COVID-19 VACCINE FAQ

Since I began taking on a few sessions per week at our respiratory clinic, I was one of the first to be offered the vaccine. After a lot of research (a lot!), and realizing the mechanism in which the vaccine works, I made the decision to get it. So I’m taking you through my research, sharing my personal experience, providing resources, diving into the history behind vaccine testing in decades past, and answering questions submitted through Instagram!

What I would first like to say is this. Your body, your decision. This post is packed with research from sources I trust. What it’s not packed with is my opinion. My goal is and has always been to present you with information so you feel educated and empowered to make a decision that’s best for YOUR BODY! Period.

What went into my own personal decision was threefold: my exposure (high – I work in healthcare with known COVID positive patients), my trust in science, and one more thing that had nothing to do with me at all. Even if I did get COVID, statistically I would be okay. I’m young, healthy, live alone, have financial and geographical access to healthful and nutrient dense foods, and do not carry any risk factors or cardiometabolic disease (for diet / lifestyle recommendations regarding COVID-19, check out this post.) It’s clear there is a metabolic and inflammatory component to COVID as well. I think it’s easy to say that if we all got really healthy (decreasing chronic disease and the inflammatory markers associated with them), then we’d be more protected. But that is no where close to reality in the US. And quite frankly an insensitive and an ineffective proposed public health initiative, if you could even call it that.

Given I am around COVID-19 often, there is a chance I could have it, be asymptomatic, and be a super spreader. Which is also really scary to think about – that I’m young, healthy, asymptomatic and okay, and yet potentially spreading it to the community. So yes, back to my original point, the decision to get this vaccine wasn’t only about me. But about my community, my family, my friends, my patients. So. Much. More. Than. Me.

And speaking of me, let’s start with my experience.

 

My experience

Did you have symptoms from either dose?

I received the Pfizer vaccine. Also right up top as this is relevant to the question, I was never diagnosed with or symptomatic of COVID. I was very closely around others who had confirmed antibodies. But to my knowledge, I never had COVID nor do I have antibodies.

Why is this important you ask? Because my reaction could be different than yours, especially if you were confirmed or symptomatic of the virus. During my first dose, I had a sore arm and that was pretty much it (I was vaccinated at around 3:30pm during my first dose).  For my second dose, I was vaccinated at noon and felt a pretty gnarly headache by the time I got home from work that night (~6pmish). The day after, I was EXHAUSTED by the end of the day. Granted, this could easily be attributed to nature of the work I’m doing. But I fell asleep and was knocked out by 7pm, which is a bit earlier than my norm (only a bit, though). I felt no fevers, chills, body aches, nausea vomiting.

Friends who had symptoms of COVID or confirmed antibodies, however, did have more significant reactions. These friends received the Moderna vaccine and side effects ranged from subjective fevers and chills to body aches to nausea and vomiting. All of which were alleviated within 24 hours.

Below are some nice graphics depicting the likelihood of side effects:

**I received both of these from powerpoints provided from work. They are not my own and I did not create them.

 

Would you suggest not working the day after?

I think it depends. I do think because I never had COVID that my reaction was not as severe as colleagues and friends. So if you’ve had it, and had it recently, I would recommend taking a day off after your second dose. Or if you have enough PTO, just take the day off! Hard to predict how everyone will react, so may as well be safe and plan a day of comfort food and movies in bed.

 

Historical context. Racism in healthcare.

It is no secret that the US’s healthcare history is embedded with racist policies and practices. From the Tuskagee Syphilis Study to Henrietta Lacks to graverobbing Black bodies for white medical students learning (to name ONLY a few – I URGE you to read Medical Apartheid if you are in healthcare, or even if you aren’t!), there is absolutely no denying racism in the history of healthcare in the US. Racist policies and practices are far from gone, ultimately leading to mistrust in BIPOC, Latinx, and immigrant communities (and rightfully so).

