Tuesday, December 15, 2020

We Asked An Epidemiologist: COVID-19 Vaccine Myths and Facts

We are beyond relieved that a COVID-19 vaccine is now available in the United States. At the same time, we worry about misinformation that could lead to people needlessly getting sick from this coronavirus—or even dying. To help reassure our community members, we spoke with epidemiologist Dr. Rene Najera about COVID-19 vaccine myths and facts.


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Thinking Person's Guide to Autism (TPGA): Could you please tell us about yourself, and the kind of work that you've been doing lately?


Dr. René Najera
[image: Black-and-white photo of a Mexican-
American man with short curly dark hair, 
resting his chin on his hand, looking tired.]

Dr. René Najera: I'm an epidemiologist, and have a doctor of public health degree from Johns Hopkins university. I also have a master's in public health, in epidemiology and also in biostatistics. I currently work for a rather large county health department in the Washington DC area. I'm also an associate at the Bloomberg School of Public Health, and an adjunct at the George Mason University global and community health department. So I do a little bit of everything. I'm also the editor of the History of Vaccines Project at the College of Physicians of Philadelphia.


TPGA: That's a lot.


Dr. Najera: Yeah, It's a few things.


TPGA: We have a decade-long history of vaccine advocacy, including countering vaccine misinformation. And we've seen an uptick in vaccine concerns and fear mongering with the release of the COVID-19 vaccines. So I'm really grateful to talk with an expert who can give us accurate information, and reassure us about what's actually happening.


And if you don't mind, I'll jump right in: Now that a COVID-19 vaccine is approved, can you tell us who is eligible, and how prioritization is working?


Dr. Najera: So technically, everybody's eligible. We want to give it to as many people as possible, but as you can imagine, with the limited supply we have to prioritize. That prioritization was done with the recommendation of the Advisory Committee on Immunization Practices (ACIP), which is a CDC committee of scientists and citizens. The ACIP looked at who was getting the coronavirus the most. Not just the numbers, but also in rates and proportions. Who was dying from it the most.


The ACIP also looked at who was driving the epidemic, because that is not necessarily the same as the people who are dying. For example, in the Washington, DC area the people who were dying in greater numbers tended to be white and more affluent. And that was because they also tended to be able to afford nursing home care or assisted living care. And that put them in a situation where they were very close with each other and with the people delivering the care.


But the group that was driving the epidemic, in terms of spreading the virus around, was mostly Latino workers who can't stay at home because they're low wage employees, who cannot skip two weeks of work, and are living paycheck to paycheck. They have to go out into the community. They do housekeeping. They do manual labor. They also work in the care industry, including of elderly patients. They are not necessarily being affected as severely, but they certainly are being affected. This is what we call the social determinants of health: If you're a low wage worker, you're more likely to live in crowded housing. You're more likely to not have access to medical care. That also figures into the equation of wanting the priority group to be people who are being affected socially.


Native Americans are also being affected in a very severe way. So they are also towards the top of the list. And then there are the critical infrastructure healthcare workers, and police and firefighters. I'm sure the military is also going to be getting it pretty soon. These are groups that are deemed to be critical.


The people at the bottom of the priority list are very likely your typical, otherwise healthy 20-year-olds who are not showing any symptoms, who are not working in critical infrastructure, who are not taking care of other people.


Children are probably not going to be getting the vaccine in this first round or in the foreseeable future, and they were not included in the clinical trials. Even though we know they do get coronavirus, it's not at the rates of adults, and certainly they don't have as many bad outcomes as adults do. So ethically, we can wait a little bit. And of course, there are exceptions: Unfortunately, I've seen reports about children in other cities passing away from this disease. But at the population level, this is the policy.


People with disabilities tend to be excluded from pharmaceutical companies' clinical trials, because of issues of autonomy or because people with disabilities often have co-occurring conditions, and clinical trials tend to be more designed towards people who are the "perfect patient." Academic institutions are more likely to enroll people with, or living in, special circumstances. They're gonna be the ones who are probably going to look into this a little bit closer, and start recruiting disabled folks and children.


TPGA: There are some reports that people with developmental disabilities are not being prioritized for vaccines, even though they are disproportionately affected by and dying from COVID-19.


