I.
I mean this now, as I type. I’m starting this post in ignorance.

Last week was Dad’s 74th. My dad doesn’t really talk on the phone. After annual birthday calls home, my partner is always shocked when I hang up after a minute. Sometimes Dad and I don’t last the whole minute. My sisters and I had planned to FaceTime together with him, because corona. We joked in advance: Well, this won’t take long.

After the initial pleasantries, Dad talking about how many miles he logged at work that day (he got his first smartphone in October), Jenny asked us all a question: If the vaccine were available tomorrow, would you take it?

Jenny works at a medical office. She’s the frontline worker of the frontline workers, in a sense, meeting the people who come into the clinic for care, some of them knowingly infected, with positive test results. She’s the most careful person I know about avoiding infections. So we got where this question was coming from.

I said “No,” and shook my head. My dad said, “I would.” Jenny elaborated that she’d read the vaccine would be given to healthcare workers first, and she wasn’t sure whether her employers would require her to take it to be allowed into the office. She was half curious and half looking for advice. Dad asked me why I said no, and I said something along these lines: It’s been rushed to the market by an administration we all know we can’t trust to provide sound medical guidance. The sample sizes of the tests haven’t been large enough, and we have no idea what the longterm effects are.

Shani was unsure, but she pointed out that she probably won’t even get access to a vaccine any time soon, so luckily doesn’t have to make the decision. Jenny said, “Yeah, it’s interesting,” and then with the topic she’d provided exhausted, we ended the FaceTime, text-joking with each other afterward about how long we actually got to talk with Dad this time.

II.
Growing up, our hometown paper was the Washington Post. These days, it’s a wreck, an Amazon property that knows to put the name Trump in every headline, whatever the costs, in order to garner the clicks it needs to turn enough of a profit for Jeff Bezos. The day before we FaceTime’d with Dad, I saw a WashPo headline that read: “Trump will soon leave the White House. How long before he stops dominating the conversation?” It was classic post-Amazon Post: performing befuddlement and prim-faced rage at Trumpism while never owning up to its role in helping to elect the man and keep him at the forefront of every American’s ailing imagination.

But I digress.

Like many newspapers, the Post has published its coronavirus reporting in front of its paywall, free to anyone. I was reminded of this the other morning, scrolling through the app on my phone, full of hate once again that I had another day of sitting at home to look forward to. “What you need to know about the AstraZeneca, Moderna and Pfizer vaccines” read one headline.^[*] I tapped on it and started learning what I didn’t know. I let the newspaper’s expert reporting transform my ignorance into something else.

III.
What I learned I’ll get to in a bit, but I want to point out what I realized a little later that morning, a new understanding of how Trumpism’s continuous lies and propagandistic control over state (and especially public health) institutions works: My distrust of this virus’s safety wasn’t my own idea. I had been made to feel that way.

When the administration stripped authority from the CDC and gave it to HHS, I saw we couldn’t trust CDC data, and from there I posited that we couldn’t trust their guidelines. This wasn’t the fault of the good people at the CDC, of course, it was the fault of our administration. But note how fault doesn’t matter in this instance. I learned what I was meant to learn: government institutions can’t be trusted.

When you can’t trust anybody, you trust only yourself (and good luck holding on to your relationships with others). When you don’t think critically about your sources of information, believing untrue things feels smart and mentally healthy, because you trust yourself that you’ve—let me stop using the 2nd person. I trusted myself that I had a healthy and useful skepticism about anything this president has ever said, such then when I read, in 2020, that vaccines may be ready as early as this month, I think, Not my vaccines.

Turns out this is a known and reported-on problem with Trump’s talking:

When I put what I knew I knew about the vaccine up against what I knew I didn’t know, it was no contest. That my ignorance initially felt to me like wisdom is why I’m glad this misinformed era is (hopefully) coming to an end.

IV.
As a person who’s never had a reason to distrust a vaccine I was given, I have 4 questions I need to answer:

1. How is this virus different from other viruses (e.g., HIV, polio, SARS, influenza)?
2. How are these vaccines different from other vaccines (e.g., polio, influenza, mumps, HPV)?
3. How have the trials for covid-19 vaccines been run differently from other trials?
4. What are the known or unknown dangers of getting the vaccine?

