COVID-19 Chapter 13: Vaccines, Take 2

happening in March and April. We only leave the house go to work in the store. We wear multi layer cloth masks every time we leave the house, we wash our hands, use hand sanitizer frequently, and we stop seeing anyone in person. Socially but not At the beginning of October, COVID still found us. It started off like a mild cold. My mom started experiencing mild fatigue and a cough. We were slightly worried, but trying not to read too much into it. I mean, we were being careful after all.

Within three days, though, I started having the same symptoms. Stepdad the day after me and my eighty seven year old grandmother. The day after him. We were still trying to not worry too much. I mean, colds are common and still happen even during a pandemic. That all changed, though, the night my mom decided to grill hamburgers. I realized we had a serious problem when I couldn't smell the charcoal, grill or cooking burgers. After that, we couldn't keep telling

ourselves it was just a cold. Over the course of the next week, all four of us were tested, and all four of our test came back positive for COVID. The second week of symptoms felt more severe, with more extreme fatigue and coughing, as well as headaches, body aches, and a loss of appetite. None of us really ran fever, with the exception of my grandmother for just one morning. She was struggling with dementia and wasn't eating or drinking enough.

My mom and I had to get her to drink fluids every hour to keep her hydrated and keep her fever down, and we had to make sure she was eating so she didn't get too weak. We meddled through well enough for a few weeks, feeling pretty crummy but managing. Around the end of October, We felt like we'd made it through the worst of things and we were starting a slow recovery process. My grandmother had even gotten a mostly clean bill of health from her doctor and was

getting up and walking around more. We really thought we were in the clear. Then at four o'clock in the morning on October twenty fourth, I heard my grandmother call out from my mom while I was on my way to bring her a drink of water. When I got to her, she was having difficulty breathing. She was still aware and talking, but she couldn't take air in properly. I ran to get my mom called an ambulance, and

within fifteen minutes she was gone. My mom, stepdad, and I are still experiencing mild symptoms from COVID two and a half months later. I personally still have shortness of breath, fatigue, trouble concentrating, and are destappetite. We're all still struggling with the fact my grandmother isn't here this year for the holidays. This is something no family should have to go through. But this pandemic only ends if we all do our part.

So please everyone, were your masks, wash your hands, stay safe, and save a life.

first visit. It took a minute to register that they would pay me. In late August, I went to my first appointment. They took a blood sample, gave me a pregnancy test and a COVID test, had me complete and sign an informed Consent form. I gave them my complete medical history, and finally they injected me with the vaccine

or placebo. They sent me home with the thermometer, a copy of the informed consent form, an emergency information card in case I have to go to the er during the study, and a swab test kit that I can administer myself and mail in if I develop symptoms and can't get tested right away. Three weeks later, at my second visit, they gave me another pregnancy test COVID nasal swab and a second injection, which was the same as the first. They administer either vaccine, vaccine or placebo placebo.

About a month after that, I returned from my third visit, during which they drew blood to check and to body levels. My fourth visit will be in March of twenty twenty one, and then I'll return for at least a fifth and a sixth visit over the next twenty months. This is an observer blind study, so they will not tell me whether I receive the vaccine or placebo until it's over. They also don't share with me the results of my blood tests. Once a week, I'm asked to complete an

illness diary through an app on my phone. I simply answer yes or no to the question of whether I have developed any symptoms of COVID nineteen. So far, I've been able to answer no every week. After my first injection, I felt nothing, no pain that the injection site, no indication of any side effects at all. After the second injection, though, my arm was sore for days, it was itchy, and there was a raised bruise of the injection site. I

was cautiously optimistic that I had received the vaccine. Actually I was pretty thrilled. I worked from home most of the time, but I had worked in the office one Thursday in late October, and by the following Monday, two of my four coworkers.

they haven't always been like this. But before I found words, he said that most people tell him they're just so tired of all this and want to help things get back to normal as fast as possible.