Dr. Najera: One important thing to remember is that this prioritization is just a recommendation from ACIP. The local and state governments are going to be the ones making the actual decisions as to who gets the vaccine. And that's where advocacy should come in. That's where you reach out to your local Board of supervisors, or to your local health board, and offer up the evidence, even if that evidence is from your own experience (even though we in science often shy away from anecdotes). But put it out there and do that advocacy more at the local level, as in the U.S., public health is very local. Make them realize that it is a need.


Officials need to understand what the risks are, like overcrowding. The definition of overcrowding is two or more per room, but the risk is not because they're being crowded all in one room, necessarily. It's because you have a person, plus their caregivers in a home situation. Even if the caregivers go to another house overnight, you have 18 hours with a lot of people in one place.


TPGA: Do you know if efforts are being made to make sure that the information going out to people is in plain and accessible language, to ensure as many people as possible can better understand why getting the vaccine is so important?


Dr. Najera: Yes. And we do it because we have non-English-proficient folks, immigrants, living in our county. Also it's a fact of life that some people don't have an education in or understand biology—but  they deserve to be as well informed as the rest of the folks. But again, public health is so local. I'm betting good money that a lot of places are going to fall short.


TPGA: So accessible information about the vaccine is not necessarily happening at the Federal level?


Dr. Najera: Exactly. To be honest, I haven't seen it at the federal level. If I go to the Centers for Disease Control (CDC.gov) website, even I, with my doctoral degree, get a little confused at some of their wording for the recommendations. They have very technical language on their website, and it's the same way with the National Institutes of Health (NIH.gov). And it's the same way with the spokespeople. Most of the spokespeople have doctoral degrees, and they talk in very technical language.


Then you have people who never learned biology or chemistry, for reasons that are not necessarily their fault. But they encounter this official information, and they say, "No, it's too complicated. I don't know what you're saying." And then they hear something that they understand a little bit better, and they go with that instead of the accurate information that they don't understand. And then the misinformation sets in.


TPGA: Yep. I can't believe we have people railing against a vaccine that combats a highly infectious and deadly disease, yet, here we are. I have a number of questions combatting this misinformation if you're up to that. When people claim that the vaccine has not received any longitudinal studies or that it's being rushed to testing, what is your response?


Dr. Najera: You have to remember that the first vaccine was Edward Jenner's, for cowpox, back in 1795. So that gives us 200-plus years of understanding the interaction between a vaccine and the immune system, right?


With vaccinations, the first leap was just getting a vaccine, so you didn't have to get the actual infectious disease to become immune. And then the next leap was in attenuating the virus, which means making it less harmful or not harmful at all. That happened with the Rabies vaccine in the 1850s. The next leap was to actually be able to see the viruses, and be able to grow them in the lab. That was in the mid 1900s. The next leap is that you don't have to get the whole virus or bacteria. You just have to get a little piece of it, and that is enough to get you your immune system to protect you.


Then the next leap is with genetic technology, where we don't even have to grow anything in the lab. We just have to know the virus's DNA fingerprints. We are able to create little bits and pieces of it in the lab, just the parts that we need for the vaccine.


And then now we have this next leap, which is based off of the last one, where we read the genetic material. We got the genetic blueprint for coronavirus in January, and then they went and said, You know what? We don't even have to make this make the little proteins and little bits of the virus in the lab. We can show our own cells in our body, make those little bits, and trigger the immune response. And that is where we are with mRNA (messenger RNA) vaccines.


If the COVID-19 vaccines seem rushed, it is because mRNA vaccines haven't been in the public consciousness. But this technology goes back about 20 years, for cancer and HIV and other vaccines. And the COVID-19 virus is actually pretty stable and mutates very slowly compared to flu virus, where we have to have a new vaccine every year, or the HIV virus, which mutates every few hours


These vaccine trials took about the same amount of time as other vaccine trials. They involved tens of thousands of people, including my wife. And we have the technology to follow up on those thousands of people. The polio field trials in 1954 were in many different cities throughout the US, and the paperwork that went into that had no computers, no social media, no internet, no email. Scientists had to pore over a lot of paperwork to look at the outcomes.


With the COVID-19 vaccine trials, you have participants who are hyper-connected. They are given an app to report any symptoms. If they get a positive COVID test, they can look almost immediately and see if the participant was vaccinated with the placebo, or with the vaccine itself. All of these technologies come together.