COVID-19 continues to disproportionately affect and kill BIPOC and Latinx communities. Further, Black people are more likely to be essential workers at greater risk of exposure to the coronavirus. Black pregnant women are more likely to get infected and the age-adjusted mortality rate for Black people is 3.4 times as high as that of white people (extracted from The Undefeated). A November study by the American Heart Association showed that Black and Hispanic people have made up nearly 60% of COVID-19 hospitalizations in the U.S; attributed to “societal structures reinforcing health disparities among racial and ethnic groups: disparities in socioeconomic status, lack of access to health care, and to Black Americans being more likely to work essential jobs that increase the likelihood of exposure” (from Time).

And yet a recent study found that half of Black adults to do not plan to take a coronavirus vaccine, even if free deemed safe by scientists.

In the two large studies (Moderna and Pfizer), the 350,000 people who registered online for the coronavirus clinical trial, 10% are Black or Latino. This is less than a third of the total U.S. population these two groups account for (31.9%). So not only is there mistreatment, mistrust, and more COVID cases with worse outcomes in these communities, but they are not even properly represented in the very limited studies we have!

I don’t have an answer on how to right these many historical wrongs, but it most certainly needed to be acknowledged. And I hope with more widespread and available digestible information, the mistrust about this one issue (the vaccine) begins to dissipate if only a little. However, I am not naive enough to think or know that it is anywhere near that simple.

This article discuss this at length as well.

 If you are BIPOC or Latinx identifying, and have questions about the vaccine, please reach out to me personally: twistoflemons@gmail.com. I would be happy to answer individualized questions.

For others: I would highly recommend reading Medical Apartheid for more background and context of systemic racism built into medicine.

 

Now that you know about my experience and potential side effects, along with some historical context, let’s talk about the vaccine itself.

 

 The vaccine

How does the vaccine work?

***(for the sake of this post, at this point in time, I’ll spend time discussing the mRNA vaccine specifically, as this is the type of vaccine made by Pfizer and Moderna)

Both vaccines that are currently available are mRNA vaccines. mRNA is a transcript of genetic material that is then used to build proteins. The cell builds a (non-infectious) piece of the virus (the spike protein) that is then presented on the outside of the cell. The immune system recognizes a novel cell surface protein and develops antibodies to it, thereby developing immune memory to this component of the virus so that if your immune system sees and recognizes the surface spike protein of COVID again (ie if you get COVID), your body is toned, trained, and ready to throw a 1,2 punch response.

Say that again?? Let’s run it back.

A snippet of mRNA is coated in a synthetic lipid shell and enters cells near the injection site. Once injected, mRNA instructs cells to make spike proteins. The spike protein then appears on the surface of macrophages (the cell responsible for detecting, engulfing and destroying pathogens). This induces an immune response that is supposed to mimic the way we fight off infections, ie it’s a dress rehearsal if your cells did encounter SARS-CoV-2 in the future. Enzymes in the body then degrade and dispose of the mRNA. No live virus is involved, and no genetic material enters the nucleus of the cells. If you understand anything from this segment, know this. The spike protein gene can only make the spike protein, NOT the VIRUS. I repeat, there is no live virus in an mRNA vaccine.  

 

Can you share research as to why the vaccine is safe?

You bet!!

Despite being a new technology, safety is actually a big advantage of mRNA vaccines. The content of vaccine is simple – it does not contain any live virus. It does not go to the nucleus or interact with host genome. In fact, a number of mRNA vaccines have been shown to be safe in human trials since 2008 (mainly cancer vaccines, none effective enough to be approved), though they have been tested.

Advantages:

• Easy to rapidly develop new vaccines
• Safety
• Generates strong immune response (no need for adjuvants)

Disadvantages:

• Highly unstable; needs to be kept cold, so a challenge for distribution (Pfizer, anyways)
• Expensive

 

How can we trust something made/trialed so quickly?

The world was able to develop COVID-19 vaccines so quickly because of years of previous research on related viruses and faster ways to manufacture vaccines, enormous funding that allowed firms to run multiple trials in parallel, and regulators moving more quickly than normal.  With large sums given to vaccine firms by public funders and private philanthropists, they could do preclinical and phase I, II and III trials, as well as manufacturing, in parallel instead of sequentially.

