“Wait and See”… for What?
Why It’s a Good Idea to Get Your Child Vaccinated (Now) against COVID-19
Many parents are taking the “wait and see” approach to getting their children (or themselves) vaccinated against COVID-19. At first glance, “waiting and seeing” seems like a reasonable idea. After all, earlier vaccines were developed over a much longer period of time and tested much more extensively than the COVID vaccines before being offered to children, right?
Surprisingly, no.
Let me tell you a story about measles.
How bad was measles in the United States in the early 1960s? There were about 400,000 cases of measles in the United States each year and about 400-500 deaths. About the same number of kids were dying of measles in 1962 as are dying of COVID in 2021.
(While many people will say, truthfully, “it’s just a few hundred kids,” COVID represents one of the top ten causes of death among kids in the United States today.)
The Measles Vaccine — A Slow Process
Measles was a serious problem, and researchers hoped to create a vaccine. In 1958, after years of effort, they were able to culture a weakened version of the measles virus, and this “live” (but weakened) virus went into the the first measles vaccine, which was tried on 11 kids.
None of the kids got measles, but nine of the kids got a measles-like rash. The scientists decided the weakened virus wasn’t weak enough. They went back to the drawing board to weaken it some more.
In 1960, 23 children received a more weakened version of a virus, and when a measles outbreak came to their school six weeks later, none of the 23 kids got sick with measles, leading to the recommendation of full clinical trials.
Later in 1960, about 300 children had received the vaccine but the trials were slow to get into full swing, partly because “Simple and effective means must be found whereby the activity of the virus can be preserved under ordinary conditions of distribution and use.”
The length of time it was taking was not a “wait and see” problem — it was a technological problem of keeping the weakened virus “alive.”
Technology: The Limiting Factor
Trials were slower in the mid-20th century for a whole host of reasons, some of which are pretty obvious: Not only did you have to keep a weakened virus alive and stable, you had to communicate with other researchers on paper, by mail. Your data was typed out —carefully! — and proofread, each time you shared it: there was no cut-and-paste, and there were no shared documents. Calculations were done by hand. Today, information and entire databases are shared instantly around the world, and the statistics are run quickly and accurately by computers.
Everything is faster in the 21st century. Whereas it took years for scientists to learn to culture a virus in the 1950s and 1960s, we had the entire genome of SARS-CoV-2 within days. The methods and the limited knowledge scientists were working with in the mid-20th century seem primitive by today’s standards.
Nevertheless, obstacles were overcome, and by 1962, thousands of kids had received the measles vaccine in clinical trials (just as today, thousands of kids have received the COVID vaccine in clinical trials) — enough to conclude that the vaccine was safe and effective. It was licensed immediately thereafter, in 1963.
Was there concern about long-term effects? No, there was not.
Was there “waiting and seeing” once they found the vaccine? No, there was not.
Back then, it took several years to find a safe and effective vaccine for kids. That’s not the same as finding one, and then “waiting and seeing” several years before you offer it.
But Why Doesn’t “Wait and See” Apply to Vaccines?
Everyone’s familiar with the long-term dangers of drugs, and probably most people know at least one person who’s had a bad experience with the long-term effect of a drug. Taken over time, some drugs can cause organ damage, toxicity, cancer, birth defects, dependence, and so on.
But vaccines don’t work the same way.
In the history of vaccines, if you have a bad effect, it crops up right away within a few weeks – it doesn’t happen 5 or 10 years later. Click here for a two-and-a-half minute summary and explanation of why that is. (Antibody-dependent enhancement, the exception that proves the rule, is not a concern with coronaviruses. Click here for a two-minute explanation why.)
Vaccines simply don’t have “long-term effects” in the same way drugs do.
That’s not happened in the history of vaccines. Ever.
The scientists who developed the measles vaccine took years to find a vaccine that was safe and effective with their clunky slow technology, but they offered it immediately, and parents used it immediately, too.
We’ve been using substances to train the immune system for hundreds of years. Smallpox inoculation goes back to at least the 1700s in Europe; and mRNA vaccines were being developed by Moderna as early as 2010, and by BioNTech as early as 2013. (That’s one reason, along with existing vaccine research for the original SARS and MERS, that a vaccine could be created so quickly.)
With the mRNA vaccines in particular, no “long-term effects” were expected, nor have any been discovered. Again, that’s just not how vaccines work.
Why Not “Wait and See”?
Back to our measles story:
By early 1966, about 12 million kids had received the measles vaccine, and annual cases had fallen to about 250,000 a year. That was not exactly an overnight miracle, but it made a difference, and it saved lives.
But wait a minute — 250,000 cases a year?
Did everyone get upset in 1966 when measles wasn’t immediately gone? No.