The other example I like to give people is, "Look, in the 1920s they started mass producing cars, and it took several weeks to make one car. Today I can order my car online, and it will be delivered to my house in a matter of hours." As humans, we attach ourselves to the way things should be, based on our experience. And when something like this vaccine technology is new and it's fast and it comes and it doesn't match our experience, we can get scared of it—when it is just adapting previous technologies.


TPGA: That's a really reassuring explanation, thank you. I'm just grateful this vaccine happened so quickly, because with the polio vaccine you mentioned, my understanding is that it took five years?


Dr. Najera: Yeah. The record was the mumps vaccine. That took four years. The polio vaccine was a little bit over five years. And with the HIV vaccine, we've been at it as long as I've been alive, but it hasn't come around because of the challenges of that virus.


If you have the time and patience to watch the entire FDA broadcast of the COVID-19 vaccine discussion, the scientists were asking very, very pointed questions about safety and effectiveness. And when you look at all that information, you see that the safety is remarkable. And in the next few weeks and months, we biologists at the local health departments and the academic institutions will be looking at adverse events that get reported, to fine tune what we know even even further, in terms of who gets the vaccine and who should probably not.


I like to remind people that health departments and institutions are not just the buildings: There's mothers and fathers and uncles and aunts and brothers and sisters working there. And we have people who we care about, people who are from all walks of life. And we are doing it for them as well. And so we're going to be looking at this matter very closely, and will hold people accountable. Accountability is not just in the courts; it's also in the court of public opinion. And we are doing this and discussing issues with openness, and also we live in an era now that if we notice an issue or shenanigans, we'll put it up on Twitter.


Consider that in Great Britain, the same day that they started giving the COVID-19 vaccine, 22 healthcare workers out of thousands developed a kind of allergic reaction. And what happened? They immediately said that everybody who has a history of allergic reactions, please stay off of this vaccine for the time being. Talk to your healthcare provider. If you're at a super high risk of contracting COVID-19, and you meet the criteria about having allergies, let's do the vaccination under the care of your physician.


It's going to be the same way here in the U.S. We'll track adverse events from the beginning. And not only with the Vaccine Adverse Event Reporting System, VAERS, which is often misused, and not only with the CDC's Vaccine Safety Datalink, but also with the surveillance systems that we have at the at the local health departments. Also with the state health departments. And also the hundreds of scientists and epidemiologists all talking to each other, formally and informally, and sharing information. It's really remarkable that you have all this technology now coming together to stop a pandemic, and save hundreds of thousands of lives.


TPGA: I can't believe that people are scared rather than grateful, but that's the result of these anti-vaccine misinformation networks.


Dr. Najera: In the History of Vaccines Project, we have several articles that talk about why anti-vax efforts are nothing new. In the early 1700s, Onesimus, an African slave in Boston, told minister Cotton Mather about giving people smallpox under controlled situations, and people survived smallpox because of this inoculation. And then anti-vaxxers firebombed his house. And after Edward Jenner developed the cowpox vaccine in 1796, there were horrible cartoons about him.


I like to remind people that the anti-vaxxers, the people who react this way, people who say these things, they're in the very, very small minority. They are very loud, they like to make a big deal out of things, and they like to pretend like they have an army of followers behind them when they really don't. There are more people who are willing to to listen and to follow the advice of experts. Anti-vaxxers want to make us feel like we're alone. And we're not alone—the majority of people are reasonable.


TPGA: Yes. My experience in moderating the TPGA community and working in vaccine advocacy for 10 years is that there are definitely more people listening and trying to to understand what's going on with vaccines who are reasonable people, like you said. Then there is this tiny but vocal minority of people who are just so loud. So I think it's important to emphasize what the reality is.


But we do need to talk about concerns people have about the COVID-19 vaccines. Can you tell us what allergic reactions look like versus normal side effects?


Dr. Najera: Interestingly, after my wife got the COVID-19 vaccine, she felt a little feverish, a little run down; she just didn't feel really well. And that was because of her immune system. When your immune system gets activated, you have to create a lot of new cells to defend you, and those cells are created in your bone marrow, the very center of your bones, and they take up a lot of energy—and that means that you're going to get tired. By their nature immune cells take the scorched earth approach, they try to take everything out. And that's what can make you feel sick. Also, obviously, you're getting an injection, so you're going to have pain at the site. It's a needle; it's going to hurt.