Further, mRNA technology is not new. 30 years of research allowed several groups of scientists (Pfizer and Moderna) to bring mRNA vaccine technology to the threshold of actually working. The companies had built platforms that could be used to create a vaccine for any infectious disease simply by inserting the right mRNA sequence for that disease.

In regards to the swift development of this specific vaccine, first remember that we’ve come a long way in expediting the other necessary parts of vaccine development, specifically gene sequencing. SARS-CoV-2, is a virus that mutates relatively slowly and that happens to belong to a well-studied family. Within weeks of identifying the responsible virus, scientists in China had determined the structure of all of its genes, including the genes that make the spike protein, and published this information on the Internet. Within minutes, scientists 10,000 miles away began working on the design of an mRNA vaccine. In the final stages of trials, it helped that COVID-19 was everywhere because firms need infections to show that vaccines work. It’s hard to run efficacy trials when the diseases themselves aren’t prevalent.

 

What about side effects? 

Short term side effects:

“The first two vaccines are classified as “reactogenic” — meaning that they cause some side effects in most people who receive them due to the immune response they generate. The most common side effect is pain at the injection site, especially in the 12 to 24 hours after administration. Around 1% of participants in the trials categorized the pain as “severe.” Fatigue and headache are other relatively common side effects; high fevers are less common. These side effects generally resolve within a couple of days and are responsive to acetaminophen or a nonsteroidal anti-inflammatory drug such as ibuprofen. In general, side effects are more common in younger vaccine recipients than in older ones, with the second shot inducing more side effects than the first.

Bell’s palsy was reported more frequently in vaccine recipients than in controls, but there was not a sufficiently large number of cases to conclude that this was beyond what would naturally be observed in populations of this size by chance. There were no cases of Guillain–Barré syndrome or transverse myelitis.” (extracted from NEJM COVID-19 Vaccine FAQ)

Long term side effects

“The remarkably fast pace of vaccine development means that we have only months, not years, of follow-up. But with other immunizations, severe reactions typically occur within days or weeks after administration. Long-term side effects with vaccines are fortunately quite rare, with putative associations later debunked by carefully done population-based studies.

Further safety data on both vaccines will be reported to the Vaccine Adverse Event Reporting System (VAERS).  This program is an existing national early warning system that was set up to detect possible safety problems in any licensed vaccine and has been in operation since 1990. In addition, the CDC has its own smartphone-based tool, which uses texting and a Web-based survey to collect information right after patients receive their Covid-19 vaccine.”  (extracted from NEJM COVID-19 Vaccine FAQ) 

This is a very difficult questions to answer because we just don’t know! What we do know is that there could be problems for those who get COVID later on. Ie we’re seeing those who got the virus in March are still symptomatic nearly a year later. At this point, it’s a weigh the cost and benefits game. Would you rather get COVID and have potential symptoms for months with unknown long-term side effects? Or would you rather get a vaccine that protects you from COVID with unknown long-term side effects?

I think it’s important to note that the technology of mRNA vaccines have been studied in the past, and there is no live virus that is part of this vaccine.

 

And what about allergies / anaphylaxis?

First and foremost, a list of the ingredients in both vaccines below:

• Pfizer: nucleoside-modified messenger RNA (modRNA) encoding the viral spike glycoprotein (S) of SARS-CoV-2, (4-hydroxybutyl)azanediyl)bis(hexane-6,1-diyl)bis (ALC-3015), (2- hexyldecanoate),2-[(polyethylene glycol)-2000]-N,N-ditetradecylacetamide (ALC-0159), 1,2-distearoyl-snglycero-3-phosphocholine (DPSC), cholesterol, potassium chloride, monobasic potassium phosphate, sodium chloride, basic sodium phosphate dihydrate (dissecting what all these mean here)
• Moderna: Synthetic messenger ribonucleic acid (mRNA) encoding the pre-fusion stabilized spike glycoprotein (S) of SARS-CoV-2 virus; SM-102; 1,2-dimyristoyl-rac-glycero3-methoxypolyethylene glycol-2000 [PEG2000-DMG]; cholesterol; 1,2-distearoyl-snglycero-3-phosphocholine [DSPC]; sucrose; tromethamine; tromethamine hydrochloride; acetic acid; sodium acetate