Doctor Maria Sunderram, postdoctoral fellow at the University of Toronto Center for Vaccine Preventable Diseases and fellow at ICES, a nonprofit health research organization, and also doctor Orin Levine, Director of Vaccine Delivery at the Bill and Melinda Gates Foundation.

at the top of our national conversation at least. So the Pfiser Beyond Tech and the MODERNA vaccines are both mRNA vaccines and the Oxford Astrosedtica vaccine is a non replicating viral factor vaccine. Your listeners may know that when we're talking about kind of a traditional vaccine, normal vaccine, like your seasonal flu shot. What we're doing, we're showing our immune systems a dead virus, a killed virus that

can't infect us, but it's the whole thing. So our immune systems are seeing this complete virus that is dead and saying, Okay, this is really helpful. Now I know what this looks like. I'm going to be prepared for next time when I see this one that looks like this,

but it's alive. So we're starting at an earlier point in the process with the mRNA vaccines, And what we're actually doing there is we're giving our cells, like the IKEA instructions to make one part of the virus, and in this case, it's the spike protein, which is this protein on the outside.

getting ill. And the non replicating viral vector that's in the Oxford astrosetic vaccine works kind of in a similar way, but instead of us making that protein, we're asking a different virus to make that protein. In this case, it's an adnovirus, So this is another resttray virus that in this case it's usually among chimpanzees. It doesn't really cause us any physical discomfort or anything. We probably don't even notice that it's there, but we've given that this ad

novirus the information to also make this spike protein. So it's on its little membrane, it's it's showing all of its sort of normal adnovirus stuff, and then it's also got the spike protein. So our immune system is like, oh, okay, there's that thing that I need to protect against now I know. So that's kind of that's kind of how those those vaccines work.

before it can be absorbed into our cells. And I said before that mRNA is kind of like an Ikea instructions, and it very much is, but it's not in the like book that you get for Mikia. It's like it's like it was written on ticker tape or like a super long CBS receipt. So it's kind of like you know,

flapping of the wind a little bit. It's bopping around, and it can be really fragile, and so we want to make sure that when it, you know, when we're giving it to people, that it really like stays intact enough so that when it gets to our cells it really has something meaningful to say, and our cells can

read it instead of being confused. So they've charged these little fat globs and the charge allows the m RNA to stick inside them, so it's really it's almost like a little sphere that surrounds the mRNA and protects it. The salts are the buffer that's in the Physer Beyon Tech and the MODERNA vaccines, respectively, allow all of the stuff that's in the vaccine, including the engine and everything else, to be the same pH and the same solidity as our bodies, and that's really helpful so that we can

only react to the enigen. And then there's sugar in both vaccines as well, and this can help, for example, if the vaccine has to be extored at very cold temperatures, it can help with the vaccine antigen not being damaged that process. And then the Bordertra vaccine also has something called sodium acetate, and this can be something that kind of holds all of this other stuff together, kind of

stabilizing everything that's in the vaccine. Because there's there's like polar items and then there's non polar items, which would be the lipids. It can sort of wind up, you know how Salad dressing separates and you've got like the oil and the vinegar and you have to like shake it up in order to like have it be like palatable. So we like obviously don't want our vaccines to be

like salad dressing that has separated. So so some of these things, the sodium acetape for example, can help kind of stabilize that, and the buffer can help with that as well. And both of those vaccines are preservative free.

And so there's really there's no virus in any of these vaccines that I've mentioned, and so it's really just not possible. It's just not there.

the case for a lot of vaccines. For example, when you get your flu shot, you're not considered to be truly vaccinated until two weeks later, because that's when your body has made sort of the maximum amount of antibody that's going to really protect you throughout the flu season. So first of all, you're not sort of immune like

superhero style, like right after you get the first shot. Unfortunately, it's gonna take a while, at least five weeks, and you have to go back for the second shot, which just also like gonna be challenging, I know for some people. The other thing is that part of this is about humoral versus mucosal immunity. So when we get these shots, we're going to have these antibodies in our blood, and you and I know that's not where COVID nineteen goes first.

