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Getting either the Moderna, Pfizer, and Johnson & Johnson vaccine for COVID-19 can slow down the rate of COVID-19 spreading. It is a safe way to build protection for yourself but also for others around you as vaccines are safe and effective. An mRNA vaccine teaches our cells how to make a protein and then triggers an immune response in our system which creates antibodies. Below is some more specific information about each of the three vaccines.

Moderna:

The Moderna Vaccine is a mRNA vaccine and has a 94.1% effective rate. The vaccine was successful and showed high effective rates among people of diverse age, gender, race, and ethnicity. Side effects usually go away a few days after receiving the vaccine.

Pfizer:

The Pfizer vaccine is also an mRNA vaccine with a 95% efficacy rate. There are two doses that need to be taken 21 days apart. Similar to the Moderna vaccine, side effects include chills, headache, pain, and fatigue but only last for at most 72 hours after the vaccination. Those who are 16 years or older are able to get it unlike Moderna and Johnson & Johnson, but it is recommended that those who have severe allergic reactions to the vaccine to avoid it.

Johnson & Johnson:

The Johnson & Johnson/Janssen vaccine is the only one of the three that is not an mRNA vaccine, and is also the only one of the above that is a single shot vaccine. The current reported efficacy rate of the vaccine is 66.3%, with people being protected two weeks after receiving the dosage. The side effects of the vaccine are similar in extent to those of the Pfizer and Moderna vaccines. Something important to note about the J&J vaccine was its brief pause by the CDC and FDA, due to a rare risk of blood clots and low platelets post-vaccination in women under 50. However, as of April 23, 2021, the pause on the vaccine has been lifted, and the CDC and FDA have concluded that the benefits of the vaccine overall outweigh the very rare risks.

Some common side effects described by those who have received either of three vaccines have been the following:

• Pain, redness, and swelling in the area where the shot was administered

• Tiredness

• Headache

• Nausea

• Chills

• Fever

• Body pain

Most side effects persist for 1-2 days post-vaccination, with the side effects typically being more intense after receiving the second shot of the Moderna and Pfizer vaccines. It takes around two weeks post-second vaccination in the cases of Modena and Pfizer, to be considered as being “fully vaccinated”.

The US has opened vaccinations to everyone who wants to get one, as of April 2021. It is strongly encouraged that everyone get the vaccination, so we are able to keep those around us safe. For more information about vaccination sites in your local area, check your local city or county website.

Links to more information about the vaccines:

https://www.cdc.gov/coronavirus/2019-ncov/vaccines/different-vaccines/Moderna.html#:~:text=How%20Well%20the%20Vaccine%20Works,evidence%20of%20being%20previously%20infected

https://www.cdc.gov/coronavirus/2019-ncov/vaccines/different-vaccines/mrna.html

https://www.ama-assn.org/delivering-care/public-health/what-doctors-wish-patients-knew-about-johnson-johnson-vaccine

https://www.cdc.gov/coronavirus/2019-ncov/vaccines/different-vaccines/janssen.html

https://www.cdc.gov/coronavirus/2019-ncov/vaccines/expect/after.html

It has been about one year since the country, and the world at large, was introduced to what is known as COVID-19, an mRNA virus that has quickly spread and put many lives on hold and at risk. While multiple vaccines have been produced, many are unsure about their efficacy, which has led some to avoid returning for the second dosage—a critical step to retain the vaccine’s full potency.

Side effects are not distinctive to the COVID-19 vaccine, with many vaccines eliciting a mild effect from the immune system. In some cases, a mild reaction is a good thing as it is a sign that the vaccine is emitting a response from the immune system. The immune system attacks anything foreign in your body, meaning if it sees proteins, bacteria, viruses, pollen, or any other unknown substance, it launches an attack. If it is fighting a virus, the immune system builds up an attack, figuring out which parts of the virus to attack and increasing the production of what needs to be attacked in the virus. This can take a couple of days, which allows the virus to keep replicating and producing copies. Once your immune system fights off the virus, it remembers it. Memory cells in your immune system remember the specific viruses, and your body uses its past history to kill the virus before it can make you feel sick.¹