“There are reports (in the US and England) of vaccine recipients experiencing severe allergic reactions (anaphylaxis) shortly after receiving their first dose. The current leading suspect in causing these reactions is polyethylene glycol, a compound present in both vaccines (see ingredient list above). Because of these rare events, administration of the vaccines includes a period of 15 minutes of observation after vaccination — 30 minutes for those with a history of severe allergic reactions of any sort. These allergic reactions are uncommon (estimated at 1 in 100,000 doses). Although this rate of severe allergic reactions is higher than that with other vaccines, it is substantially lower than the rate reported with penicillin, which is estimated to be 1 in 5000. But since severe penicillin allergies don’t turn up as news stories, our challenge will be to contextualize this risk”. (extracted from NEJM COVID-19 Vaccine FAQ)

Week 1 of Pfizer roll out :

• 2 cases of anaphylaxis in UK, 5 cases of anaphylaxis or severe allergic reaction in US (2 were in Alaska)
• 2 individuals in UK both had history of anaphylaxis to food, needed epinephrine to treat vaccine induced anaphylaxis and recovered

• What is causing the anaphylaxis: not known, could be PEG (polyethylene glycol) which is an ingredient in both vaccines “but in different formulations”
• PEG is ubiquitous (ultrasound gel, miralax, injectable steroids) and allergy is rare

Moderna Clinical Trial: People with a history of anaphylaxis were included. No cases of anaphylaxis following administration of the vaccine

 

Should I avoid getting the vaccine if I do have allergies?

“There are no data to suggest that patients with most types allergies should not get the COVID vaccine, aside from people who have specifically had a severe allergic reaction to the COVID vaccine. There have been several reported cases of anaphylaxis to the vaccine, all suspected to be to a specific ingredient in the vaccine. The CDC recommends that people with a history of any other severe allergic reaction, including to foods, medicines, or latex, can get the vaccine. Patients with a history of severe allergic reaction should be monitored for 30 minutes.

Patients with a history of severe allergic reaction (e.g. anaphylaxis) to any ingredient in the COVID vaccine should not receive it (see ingredients above). Patients with a history of other immediate allergic reaction (urticaria, wheezing/stridor, angioedema within 4 hours) to any component of the vaccine or to polysorbate (which may cross-react with PEG, a component of the vaccine) should not receive the vaccine unless they are evaluated by an allergist-immunologist first.

A history of immediate allergic reaction to an injectable therapy or vaccine is a precaution but not a contraindication to the vaccine. Such patients can still receive the vaccine if they would like to, and may also consider consulting with an allergist-immunologist first.

A history of mild allergic reaction to a vaccine or injectable therapy or a history of any allergic reaction to a non-injectable substance (e.g. food or medicines, including oral equivalents of injectable medications) is not considered a precaution. Note that the vials and stoppers of the vaccines do not contain latex, and the vaccines do not contain eggs or gelatin.

Unless you have a specific, severe allergy to an ingredient of the vaccine, you may receive the COVID vaccine per the CDC. All patients will be monitored after the vaccine by trained staff. If you have a history of an immediate allergic reaction to a vaccine or medication injection, or a history of anaphylaxis, you will be monitored for 30 minutes.” (extracted from NEJM COVID-19 Vaccine FAQ)

 

What if I’m immunocompromised?