It doesn't sort of like get injected directly into our skin. It comes into our body through our restory pathways, and so there are these mucosal surfaces in our nose, in our nasopharynx, kind of the back of our nose and throat area that also have kind of their own sort of unique mucosal defense mechanisms, and there can be cells

waiting at that mucosal surface for different pathogens. It's not clear yet exactly what kind of immunity we might be developing from the vaccine at those mucosal surfaces, and so if that's not as rob as the immunity that's in our blood, we could wind up sort of hosting COVID nineteen in our nasal mucosa and then inadvertently, you know, sort of like wiping our nose and then like sort of exposing someone else to that. It's possible that it

could happen. Even though we wouldn't experience sort of physical discomfort from any sort of colonization, it's still possible that we could spread that onto someone else. And it's always possible for us to sort of touch a surface and then touch something else that someone else may touch and then touch their face. So it's not as though we're completely cutting off all modes of transmission. We're reducing them quite a lot, but it's still maybe possible to transmit

that virus even if you don't feel unwell. So that's why it's a really good reason to continue wearing a mask and continue taking those other precautions as will, including washing your hands.

for healthcare workers, older adults, and essential workers. Those people have the greatest risk and they need to be prioritized. We need to protect them. The additional steps include sort of the manufacturing, the delivery, rolled out campaigns, and you know, establishment of systems that help people remember to come back for their second dose. Again, that can be really challenging. So those are all of the steps for vaccines that

have obtained this emergency use authorization. For vaccines that aren't quite there yet, that's another step. So it's really hard to say exactly what all of that means. I'm hopeful for the fall, but I have to be honest and tell you I'm not exactly sure what date.

these vaccines. So this is why we do phase one, in phase two, in phase three studies, different phases of clinical trials. So in phase one studies, in preclinical studies, what we're trying to do is identify is this something that could help people, but more specifically, is this something that could potentially be harmful to people? And we're continuing to ask that question about safety in each subsequent phase of clinical trials, and in each subsequent phase, we're asking

more and more people, Hey, are you feeling okay? How was that for you? Are you feeling discomfort? You know, do you have like a mile headache? We want to know about that as well. And that doesn't stop after the emergency use authorization or even after full approval from FDA. So the US, for example, and this is true in other countries too, but specifically in the US, there are several different mechanisms for the reporting and sort of identification

of different safety outcomes for vaccines. One of those is called the Vaccine Safety Data Link and another one is called VEYERS or the Vaccine Adverse Event Reporting System. So these are super fast mechanisms where we're constantly looking to see, Hey, is there anyone who received this vaccine that maybe a week later they had like a headache still, or they had some fatigue, or they know they had some other sort of safety outcome We want to know about that.

Even though this vaccine has been approved by FDA, we're going to continue to ask these questions and continue to make sure that there isn't, for example, some really super rare, one in a million type of event that could make us reassess the risk benefit ratio of this vaccine.

a year old. But we knew during that swine flu pandemic that very young children were having really severe outcomes, and we were really concerned specifically for that age group, and so we said, okay, you know, the available safety data indicates that this is probably a good risk benefit ratio for children under one year old, and then you know,

that kind of became part of our pandemic response. So it's certainly not the first time that we've used this mechanism, and I think it's really important that we do use it when we really need it, such as during a global pandemic. Euas can only be given based on Phase three results or interim results from Phase three studies, and those interim results are sort of decided upon by this

independent Data Safety and Monitoring Board. And then there's this expectation that those applications for euas that companies have to make formally to FDA when they apply for the EUA, they include all of the safety information from their Phase one and their Phase two studies and then ideally their Phase three study with a median of two months of follow up. So that means that not only are they assessing safety outcomes, but.

vaccines that we've had. So we took the same amount of steps and asked the same amount of questions that we would have if this vaccine development process had taken ten to fifteen years. We just did it in a much shorter timeframe.

gonna I'm going to participate in this study. So they've all gone through the same evaluation process and they all continue to be assessed with the same safety reporting mechanisms. So you know, we're not just skipping steps just because you know, this one time it's convenient for us. No, we're still adhering to all of those rules. We're not

cutting any corners there. And again I kind of mentioned this a little bit earlier, but the vaccines also cannot these mRNA vaccines and the viral vector vaccines that can't give you COVID nineteen because they don't contain the virus M.