Scientists determined a protein on the outside of the COVID-19 virus that looked like a good candidate to attack, and thus “disarm” the virus. This protein is important as the virus uses it to get into your cells, which makes the virus more infectious. Scientists took the instructions for the protein and made an mRNA version, which holds the instruction on how to make the protein. The recently-developed vaccine holds the instructions on how to make the protein, so when the vaccine is injected the body is not receiving the virus – but instead the blueprints of the protein. The cells of the immune system read these blueprints and make the proteins, which then immediately recognize it as a foreign body. Foreign bodies are attacked, as mentioned previously, so the immune system takes some time to determine the best plan of attack and as a result, the fevers, chills, soreness, and more are simply a side effect of your body fighting the protein. When the body finally destroys the protein, it remembers exactly what to do when it comes into your body again. When a COVID-19 virus enters your body, it remembers the protein attached to the virus and your immune system quickly attacks the protein, using the instructions it had from when it destroyed the protein the last time. This leads to a much faster recovery time, as opposed to the immune system of an unvaccinated individual, which would have to start from scratch.²

Each individual has a unique immune system, which results in different responses to the foreign body that has entered. While the vaccine is effective on all individuals, people aged 65 and older experience fewer side effects than younger volunteers. This could be due to the declining immune response that usually comes with age. The vaccine can provoke an inflammatory response and older adults will react less if they have a weaker immune system.

Most Common Side Effects of the COVID-19 Vaccine

• Injection Site Pain

• Fatigue

• Headache

• Muscle pain

• Chills

• Joint Pain

• Fever

Timeline of “Who and When” in California

• Phase 1A

  • Healthcare workers

  • Long-term care residents

• Phase 1B

  • Individuals aged 65+

  • Those at risk of exposure who work in:

    • Education and Childcare

    • Emergency Services

    • Food and Agriculture

• Those at risk of exposure in:

  • Transportation and logistics

  • Industrial, commercial, residential, and sheltering facilities and services

  • Critical manufacturing

• Congregate setting with outbreak risk

  • Incarcerated

  • Homeless

• Phase 1C

  • Individuals aged 50-64

  • Individuals aged 16-49 who have a health condition/disability that increases the risk of severe COVID-19

  • Those at risk of exposure who work in:

    • Water and wastewater

    • Defense

    • Energy

    • Chemical and hazardous materials

    • Communication and information technology

    • Financial services

    • Government operations³

Sources

1. https://www.aarp.org/health/conditions-treatments/info-2020/coronavirus-vaccine-side-effects.html

2. https://www.immunology.org/celebrate-vaccines/public-engagement/guide-childhood-vaccinations/how-vaccines-work

3. https://covid19.ca.gov/vaccines/

Despite being one of the leading developed countries, the United States does not have a universal healthcare program and was ranked 29th in healthcare access and quality in 2018 (Lancet, 2018). The seemingly never ending COVID-19 outbreak has highlighted the already existing health disparity in the United States with the climbing number of COVID-19 related deaths in minorities and lack of trust in the medical system. There is a glaring correlation between race and healthcare; the healthcare system has failed a large portion of American citizens by limiting the quality of care for minority groups while also charging unnecessarily high costs. As a result, many minorities and lower income communities do not have the means to afford health insurance and thus have a higher mortality rate.

There are many key differences between those who receive some form of health insurance versus those who are not able to afford or get insurance coverage. Some of those differences are the mortality and morbidity rates and higher risk of contracting specific health conditions. The Kaiser Family Foundation article “Disparities in Health and Health Care: Five Key Questions and Answers,” further emphasizes this key difference through the astonishing data it presents. The article states, “Health disparities are particularly striking in AIDS and HIV diagnoses and death rates (Figure 7),” (Artiga et al., 2020). These differences most often only end up affecting lower income communities and minority groups in the United States due to lack of health insurance.

Furthermore, with regards to the connections between race and inequities in health care, analysis of data only leads to the uncovering of a very prominent modern health crisis. The Kaiser Family Foundation article further underlines this issue in the key data saying, “Moreover, the relative risk of being uninsured compared to Whites did not improve for some groups. For example, Blacks remained 1.5 times more likely to be uninsured than Whites between 2010 and 2018, and the Hispanic uninsured rate remained over 2.5 times higher than the rate for Whites,” (Artiga et al., 2020). This unfortunate tie between racial identity and health coverage is alarming and emphasizes how there is so little being done to support a large portion of this country. Many are unable to access basic essentials like regular health checkups and are succumbing to short life spans due to health problems that arise from not being able to access the appropriate care in the first place.

The COVID-19 pandemic highlights how divided the country’s healthcare system is. For example, Black Americans make up 14% of the state’s population in Michigan but consist of 41% of COVID-19 related deaths (Connley, 2020). Reasons for this disproportional data are due to structural racism against African Americans, leaving them “vulnerable and marginalized” with 55.5% of Black Americans having private health insurance versus 75.4% of white Americans in 2017 (Connley, 2020). Many avoid the doctor until it is too late, leaving many underlying health conditions untreated. Due to a long history of racism, there is also a mistrust in the medical system among Black Americans. One of the ways the country is trying to gain trust is by diversifying the medical workforce. However, only 5% of physicians in the US are Black, showing the United States still has a long way to go before building an adequate healthcare system that benefits all people.