“The CDC considers immunocompromised patients to be at increased risk for severe Covid-19. opens in new tab. This is broadly defined as patients with histories meeting the following criteria, which are not 100% inclusive:

• Cancer
• Bone marrow transplant
• Solid-organ transplant
• Stem cells for cancer treatment
• Genetic immune deficiencies
• HIV
• Use of oral or intravenous corticosteroids or other medicines called immunosuppressants that lower the body’s ability to fight some infections (e.g., mycophenolate, sirolimus, cyclosporine, tacrolimus, etanercept, rituximab)

Because of the heightened risk of severe Covid-19 in this population, immunocompromised patients should receive the Covid-19 vaccines if there are no contraindications. That’s the easy part.

What’s more challenging is estimating the safety, and particularly the efficacy, of the vaccines in this population, since neither clinical trial included large numbers of people in these individual categories. Since the Pfizer/BioNTech and the Moderna vaccines don’t include live virus, there is no risk of virus dissemination. Whether the antigens in the vaccine will trigger either an increased risk of rejection (for transplant patients) or autoimmune disease (for those with rheumatologic or other autoimmune conditions) is unknown, but it is reassuring that such adverse effects are infrequent with other vaccines. Furthermore, the clinical trials did not see a difference in the occurrence of autoimmune conditions or inflammatory disorders in study participants who received the vaccine as compared with placebo.

Vaccine effectiveness depends on an intact host response; as a result, immunization might be less effective in immunocompromised hosts than in the general population. When immunizing immunocompromised patients for Covid-19, they should be counseled about this potential difference and hence about the continued importance of other prevention measures, such as mask wearing, social distancing, avoidance of crowds, and hand washing. Household members of those with weakened immune systems should also be immunized if possible.” (extracted from NEJM COVID-19 Vaccine FAQ)

 

What if I have an autoimmune disease?

For this answer, I will note a message from a dear reader, Abby (@aprintz16). Shared with permission:

“I have an autoimmune disease, though I’m currently in remission and not on immunosuppressants. My docs growing up were hesitant to give me new vaccines (HPV for example) and I couldn’t get live vaccines either. I believe the concern with HPV vaccine was that it could potentially trigger a flare. I have received it now that I’m in remission and after seeing 5+ years of research, but I think it as out of an abundance of caution.

However, when I talked to these same docs about getting the COVID vaccine, they were fully on board with me getting it because the risk of getting COVID is worse than any potential side effect of the vaccine that seems to be pretty safe so far.

The only thing my docs have seen about autoimmune disease and COIVID vaccine is that these people tend to have more severe side effects (which totally makes sense!) Just got my second dose Monday, and my side effects were definitely more severe than anyone I’ve talked to – but so worth it.

Multiple rheumatologists are supporting it, some just suggesting holding immunosuppressants for a certain amount of time depending on the patient to ensure a proper immune response. If this vaccine was live, I think there would be a lot more hesitancy around getting it. But since it’s dead its’ much safer for us!”

 

Should we be worried about not ever experimenting with the mRNA vaccines in humans?

See above: a number of mRNA vaccines have been shown to be safe in human trials since 2008 (mainly cancer vaccines, none effective enough to be approved), though they have been tested.

 

Can you still spread / be a carrier even if you get the vaccine?

“Many commentaries on the results of the vaccine clinical trials cite a lack of information on asymptomatic infection as a limitation in our knowledge about the vaccines’ effectiveness. Indeed, this is a theoretical concern, since up to 40% of people who get infected with SARS-CoV-2 have no symptoms but may still transmit the virus to others.

So, until we know whether the vaccines protect against asymptomatic infection, we should continue social distancing, masking, avoiding crowded indoor settings, and regular hand washing.

There are several good reasons to be optimistic about the vaccines’ effect on disease transmission. First, in the Moderna trial, participants underwent nasopharyngeal swab PCR testing at baseline and again at week 4, when they returned for their second dose. Among those who were negative at baseline and without symptoms, 39 (0.3%) in the placebo group and 15 (0.1%) in the mRNA-1273 group had nasopharyngeal swabs that were positive for SARS-CoV-2 by PCR at week 4. These data suggest that even after one dose, the vaccine has a protective effect in preventing asymptomatic infection.