But these symptoms go away. People will say "I got the flu shot and I got the flu," and you ask them to describe their flu. And it's nothing like the actual flu. They didn't land in the hospital. They didn't stay away from work for two weeks. They weren't getting winded just walking on the hallway. They felt a little feverish for a couple of days, and that's the kind of thing you expect to see, because your immune system is being called into action, right?


Some people have no side effects to vaccines because their immune system doesn't take the scorched earth approach, and is more relaxed in how it handles things. And on the other end of the bell curve are people who are going to have more serious reactions because their immune systems are a little bit hyperactive. These are the people who have allergies—or they don't even know that they have an allergy, and then they get exposed to something they're allergic to, and then their bodies overreact. That's where you get into the inability to breathe, because their throat is swelling up. Or, the feeling flushed, or dropping of blood pressure, things like that.


This is when knowing your medical history is very important. When you get the vaccine, they ask you a number of questions. And people often skip these questions because they think they're like the licensing terms for software. They think, "It's just It's too long; I'm not gonna read this." And that goes back to our whole thing about accessible language, right? But in those questions are things like, "Do you have a food allergy? Have you ever had a vaccine reaction before?"


If you have ever had a bad reaction to a vaccine, you need to have a conversation with whoever is giving you the vaccine, be it at the pharmacy or a medical office. You need to tell them that, "Last time I got the flu vaccine, this is what I felt," or "I'm allergic to eggs. I'm allergic to food dyes." You need to have those conversations to prevent those reactions. My guess is that out of the thousands of people in the UK that were getting the vaccine, those few people who had reactions probably didn't know that they had an allergy.


I know that the coronavirus is scary, and some people who have food allergies will want to get the vaccine because they feel like the virus is some ways worse than their allergies. But at the same time, allergies can get really bad if they're not careful. And so they need to have a conversation with a healthcare provider to be sure that they're they're going to be okay getting this vaccine,


TPGA: People in the autism and developmental disabilities community are more likely to hace co-occurring conditions, like Mast Cell Activation (MCA). Is that something that to be aware of, for getting the vaccine?


Dr. Najera: That is something where you'd say, "Let me talk to my health care provider." And consider that we are several days into the UK vaccinations, and now that data is being looked at. So statistically you're probably going to start seeing people with these kinds of medical histories, and people will be looking closer at how they come out of the vaccine. I can't give you a certain answer, but it's a subject for discussion with a health care provider that knows your medical history.


I try to remind people that if they have a medical condition and a vaccine concern, they really need to talk about it with a healthcare provider. They don't want to talk about it with random people on the Internet. They want to go to the subject matter experts. We live in an era where telemedicine is a thing. And I know that healthcare health access is still a big problem in the U.S., but I at least want to get ahold of a healthcare provider. If I go to the pharmacy, I can ask the pharmacist. I just want to double-check with somebody who knows a little bit more than the random person on the Internet. If people did that, we would be so much better off in so many ways. That's another avenue that we are working towards correcting.


TPGA: Yeah, We definitely have to remind people in our TPGA Facebook page that we are not vaccine experts, and they need to talk to their medical providers.


Dr. Najera: I had a person email the History of Vaccines project with a personal medical question. I replied, "You're better off talking to your health provider." And they shot back with a lot of mean language of, "Well, you're a doctor in public health, you should know better." But no, I'm not a physician, and you're asking a very personal question and I have no access to your medical history. And even if I did, again, I'm not a physician. You know that, that kind of thing. It's understandable; we are in uncertain times, and people are looking for confirmation.


TPGA: But it's interesting to me because they're asking an expert for a question, and the expert says "I'm actually not that kind of expert. Please go to another expert."


Dr. Najera: And that makes them upset. I know. Like my grandmother used to say, "Every head is its own world." Every person that I encounter is different. For instance, the anti-vaccine people. I used to lump them all together, but I've learned in the last 13, 14 years of dealing with them that some are skeptics because they have healthy skepticism, some are cynical people, and then there are the people you can't reason with—and I kind of just let them go their own way.


TPGA: Exactly.


Can you tell me, how does this vaccine compare to other vaccines that we know to be safe?


