Vaccine Cheat Sheet and a Thanksgiving Prayer for the Scientists

Just in time for your Thanksgiving dinner (live or zoomed) or those fun holiday social media debates, I’ve made a little vaccine cheat sheet!

Three top vaccine contenders recently released phase three results: Pfizer/BioNTech, Moderna, and AstraZeneca/Oxford University. 

All three studies meet the gold standard of science research: huge study groups, randomly assigned and double-blinded trials. In a double-blind trial, neither the study groups nor the people running the trial know if a volunteer receives a placebo or the actual vaccine. 

All three of the first-out-of-the-gate vaccines are bioengineered. All three use genetic information to teach the immune system to attack the COVID-19 virus. 

The Pfizer and Moderna vaccines are very similar, so we’ll start with them.

How Do They Work?

Both vaccines use a molecule of RNA, coated in an oily micro-bubble. 

RNA is closely related to DNA, the molecule that carries the genetic code. When our cells need to make something (like a protein), a copy of the DNA gene for that protein is made on an RNA molecule.

Think of it this way: grandma’s cookbook contains all her recipes. You make a copy of one cookie recipe on a notecard and carry it back home, where you create the cookies. DNA is the cookbook; RNA is the notecard.

Both the Pfizer and the Moderna vaccines use RNA with the “recipe” for one of the protein spikes on the COVID-19 virus. 

When injected, the oily micro-bubble fuses with a muscle cell. The cell uses the RNA “recipe” to make spike proteins, which are released into the body.

A spike protein alone won’t make you sick, but it will teach your body to attack anything presenting the protein – like an actual COVID-19 virus.

Although RNA vaccines have been studied for years and are approved for animal use, if approved, these vaccines would be the first for human use. 

Do They Work?

Apparently, magnificently.

The Pfizer vaccine was reported to be 90% effective and the Moderna vaccine 94.5% effective. 

What does that mean in actual humans?

In the Moderna study, for example, 95 of the 30,000 volunteers got sick with COVID. Of the 95 sick people, ninety people received the placebo and only five received the vaccine, giving us an effectiveness rate of 94.5%. 

An especially promising bit of news is that the five who got the vaccine and also got sick experienced only minor symptoms. 

Severe symptoms were only found among the 90 people who got the placebo. This finding suggests that Moderna’s vaccine reduces the severity of disease in vaccinated people who still get sick. 

To put a 90-95% effectiveness rate in perspective: in order for the FDA to consider a vaccine for use, it must demonstrate a 50% efficacy rate. Seasonal flu vaccines are 40-60 % effective. The measles vaccine is 97% effective. 

Are They Safe?

Neither the Pfizer trial (44,000 participants) nor the Moderna trial (30,000 participants) uncovered any serious side effects. Both studies included volunteers of all ages and multiple ethnicities. But research doesn’t stop there. Safety studies continue as vaccines are rolled out to the general population.

Before launching their large phase three study, Pfizer tried out four versions of their vaccine in smaller groups. Pfizer selected the version that produced the fewest cases of mild and moderate side effects, such as fever and fatigue.

Once Approved, How Will the Vaccines be Distributed? 

Gus Perna is the army general in charge of “Operation Warp Speed”, the plan to distribute enough vaccine for 300 million Americans in the most timely and efficient way. General Perna is an army logistics expert. (Check out Perna’s “60 Minutes” interview on November 6 for the details). 

A problem to be solved with both the Pfizer and the Moderna vaccines is transportation and storage. 

Pfizer’s vaccine needs to be really cold, stored at -112 degrees Fahrenheit. Pfizer is making special ultra-cold shipping boxes and storage containers for use until the vaccines are given. (For reference, your home freezer is 0 degrees Fahrenheit). 

Moderna’s vaccine is a little less finicky, requiring “only” -4 degrees Fahrenheit. Additionally, Moderna’s can be stored in a regular refrigerator for 30 days after shipping. 