Second, findings from population-based studies now suggest that people without symptoms are less likely to transmit the virus to others. Third, many of the vaccines in wide use powerfully protect against both disease and transmission, so much so that infection control is one of the main motivators behind some vaccine policies.

Some of my colleagues have reminded me that certain vaccines allow asymptomatic colonization, and no doubt this will sometimes be true about the Covid-19 vaccines. Plus, the protective effect will never be 100%, which is why while case numbers are still high, we still recommend the use of social distancing and masking in public. These caveats notwithstanding, the likelihood that these vaccines will reduce the capacity to transmit the virus to others remains excellent.” (extracted from NEJM COVID-19 Vaccine FAQ)

 

Will we need another booster / how long is immunity is expected to last from the vaccine?

“Since the vaccines have been tested only since the summer of 2020, we do not have information about the durability of protection. Data from the phase 1 trial of the Moderna vaccine suggested that neutralizing antibodies persisted for nearly 4 months with titers declining slightly over time. Given the absence of information on how long the vaccines will be protective, there is currently no specific recommendation for booster doses.” (extracted from NEJM COVID-19 Vaccine FAQ)

 

Are vaccines needed for people who already have had COVID?

“Yes, they should receive the vaccine. Some of the people who participated in the clinical trials had evidence of prior SARS-CoV-2 infection (based on a positive antibody test), and the vaccines were safe and effective in this group.

Since re-infection after recovery from Covid-19 is rare in the first 90 days, some people may wish to defer immunization for this long — however, if they wish to be immunized sooner, there is no contraindication. Patients who were treated with monoclonal antibodies or convalescent plasma should wait this long, however. These treatments might inactivate the vaccines, making them less effective. Deferral of immunization for 90 days after treatment with monoclonal antibodies or convalescent plasma is recommended.”  (extracted from NEJM COVID-19 Vaccine FAQ)

 

OB/GYN Questions 

**the majority of these questions were answered when I watched the lecture hosted by Modern Fertility. For a replay of the lecture (which was extremely well done, I may add), can be found here. Some answers are direct copy/paste because it was so well written!

Does the vaccine affect fertility?

It’s important to note, the studies done before the authorization of the COVID vaccine did not specifically include pregnant or breastfeeding patients. People were not allowed to participate if they were pregnant or breastfeeding at enrollment. Because of that, it’s not possible to conclusively say that the COVID-19 vaccine is safe or unsafe for this population. With that being said, some patients in the studies became pregnant and there is no evidence of adverse effects. Choosing to get vaccinated is a decision you can make, and your provider is here to help you if you would like to discuss with them. The CDC and others have said that women who are pregnant or breastfeeding can choose to get the vaccine if they wish to.

More on this:

• There is every reason to think that, based on the mechanism and science of this vaccine, the risk to preconception, conceiving, or pregnant women is extremely low.
• Neither the CDC, ACOG, nor SMFM have cautioned against getting the vaccine for people who may want kids now or in the future. Similarly, the majority of vaccines are safe(and several are specifically recommended!) for people trying to conceive.
• ASRM’s official statementsays: “The Task Force does not recommend withholding the vaccine from patients who are planning to conceive, who are currently pregnant, or who are lactating.”
• Twelve people in the vaccine arm of the Pfizer trial got pregnant, meaning the vaccine doesn’t cause infertility; their fertility-related outcomes and health are now being followed closely.
• Some women became pregnant during the vaccine studies. Eighteen of these women were in the vaccine group, and two months later none had miscarried. There were seventeen women in the placebo group who became pregnant, and two months later two of them had had miscarriages. (In general, 10-20% of pregnancies end in miscarriage).
• There was a now-debunked(by numerous experts) article claiming that the COVID-19 vaccine could cause infertility in people with ovaries because the vaccine would cause the body to attack a protein that’s crucial to the formation of the placenta (the organ that provides a fetus nutrients during pregnancy). Though this important placental protein and S protein produced by the COVID-19 vaccine have similar biological functions (they both cause membrane fusion), they are not related, nor are they structurally similar enough for a vaccine targeting one to affect the other. Read reproductive endocrinologist Dr. Lora Shahine’s take on this for more info.
• According to ASRM, “Patients undergoing fertility treatment and pregnant patients should be encouraged to receive vaccination based on eligibility criteria. Since the vaccine is not a live virus, there is no reason to delay pregnancy attempts because of vaccination administration or to defer treatment until the second dose has been administered.”