Did they say, “Everyone can count on getting measles, so people just need to learn to live with it”? No, because while it was true in 1966 that just about everyone could still count on getting measles, scientists also knew it would not be true in the future, if they continued vaccinating kids, year after year.
Did they say, “Only a few people die of measles anyway. Let’s focus on just the most high-risk people to vaccinate?” No, that’s not how infectious disease outbreaks are controlled. You vaccinate everyone you can. You give the virus nowhere to go.
Did they say, “Look at all these cases still! The vaccine doesn’t work! Herd immunity can never be achieved”? No, because that’s not how it works, either. Vaccine programs don’t work overnight.
The takeaway points, demonstrated by earlier vaccination programs, are
We win this game only if we all play.
The more quickly we act, the more quickly we get the disease under control.
By 1970, there were only 47,351 cases of measles and 89 deaths in the US. And in recent years, in the 2000s, with persistent vaccination of nearly everyone, we’ve had many years in which there were fewer than 100 cases and no deaths. A “bad year” for measles (like in 2019) is one in which we have more than a thousand cases. Compared to 500,000 cases, even a “bad year” looks pretty good, thanks to vaccines.
Measles, a more contagious virus than even the delta variant of SARS-CoV-2, is essentially gone from the US. Today’s parents don’t have to settle for “just a few hundred” kids dying of measles every year.
Why? Because of a lengthy, prolonged effort to vaccinate virtually everyone who was medically able to have the vaccine.
An effort that parents worked together to achieve.
An effort that no one turned into a political litmus test — it was too important to be politicized.
It takes time to get there. If parents “wait and see” — if they exercise caution, on the basis of no evidence — pandemic control, which is already taking years to achieve, will be prolonged.
The safety and efficacy of the vaccine are established, not just in clinical trials (the Phase 2/3 Pfizer trial on 5- to 11-year-olds included thousands of kids, similar to the early measles vaccine trials) but also by the more than 7 billion doses administered worldwide to adults and older kids.
As a parent in 1963, you were asked to vaccinate your kid against measles based on thousands of kids who were recently vaccinated with a live virus. That’s kind of scary.
As a parent in 2021, you are asked to vaccinate your kids against COVID based on thousands of kids — and, quite literally, billions of other people — who were recently vaccinated with a much safer type of vaccine.
Parents have never had so much available data before being asked to give a vaccine to their kids.
For what? How about for an improved vaccine. Why accept version 1 when doing so confers antibodies for a strain that has, per your recent post on lab leaks, been reengineered twice. The effectiveness of the current vaccine is also debatable. You might say that since it offers some protection its better than nothing, and if you believe that “Vaccines simply don’t have long-term effects…” then I can understand that position. But vaccines do have long term effects. The antibodies they confer stick around for a lifetime, and the first antibodies you get for a particular infection are of particular importance. There is a paper written by Thomas Francis JR, MD in the 1960s called ‘More on Original Antigenic Sin’ that describes just how consequential that first infection or vaccine is. In the paper he states that “The antibody of childhood is largely a response to the virus causing the first Type A influenza infection of the lifetime. As the group grows older and subsequent infections take place, antibodies to additional families of virus are acquired. But the antibody which is first established continues to characterize that cohort of the population throughout its life. The antibody forming mechanisms have been highly conditioned by the first stimulus, so that later infections with strains of the same type successively enhance the original antibody to maintain it at the highest level at all times in that age group. The imprint established by the original virus infection governs the antibody response thereafter. This we have called the doctrine of original antigenic sin.” Considering all of that I still support vaccines, but don’t think its fair to treat all vaccines as equal. It is possible for a vaccine to miss the mark on the imprinting of the virus, and handicap all future immune responses for that virus if it serves as the first exposure. In cases where we are seeing rapid, unexplained, and unprecedented changes in strains of SARS2, that is a real possibility. I hope that a vaccine can be developed that accounts for these things but I have a hard time believing the current vaccine has cracked the code. I was willing to take the chance personally, but I have found it hard to come to the same conclusion for my children. So I think I’m going to wait. Not because I think the vaccine is unsafe, but because I’m not convinced it’s a good candidate for original antigenic response for the rest of their lives.
More on that topic can be found on another substack here: https://eugyppius.substack.com/p/more-on-original-antigenic-sin-and
Respectfully, I disagree with the statement that the mRNA vaccines are safe. The original vaccine safety papers from Pfizer and Moderna show more severe outcomes for the vaccine than the placebo group. "Severe outcomes" means "severe adverse events" or "severe COVID-19", which are both defined by the FDA who carefully standardize their terms. The trials were too small to show a statistically significant signal in any direction for more serious things like critical illness/events or death, but the signal for the weaker category "severe" shows the opposite of safety.
More details: https://norstadt.substack.com/p/severe-adverse-events-vs-severe-covid