The latest vaccine announcement comes from AstraZeneca and Oxford University.

How Does it Work?

Although the AstraZeneca vaccine is also bioengineered, it differs in delivery from the other two. The AstraZeneca vaccine uses a “vector” – a biological delivery truck – to deliver the genetic information needed to teach the immune system how to fight the actual COVID-19 virus. 

The vector used is an adenovirus. This adenovirus causes colds in chimpanzees but is harmless to humans. 

The adenovirus’ DNA is modified to contain the code for a COVID-19 spike protein. The adenovirus given in the vaccine “infects” human cells, delivering the gene for the spike protein. The cells in turn churn out the spike protein.

And just as with the other two vaccines, the spike protein teaches your system to fight future infections by the actual virus. 

Adenovirus vaccines have been studied for decades, and European regulators recently approved a Johnson & Johnson adenovirus vaccine for Ebola. 

Does it Work?

The AstraZenaca vaccine is reported to be about 70% effective. During the phase three trial, two versions were used. One version was 62% effective, one was 90% effective, for an average of 70%.

Is this enough data for AstraZeneca to ask for FDA emergency authorization? We don’t know yet. 

Is it Safe?

AstraZeneca’s phase three trial was briefly halted due to possible reactions by two volunteers. However, the symptoms were found not to be directly related to the vaccine and the trials resumed.

That’s your cheat sheet for the first three vaccines. 

So, what’s next?

Mark your calendars for December 10, 2020. Pfizer’s vaccine is on the FDA’s docket for emergency authorization consideration. If approved, get in line – healthcare workers, you’re first. 

Regardless of your Thanksgiving dinner plans, consider this lovely little prayer, penned by Amanda Held Opelt, sister of Rachel Held Evans:

“These vaccines represent the tireless work by scientists & researchers who have already led lives of rigorous study and discipline.  Lord, for these women & men, many of whose names we may never know, we give thanks.”

Happy Thanksgiving, 2020 style.

And as You speak

A hundred billion creatures catch your breath

Evolving in pursuit of what You said

If it all reveals Your nature so will I

(Hillsong United So Will I)

A 20th Century Medical Miracle and the Hunt for a COVID19 Vaccine

The hospital ward had beds for as many as fifty children.

Dr. Banting and his associate quietly stepped inside. Bed after bed was occupied by a child, comatose and dying from diabetic ketoacidosis. Grieving parents sat bedside, awaiting the inevitable. 

The year was 1922. Medical researchers Fredrick Banting and his assistant Charles Best had been studying type 1 diabetes for the past two years. Using dogs, Banting and Best isolated insulin and treated (induced) diabetes in the animals. 

We’ve known about type 1 diabetes for centuries. The condition is well documented in ancient Egyptian, Hindu, and Chinese medical records. Aretaeus of Cappadocia, a second-century Greek physician, described diabetes as “the melting down of flesh and limbs into urine”. 

When the pancreas no longer produces insulin, people with type 1 diabetes cannot metabolize carbohydrates. Without insulin, patients waste away and suffer greatly, no matter how much they eat. The death rate for type 1 diabetes, prior to insulin therapy, was 100%. 

By the nineteenth century, we realized the role of carbohydrate metabolism in diabetes. Doctors attempted to control the disease with diet – prescribing only meat or fat for suffering children. On severely calorie-restricted diets, children lost weight and were critically malnourished.

Still, instead of death in a few weeks, children might survive a year. 

Encouraged by their success with dogs in the lab, Banting and Best injected an emaciated 14-year-old boy with insulin obtained from a cow in January 1922. Daily injections over the next twelve days dropped his blood sugar until it was no longer detectable in his urine. 

Soon after, Banting and Best walked into the solemn and quiet ward in a Toronto hospital, filled with comatose children. Banting and Best went bed to bed and injected each child with insulin. 

As they injected the last child, the first child woke up. 

