Better days are coming... perhaps... maybe...
Vaccination is happening! Gradually, starting with my parents a few months ago, my family and friends are getting their shots.
On a Tuesday at the end of March, I got my first dose of the Moderna vaccine. Then four weeks later my second. As of May 10 I am considered fully vaccinated!
My appointments were at a mass vaccination center about 25 miles away set up by Sutter Health where I am a patient. Sutter Health is a 'not-for-profit integrated health delivery system', a mouthful for basically what feels like the national healthcare systems I've experienced in Canada and the UK, but instead is fueled by the private health insurance quagmire that is American healthcare.
As I drew near on that first time in March I was feeling quite blasé about getting vaccinated. But as I started following the avenues of orange cones and digital displays signposting the way to the vaccine center, a tingle of surreality kicked in. I've done a few drive-through COVID tests in the last year and these mass procedure sites have always felt a bit surreal. It is a reality check-point for sure, and I realize that often I've been been kidding myself that this pandemic isn't really happening. But when I'm driving through the lines of cones leading to white canopies in parking lots dotted with people in gowns, face shields, and masks it all sinks in. It really is happening. This is not a movie set for some sci-fi disaster movie.
The vaccination site was clearly set up to process a LOT of people. A sprawling convention center surrounded by massive parking lots has been converted into a vaccination site for several different health providers. But back in March the Bay Area was experiencing an acute shortage of vaccine and so it was quite hard to get an appointment. The huge parking lot held just ~20 cars. I was quite surprised to get this appointment. When I first tried to schedule an appointment a week before the only availability was at a site 100 miles away, but I kept checking back and got lucky.
Once parked I had to pass through several checkpoints to prove I did have an appointment, hadn't already had the vaccine, and didn't have COVID symptoms (I think I could recite the questionnaire off-by-heart by now, "In the last 48 hours have you experienced fever or chills, cough, shortness of breath, headache, new loss of taste or smell...").
As I progressed through the checkpoints I was still feeling blasé but then I encountered this 'floor art' in my path and was surprised to find myself welling up:
"Welcome! You are moments away from making history. Your journey starts here."
This is America after all where everything, even healthcare, gets Disney-fied. Coming from two national healthcare systems (the UK and Canada) I still find it bizarre and amusing how much the American 'not-for-profit integrated health delivery systems' care about your 'customer experience'. And shocked by how much money and time gets wasted on non-health stuff. Every doctor's appointment or lab work is followed up with a customer service survey. I've even received thank-you cards following procedures - signed by all the staff and doctors! It feels totally crazy and a bit... ghoulish... to get a thank-you card for being sick. I was talking to a friend today in Minnesota whose health provider, at the height of the pandemic surge in December, sent her one of those adult relaxation colouring books and pencil crayons. It came with a card of 'Pandemic Tips' - the usual reminders for how to stay safe and well during the pandemic, social distancing etc. etc., but it ended with the macabre recommendation to 'Get your affairs in order'!
While I think the actual standard of health care I've received in the UK, Canada, and the US have all been similarly excellent, the crazy thing is that sometimes the schmaltzy customer care works. As I walked past the floor signs on my way to get my vaccine, I suddenly did feel part of this huge amazing scientific experiment and marvelled at the achievement of a vaccine being produced so quickly. Our journey out of COVID-19 was starting here!
Until now the fastest vaccine to be developed was the mumps vaccine in 1967, which took four years. Typically vaccines take 10-15 years to develop, largely because the final phases of human testing trials require thousands of participants who could potentially contract the disease. There is a strange beauty in the fact that the very prevalence of COVID-19 that made the vaccine development so vital also accelerated data collection in the final-stage human clinical trials.