Dr. Najera: Sure. For example in 1976, a new flu virus came out of Fort Dix in New Jersey. A soldier got sick, they did a swab, and when they took it to the lab, they discovered it was a novel flu virus, a swine flu strain. And the CDC and the World Health Organization got scared, because a pandemic could begin from that one outbreak. President Ford signed into law a lot of money to be given to scientists to develop a flu vaccine immediately. Then when they were giving the vaccine out, they noticed that about 2 to 3 people in a hundred thousand were getting a very severe auto-immune disease called Guillain-Barre syndrome.


What they didn't know, because there was no surveillance system and no systematic collection of data for Guillain-Barre, is that this disease occurs at 2 to 3 per hundred thousand in the general population. Which is rare. But because they were paying close attention to the vaccine, they noticed Guillain-Barre as well—and when they backed off of the vaccine, they stopped it early. Thankfully, no pandemic ever materialized.


And this vaccine became known as a fiasco that gave so many people Guillain-Barre. But later on in the 1980s and 1990s, the public health people started looking at the literature, and we realized, "Hey, that's actually the background rate for Guillain-Barre." So the vaccine is actually safe, and it wasn't the vaccine. The vaccine might have triggered it, but the flu would also have triggered it.


For the COVID-19 vaccine, 72,000 people were in the Pfizer trials and 36,000 or so were in the Moderna trials. That's a lot of people. And they might not detect the one in a million reactions, but you will detect more things that are more one in one thousand.


Also, in the Pfizer placebo group, they saw eight deaths—not immediately, but in the weeks after the vaccine. And in the group that got the vaccine, they had two deaths. So does that mean that not getting the vaccine is four times as deadly as getting the vaccine? Well, no. These were expected background rates of death, because the participants were people who were advanced in age, and so they actually died of natural causes. One I think it was an accident.


And so, compared to those to other vaccines, and taking into account the background rate of things that happened, these new vaccines are very safe. There hasn't been a point where we gave you the vaccine and within hours, they were dead, and then we did an autopsy and and research, and we found that it was the vaccine component that did it. There hasn't been anything like that.


At this level they've already gone through the initial phase of trials in animal models and in computer models and experiments. They already gave it to a few dozen volunteers who were checked daily, in person, for any kind of adverse reactions. And then they were given to a one hundred people to check for immune reactions. And then phase three of the process had thousands of people tested for safety, immune reaction, and protection of the vaccine against the virus. So it's a lot of steps.


Are we going to see one in a million reactions? Once we start hitting a million people getting vaccinated, probably. And then that's where we fine tune again. And that's another thing I think people don't take into account: that vaccines do get fine tuned.


Also, everybody seems to think that we want to give a vaccine to everybody. No, no, no. We want to give the vaccine to everybody who can get it. And that provides herd immunity, which helps protect the people who cannot have vaccines.


TPGA: Can you also address why this vaccine is not going to mutate our DNA, even though it's an mRNA vaccine?


Dr. Najera: The reason why the COVID-19 vaccine is not going to mutate the DNA is because it never makes it into the nucleus of the cell. That's it. And again, people will say, "I never paid attention in biology class. So I'm not gonna know these things." But they hear DNA, RNA, and think, "Oh, there's gonna be some genetic interaction there." There isn't.


When people eat meat, they eat a lot of mRNA. And our bodies are great at not letting the mRNA from other cells do anything to our cells. And with this vaccine, you're giving the mRNA in a shot. It goes into the cells, but not the nucleus of the cells, because the cell would rather die before letting anything into the nucleus. And that's actually what happens when you get a viral infection: Viruses do get all the way into your DNA on some of the viruses. They do that, and they kill the cells. And that's why you have injuries to tissues themselves.


So the mRNA gets into your cell and it finds these little, little things called ribosomes. They put together proteins, and can make the protein that looks a lot like the virus protein. And then those virus proteins go out and your other cells pick them up, and they begin to make antibodies—but it never gets into the nucleus. It doesn't change your DNA because that's not how it works.


Viruses themselves can change your DNA, like the human papillomavirus (HPV). That virus goes into cells, like in the cervix in women. It makes the cells multiply, and that's how it creates cancer cells. That's the danger. The HPV vaccine prevents cancer. That's the kind of thing that I remind people of: Look, the COVID-19 vaccine will not get into the cell nucleus, But you know what does? HPV, and we have a vaccine for that, too.