How SARS-CoV-2 is Different
Well for one, the spike-shaped proteins that form the “corona” of the coronavirus “interact with receptors on cells like keys in locks, enabling the virus to enter,” says the Post. That is, it’s stickier than most viruses—all of which seek to replicate themselves in other cells. Two: the spikes are coated in sugars the way healthy human cells are, making it seem safe and familiar to other cells. Three: it differs from most respiratory viruses in how it can root itself both in the nose and throat, which makes it more contagious, and deep in the lungs, which makes it more deadly. Fourth: it famously begins replicating in the body before symptoms of the virus are present, making people contagious long before they know it.

Then there’s the issue of RNA replication, which has come up a lot in the little reading I’ve done on the vaccines. I don’t recall anything about RNA from biology class (which I took in ’93-’94 and got mostly B’s). From what I can understand, DNA is the genetic code used as instructions for creating/replicating essential parts of the body. DNA is stable and guarded. It’s like a master recording of a track you don’t want to fuck with. So, to transmit those instructions to other cells, there’s RNA, which are less stable copies but way more mobile.^[**] SARS-CoV-2 encodes its genetic material in RNA, like Ebola does, and the 1918 flu. RNA viruses don’t need to infect a cell’s nucleus (like DNA-based viruses do); they can replicate in the more easily accessible goo that floats around the nucleus.

So if you judge a virus based on outside-the-body optics, SARS-CoV-2 doesn’t seem too terrible. Most people get sick for a week and then get better. But if you know what viruses are and how they work, then CoV-2 is super scary. We all know this already, if not the biological specifics. This virus is serious. Wear a mask.

How the Moderna, Pfizer, and AstraZeneca Vaccines are Different
Well first, these 3 leaders in the race, so to speak, are different from each other. The AstraZeneca vaccine works like most vaccines: it “infects” the body with a harmless virus; theirs happens to teach cells how to make the spike protein to battle CoV-2. Moderna and Pfizer’s vaccines use RNA, and the Post tells me that, if approved, they’d be the first ever vaccines to use RNA transmission technology.

Which is the part that worries me. Which is why I spent all that time learning what the hell RNA is.

RNA vaccines seem to work the way RNA does in the body, but rather than carry our DNA off to other cells, it carries the replication instructions for the spike protein. What happens next is beyond my understanding. The Post has a diagram I can barely makes heads or tails of.^[***]

Vaccination seems to work a lot like stay-at-home orders do: the goal is to avoid overcrowding. If we avoid each other long enough so that enough ICU beds are always open, then the overall effect of the virus on a population is minimized—because anyone who gets sick can get tested, tracked, and the care they need not to die from the virus. Likewise, a vaccine (specifically the AZ one) delivers a small and manageable dose of a virus that does just enough to teach the immune system how to fight, so that it’s not overrun by CoV-2 should it appear.

These RNA vaccines seem to be able to teach the immune system what to do without infecting the body with a virus, even a benign one. Here’s how Forbes puts it: “Essentially, the body receives a target antigen — such as the coronavirus spike protein — despite the fact that an mRNA vaccine doesn’t itself contain the antigen.”

Which makes it feel safer, even though I don’t think there’s any science behind that feeling.

How the Trials are Different
The Post tells me that these vaccines were made so quickly because scientists had the genetic code for the virus before there were any actual cases in the country, but this is a stupid thing. Like: they had this info maybe 1 month before cases appeared, given that the genome wasn’t sequenced until 2020. The fastest we’ve ever had a vaccine produced and distributed was the mumps vaccine, and that took 4 years. So what’s happening this time?

Vaccines have 3 phases of clinical testing, and before any of these start, researchers test vaccines on animals to see if there’s any immune response. If so, Phase 1 tests the vaccine on 10-100 people, just to see if it’s safe in humans. Phase 2 expands testing to certain demographic or health groups to check for side effects and see if the vaccine acts differently in different populations. Phase 3 tests on “thousands of people”, as the CDC tells me, with a control group receiving a placebo, and then sees how many in the experimental group get the virus.

How long do these phases last for, I wonder? It must differ because I can’t find info on this in the Post, the NY Times, or the CDC’s website. But I do know that in September, the FDA announced that they’d require anyone looking for emergency authorization (i.e., distribution and administration of a vaccine before it’s gone through a formal application process) to provide follow-up data from 2 months after subjects receive the vaccine in full (most vaccines require 2 shots administered a week or two apart). Also, China and Russia have approved vaccines without waiting for Phase 3 results to come in.