The rapid development of the COVID-19 vaccines is also because of unprecedented collaboration across the scientific community and vast amounts of funding from governments around the world. In the US alone, 'Operation Warp Speed' has a budget of $9 billion for vaccine development and production. So far, Moderna, for example, received $1 billion for vaccine development and $1.5 billion for production of 100 million doses. Currently all vaccines are free in the US irrespective of a person's health insurance status. As I was looking into the cost of the COVID-19 vaccine development I found an article in the Lancet from 2018 that surveyed the history of vaccine development and in summary stated "In general, vaccine development from discovery to licensure can cost billions of dollars, can take over 10 years to complete, and has an average 94% chance of failure." Thank goodness only one of those three generalizations proved to be true for COVID-19.
[A quick aside - $1 billion sounded like a lot of money but I've since learned that the recent expansion to double the footprint of a local mall cost $1 billion! The expansion was finished during COVID and is now sitting empty. I recently saw an estimate that it would cost $25 billion to vaccinate the world against COVID. Sounds a lot, but not when you think of it as just 25 useless mall expansions! ]
We have vaccines for some of the most common diseases such as diphtheria, Hepatitis A and B, measles, meningitis, mumps, whooping cough, polio, rubella, tetanus, TB, and yellow fever. But even with the fancy new gene-editing methods there are still no vaccines for many tropical diseases and parasites such as malaria, chagas, and hookworm. After 30 years of research there is still no HIV/AIDS vaccine, nor a universal flu vaccine.
So the achievement with COVID-19 really cannot be overstated. Worldwide, 13 vaccines are now in use against Covid-19, with 67 more in clinical trials.
At some point I would like to try and get a handle on how these mRNA vaccines work (Pfizer/BioNtech and Moderna) but for now here's the basic history. The journal Nature has a now outdated (2018) but very readable article here. (Incidentally I'm sure there are lots of current articles explaining the history but I do get a ghoulish pleasure from reading these pre-COVID articles that have sentences like "[mRNA vaccines] provide great optimism for future responses to emerging viral epidemics." No kidding!)
The first successful transcription of animal mRNA (transcription is the copying of a gene's DNA sequence to make a new messenger RNA (mRNA) molecule) was in back in 1990, inspiring a new branch of academic and commercial research that blossomed over the next two decades. Early research showed that mRNA vaccines had the promise of several benefits over other types of vaccines: (i) the are thought to be very safe since they are completely non-infectious and easily broken down in the body by normal cellular processes; (ii) they seem to be very effective since special modifications were developed to make the mRNA very stable and allow for rapid uptake in the body. Additionally, the body does not become immune to mRNA so mRNA vaccines can be given repeatedly; and (iii) mRNA can potentially be made rapidly, inexpensively, and at scale. Interestingly, as well as research into animal models of vaccines for the flu, Zika, rabies, and others viruses, a promising area of research was for mRNA cancer vaccines. I didn't even know that vaccines for cancer was a possible concept! Adverse side-effects were a problem in the initial research but over the last few years there was optimism following several major breakthroughs in the understanding of RNA biochemistry and innovation in techniques and technology. The research and technology development were getting to the point where actual real-world use might be a possibility.
Two main companies were emerging at the forefront of pushing for real-world vaccines. BioNTech was founded in 2008 and focused mainly on personalized cancer approaches using mRNA vaccines. Moderna was founded in 2010 and by 2018 had advanced to carrying out clinical trials on a mRNA Zika vaccine.
But until COVID-19 no mRNA vaccine had ever been licensed for use in humans.
On December 2, 2020, just seven days after the end of the final Pfizer-BioNtech clinical trial, the UK became the first country in the world to approve an mRNA vaccine.
Time will tell if the full promise of mRNA vaccines is realized - so far they appear to be astonishingly safe and effective and it is clear they can be developed rapidly to respond to pandemics and manufactured at scale. They aren't cheap though with the Moderna at $20, Pfizer at $35 compared to the Astra Zeneca vaccine that uses a more traditional viral vector method and costs $2-$5. Recently, Pfizer announced that its vaccine has generated $3.5 billion in revenue in the first three months of 2021.
Other fun facts I learned on my way to get the vaccine:
While you wait, choose a song to add to our vaccination playlist!
While you wait, meditate:
- I want this pandemic to end!