on the line at this point. And so it really does seem like there's so much to risk, So why would there be steps skipped or something like that, Like there's just so much on the line.

seem to be short and mild. But how likely is it that additional side effects severe or not that we haven't yet seen, or even long term side effects may emerge later on, you know, months from now, as more people take the vaccine.

good sign for us. And you know, it's a possibility, however small, that rare side effects that maybe more serious could happen, and that's why we continue to monitor vaccines for safety well after they're approved. We still are doing

safety assessments for flu vaccines, for example. So we take that so seriously, and especially, you know, you mentioned with COVID nineteen vaccines, there's so much on the line with keeping people safe and then you know, proving to people that we've made sure that these vaccines are safe and okay for them to get. We really take that so so seriously.

going to be uncomfortable but maybe not terrible. But then your risk of more severe disease, including like dengie hemorrhatic fever, is really increased if you then get infected with a different zero type like two through four. And that's because your body has created these antibodies, but those antibodies don't neutralize the virus, and so unfortunately, one of two things

can happen. One of those things is that those antibodies then promote the uptake of the virus into for example, macrophages other cells in your immune system, and instead of destroying the virus, the virus then infects the macrophage and then produces more copies of itself. So that's one sort of way in which that can sort of make the

disease more severe. And the other way that's kind of generally seen is that we're reacting to this infection in a much more severe way than we might have during the first time around, and so our bodies are forming these immune complexes that are kind of viruses plus a bunch of antibodies glommed on, and they're promoting these kind of really severe inflammatory chains that kind of really cause a lot of discomfort and maybe some really bad side effects.

So that's kind of like the two main avenues where this could happen and where we've seen it potentially happen for stuff like Denky. I will say for sarscov two. The studies that have been done in animals, the results are really variable about which, if any of these things could be happening. But what does seem to be consistent is that neutralizing antibodies, so anybody that can sort of take out the virus, those do protect animals from subsequent challenge,

so subsequent exposure to that virus on purpose. And we do see neutralizing antibodies for these vaccines, the Pfizer and Moderna vaccines that have been reported, because that's a really good sign that this is not sort of a major concern for these vaccines. And I will say as well, this hasn't been sort of a focus of the primary

sort of efficacy or safety outcomes of the vaccines. But it's certainly the case that people in both the Pfizer and the Moderna clinical trials will have been zero positive at baseline. So that means some people, whether they know it or not, will have had a Saruscobe two infection

before they get vaccinated. And we see very favorable safety profiles for both of these vaccines, and so we really do sort of that's an additional sort of uh, you know, notch that can help us feel comfortable about this, but we're obviously going to sort of still be assessing that particular question.

that down. So we're like really like very closely following everyone that are in these clinical trials. Now, in the real world, you can, I'm sure you can imagine a lot of differences. For example, I don't check a time or at seven pm every night to see if I have a headache. So there is like, you know, the real world is a little bit messier, and you know, things might sort of float away from us. We might forget, for example, that we're feeling just a little junkie today

if something really good is on TV or something. So there's a little bit of a difference in terms of like how well we know it works in the ideal scenario, where like we're absolutely like assessing every possible thing we can assess, and we're making sure everyone's coming back for their second dose at the right time. In the real world, you know, maybe it doesn't happen exactly that way, and so we want to make sure that it's also as effective and as safe in the real world setting. And

so that's what effectiveness is. So when we say the Pfizer A modern vaccines are about ninety five percent effective, that means we're saying, okay, you know, we gave people these shots. We try to get them in at the time that they were supposed to do for their second shot, but you know, they weren't living in a lab. They were also kind of at home, like living their own normal lives. So when we say that they're about ninety five percent effective, that kind of relates to this understanding

that this is. We think that this is more mirroring like a real world scenario than like a you know, a very regimented clinical trial. Of course, they're still in a clinical trial. So we do after vaccines become available for use by like, for example, you and me, we do something called a phase four steady And that's kind of to assess, like in truly real world conditions where people are not participants in a clinical trial, how well

is this vaccine working. So we're going to continue to update that number.