TPGA: Great. Thank you so much. Can you tell me why is it significant that this is not a live vaccine?


Dr. Najera: Good question. If you have a live vaccine, you have to find a way to grow it in the lab. And when the pandemic started, I emailed Dr. Paul Offit, and said, "Hey, it's gonna be hard to make a vaccine because it's hard to grow the coronavirus in the lab, correct?" And he replied, "Yes, correct." With this vaccine, we don't need to grow it in the lab. We have just the genetic code, and that's enough to make the vaccine.


The other thing is, if you don't have a live vaccine you don't expose laboratory workers or people who are manufacturing the vaccine. You're not exposing them to the virus either. You don't have lab accidents like we used to do with smallpox. When you're handling a virus that doesn't have a known cure, treatment, or vaccine, you have to set up what's called a Biosafety Level Four lab, and there's only three or four of those in the U.S.


We don't need to use those labs for this vaccine. All we need to do is put the virus in the machine that reads the genetic code and tells us what that code is, and then we go to another machine and say, "Hey, make me some mRNA with this code," and then package it up, and you're good to go. That's a very simplistic way of putting it, but that's where the safety comes in.


Then the other thing is the immune response. If you were giving somebody a live virus vaccine, even though it's attenuated, the reaction or the chance of a severe reaction is higher, because your immune system has to react to an actual invader instead of just getting prepared for a little protein.


TPGA: That's super helpful. Can you talk about why prioritizing people at the highest risk is not the same as experimenting on them?


Dr. Najera: The COVID-19 guinea pigs were actually the first five or ten people who got the vaccine way back when, to see if the components were safe. I would dare to say that maybe my wife was a "guinea pig," even though she was part of tens of thousands of participants.


Prioritization happens because we have a very deadly virus that is killing people in a group. And we have a vaccine that has been shown to be safe. Ethically, you have to give it to that group. You have to prevent disease.


Even if it were an experiment, knowing what we know, it's still an ethical experiment because you're preventing something that is deadly with something that is known to be safe. If we had no idea of the safety of the vaccine, then the ethics get a little hazy: is it as bad as the virus, or worse? If we didn't know that, we wouldn't be able to do this. But we do know that, and so we're able to be ethical about it.


And that's the other thing. When I was telling you earlier that health departments are not just buildings, they are people, I mean that we all took an oath to protect public health, and we take that oath very seriously. People who don't take it seriously are not working in public health anymore. Those of us who take it seriously, we do this work out of caring for communities and our families, and and and wanting to stop things like this disease.


TPGA: We also have encountered wariness from the Black community about the COVID-19 vaccine, based on that community's history of mistreatment by the medical establishment. How are you and other public health workers addressing these types of concerns?


Dr. Najera: When we have discussions about anything like this vaccine with the African American community, they bring up the Tuskegee Trials. The issue there was that they had African-American people who had syphilis, and the scientists didn't do anything about it. They just let the disease run its normal course. And this was in an era when antibiotics were available to cure it. If it had been 300 years earlier, when there were no antibiotics, and there was nothing to do, they might as well observe it and see how it goes. But at this point in history, they already knew that antibiotics worked. They already had plenty of cases of syphilis, and they knew how it behaved. For some reason, they thought it was okay to do this, and it was probably born out of institutional and personal racism.


The story of Henrietta Lacks is another one that resonates with the African American community. She was a woman who died of cervical cancer. Her cells were used for medical advancement, but there was no justice in it—neither she nor her family got to benefit from her sacrifice. You see this over and over again. In the Latin American community, we have the contraceptive pill experiments in Puerto Rico. The Army also bombed Vieques Island there, sometimes with chemical weapons. You have companies that went down to Central America in the 1970s and 1980s to do clinical trials for their medications. And then and then they left the people without the medication when it was proven to work, or so expensive that they weren't able to afford it.


And if we're talking about justice, you also have people who are fleeing their own governments or have been abused by governments. And then the U.S. Public health system is run by governments, and so naturally they mistrust it.


Going back to the question from the African American community, having doubts is understandable. My best reply is that we have gone very, very far in ethics, and in ensuring ethical treatment of people. We're not perfect, but it's much, much better than it used to be. Many of the researchers are African American. They don't only speak the language of the people that they are trying to help. They also speak the language of the experience of the people that they are trying to help. They come out of underserved communities, they go into scientific fields, and they help to do this.


