Ask the Experts Webinar: COVID-19 vaccine updates

While many people are jumping at the chance to get a COVID-19 vaccine, others have been a little bit more hesitant because they're so new in the relative terms of drug development. They've created quite the buzz on the news and also on social media. There's plenty of solid facts and data about the vaccines, but there's also a lot of misinformation that's being shared as well.

Roswell Park's Director of Infection Control and Prevention, Katherine Mullin, MD, recently participated in a webinar to help to set the record straight and answer some questions for our patients and caregivers. Below you'll find some of the key takeaways from the discussion.

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Q: There's been some discussion recently that the vaccine may not be as effective for those who are immunocompromised. Can you shed any light on that?

Dr. Katherine Mullin: We hadn't seen this virus in the U.S. before February of 2020 and in other areas of the world, the month or two prior to that. It's important to remember that this is a new virus, and these are totally new vaccines. But we did know, going into a vaccination process, that certain patients cannot mount a good response to any type of protective antibody-based response to any pathogen or vaccine.  These are the same people who would have a difficult time mounting a response to the virus itself. When they get COVID, they have a very difficult time clearing it because the process that your body uses to clear the virus is the same process that the vaccines use to trick your immune system into thinking that “oh, they've built up this machinery and this protection against this virus, when they meet it again he wouldn't get sick.”

But there are certain people, because of their underlying condition, including certain types of cancer, or because of the drugs that they're on because their cancer is related to abnormal production of certain antibodies, so the treatment response is to decrease the immune system's ability to mount that response.

That being said, we're still learning. The immune system has lots of different arms to it. And so we're still learning a lot about these vaccines. The antibody response is really just a component of it. And so we're doing further studies, and there are studies ongoing at Roswell Park in our vaccinated patients, to look at particularly how much and how effective vaccines are in certain components of our population. Each patient is different. And so we may have certain patients that we're a little bit worried that they're not going to respond as well to a vaccine, but we can't say 100% that they're not going to have any response. We think that there's a really good chance that at least some of these patients, even if they're on a medication that depletes their immune response, that they still could have somewhat of a response to vaccines, and therefore that vaccination could still offer some benefit to these patients.

I would still say at this point that we very much recommend everyone to get vaccinated, that the benefits significantly outweigh any risks.

Is there a way to test immune response to the vaccine?

A: There are some antibody-based tests that you can test response from an antibody perspective. Most of us in infectious disease or immunology, in general, think that the immune response to vaccines has multiple different components so that using the antibody test alone is an insufficient marker of how protected you are. Particularly with vaccines that are so effective, almost 100% effective, it's very good evidence that there's other components of the immune system that have protective mechanisms. The CDC actually recommends that antibody testing should not be done outside of clinical trials because the value of that result right now is not known. I think at the end of the day, we do know that certain subgroups are more at risk for not mounting an appropriate response. They may need boosters; they may need special schedules. We don't know the answers to those questions right now. But this is why we're doing clinical trials on these patients to get some of these answers.

For people who have already gotten the Johnson & Johnson vaccine, is there any worry or concern that should be there, or any warning signs and people maybe should look out for this very rare blood clot disorder?

A: The Johnson & Johnson (J&J) vaccine has recently resumed distribution and a few weeks pause while they were reviewing all the data. There shouldn't be many people who've gotten it super recently. The time course that these clots were seen is pretty much in the one- to two-week range. There shouldn't even really be that many people out there that are still in that range where even they could have this potentially rare concern.

There were six cases of a certain kind of blood clot that caused the FDA to pause the J&J vaccine distribution and basically say, "Listen, we need more time to review these special cases." Almost 7 million J&J vaccines have been dosed in the United States, so six out of almost 7 million is extremely low risk.

That being said, this really shows, I think, the robust nature of our safety process, particularly for vaccines that are under the emergency authorization protocol.

Again, the risk of getting blood clots related to a COVID infection, in general, is much, much higher. Something like 150,000 people in a million people who have COVID, in general, will get blood clotting and clotting disorders. And there are a lot of other drugs and other things that can predispose you to clots. But again, I think having some clarity on which groups maybe we should consider monitoring more carefully is helpful.

Was the Johnson & Johnson vaccine researched as much as Pfizer and Moderna?

A: Yes. There's a standardized process that all vaccine trials have to go through. They have to meet certain bars for efficacy and safety. All of the trials had to go through the same type of research, and all three vaccines pass very robust safety and efficacy trials. The process is not different. J&J was approved later because it had to meet that same criteria as the other vaccines and started enrolling later. But also, the J&J trial included data on people who had variants of COVID as well.

Can we be sure that there won't be any other side effects that pop up down the road after getting the vaccine?

A: We don't think there will be. Right now, people who were a part of the initial trials are maybe 10 or 11 months out from getting the first doses of the vaccines that are now approved. If we had seen a signal, we had seen that there was some sort of more "short" long-term effects, we would already be hearing about them because those people in the trials are still being monitored for long-term effects.

We really want to be transparent with patients if there are any risks. Just like the risks with taking any medications, you want to be upfront with patients saying, "Listen, you need this medication, but I do need you to look out for these certain things." If that was the case, we would really want to make sure we educate patients about that. But that does not appear to be the case.

That being said, I think it's important to say that none of us are omniscient and can say, "Oh, in 10 years, this is going to pop up." We don't have data from 10 years ago.  It's impossible to say that we don't think, from a scientific perspective, there are no theoretical risks that we have hypothesized. But there's no way to 100% say that there's nothing crazy that could happen. But I think the risk is very, very low. And again, there is a much more theoretical risk in the very real risk of getting COVID and potentially dying from COVID or passing it to someone else who can potentially die from COVID.