to know that for sure. The existing evidence, based on the follow up that we've been able to have so far, suggests that it does last for at least a few months, and that is really great news.

general US population. But maybe not every single person. For example, frequently clinical trials for vaccines don't include pregnant women, and they don't include people with underlying immunosuppressive conditions, like people

that have MS or my senia gravis. And that's because we want to know is this vaccine going to work in people that it absolutely definitely should work in people whose immune systems are functioning in the way that we kind of expect, and unfortunately this can exclude people who are at really high risk sometimes, and so this is a really challenging sort of push and pull with vaccine development.

And the other really important component here I think a lot of the clinical trials have really tried to address this, but it's still very challenging is that there's probably not enough outreach to folks who are not white in clinical trials, and so that makes it hard to understand exactly is this vaccine going to be, for example, better in this community, or is it going to be exactly the same, or is it going to underperform, you know, so we need

to make sure that we're getting a really representative sample. And then sometimes age too. I mentioned earlier the EUA for Tama flu was sort of then applied to children under one year of age. A lot of things are not tested for children unless the disease is specifically like mostly in children, because we have this different sort of you know, risk benefit calculus for children. We really want to keep them safe from any possible thing that they could experience.

for example, younger than sixteen. And we'll probably have to do separate studies about the safety and effectiveness of these vaccines, for example, in pregnant women or people with underlying immunosuppressive conditions.

epithelial interface. It's also not clear, for example, if you actually truly have a COVID nineteen infection, how long you may shed that virus. So that's another really important difference between COVID nineteen infection and receiving a vaccine against COVID nineteen. There are reports of people shedding virus for quite a

long time. You know, even if you were recovered sort of physically and you are feeling great and you have antibodies, you could still be exposing other people and that's certainly not something that you want to do. And then finally, it's not really clear from the available data exactly how long you're neutralizing anybody's going to last, and so it's really tough to say, oh, you know, I was I had a COVID nineteen infection in March, so I'm good, I'm superman.

And it's also about the risk of me spreading it to others that I really love and care about. And on the flip side, I the benefit from this potential vaccine is that I could be protected against an illness that could cause very severe and or long term illness, but it would also give me peace of mind. And it wouldn't just benefit me, it would likely also benefit

my community. So for me, that's more than enough to say, you know, this is this is a really good thing that I'm doing for myself and also for all of the people that I care about around me. If you're embarking on a convers you know, on a conversation with someone you maybe don't see eye to eye with in terms of your risk benefit, or maybe they just have questions and they're not totally sure. I think it's really important to start for a place of common ground and

kind of lead with empathy. I know that can be challenging sometimes, especially if you don't see eye to eye, but if you can see kind of common ground in terms of like, you know, you care about the people around you, or you don't want to be out of work for two or three weeks or potentially longer, you know, or thinking about like what is important to them, I

think that's that is really important. And then as much as you can sort of just being patient and empathetic with the reasons that they might be concerned or the way that they're thinking about risk benefit, I think is also really important. It can be challenging sometimes, and so I also recommend that you take breaks if you get really frustrated and be like, you know what, I'm so sorry,

I have to go right now. I got to go to the bathroom, or like I'm just sitting down to dinner, or oh, someone just called me, can I call you back. I think it's really helpful and important, like take breaks and then maybe revisit it when you're feeling like you have more, you know, emotional equipment to have that conversation. I've been thinking about this a lot, and how great it is that we have a vaccine that can be

delivered to people in the US now. And I was really thinking about my mom, who was born before the polio vaccine existed, so she was six when the polio vaccine became a thing, and at the time, there was just huge amounts of celebration. There were literal ticker tape parades for this vaccine because it was just this terrifying childhood illness that could just be so challenging and so terrible for so many people, and it was a huge relief to know that we would be able to protect

children against that. And I have been thinking about, like, man, it's kind of a shame that we can't have a ticker tape parade for these vaccines, because they represent an incredible amount of effort and sacrifice and hard work on so many people, including the trial participants, who have given their time and their energy for us to know that

these vaccines are safe and effective. And I really hope, as silly as it might seem, I hope that everyone gets a chance to set aside some time and truly celebrate the fact that this work has been done and it continues to happen, and that people are working so so hard to help us bring an end to this pandemic.