- I'm going to beat CANCER!!
- I want to keep myself and my family safe for my wedding (that’s now been rescheduled three times!)
- I want to help us achieve herd immunity
- of fear
- it’s the right thing to do
- as a healthcare worker, I wanted to keep my patients and my family safe
- of family. I have small grandchildren, a sick mom in a home, and my son and husband are police officers
- of healthcare workers. They've helped us through 2020, it's time to give back.
- I’m a high-risk healthcare provider
- health is the most important thing in life!
- I’m a child of an elderly parent
- I almost died of COVID this summer. So this vaccine is a godsend
- I am 73 and a breast cancer survivor
- I am 75 years old and not crazy
- I am 75 years old and want to keep living
- I am 84 years old and my son is very concerned about my health
- I am a healthcare provider with lots of exposure and my wife has an autoimmune condition
- I am an immunologist by training and believe 100% in the power and importance of vaccinations to stop spread if this pandemic. I want to avoid this awful disease and I will feel a lot more comfortable going out and eventually traveling again once I am immune
- most of all, I want to be a part of the effort to bring this pandemic under control so our country can return to what will be a “new normal” with family, friends and society as a whole!
- I'm healthy and wish to stay that way
- I'm my husband’s caregiver, he is on dialysis waiting for a kidney transplant
- I needed to make sure I was safe around my mother, who has stage 4 cancer
- I want to be able to spend time with family, friends and enjoy museums, musical and theater again
- I am 73 and a heart patient and Covid will kill me if I get it. I have been on lock down and in isolation for a year. I lost 2 part time jobs and have been isolated from my family and friends.
- I want to see my kids, grandkids, friends - go to restaurants, enjoy baseball, get back to as normal as possible
- I want to be part of the cure and to travel!!
- I am 65 years old and have been shelter in place for close to a year. I cannot wait for the 2nd vaccine so I can see my family - siblings, children and grandchildren.
- I want to eliminate the fear of dying from COVID-19 from my thoughts.
- I want to live long enough to have grandchildren and write a few novels.
- I want to protect my kids & grandmother as much as possible.
- I want to protect my medically fragile child, myself and my community
- I want to live! Now! I drove 150 miles because this was the closest location with the supply. But the experience was worth the trip. Thanks, Sutter!
- I work at a COVID testing lab
- I teach First Grade and I hope I can someday be in my classroom without fear. Thank you for my vaccine.
- It was my turn and I want to see my kids, grandchildren and great grandchildren some time soon
- I’m a senior with underlying health condition & I want to protect myself from getting Covid19. And also so I can visit my kids & grandkids. I also would like to start traveling so I can enjoy my retirement.
- I am not an idiot
- Que mi vacuna para mi proteccion
- I want our nation to rise up and beat this virus together and to hug my family and friends again.
- Death bad.
Then before I knew it I was driving home singing along to the vaccine playlist (I added the song Better Days by Ant Clemons featuring Justin Timberlake )
A few hours later I got a text asking me to fill out a questionnaire about side effects. I felt fine apart from a slightly sore arm and annoyance that I was feeling guilty about getting the vaccine before other people (funnily enough there was no check box for that side effect!).
I had discovered almost by accident that I qualified for early vaccination in California due to a medical condition and after some ethical dilemmering I decided that taking advantage of this was the right thing to do. Bizarrely a few weeks earlier my parents in the UK were receiving letters inviting me to get vaccinated (during a visit to the UK I went to a doctor and now that doctor's office seems to think I live in the UK). In the UK Mr Husband would have also been vaccinated since the system there sensibly vaccinates family members of people with qualifying medical conditions.
Apparently vaccine guilt is a common thing and once I'd been vaccinated and was telling people about my experience I discovered that two friends had already been vaccinated and were hiding the fact since they also felt guilty! One had got the vaccine in a similar way to me - she looks outwardly healthy but has a qualifying medical condition. The other had got it through slightly dodgy means - her sister-in-law had a friend who was a pharmacist who was using up vaccine at the end of the day to vaccinate family and friends.
