BERREMAN: COVID-19 vaccine: The science and the heart

Kaua‘i residents have performed admirably in the face of the pandemic, leading the rest of the state in keeping the virus in check.

Much of our success so far has been the result of Kaua‘i residents taking prevention seriously. We have been good about physical-distancing, wearing masks, avoiding large gatherings and limiting travel.

We can continue to lead by example in the coming months. Each of us will have the opportunity to receive a COVID-19 vaccine. Understandably, some Kaua‘i residents have concerns about taking the vaccine.

As a public-health physician and a pediatrician, I would like to share insights about the science of the vaccine, and then share from my heart as a mother, spouse and daughter.

Let me start with the science. Although the SARS-CoV-2 virus itself is new, research and understanding about coronaviruses date back decades: science did not start from scratch in this pandemic. The two vaccines expected this month are from Pfizer and Moderna. The data released for both vaccines show very-high levels of protection from disease after two doses of vaccine — more than 90%. Even if actual protection is lower, vaccination can dramatically reduce the spread of disease in our community.

These two vaccines are called mRNA vaccines. Unlike other vaccines, they are not made from killed or inactivated viruses. This offers two major advantages. First, because they contain no virus, they cannot pose any risk of disease or disease transmission. Second, mRNA is broken down by the body, so it has no lasting presence after it stimulates an immune response. It is also important to note that these vaccines can be produced rapidly, inexpensively and in large volume — something critically important to an effective response.

The trials held to date have involved tens of thousands of people rather than hundreds of thousands of people, so naturally there are things we do not yet know about these vaccines. First, we do not know how long immunity lasts or whether a booster dose will eventually be needed.

Second, we don’t know whether they may have rare side effects that have not yet been detected. A “one-in-a-million” event is statistically unlikely to appear when only tens of thousands of people have received the vaccine. Similarly, side effects that occur months to years after vaccination would not have come to light yet. To see those effects, we will need to follow large numbers of vaccinated individuals over long periods of time.

Third, the vaccines available in the next weeks and months are for adults. We are still learning about their safety and effectiveness in children or during pregnancy, and whether they can prevent asymptomatic spread of disease.

Although Kaua‘i has not been as impacted by the disease as other counties, we are aware of its devastating effects. There is strong science about this virus. We know it is very easily transmitted from person to person. We know that it can cause serious disease and even death. We know that some are at higher risk of severe disease than others: those with high blood pressure, diabetes or heart disease, and those age 65 or older are all at higher risk of becoming seriously ill if infected. Pregnant women and their fetuses experience higher rates of severe disease.

We also know that young and healthy people — including children — can experience severe disease and even death if infected. Young adults with seemingly mild disease have died suddenly of heart attacks — a severe complication of COVID-19. The rates are lower, but the risk is real. We know that even those with relatively mild disease can experience lingering poor health for many months after their acute illness. And everyone who becomes infected can, inadvertently, spread disease to others, including to high-risk family and loved ones.

Let me take off my hat as a doctor and speak from my heart, offering my perspective as a mother, spouse and daughter. Like most of you, I am tired of the isolation of this last year. And, like many of you, I have experienced up-close the effects this virus can have. I lost my elderly stepfather to COVID-19 this year. He died alone. His memorial service took place online.

Our family has not had the opportunity to exchange hugs and grieve together in person. My husband and I have not seen our daughters for a year. Both of them live in new places and have new jobs, and one a new fiancée, since we last saw them. My frail mother-in-law has seen my husband only once this year, rather than on his regular monthly visits. Like most Kaua‘i residents, we are ready for a change.

The choice of whether to be vaccinated is not just a personal decision. The pandemic has shown us, more than ever, that we are connected to each other. The decisions we make affect our families, our friends and our community.

The decision to vaccinate or not involves weighing risks, including unknown risks, against benefits. Being vaccinated carries the risk of potential, yet-to-be-discovered, rare side effects of the vaccine. It provides the benefit of a significant added layer of protection from disease.

Not being vaccinated carries the ongoing risk of infection with SARS-CoV-2, possible severe disease or death, and potentially spreading disease to family, loved ones and coworkers. We can lessen the risks associated with not being vaccinated by wearing masks, keeping our distance, limiting our exposure to others and limiting our travel. These behaviors, as we know, come with a steep price, and take an increasing toll over time.

When I balance the science and the heart, the knowns and the unknowns, my choice is clear. I plan to be vaccinated when it is my turn. When my family and friends ask for my guidance, I will share this thinking with them and tell them my decision.

In making your decision, I encourage you to balance the risks and benefits. Please seek out strong science — more is emerging every day. Please talk with your loved ones and trusted advisors. Consider what matters most to you. Pay attention to the course of the pandemic. We all share the goal of leading safe and healthy lives together in harmony. The coming months can bring us closer to that ideal.

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Dr. Janet M. Berreman has been the state Department of Health Kaua‘i District Health Office officer since January 2017. Prior to that, she was the health officer for the City of Berkeley, California, for 10 years. She was one of the first pediatricians to join the Wai‘anae Coast Comprehensive Health Center on O‘ahu, where she cared for children for 11 years. Before that, she served as a pediatrician at the Lyndon B. Johnson Tropical Medical Center in Pago Pago, American Samoa. She trained at the University of California San Francisco School of Medicine.