It is truly amazing and just a feat I specifically the contributions of the people who have been study participants, I think is so amazing, and when I think about it, it really it kind of gets me choked up because it is literally these people are heroes for us. They have helped save so many lives and we're very lucky, I think, to live in a world where people are going to work this hard to keep us safe.

and improve primary healthcare systems around the world. One of the roles that I play externally for the Foundation is that I sit on the board of GAVIY, the Vaccine Alliance, which is one of the central players in global organizations and more recently in KOVACS, the international collaborative effort to vaccinate everybody around the world.

to challenge every system around the world. And the challenges can be bucketed if you will, into both supply challenges, right, So there's a volume of materials logistics that need to be sorted out to make sure that the right vaccines end up in the right place, with the right supplies and the right people to deliver them at the right time. And demand issues, and we're seeing the emergence of demand

issues around the world in the US and elsewhere. Ironically, COVID vaccines had an anti vaccine movement even before they had vaccines, and that complicates things in terms of the acceptance and demand for the vaccine. So I think one of the things I worry about in the usnswhere is

we can't take for grantedvaccine demand. We're really going to have to engage with people and listen to them and then answer their questions so that they can feel the confidence they need to accept the vaccine and get the immunity and protection that comes from those and help us all to get back to an increased comfort of interacting with each other.

kind of vaccinate the world evenly. That is operating in an environment where there's been a lot of bilateral deals individual countries kind of locking out vaccines supply for themselves. So one of the things that is different is a kind of power dynamic and who's laying claim to different doses at different points in time.

It's also a complicated vaccine to deliver in terms of some of its characteristics. It requires what's called ultra low temperatures. It's required to be stored at negative seventy celsius. Most vaccines are stored between two and eight degrees celsius, which is like your kitchen refrigerator. Some vaccines are stored at negative twenty celsius, which is more like your freezer of your kitchen refrigerator or your or your downstairs freezer. Negative seventy is dry ice. You got to wear of admits

when you handle it. You got to have a special supply chain for it. It also is administered in a point three mL dose. Every other vaccine is administered as zero point five mL dose, and so it requires a little bit of special training, a little bit of special handling, an ultra cold chain delivery system. It's going to be

more complicated. On the other hand, it's going to deliver ninety five percent efficacy and have a differential price point from other vaccines, So that complex mixture of can I afford it, can I get it?

The early Ebola vaccines required negative seventy as well, and so countries like the Democratic Republic of Congo and Rwanda, Uganda, Guinea, Sierra Leone, Liberia, these are actually countries that have experienced using in small volumes ultra cold chain requiring vaccines. But that complex set of factors is what I think we'll go into the decisions that countries make and the rollout plans that they make with the vaccines.

bulldoze forward with one of those options. Is that what we might end up seeing for some of these countries or do you think it might be Oh well, we'll have to just kind of create a different supply chain or a different deployment chain for each one of these in case one ends up working better than the others, or one is cheaper than the others, or one is going to be more available than the others.

is large enough, you might think about that. But ideally, because these vaccines aren't going to be interchangeable with one another, you're going to want to simplify I think that part of the supply chain, and then from thereforward, say everybody in this country is getting either this mRNA vaccine or

this live vaccine or this inactivated vaccine. Those decisions to kind of supply a country with a single vaccine simplify some of the logistics that would become way more complex if there are multiple vaccines flowing around at a subnational level.

or mistrustful of the medical system. So could you talk about how that plays into not only vaccine development, administration, and also what are some of things that could be done to rebuild trust in those communities.