One by one, all the children awoke from coma. 

A room filled with impending death became a place of hope. 

The 1923 Nobel Prize in Medicine was awarded to Fredrick Banting and John Macleod, in whose laboratory Banting and Best worked. Banting shared his prize with Best. 

The Eli Lilly Company improved the process for obtaining insulin from animals and sold the patent to the University of Toronto for $1.00. 

For the next six decades, insulin for human use was obtained from the pancreases of pigs and cows, a difficult and expensive process.

Everything changed in 1982. Using new genetic technology, the gene for making insulin was snipped out of human DNA and inserted into the DNA of a bacteria. The new transgenic bacteria were cloned. Entrepreneur Bob Swanson and his partner biologist Herbert Boyer grew vats and vats of the bacterial cells, all of which churned out huge quantities of insulin. 

HUMAN insulin.

For the first time, human insulin was produced in enormous quantities and made available to people with diabetes. 

Human insulin was the first genetically engineered drug approved by the FDA. Today, hundreds of medical conditions are treated with recombinant DNA drugs.

Objections to genetically modified organisms (GMOs) play on fears of the unknown. All too often, biotechnology is rejected without fully understanding the underlying science.

Fear of GMO technology results in absurd nonsense like the marketing of “NON-GMO” labeled salt. Salt contains no DNA to modify.

The top five contenders in the race for a COVID-19 vaccine use genetic information to teach our immune system to fight a viral infection. Already the anti-GMO movement is joining forces with anti-vaccine groups. Already vaccines developed using biotechnology are suspect.

Drugs developed using biotechnology have saved countless lives. A new generation of bioengineered vaccines are ready to join to the fight. 

November is National Diabetes Awareness month.

Thank you, Drs. Banting and Best. 

And thanks to the pioneers in recombinant drug therapies.

Best and Banting
National Museum of American History – Smithsonian

And as You speak

A hundred billion creatures catch your breath

Evolving in pursuit of what You said

If it all reveals Your nature so will I

(Hillsong United So Will I)

Meme Busters: The Anonymous Nurse

They escaped from Alcatraz, exploded a toilet, drank mentos and Diet Coke at the same time, and lived to tell the tale. They even proved there was room for Jack as well as Rose on that plank of wood. 

Discovery Channel’s long-running MythBusters put questions, myths, and urban legends to the test. Sometimes there was truth, sometimes a bit of truth, and often the myth was busted (no, your stomach will not explode if you drink Coke and Mentos at the same time). 

INTRODUCING: Science Meme Busters! I can’t bust them all, but I’ll be on the lookout for the good ones!

Memes make the rounds on social media, especially science memes. Sometimes photos with clever captions, sometimes cut-and-paste stories that begin with “I copied this from someone else” or “copied and shared from a friend”.

Making the rounds lately are the thoughts of an anonymous “ER nurse” regarding “diverse opinions” about Covid-19. 

So much to bust in this meme, but for now, I’ll focus here:

Anyone out there who can tell me what our end game is with the covid19? . . . Is it a vaccine? . . .It took 25 years for a chicken pox vaccine to be developed.” “Do you really think people will flock to get a fast tracked, quickly tested vaccine, whose long term side effects and overall efficacy are anyone's best guess?

Vaccines train our immune system to recognize and fight invading pathogens. Before the 20th century, this could be an effective but often dangerous practice. 

For centuries, doctors rubbed scabs from smallpox victims into a scratch on the arm of a healthy person, a process called “variolation”. A single smallpox blister would form, heal, and the variolated person was immune to smallpox . . . hopefully.

Sometimes the variolated person developed smallpox. Two percent of variolated people died. Still, two percent is a far cry from the 30% death rate from natural smallpox infection. 

Weighing the risks, many opted for smallpox variolation when it was available. George Washington ordered the variolation of his troops at the height of the American Revolution. 