We’ve got Phase 3 results. The FDA required anyone looking for authorization to show 50% efficacy, and we’ve got three vaccines whose Phase 3 trials show over 90% efficacy:

• Moderna’s RNA vaccine was bankrolled by the U.S. government to the tune of $1 billion. Its Phase 3 began in July with 30,000 volunteers, and on Nov 16, it reported results that showed 185 out of 196 cases of covid-19 among those 30,000 people came from control subjects—i.e., people who got the placebo. Moderna got $1.5 billion again from the U.S. to manufacture 100 million doses if it proves effective; they’ve made similar deals with other countries.
• Pfizer’s RNA vaccine was bankrolled by Pfizer and a German pharma company. They started Phase 2 & 3 trials together in July with 30,000 volunteers in the U.S. and other countries. (Moderna’s was all U.S. volunteers.) In October they got approval to test on children as young as 12, which brought the test size to 43,000 participants. They tried to get their results in before October, but they couldn’t, because of something key to note about vaccine trials:
  • Researchers do the math to know how many positive cases in the experimental group (who received the vaccine) they need to see to know its efficacy. Because the FDA demanded 50% efficacy, both Pfizer and Moderna set a buffer at 60%, which means that their Phase 3 trials couldn’t end until they had enough experimental group subjects present with coronavirus. All this was decided months before the election, so there was no rushing or delaying vaccines for political reasons. It was a waiting game, and by November (thanks to the surges over the fall) they had the results they needed. Pfizer showed that 162 out of 170 cases were from the placebo group.
• AstraZeneca’s vaccine started Phase 3 in the U.S. in August (a bit earlier in other countries) with 40,000 volunteers. But it’s unclear whether they’ve secured this many, or if any company has. There’s a target enrollment, but trials begin when volunteers are ready, and if you look at the study info, you’ll see the trial ends in 2022. So it remains unclear exactly how many test subjects there have been in any of these trials as of today, Dec 1. Anyway, AZ’s vaccine has had some safety issues, but not many, and the trials showed equal effectiveness among younger and older subjects. But the weird thing is that they found higher efficacy with a single dose (90 percent) and a lower one after the second dose (62 percent). Also: fewer than 3,000 subjects got that single dose, so the Times says the FDA is unlikely to approve.

In sum: the trials are different from previous vaccines’ trials because they’re still ongoing. Nothing about the makeup of each trial is different, it’s just that we don’t have a (relatively) large sample set, and we don’t have longterm data.

The Dangers of Getting Vaccinated
Well, there’s all the unknowns and the enormous scale of innoculation. As Scientific American reminds us, “One serious adverse event per thousand of a vaccine given to 100 million people means harm to 100,000 otherwise healthy people.” Though basically everywhere has pointed out that we don’t know how long any vaccine lasts, that’s not really a danger. We all (or we all should) get booster shots and annual flu shots, so I’m unbothered by this unknown.

There’s still the longterm effects question. We’ve only got about 10 weeks of data about what is going on in people’s bodies after taking the vaccine. It’s not a lot of time, but then again: what possibly could happen? This is where trust comes back in: I have to choose whether to believe the public health professionals approving vaccines are doing so because they know it’s safe.

The Times points out that vaccines are among the safest medical products in the world, given the thoroughness and rigor of their testing. Plenty of vaccines that look great in Phase 2 then fail in Phase 3, which is why the global scientific community is disregarding China’s and Russia’s vaccines. The UK approved Pfizer’s vaccine today. The EU is expected to do so soon. Good science transcends national borders. I know this. I know I’m not alone in my worry about new medical technologies, but I have to remember I’m also not alone. I’m out in the world, and this is one way the world is deciding—bit by bit—to protect ourselves.

V.
So I’m on board now, probably. I’ll echo Shani: I’m lucky I don’t have to make this decision for a while now. Long(er)-term data will be in by then. And it will be a decision: vaccines released under emergency authority can’t be mandated. But for now, I’d like to see slow but sure inoculations. Yes, healthcare workers should get vaccinated first, but also should the researchers and drug company executives who made the vaccine. It’s like that old movie trope, when a suspected poisoner also has a drink to show there’s no poison in it. Yes, double-crossings are also a movie trope, but this morning that’s the best trust exercise I can think of, and maybe every day we should all be thinking of ways to restore trust, in our institutions, our scientists, our public health officials, and each other.

There’s probably room in trust for skepticism, but that’s a question for another post.