 

Is it safe for women who are pregnant in their 1^st trimester?

• We do not have sufficient evidence to definitively say that it is safe to be vaccinated during pregnancy or breastfeeding because pregnant and breastfeeding people were not included in the studies. However, we have no data to show that it is unsafe, and other vaccines are safely given to pregnant and breastfeeding women on a regular basis.
• We do know, by contrast, that COVID infection can be severe in pregnant people (in fact, pregnant women are 5 times more likely to end up in the intensive care unit (ICU) or on a ventilator than COVID patients who are not pregnant.) CDC guidance is that there is insufficient evidence to comment on pregnancy and breastfeeding specifically, and that pregnant and breastfeeding patients can choose to be vaccinated if they would like.
• ACOG specifically recommends that the COVID vaccine not be denied to pregnant patients and should be offered to breastfeeding patients, and that while patients should be able to discuss vaccination with their provider, they should not be required to do so before getting the vaccine, if they choose to do so.

 

Research about the vaccine for pregnant and breastfeeding women?

• Clinical trials did not include pregnant women (d/t fear of injuring fetus or threatening pregnancy)
• Not enough data to gauge whether they are safe for pregnant or lactating people
• DART animal studies
  • Moderna has completed animal studies the FDA demanded of manufacturers; these studies look for evidence that the vaccine might harm the pregnancy or the developing fetus. The company said it saw no such signals.
  • Pfizer has only interim data from its animal studies, but said it saw no concerning signs either.
  • According to a recent statement from the Academy of Breastfeeding Medicine (ABM), it is likely that the antibodies created in response to the COVID-19 vaccine would transfer into breast milk, providing the baby with these antibodies and strengthening their ability to counter COVID-19 if they were exposed. Some initial studies based on small samples do indeed find COVID-19 antibodies in breast milk of people who previously had the virus, though we’re still waiting on data on how those antibodies may (or may not) protect and affect breastfeeding babies.
  • More generally, of all commonly administered vaccines, there are only two that the CDC recommendsholding off on while breastfeeding — the smallpox and yellow fever vaccines, both of which contain a weakened version of the actual virus (unlike the mRNA COVID-19 vaccines, which don’t contain any trace of live virus).

If you are pregnant and considering, here are some other questions of relevance:

1. What is the level of community spread in your area? Check out this resource from Johns Hopkins (which is updated daily) to get an idea of community spread in your county.
2. Does your job or lifestyle put you at higher risk of contracting COVID-19?For example, it is more important for essential and frontline workers who may have to interact with people on a day-to-day basis to get vaccinated because they may be at higher risk of contracting COVID-19.
3. Do you have any health- or lifestyle-related risk factors that put you at greater risk for severe illness if you were to contract COVID-19? People who have heart conditions, diabetes, a higher body-fat percentage, type 2 diabetes, and who are immunocompromised are at greater risk for severe symptoms of COVID-19 if contracted and may benefit more from getting vaccinated.
4. How do the known side effects of the COVID-19 vaccine compare to the potential side effects of the virus? Though roughly 30% of COVID-19 cases are asymptomatic (i.e., there are no noticeable symptoms), 70% of people will experience symptoms — and these symptoms are similar to or more severe than the known side effects of the vaccine.
5. Finally, how are you personally weighing the lack of concrete data on the effect of the COVID-19 vaccine and fertility against the recommendations by trusted health institutions suggesting there is likely to be no evidence of an effect?Some people are comfortable trusting reputable health institutions to guide their decision-making, while others may prefer to make decisions based on data they can evaluate themselves.

this decision tool may be helpful.

