Two doctors who are part of the Food and Drug Administration's vaccine advisory group answered questions today about getting inoculated against COVID-19
Geeta Swamy is associate vice president for research and vice dean for scientific integrity and an associate professor at Duke University. Paul Spearman is director of the division of infectious diseases at Cincinnati Children’s Hospital.
Here are their answers to five common questions about the coronavirus vaccine:
Who should not get a coronavirus vaccine?
"There are basically just a few categories of those that are completely excluded," Spearman says.
"One is if you have already had a terrible reaction to a COVID mRNA vaccine, you wouldn't want to get another one. So that's one that would be excluded. If you know that you have a severe allergic reaction to any of the components of the vaccine—there's something called polyethylene glycol or PEG in these formulations—so if you know you've had a bad reaction to that ingredient you'd have to stay away—if you had a severe raised rash or anaphylaxis or those kinds of bad reactions."
Spearman says there are other cases he calls "intermediate" where a person wouldn't be excluded from getting the vaccine, but should talk to their doctor first—like if they have had a really bad reaction to another kind of vaccine or medication in the past.
He also says someone who is receiving large amounts of immunosuppressants and might not be able to make anitbodies would want to to their doctor about the pros and cons of getting the vaccine. Swamy says there's no evidence the vaccine would be harmful in that case, but it just might not work as well.
The same goes for someone who received monoclonal antibodies—that's an antibody treatment that someone who has tested positive with the coronavirus might get in the hospital in an attempt to try to keep their condition from getting much worse. Spearman says the Centers for Disease Control and Prevention recommends waiting 90 days after that to get the best benefit from the vaccine.
Swamy says pregnant women should also talk to their doctors when weighing whether to get the coronavirus vaccine.
"Pregnant women are at a higher risk for severe COVID disease," Swamy says. "They have a higher risk of hospitalization, a higher risk of admission to the ICU, a higher risk of requiring mechanical ventilation and even a higher risk of mortality.... It really comes down to a patient level decision to weigh the risks and benefits."
Swamy says she would encourage a pregnant women to consider what her personal risk of getting COVID might be. She says that answer will be different for a person who has the ability to work from home compared to someone who might be a frontline worker, or even a teacher.
Should I get vaccinated if I've tested positive for the coronavirus in the past?
"Having COVID infection by itself is not protective against getting COVID infection again," Swamy says.
Swamy says a repeat infection is not "incredibly common," but it is not a surefire way to keep from getting sick again. She says that's one reason the vaccines each have two doses.
Swamy says someone who has been sick should get vaccinated. She says current CDC guidance is that someone who has tested positive with the coronavirus should wait to get vaccinated until they are no longer symptomatic and are no longer under quarantine.
What happens if I'm late getting my second dose or I miss getting it altogether?
"There probably isn't any harm in extending out the time frame between the two doses—meaning if someone can't get there on the day they're scheduled for their dose, or if something happens to the supply. I don't think you would want it to be many months, but a few days to a few weeks probably won't make much of a difference," says
Swamy.
Swamy says data shows a there's "dramatic reduction in disease even within the first few weeks after the first dose" of the vaccine. But, while she says "one is better than none," she says it is important for people to do their best to get the second dose. That's because there's not a lot of information about how getting only one dose could impact how long the benefits of the vaccine could last.
Spearman agrees.
"The first goal is to get the first vaccine because we know that does offer some protection. Getting the boost is also going to be important but you will have some significant protection from the first shot. But I think we should put that in the context that all of the studies were done with both of those immunizations. So there's a bit of uncertainty," Spearman says.
If I start with one brand of vaccine, can my second dose be a different brand of vaccine?
"You don't want to mix the two," Spearman says.
Spearman says all of the studies conducted so far have used one brand of vaccine, followed by a second dose of the same brand of vaccine.
"The recommendation is if you get the Moderna vaccine first, get the Moderna vaccine for the second for the booster. If you get the Pfizer first, get the Pfizer booster. "
Spearman says it is an interesting idea to mix the vaccines and he expects scientists to begin studying that possibility in human trials sometime in the future.
Where can I get more information about the coronavirus vaccine?
“When you want the right advice on these kinds of a question and you’re not in the midst of a forum, CDC has answers to many, many of these things on the FAQ on their website. So it’s a great resource for the future,” Spearman says.
Spearman says more information can be found by talking to your doctor or checking out the Centers for Disease Control and Prevention website.
Spearman and Swamy participated in a virtual Q and A session today during a Tallahassee Village Square meeting.
