a biotech PhD.] The other, more traditional, antigen-based vaccine was developed by the British-Swedish firm Astra-Zeneca. Its CEO is Pascal Soriot, a Frenchman who is also a veterinarian. Vets seem to be more prominent in the international pharmaceutical industry than one might suppose at first, but it makes sense.

  8. I still do not get WHY a vaccine that is 95% effective a has more value than our immune system that is 99% effective. Why is it better than some of the old meds that are also 95% effective at preventing the disease?

    1. I will take a wild swing at this. But I just play a doctor on tv, as it were.
      A natural immune reaction to a virus makes lots of different antibodies, many of which are worthless for fighting the virus. The % of ‘effective’ antibodies can be pretty low even though the overall antibody response can be high. This can still be an effective route to natural immunization, but C-19 is a virus that respond well to natural immunization, it seems.
      A vaccine developed against, say, a critical surface protein, like the C-19 spike protein, will make a much higher % of effective antibodies. So the effectiveness of the vaccine is much higher, at least in the short term. So far that seems to be the case with the new vaccines being discussed here.

    2. In an infection, the immune system fights off the virus only after an infected person has been affected by it…and that includes what seems to be a roughly 1% chance of dying and an unknown (but very probably quite a bit higher) chance of having long-term sequelae that might be quite serious. Also, treating even the people who recover completely from an infection is resource-intensive and increases the risk of spreading the virus to others, whereas that does not happen with immunity acquired through vaccination.

      And, of course, a vaccine works via the immune system, usually by triggering mainly (but not solely) humoral immunity, and usually leading to the development of long-lived plasma cells that are specifically geared to secrete antibodies against particular antigens. So it’s all about the immune system in both cases, but with the vaccine, you develop a level of immunity that may be as good as the immunity you have from actually catching the virus (though it’s probably not quite as strong, I would guess), without the pesky Russian Roulette game of either being killed, getting permanently damaged, or passing the virus on to someone else so that THEY can spin the cylinder on that gun.

      1. And immunity needs to start all over with every generation (who will also likely mutate the damn thing causing further immunity complications). There is a high cost to herd immunity. Further, even a person who gets a relatively easy pass is now a vector who passes it on to someone who could die from it because they are vulnerable. That’s not very ethical.

        1. I would think that COVID-19 is one of those diseases that can be eradicated entirely since it is so dependent on human transmission, though perhaps there’s risk of pools in animal populations. Animals need to get their shots!

          1. Kill all those animals /s
            I’m disgusted at the mass slaughter of animals that might suffer from diseases we have vaccines for. Maybe a veterinarian among us can elucidate?

    3. Which old meds are you referencing? We don’t have anything to fight coronavirus. Also need clarification on what you mean by 99% effective? Are you saying that only 1% die? Others have answered this and I should add that indiscriminately becoming a vector if you have a mild case to inflict on anyone else or pass it to someone who will also pass it is like just shooting a gun in a crowd. It’s not really fair to put others at risk like that. Who will it be? Someone’s daughter, mother, brand new baby or that kid with diabetes?

  9. Does the Pfizer/BioNtech vaccine have any inbuilt tracking for its temperature history? Something dramatic such as a change of colour would be a nice indicator if it went out of bounds.

    Temperature logging devices are apparently packed with the vaccine shipments, but there’s nothing to prevent them being divorced from the cargo.

    What happens if the ultra-temperature regime is not maintained? Does the product just become ineffective, or is it then dangerous?

    1. I have a question for Dr. Lickerman: How often would you advise changing masks. I have been chucking after five or six uses.

      1. Surely better to get a reusable mask – my friend made me 2 but all supermarkets sell them, the you can reduce waste & wash them regularly.

    2. Temperature logging devices are apparently packed with the vaccine shipments, but there’s nothing to prevent them being divorced from the cargo.

      That is why the temperature limits hardware is irrevocably glued to the outside of the shipping crate, where it’s GO/NOGO status can be seen by everyone in the chain, and read at many metres range. When the crate reaches a destination where there are people authorised to open it, then photographing the status of the packaging telltales is part of the procedure for signing the receipt.
      At least, that is how the maximum-acceleration/ shock telltales which I sourced for work back in the mid-90s worked, and were intended to be used in the supply chain. We’d had 30-odd k$ of analytic equipment arrive in Abu Dhabi … not the same shape as it had left the workshop, and had to send a technician business class hand-carrying spares to rebuild it against the clock. At which point, $50 per telltale and several hundred dollars for signed chain-of-custody documentation became a worthwhile investment. We’d also put a 20G telltale inside the packing crate.
      The logistics industry is very familiar with telltale packaging tools, data loggers, that sort of thing. They hate them – lots of paperwork, lots of downhill excrement avalanches – but know why people use them. This isn’t a new invention.

  10. The Pfizer vaccine has the disadvantage of being considerably more expensive compared to some of its equally effective competitors (the Russian “Sputnik” vaccine and China’s CoronaVac, still not fully evaluated: <U$10 a dose compared to U$20 or so a dose for the Pfizer vaccine. Cost and storage will be important issues in poorer nations.

  11. I have rheumatoid arthritis and take orencia and methotrexate. Will my underlying condition or the immune suppressant drugs I take prevent me from being vaccinated?

    1. Robert – since you have RA, and especially if you’re taking barictinib, you may find cheer in this, which just crossed my window a couple days ago.

    2. There weren’t enough patients with immunocompromising conditions in the Pfizer study to say if the vaccine with efficacious or safe for people in that category. More data is coming. I’d wait to be vaccinated in your case until we have that data.

  12. THANK YOU for the doc’s latest link. His earlier ones were useful also. Recently quite a few closet anti-vaxers have come out of the woodwork in my life – to my horror. Not friends I might ad, just people I know. Unfortunately. (My aged parents in Australia were nearly killed by a disease that’d be impossible to get were it not for those danger idiots the anti-vaxers: whooping cough, so I feel I have a dog in this fight).

    The doctor’s link is a good, ground level easy to understand explanation even for the scientifically illiterate.

    D.A.
    NYC
    https://whyevolutionistrue.com/2020/06/10/photos-of-readers-93/
    (picture of the dog I have in this fight) 🙂

  13. I don’t understand Unanswered ? #4, We don’t yet know if the vaccine reduces the risk of dying from COVID-19, and by extension Unanswered #3.

    None of those vaccinated who contracted COVID required hospitalization = none of those cases were severe. Can we not infer/impute the answer to #4 from that?

    1. If the vaccine prevents you from contracting COVID, obviously from one perspective it’s prevented you from dying from it. But if you get vaccinated and still get COVID, are you less likely to die than if you hadn’t been vaccinated? That’s the question we don’t yet know the answer to.

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