What are the benefits?

1. COVID is dangerous. It is more dangerous for pregnant people.

• COVID patients who are pregnant are 5 times more likely to end up in the intensive care unit (ICU) or on a ventilator than
  COVID patients who are not pregnant.
• Preterm birth may be more common for pregnant people with severe COVID.
• Pregnant people are more likely to die of COVID than non-pregnant people with COVID who are the same age.

2. The mRNA COVID vaccines prevent about 95% of COVID infections.

• As COVID infections go up in our communities, your risk of getting COVID goes up too.
• Getting a vaccine will prevent you from getting COVID and may help keep you from giving COVID to people around you, like your family.

 

Some quotes from pregnant physicians!

• We know COVID can be terrible in pregnancy, and we know the vaccine doesn’t contain live virus. I’m approaching my third trimester and I work on the front lines of this disease, so for me the choice is clear, I intend to be first in line as soon as they will let me have one. (Pregnant Emergency Department Doctor)
• I am a little nervous about getting something that hasn’t been tested in pregnant patients. Early pregnancy is a nerve-wracking time, even without the unknown of a new vaccine. So, I went over the risks and benefits of getting or not getting it as a front-line worker – with myself, my partner, and my doctors. We ended up deciding I should get the vaccine. (Pregnant Emergency Department Doctor)
• I’m 34 weeks and I’m going to try to get vaccinated after delivery, but during pregnancy I’m holding out. Pregnant people were excluded from the studies and, in the meantime, I don’t see COVID patients at work so I feel like my exposure will be low during this second wave. (Pregnant physician)
• I am still breastfeeding my baby, and I think the risk of exposing my infant and other children and partner to COVID is far greater than any theoretical risk this novel vaccine may have. I’ve decided to get vaccinated whenever it becomes available. (Breastfeeding OB/GYN Doctor)

 

Resources

• COVID-19 Vaccine FAQ from New England Journal of Medicine – https://www.nejm.org/covid-vaccine/faq?cid=DM108101_&bid=351647437
• An mRNA Vaccine against SARS-CoV-2 — Preliminary Report – https://www.nejm.org/doi/full/10.1056/nejmoa2022483
• Adenovirus as vaccine vectors: https://doi.org/10.1016/j.ymthe.2004.07.013
• CDC overview of mRNA vaccines: https://www.cdc.gov/vaccines/covid-19/hcp/mrna-vaccine-basics.html
• More detailed review of mRNA vaccines: https://www.tandfonline.com/doi/full/10.4161/rna.22269
• NEJM 12/9/2020 review of Pfizer vaccine https://www.nejm.org/doi/full/10.1056/NEJMoa2034577?query=RP
• https://modernfertility.com/blog/covid-19-vaccine-pregnant-ttc-fertility/?utm_source=drip&utm_medium=email&utm_campaign=COVID+vaccine%2C+TTC%2C+and+pregnancy%3A+replay+%2B+resources&utm_content=COVID+vaccine%2C+TTC%2C+and+pregnancy%3A+replay+%2B+resources
• https://time.com/5925074/black-americans-covid-19-vaccine-distrust/
• https://www.usatoday.com/story/opinion/voices/2021/01/12/african-americans-black-race-health-care-covid-19-vaccination-column/6622889002/
• https://www.apmresearchlab.org/covid/deaths-by-race
• https://theundefeated.com/features/half-of-black-adults-say-they-wont-take-a-coronavirus-vaccine/
• I WOULD ALSO HIGHLY RECOMMEND FOLLOWING @KINGGUTTERBABY on Instagram! She is an infectious disease researcher and posts lots of amazing information on her page! Her Venmo is @laurelbrose if you find this information useful.
• See here for complete FDA analysis of the Pfizer and Moderna
• See this table from the WHO or this Covid Vaccine Tracker from the New York Times and this Covid Vaccine Tracker from Bloomberg.