The United States’s healthcare system is deeply flawed due to its bias against lower income communities and minorities. Both demographics have, on average, higher health related death rates and lower percentages of health insurance coverage. The role of race in the inequity of our healthcare system needs to be further emphasized and addressed. Everyone deserves to receive equal access to healthcare.

Sources:

1. https://www.kff.org/racial-equity-and-health-policy/issue-brief/disparities-in-health-and-health-care-five-key-questions-and-answers/

2. https://www.cnbc.com/2020/05/14/how-covid-19-exacerbated-americas-racial-health-disparities.html

3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5986687

COVID-19 in Marginalized Communities: Institutional racism is prevalent in America’s healthcare system, and it has left BIPOC communities across the country vulnerable to COVID-19.

Racism in healthcare takes many forms, and has led to inequities in access to quality healthcare for many BIPOC. For example, uninsurance rates are significantly higher for marginalized communities in the US. Expected years without health insurance is about 10 years for Asians, 21 years for Hispanics, and 12 years for Black people (Sohn). Without insurance, fees required for quick visits to the doctor begin to add up. So, individuals are less likely to visit a doctor or seek out preventative care simply because they know they will not be able to afford it.

Even when BIPOC do have insurance or the means to pay for hospital visits, they are very likely to face implicit bias from hospital staff. When Black women, in particular, come to hospitals displaying the same symptoms and pain levels as non-Black patients, their concerns are often dismissed or they are denied medication or referrals to specialists. Statistics show that Black women are more likely to die from pregnancy, cancer, or heart disease than white women are. Numerous Black women have also shared anecdotal evidence to prove that situations like these are directly related to the fact that Black women are expected to have worse health outcomes relative to white women (Stallings).

On top of these circumstances, statistics show that a majority of frontline workers are BIPOC. A study conducted by the CEPR found that Black and non-black POC are overrepresented in occupations found in public transit, cleaning services, warehouses, factories, and grocery stores. These jobs cannot be done remotely, do not pay very well, and/or require some form of human interaction. These factors combined with a lack of proper income support from the government means that frontline workers do not get the opportunity to take time off from work and are at high risk of getting COVID-19. If these workers have young children and cannot afford child care, they have to make difficult decisions to prioritize supporting their kids through online school as well.

In addition to working on the frontlines, BIPOC are more likely to be affected by COVID-19 because of their living situations. If they live in highly populated areas, it would be difficult to practice social distancing. If they live in rural areas, it is unlikely that they have access to basic necessities such as groceries, medical care, Internet, or even clean water and plumbing. They may also live in a multigenerational household, where it would be difficult to protect older family members from getting sick.

According to the CDC, the simplest way to protect these marginalized communities is to continue to work together to prevent the spread of COVID-19. On an individual level, easy action we can take is to wear masks, social distance, and stay home as much as possible. If you are looking for bigger ways to make an impact, try joining or starting a community organization that shares prevention information with the public, connects community members to healthcare providers, or works to set up local testing centers. Until an affordable and accessible vaccine is available, it is up to us to protect each other from this virus.

Sources:

1. A Basic Demographic Profile of Workers in Frontline Industries

2. The Article That Could Help Save Black Women's Lives

3. Racial and Ethnic Disparities in Health Insurance Coverage: Dynamics of Gaining and Losing Coverage over the Life-Course

4. Health Equity Considerations and Racial and Ethnic Minority Groups

5. Racism and discrimination in health care: Providers and patients - Harvard Health Blog

Proper accessibility to healthcare in the United States normally suggests that residents are able to access primary care, dental care, mental and behavioral health, emergency care, and more. Unfortunately, those living in rural areas encounter several barriers that prevent them from getting appropriate healthcare. Some of these barriers include distance and transportation, lack of health literacy, health insurance coverage, and workforce shortages. There are over 57 million Americans living in rural areas, so the question of how to provide them with sustainable healthcare is critical.

Geographic access and technology play a huge role in healthcare accessibility. Those living in remote rural areas may have a difficult time reaching hospitals and clinics; many don’t have reliable private or public transportation to travel large distances. Many rural residents also don’t have access to the internet; according to the Pew Research Center, roughly 58% of rural Americans say that internet access is a problem in their local community compared to 13% of urban and 9% of suburban Americans. For rural populations, this poses a variety of barriers: inability to research health problems, locate healthcare facilities, plan modes of transportation, and denied access to telemedicine services (especially significant during crises like COVID-19).

