Specialists from a variety of medical fields answered community questions on topics from potential vaccine side effects to vaccinating while pregnant.
By Ruth Steinhardt
Medical experts from the George Washington University answered questions about the COVID-19 vaccine and addressed community concerns at a virtual forum last Wednesday, emphasizing the safety and efficacy of the three vaccines approved for emergency use in the United States.
Ray Lucas, associate professor of emergency medicine in the School of Medicine and Health Sciences (SMHS) and the university’s COVID-19 coordinator, moderated the session, which was recorded and is available for viewing.
Panelist David Diemert, SMHS professor of medicine and an infectious disease researcher with the GW Medical Faculty Associates (MFA) and SMHS, said the question of whether the vaccines are safe has a simple answer: “An unequivocal yes.”
“A requirement for authorization by the FDA is that safety is shown,” he said. “Each of the three authorized vaccines have been tested in Phase 3 trials, each of which enrolled at least 30,000 people…, [and] we have data now from literally hundreds of millions of people who have received at least one dose of one of the three vaccines. So we have an immense amount of safety data.”
Some people do experience the side effects expected for vaccines, but these are mostly well-tolerated and pass quickly, Dr. Diemert said. More serious side effects, though sometimes highly publicized, are “exceedingly rare.”
Some young patients may question whether the chance of experiencing unpleasant side effects from the vaccine is higher than the chance of a bad outcome like hospitalization or death from COVID-19. But panelists said it’s a false equivalency that doesn’t take into account the duration and severity of symptoms.
“After a vaccine, people may experience a sore arm for a couple of days, fever or headaches or an upset stomach,” said Hana Akselrod, assistant professor of medicine, director of the GW COVID-19 Recovery Clinic and an infectious disease specialist at the MFA. “But one of the most fearful and unpleasant consequences of COVID, speaking from my clinical experience of the past year, is long COVID.”
Dr. Akselrod said a significant percentage of patients, including young people and people who have mild infection initially, experience more than two months of post-COVID symptoms that may include shortness of breath, severe fatigue, debilitating headaches, brain fog and even cardiac irregularity.
“Having taken care of people in the past year in the COVID Recovery Clinic who have been debilitated for months, who were previously exceptionally healthy and fit, I am quite impressed that the consequences of this virus in the long run are orders of magnitude greater than the side effects people experienced after vaccination, which fade in a few days,” Dr. Akselrod said.
Panelists said that the knowledge base around COVID-19 vaccination is expanding and evolving as the vaccination effort continues. While early guidance suggested that no additional vaccines should be administered within two weeks of being vaccinated for COVID, for instance, the present consensus is that the COVID vaccine can be safely administered alongside other vaccines, even at the same doctor’s visit.
The duration of immunity conferred by vaccination is also still an open question, Dr. Akselrod said. Encouraging data shows that antibody immunity may last eight months or more, and immune memory mechanisms may provide protection for a year or more.
“As for when or whether additional boosters or third doses may be required, we hope to get more information from studies that are ongoing,” she said.
Vaccine hesitancy continues to be an issue for as much as 30 or 40 percent of the population, said Karen Drenkard, associate dean of clinical practice and community engagement and associate professor in the School of Nursing. This hesitancy may stem from a lack of information, from myths spread on social media or from community skepticism about medical authority. Whatever the root cause, Dr. Drenkard said medical professionals and laypeople can combat vaccine hesitancy in their own communities by sharing their own positive vaccination experiences. They can also volunteer as vaccine ambassadors.
Dr. Drenkard emphasized that people experiencing vaccine hesitancy should be treated with compassion, and that if you know someone who is hesitating to be vaccinated, the best way to encourage them may be to offer information and emotional support without judgment.
“People look to their colleagues and friends and the people that they look up to for some sense-making of the issues,” she said. “Sometimes people are just afraid, and they need time to process that.”
Michael Knight, assistant professor of medicine and primary care specialist and physician with the MFA, said minority communities were well represented in the vaccine trials and that vaccines showed as much efficacy in people of color as in white subjects.
Vaccine hesitancy and trust in the medical establishment may understandably be an issue in marginalized communities, he said. But since COVID-19 has had a particularly severe impact in Black, Latinx and Native American communities, building back that trust and advocating for patients of color to get vaccinated should be a priority for doctors and public health professionals.
“What we’re working to do is to build confidence, because it’s okay to question new things,” Dr. Knight said. “We want to answer these questions so that everyone in every community can feel comfortable about the COVID-19 vaccine.”
That comfort should extend to pregnant people, a demographic excluded not just from initial COVID-19 vaccine trials but from almost all such trials, said Homa Ahmadzia, SMHS assistant professor of obstetrics and gynecology, director of maternal-fetal medicine research and maternal-fetal medicine specialist in the MFA. More recent CDC data has included over 35,000 patients who were pregnant when vaccinated, and this group showed no increase in risk of miscarriage, stillbirth, congenital anomalies or birth defects compared to the general population.
Vaccinating a pregnant parent also has the potential added benefit of conferring increased immunity to their baby after birth, she said. And there also is no reliable peer-reviewed evidence to show that vaccination has a damaging effect on fertility.
“The risks of getting COVID while pregnant far outweigh the risks of getting the vaccine while pregnant,” Dr. Ahmadzia said.
The risk of a severe anaphylactic allergy response to the vaccine is also extremely low—approximately three in 1 million, said Anjeni Keswani, assistant professor of medicine and director of the Division of Allergy and Immunology. Nearly all of these severe reactions happen immediately after immunization and occur in people with known or suspected allergies to injectable polysorbate or polyethylene glycol.
People with a history of severe anaphylactic reactions to medication or food are considered to be at moderate risk and should bring their EpiPen to the immunization site and remain there for at least 30 minutes for observation after receiving the shot.
“The majority of people with allergies can receive the COVID vaccine safely,” Dr. Keswani said.