And to do that, people have to trust their health system, They have to trust their medical providers, they have to trust the process by which the vaccines were carefully manufactured, carefully regulated to make sure that they're safe potent when they come out. And any of us who's a human knows that that trust is slow to build and quick to erode. And in the most recent era, we've had an erosion of trust on many levels, some of it related to vaccines specifically, and some of it more generally

in institutions, in science and many other things. So I hope we can use vaccines actually as an opportunity to restore trust. And that restoration probably starts with listening to people. There's been too much, in my view, polarizing yelling at each other, and other enough listening to one another. So I'm really hopeful that one of the things.

access to family planning or other preventive services. I wonder if, in the execution of our rollout of COVID vaccines, if we integrate COVID vaccination with a package of services that they want and value.

Astrozenica vaccine. And importantly, none of these vaccines contain the entire SARS covy two virus. They all contain what are essentially instructions of one kind or another to make one protein or antigen that is specific to SARS CoV two that our body can then recognize and respond to in the case of a future exposure or infection. So what that means is that none, I'll repeat none of these vaccines is capable of giving somebody COVID nineteen, which I

think is so important. While it is normal to have some mild side effects after a vaccine, like a headache or maybe pain where you got the vaccine shot, or even a mild fever or just feeling kind of cruddy. These kind of symptoms don't mean that you have COVID nineteen, and they don't mean that you're infectious to others either. They just mean that your immune system is doing its job and responding to the vaccine, which is awesome and what we want your immune system to do.

also had to go through. All of the same regulatory and safety questions were asked about the COVID nineteen vaccines as they were for these other vaccines that were more familiar with the difference is that with these COVID nineteen vaccines we were able to ask and answer these questions in a much shorter timeframe, which was made possible by the sheer amount of people and resources committed to this project.

And like those other vaccines, we will continue to monitor the safety of these COVID nineteen vaccines, both in the people who were involved in the clinical trials as well as everyone else who takes them. Tens of thousands of people were involved in these COVID nineteen vaccine clinical trials, and the results have been very encouraging, not just in

terms of efficacy, but also in terms of safety. Some mild side effects such as headache or fatigue might be expected, as you mentioned in point one erin, but so far it doesn't appear that there are major adverse events associated with the vaccine, and are incredibly robust vaccine adverse event reporting system means that any and all side effects of these vaccines will be cataloged and closely examined, and if there do emerge more severe side effects later on, we will catch them.

the case of these vaccines, immunity isn't immediate. Because all the vaccines that we have that are close to approval are two dose series, meaning you have to get one dose and then another three weeks later. Full immunity isn't expected until at least five weeks or longer after the first vaccine, or two weeks after you get that second dose. And because these are not live virus vaccines and they're given in our arms rather than through like our nose,

like some of the live flu vaccine nasal sprays. We're not positive about the amount of mucosal immunity that they provide, so it's at least theoretically possible that even after vaccination, somebody could harbor the SARS covy too virus in their

mucous membranes. And even after a real infection with SARS covy two, people can shed virus for a really long time after infection, and that is why it's so important that even after vaccination or infection, we continue to practice all the same control strategies we've discussed at length, like wearing a mask, social distancing, etc.

of different moving parts. For instance, all of these vaccines that are close to approval or have been approved are two dough series, which does make their rollout a bit more challenging to make sure everyone gets both doses in

the proper timeframe. Fortunately, some countries have the supply and deployment change already in working order from past vaccine campaigns, but the existence of three different vaccines that may vary in their storage and administration requirements could lead some countries to build up a system around one of the types

of vaccines. And I mean, all in all, it's kind of a good problem to have, like we'd rather be choosing among several effective vaccines rather than none at all, But it does mean that some places will have to put their resources towards one of these vaccines over the other.

vaccine or any of these vaccines. We have to have good, honest, open communications surrounding these vaccines and the development process and everything surrounding them, and encourage that people get it and make it really easily available, rather than just assuming that people are going to want a vaccine or will seek it out on their own.

University of Minnesota, among other places. It's an incredible resource with tons of great information and you can find it at COVID nineteen dot track, vaccines dot org and we will also post a link to it in our show notes as well as on our website.