While the inability to research medical-related issues is a problem due to lack of internet, another dilemma is poor health literacy within rural communities. These populations have lower education levels, many aren’t proficient in English, and some are below the poverty line. Health literacy affects people’s health choices, their ability to understand a physician’s instructions and follow treatment, and their navigation through our country’s complex healthcare system. Health insurance poses a problem for many, but rural residents face higher premiums and can’t afford their co-pays. According to the 2016 report by the Department of Health and Human Services, 43.4% of uninsured rural residents reported not having a regular source of care, and 26.5% of uninsured rural residents delay or forgo receiving healthcare due to cost.

Rural communities experience workforce shortages, especially in different fields of healthcare. According to the Health Resources and Services Administration, rural areas tend to have fewer primary and specialty care physicians, home and community-based service providers, and mental health professionals. For example, urban areas in the U.S. have an average of 31.2 physician and surgeon providers per 10,000 residents whereas rural areas have an average of 13.1 per 10,000 residents. This disparity is seen in data for almost all healthcare occupations. In many of these communities, populations are at a greater risk of health problems like obesity, opioid crisis, HIV transmission, and higher mortality rates. In addition, rural facilities have a difficult time staying open and often have to discontinue services.

There are many organizations that support the needs of rural communities and work to increase availability of healthcare services. While this is hardly a comprehensive list of the healthcare barriers rural populations face in our country, it does bring up some of the general long-standing, systemic challenges that we need to address.

Sources:

1. https://www.hrsa.gov/rural-health/rfi-rural-health-care-access

2. https://www.ruralhealthinfo.org/assets/1275-5131/rural-urban-workforce-distribution-nchwa-2014.pdf

3. https://www.pewresearch.org/fact-tank/2018/09/10/about-a-quarter-of-rural-americans-say-access-to-high-speed-internet-is-a-major-problem/

4. https://aspe.hhs.gov/system/files/pdf/204986/ACARuralbrief.pdf

5. https://www.ruralhealthinfo.org/topics/healthcare-access

6. https://www.ruralhealthinfo.org/topics/healthcare-access/organizations

Overview of Vaccines

Vaccines are a trial and tested treatment that are used for many diseases especially those dealing with viruses. The first vaccine trials for the coronavirus began back in March and currently we have 10 in the final stages of the testing. There are four different types of vaccines. The first one are genetic vaccines where the vaccines deliver the coronavirus gene into our immune system and different companies are in different phases for the vaccines. Some popular names are Moderna and Pfizer. The second one are viral vector vaccines that have viruses carrying the coronavirus genes. A popular company with this vaccine is Johnson and Johnson in the phase 3 of the vaccine. Next we have protein based vaccines where the vaccines contain coronavirus proteins but no genetic material. Lastly we have the inactivated/attenuated vaccines which have a weakened form of the coronavirus. There are 3 phases that vaccines must go through in order to be distributed worldwide. Overall, on Monday November 2, 2020 we have 36 vaccines in Phase 1, 14 vaccines in Phase 2, and 11 vaccines in Phase 3. Currently we have 6 vaccines that are in the process of being approved, but so far no vaccines have been approved.

Differences in Phases and Testing

(Used citations 1 & 2)

Phase 0 - preclinical testing: The new vaccine is tested on cells and given to animals such as mice and monkeys to see if it produces an immune response.

Phase 1 - safety trials: The vaccine is given to a small number of people (usually around 100), being tested for safety, dosage, and stimulation of the immune system.

Phase 2 - expanded trials: The vaccine is given to hundreds to thousands of people in different health/age groups, seeing if the vaccine acts differently between them.

Phase 3 - efficacy trials: Several thousands of people are given the vaccine. We wait to see how many are infected compared to volunteers who received a placebo. These determine if the vaccine protects against the virus. The FDA states that they want to see evidence that the vaccine protects against at least 50% of those who use it in order for it to be approved. These trials can reveal side effects that were missed in earlier studies.

Phase 4 - approval: Officials review the trial results and decide whether to approve the vaccine or not. During a pandemic, the vaccine may gain “emergency use authorization” or gain some sort of early or limited approval. Researchers continue to monitor the vaccine, making sure it’s safe and effective.

Sometimes phases can be combined to accelerate development. Also, the main reason why clinical trials take so many years is because of the intense costs of each step. For the COVID-19 vaccine, lots of investment has already been done, so that is less of a problem.

