The University of Michigan’s School of Public Health and Michigan Medicine held a panel discussion about COVID-19 vaccine efficacy, safety and what life could look like after the pandemic Thursday morning. The event was moderated by Dr. Emily Martin, associate professor of epidemiology at the School of Public Health.
The panelists first discussed the effects of different COVID-19 variants, specifically the B.1.1.7 variant which was first detected in the United Kingdom, on vaccine effectiveness. The first known case of the B.1.1.7 variant in Michigan was detected in Washtenaw County in January and is more easily transmissible, as well as more likely to lead to severe infections. The B.1.1.7 is now the most dominant COVID-19 strain in the United States.
Dr. Sandro Cinti, clinical professor of infectious diseases at Michigan Medicine, said the B.1.1.7 variant currently accounts for more than 50% of cases in Michigan. Cinti also said the new variants, including ones initially found in Brazil and South Africa, could lead to a slight decrease in vaccine efficacy, but that overall the vaccines will still work well.
“Those strains may have a little bit of reduced efficacy in terms of preventing symptoms,” Cinti said. “Now, a very important thing to remember when we’re talking about vaccines is … efficacy means people getting symptoms. What you really want to see is, are people getting hospitalized? And are they dying? And probably both of these strains you will still be protected (from developing a severe case).”
Dr. Arnold Monto, professor of epidemiology at the Public Health School and acting chair of the Food and Drug Administration’s Vaccines and Related Biological Products Advisory Committee, explained why the FDA issued emergency use authorizations for the Pfizer-BioNTech, Moderna and Johnson & Johnson vaccines instead of giving them full licensure.
“The only difference is the timeframe,” Monto said. “The emergency use authorization is given after no less than two months from the time the doses were given, but they’re looking at the same efficacy as would be required before licensure. There was an emergency, we had vaccines that clearly worked very well, and they needed to get out there … One of the few things we were lucky with this virus is the vaccine works and works better than we could have hoped.”
Dr. Laraine Washer, clinical associate professor of infectious diseases at Michigan Medicine, said in addition to the risk of hospitalization and death from being infected with COVID-19, some people experience long-term health effects after contracting COVID-19 such as loss of taste or smell and difficulty concentrating. Washer said any potential side effects from receiving a COVID-19 vaccine are preferable to any symptoms experienced from COVID-19.
“The safety of the vaccine is really high… But on the flip side of that, we know that there are both short-term consequences — hospitalization, mortality — related to actually getting COVID, and even long-term complications that people who may not be as much at risk for severe disease may feel,” Washer said. “When we compare the risk of severe disease … with the potential risks of vaccines, it’s really, really in favor of getting the vaccine for everyone who is eligible, not just those who are at highest risk of disease.”
Washer also said people who are vaccinated should get tested if they have any symptoms commonly associated with COVID-19, because the vaccines are not 100% effective. The Pfizer and Moderna vaccines were both found to be about 90% effective in a “real-world setting,” while the Johnson & Johnson one-shot vaccine is about 72% effective in the U.S.
The Pfizer-BioNTech vaccine was approved by the FDA for anybody 16 years or older, and the Moderna and Johnson & Johnson vaccines were approved for anybody 18 years or older. Monto said it is likely that at least one COVID-19 vaccine will be authorized for use in children by the time school starts in the fall.
“Sooner or later we’re going to be able to vaccinate way down in age… It is going to take the conclusion of the trials, and first the age 12 and above year olds, and those are underway,” Monto said. “Right now this is another reason why everybody else should get vaccinated. Because if we in the household prevent the adults from getting infected, then the children will also be protected.”
Washer said the vaccine trials measured symptomatic infection, severe disease, hospitalization and death, but lowering the transmission rates will be key to ending the pandemic. Washer said real-world data is coming out about transmission of COVID-19 among vaccinated people.
“Transmission is really the key thing when we’re trying to stop pandemic and so the trials, as Emily stated, were really set to measure symptomatic infection,” Washer said. “More recently, there has been additional information coming out from real-world information from clinical trials that looks at outcomes including asymptomatic infection … This is evolving data, but it’s very promising, and it’s really important as we think about preventing transmission.”
The panelists then spoke about assessing the risk of certain activities after being vaccinated. While all four panelists are fully vaccinated, Cinti, Martin and Washer all said that they are still limiting their activities because not everybody in their respective households is fully vaccinated.
The panelists noted the importance of factoring public health risks into individual decisions. Washer said that even though she is vaccinated, she does not eat at restaurants in case restaurant employees have not been able to get vaccinated. Cinti also said it is important to look at community spread before going out.
According to the Center for Disease Control and Prevention, individuals who have been fully vaccinated are only able to gather indoors with other fully vaccinated people without wearing a mask or socially distancing. Fully vaccinated individuals are also able to gather indoors with unvaccinated people within the same household who are not at risk for severe illness. The CDC still recommends fully vaccinated individuals to wear a mask and stay six feet apart from others in public, when gathering with unvaccinated people in different households, or visiting unvaccinated individuals at increased risk of severe illness.
All Michigan residents 16 and older are currently eligible for a COVID-19 vaccine, and vaccine eligibility is expected to be available to everybody nationwide by April 19. An NPR/Marist poll released on March 30 found that 25% of adults do not want to get a COVID-19 vaccine, and an additional 5% are undecided. Martin stressed the importance of getting everybody vaccinated and overcoming vaccine hesitancy.
“In Michigan, we have wide-open eligibility,” Martin said. “National eligibility is going to be opening across the country within the next couple of weeks everywhere for everybody. But it only works if people use it.”
Washer said it is important to try to understand why people are hesitant to get vaccinated, and then try to motivate individuals to get vaccinated on a personal level.
“These are hard conversations. And the first thing is you don’t want to badger people and kind of bully them into changing their minds, because it doesn’t work,” Washer said. “A couple of strategies that I think could be effective are number one, try to understand their reason for vaccine hesitancy … and secondly, understanding what might motivate someone to get vaccinated and trying to address those on a very individual basis.”
On March 11, President Biden set a goal for Americans to be able to return to a more normal life by the Fourth of July. Cinti said he thinks COVID-19 will be a much smaller problem in the U.S. by this summer.
“We’re going to see the rates go down as weather improves… we’re not going to be as close contact (but) I think (weather), plus the increase in vaccination, is going to give us a relatively quiet summer compared, certainly, to last summer,” Cinti said. “I’m pretty sure I’m going to be able to see my kids … I’ll be able to play basketball again with my group of friends. And so if I can achieve those two things, that’s as close to normal as I need to get.”
Daily Staff Reporter Justin O’Beirne can be reached at firstname.lastname@example.org.