Myself, I was born and raised in a very poor part of Mexico, and migrated to the United States when I was ten. And here I am: Doctor of public health. Helping with this vaccine effort and the pandemic, and explaining things. So I have an interest as well in promoting the justice of this vaccine, and in the ethics, and in making sure that the distribution, prioritization, etcetera are ethical.


And so that is my best answer: it's very hard to get over what is centuries of mistreatment and injustice. And I completely understand that, I will never have any judgment against people who are skeptical, or even cynical to be honest, of vaccines because of that history.  


But at the same time, my mission is to inform them and say, "Look, I understand this is what happened. And this is where we are now. We've come a long way. We still have a long way to go. But we can make strides." And just one is that we recognize that minority communities have been hit very hard by COVID-19, and so they are being prioritized to receive this vaccine.


TPGA: Does a COVID-19 vaccine mean that we can stop wearing masks and washing your hands?


Dr. Najera: No, no, no. And the reason is because the vaccine is not perfect. It has 95% efficacy, which is how it performs under controlled conditions. It's probably going to have a very high effectiveness, which is how it performs once it goes out into the communities. But that is going to depend on who takes it and who doesn't.


For example, The MMR vaccine is very highly efficacious, at 98%. But it's not very effective in the anti-vaccine community. Because it's not perfect, and because not everybody's going to take it because it's going to take a while for immunity to develop, we're going to have to wear masks for a while. We're gonna have to wash our hands, and we're gonna have to be careful for a little while.


I think at the local level, when we start seeing herd immunity kick in, community immunity, then we'll probably start easing those restrictions.


TPGA: The main thing people seem to want to know is when can we get back to "normal"?


Dr. Najera: My best guess is the fall of 2021. And that is if everything goes according to plan. But we're going to have a U.S. administration that is pro science and pro-evidence, and so that'll help. We're going to have a partnership—and by "we" I mean "We the people"—with UPS, FedEx, the U. S. Postal service, the military, the police. Everybody's going to get involved in distributing this vaccine throughout the whole country. We have the ethics committees, the ACIP, and everybody recommending priority groups, and that will cut down on infection rates.


And if we can get all this done in the next nine months, then you're looking at the holiday season of next year (2021) with remarkably less restrictions. But it's going to take all of that put together. So I'm hopeful. I'm hopeful.


My best guess is it's gonna be late next year when we all finally get to take off the mask and go back to a new normal. It's not going to be the old normal—I think that movie theaters are done, and a lot of restaurants are going to be done. But in 1919 after the Spanish Flu pandemic, a lot of things changed, and that was the new normal. And now we're going to go into our new normal.


I do hope that the incoming administration reinstates the CDC surveillance systems around the world, which were cut and killed under the Trump administration. Those systems would have given us a warning about COVID-19 as early as September of last year. Those three-four months, those were critical. SARS in 2002-2003 and MRSA in 2011-2012 did not become pandemics because the first few cases were identified and acted upon so early that it just stopped everything. Those were coronaviruses just like COVID-19, but they didn't become pandemics. But the current administration, unfortunately, came in and killed a lot of our institutional knowledge, and we were left defenseless. And this is where we are.


TPGA: So infuriating.


Dr. Najera: Yeah, it is.


TPGA: I really, really appreciate your time. Is there anything else you wanted to add that I haven't asked about?


Dr. Najera: I'd like people to be very mindful that people with intellectual disabilities, or who are non-speaking, know that something's going on with this pandemic, because they feel the stress, they see the stress. I'd want to transmit my hope about this vaccine to them.


TPGA: That's wonderful. It's a really great way to end it. So thank you, René. Again. So grateful.


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René Najera, MPH, DrPH, was born and raised in Mexico. He immigrated to the United States at the age of ten and graduated from the University of Texas at El Paso with a degree in medical technology. He holds a master’s in public health and biostatistics from George Washington University and a doctorate in public health from Johns Hopkins University. He is currently the editor of the History of Vaccines Project from the College of Physicians of Philadelphia, an associate in the Department of Epidemiology at JHU, an adjunct at George Mason University and a senior epidemiologist at a county health department in northern Virginia. He is the father of a three year old and husband to a physician assistant.