Current Phase 3 Vaccines

According to the New York Times, 11 vaccines have entered phase 3 trials as of Summer 2020, 6 vaccines (not all of which are even in phase 3 are already being approved for “early use”. The only governing bodies that are allowing use of vaccines without knowing their phase 3 results are: China, Russia, and the U.A.E. This is especially dangerous as some of these approved vaccines are still in the combined ½ phase being especially detrimental to understanding how experimental these trials are. Just as the full extent of Sars-CoV-2 is not understood with its long-term effects on health, the adverse effects of an experimental vaccine are not studied on such a short notice. For example, the side effects of a vaccine could range from sore arm akin to a flu shot to a serious immunogenic reaction or even temporary paralysis (“Why Approving a COVID-19 Vaccine Too Early Could Cause More Harm Than Good”). However, the fastest vaccine produced in human history was the mumps vaccine in 1948 after a four year trial. Right now, there are 51 vaccine trials being studied in phases ranging from preclinical to early approved vaccines that have been developed over the last 11 months and the course of trials are still yet to be understood.

Phase 3

• Moderna

• BioNtech

• Johnson & Johnson

• AstraZeneca

• Novavax

• Bharat

• Murdoch Children’s Research Institute

Approved for Limited Use

• CanSinoBio

• Gamaleya Research Institute

• BEKTOP

• Wuhan Institute of Biological Products

• Sinopharm

• Sinovac

Timeline

After almost 8 months of quarantine from and accelerated research on COVID 19, the public anticipates a vaccine to aid in decreasing case numbers by the time 2021 comes around. Unfortunately for the United States, no drugs so far have been approved for limited or early use. However, research from around the world has many promising results in various clinical trials other nations have run. In the lead for the use of their developments are China, Russia, and the United Arab Emirates. There are a total of 6 trial vaccines that have been approved by these countries. CanSinoBIO Biologics, a Chinese company, “has developed a vaccine based on an adenovirus called Ad5, in partnership with the Institute of Biology” (Corum, et al CHECK CITATION). Reportedly, this collaboration published promising results in a Phase 1 safety trial back in May and later in July more progress in a paper published in July. Since this is a military commissioned vaccine, the Chinese military approved the use of the drug under the terms “specially needed drug”. This vaccine has been approved for limited use in China. The Wuhan Institute of Biological Products has been testing two inactivated virus vaccines. Phase 1 and 2 trials showed that the first vaccine produced antibodies in some patients who then experienced fevers or other side effects. This collaboration then “launched Phase 3 trials in the United Arab Emirates in July and in Peru and Morocco the following month” (Corum, et. al). The Wuhan Institute later claimed that their government gave them permission to inject thousands of people with its two experimental vaccines. On September 14th, the United Arab Emirates approved Sinopharm’s vaccines to be given to health care workers before Sinopharm was able to indicate if it was safe and effective. These two vaccines have been approved for limited use in the United Arab Emirates. The final company to create a vaccine from China is Sinovac Biotech, where scientists have been developing an inactivated vaccine called CoronoVac. Clinical Phase 1 and 2 trials for this vaccine have found no adverse effects and produce an immune response. Phase 3 trials of this vaccine have launched in Brazil, Indonesia, and Turkey. This vaccine has been approved for limited use in China. Finally, Russia has been working on 2 vaccines that have been approved for early use in Russia. Gamaleya Research Institute launched clinical trials in June for a vaccine called Gam-Covid-Vac which is a combination of two adenoviruses, Ad5 and Ad6. The vaccine was later renamed the Sputnik V. This vaccine was approved for early use in Russia. The second vaccine was created by the Vector Institute. This Institute registered a 1st and second trial vaccine called EpiVacCoronoa. This vaccine contains viral proteins called peptides, and its trials had begun by August 26th. Putin later announced that Russia has granted regulatory approval which also received permission to start the Phase 3 trials which is expected to start later this year. EpiVacCorona is approved for early use in Russia. Most of these trials aim to finish and respond with results by the end of 2020 (Corum, et. al). So far there has not been an approved vaccine to be in use for the worldwide population, but companies all over are testing different potential vaccines. As of right now, the best thing we all can do is social distance, stay safe, and wait for science to do its magic.

Sources:

1. https://www.nytimes.com/interactive/2020/science/coronavirus-vaccine-tracker.html

2. https://medicalxpress.com/news/2020-08-vaccine-clinical-trial-phases.html

3. https://www.healthline.com/health-news/why-approving-a-covid-19-vaccine-too-early-could-

cause-more-harm-than-good#Experts-alarmed-at-potential-authorization-before-phase-3-trial-is-finished