The kids were very happy that the adults around them were being vaccinated. Many of their teachers were talking in online school about getting their shots (in California teachers were prioritized starting in February). For the kids the idea that they might not kill their teachers or parents through the simple act of going back to school was a... relief! Such wild times we live in!
On April 9 our county announced that the Pfizer, Moderna, and Johnson and Johnson vaccines would be available to anyone over 16 in California. Suddenly all everyone could talk about was how to get an appointment - this being Silly Valley a slew of apps appeared overnight to help find slots. Suddenly all those the empty mass vaccination sites were full to capacity with long lines. Mr Husband found an appointment on April 14.
At that point our COVID case numbers were still pretty high - the county seemed to have plateaued around 125/day. This translates to around 6 per 100,000 per day which was a huge drop from the high of 110 per 100,000 per day in January but still not great. But the effect of the mass vaccination was pretty incredible. This graph below shows how in mid-April cases in our county started to steadily drop, and a month later the number of deaths also began to fall.
On May 10 the Food and Drug Administration approved the Pfizer vaccine for children aged 12-15 and two days later the Centers for Disease Control and PRevention (CDC) gave the final approval. All the parent chat groups lit up with how and where to find your teen a vaccine appointment. Simultaneously the World Health Organization issued a statement saying that wealthy countries should send vaccine to developing nations rather that vaccinate their kids. More ethical dilemmering but we decided to get ThingOne vaccinated and signed him up for a vaccine clinic held at his high school on May 15. ThingTwo is too young for the time being.
Driving up to ThingTwo's high school that Saturday morning we encountered some of the anti-vaccine sentiment we'd heard about in the news. I was surprised and shocked to see this in California, and even more so in Silly Valley. But there are crazies everywhere I guess. But still, it was a depressing sight to see the eight or nine people with placards at the school entrance.
The placards had bizarre inaccuracies saying, for example, that 'mandatory vaccination is illegal'. Currently I don't think any country has made vaccination mandatory, certainly not the US.
To date, about 162.5 million people (~61% of the population) in the US have received at least one dose of a COVID-19 vaccine, including 129 million people who are fully vaccinated. President Biden has set a goal of reaching 70% by July 4. The initial hysteria to get appointments has died down and long lines at specialized vaccine sites at stadiums and convention centers have disappeared. These sites are closing and the vaccine is now available at most local pharmacies. Some regions across the country have almost 95% of their over 65s vaccinated! Despite a lot of bluster by conspiracy theorists and Republican politicians, a lot of people are getting vaccinated. White, male Republicans remain a major hold-out in resisting the vaccine, due in part to Trump taking so long to publicly endorse the vaccine despite being secretly vaccinated back in January. Unfortunately, experts say that vaccination hesitation means the US as a nation will likely never achieve the golden 'herd immunity' where the transmission of the virus disappears due to a mix of vaccination and immunity through past infection. So there will likely continue to be outbreaks. One very depressing article said that COVID-19 could take decades to disappear. But let's not think about that.
Locally, here in Silly Valley, the mood is optimistic. "Santa Clara County’s vaccination rate is among the highest in the nation, with more than 75% of county residents 16 and older having received at least one dose of vaccine and 60% fully vaccinated (May 19 2021 SF Chronicle)."
In the past few days new the government has issued new guidance for people who are vaccinated vs. unvaccinated. The main message being that vaccination = freedom from masks and social distancing when you are with other vaccinated people. I think the idea was to provide an incentive for more people to get vaccinated. But the reality is that now there is a new confusing honour system to navigate. Is that person not wearing a mask because they are vaccinated or because they think mask wearing violates their First Amendment rights and vaccines are a secret conspiracy to micro-chip their children?
And so begins yet another strange new phase of this pandemic.
Last night we celebrated the generally optimistic state of affairs with a glass of wine with some fully vaccinated friends. We sat outside and gingerly removed our masks. These are friends we met last summer and I realized I'd never seen these people without masks. It was nice to get to know their faces.
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