No one knew why variolation (sometimes) worked. But by the 20th century, we knew about viruses and we fixed our attention on them. 

We looked for a safer way to train the immune system using vaccines containing inactivated or weakened viruses. 

When vaccines for diseases like measles, mumps, and chickenpox were developed, researchers weakened viruses by systematically growing them in a variety of cultures. Viruses were forced to grow for hundreds of generations in a hodgepodge of human and animal cells. As the viruses adapted to ever-changing environments, they became less dangerous to humans. 

As you can image, it was time-consuming to grow strains of disabled viruses. Following the creation of a disabled strain, vaccines were developed, then tested – all time-consuming processes. 

We aren’t starting from scratch with Covid19. This is the 21st century and we aren’t just figuring out this whole vaccine thing.

In 2020, we have more technology in our arsenal. In our age of modern genetics, the five top candidates for a Covid19 vaccine use information to teach our immune system, not the actual Covid19 virus.

Two of the top contenders use a copy of a gene that makes one of the protein spikes on the corona virus. The vaccine delivers the genetic instructions, and the body responds by using the instructions to make the spike protein. 

The spike protein alone won’t make you sick. BUT – the presence of the protein teaches your immune system to recognize and destroy anything presenting the protein – including an entire Covid19 virus. 

wiki commons

The remaining top contenders use other versions of delivering genetic instructions for a single Covid19 protein. 

Instead of months (and more) of transferring viruses from culture to culture, the genetic code for a protein can be read almost immediately. 

We can make an experimental batch of vaccine in a week. 

The mysterious and anonymous “nurse” in this meme cites the years needed to develop the chickenpox vaccine and worries about the “fast-tracking” of a Covid19 vaccine. Should we fear a vaccine developed under a program termed “Operation Warp Speed”?

The unprecedented speed of a Covid19 vaccine is not due to fast-tracking and corner-cutting in safety and effectiveness testing. 

The “speed” refers to the manufacturing process. While all the long phases of safety trials are occurring, the most promising vaccines are being manufactured on an industrial scale. Usually, vaccines aren’t manufactured until after the trials.

In order to speed things up, doses of the promising vaccines are already being made. If all of the phase trials show a vaccine to be safe and effective, we won’t have to wait months to manufacture it.

On the other hand, we are possibly manufacturing doses that will never be used.

The risk in Operation Warp Speed is financial, not safety.

Conclusion: Meme Busted!

The 2nd place winner at Mark’s office Halloween party (she was robbed I say!). Her cute red “spikes” aren’t so scary.

And as You speak

A hundred billion creatures catch your breath

Evolving in pursuit of what You said

If it all reveals Your nature so will I

(Hillsong United So Will I)

Covid-19 Shortcut 4.0: The Great Barrington Declaration

Located halfway between London’s posh Barbican theater district and the famed Smithfield Market is a plot of land with a gruesome past. Excavation in the 1980s revealed bodies – loads and loads of bodies. So far, 600 bodies have been catalogued, but there are probably at least 2,400 total.

The year was 1348, and after devastating the continent, the Black Death had arrived in England. By 1350, one-third of Britain was dead of plague.

At the height of the plague in London, 200 people per day were buried in the mass grave known as “East Smithfield”. London’s churchyards could not accommodate such a colossal demand, so the city created the five-acre burial pit. Hastily, the dead were buried en masse, some neatly lined up, others tossed in haphazardly.

The plague struck hard and fast in Britain and across Europe, and in a short time decimated the population.

Prevention measures (as best as possible in the pre-scientific, pre-modern epidemiology days of the fourteenth century) were practiced. In order to avoid the “bad air” thought to spread plague, doors and windows were shuttered, suspending easy access to family, friends, and neighbors. Households with plague were quarantined.

But for the survivors, the story took a bit of an uptick.

For generations after the plague years, survivors were generally healthier and lived longer than did the general population pre-plague.

Interestingly, modern genetic studies suggest that some survivors had innate genetic resistance to the plague or to its fatality.

However, there was probably an additional environmental factor.

As much as half the population died in some areas. With the weak winnowed out, survivors had access to more food, more meat, more and better bread. After four years of lockdowns and quarantines, survivors were ready to return to life as usual.

Blinking in the plague-free sunlight, survivors emerged, ready to get on with life, with socialization, with commerce.

Centuries later, we, too, are weary of lockdowns. Our modern plague is world-wide, and the death and damage rates are frightening. Thankfully due to modern therapeutics, we are not looking at a death rate of one-third of our population.

Still, we are tired of it all. In the decade (it seems) of 2020, we have endured multiple claims of those who offer shortcuts to our misery: the “Plandemic” video, America’s Frontline Doctors’ white-coated press conference on the steps of the Supreme Court, and the Yale doctor with his hydroxychloroquine conspiracy.

After their fifteen minutes of fame, each faded, answered by evidence and the scientific method.

Enter the ostentatiously titled “Great Barrington Declaration”, signed on October 4 and currently muscling its way into the headlines.

The document argues that Covid-19 should be allowed to spread uncontrolled among the healthy, while presumably protecting the vulnerable. The result of such a strategy (according to the document) would be “herd immunity” without the use of a vaccine.

In the last few days, heavy hitters in the field of epidemiology and infectious disease have weighed in, including Anthony Fauci (“total nonsense”) and the prestigious Lancet medical journal (“a dangerous fallacy unsupported by scientific evidence.”) The director of the World Health Organization called the plan “scientifically and ethically problematic.”

Sponsored by a Libertarian think tank, The Great Barrington Declaration is penned by three scientists associated with big-name universities. The Declaration’s website claims tens of thousands of online signatures from medical practitioners and public health scientists, but the signees were recently made anonymous after too many Fakey McFakenames were found on the rolls.

In cases of viral diseases for which we have a vaccine (like measles), it’s true: we rely on herd immunity to protect the very young, the immunocompromised, and the few who (unknowingly) do not mount an immune response following a vaccine. But in the case of measles, herd immunity is not achieved by deadly disease sweeping through an entire population, killing and maiming many but leaving a few survivors with resistance. With measles, herd immunity is achieved without the devasting effects of the actual disease.

The Great Barrington Declaration is problematic scientifically:

  • A pandemic control strategy that relies on herd immunity is seriously flawed and is not supported in scientific literature.
  • Uncontrolled spread of Covid-19, even in a young population, increases the risk of death and long-term damage.
  • At this point, we do not know how long natural immunity to Covid-19 lasts. Relying on natural herd immunity could result in repeated epidemics, as we saw before the advent of vaccination.

The Great Barrington Declaration is problematic ethically:

  • Uncontrolled spread of Covid-19 increases the risk to frontline health workers, already at a heightened risk.
  • The Great Barrington Declaration advocates protecting vulnerable populations, but how do we define “vulnerable”? So, we isolate all the sick and elderly in nursing homes. What about people with unhealthy BMIs? What about people living in crowded homes with multiple generations of family? What about people with limited access to healthcare? That’s a lot of people to isolate while we let a virus run free.
  • Marginalized communities are at a higher risk, and many are young, the demographic in which The Great Barrington Declaration would allow the virus to run rampant. Are we willing to winnow the marginalized in pursuit of a shortcut to social normalcy?

No one wants endless lockdowns and the destruction of the economy. Social safety, common sense, increased and affordable testing, contact tracing, and mask-wearing are not draconian.

It’s not all or nothing.

I visited East Smithfield in London in 2016. Our “London Plague” tour guide lead us through the city with a rat on a stick.

Seen this weekend in my local Kroger: A Covid-19 mask, plague-style.

And as You speak

A hundred billion creatures catch your breath

Evolving in pursuit of what You said

If it all reveals Your nature so will I

(Hillsong United So Will I)