‘The Year of the Vaccine’: 2021 gave us vaccine protection and pushback
From Operation Warp Speed to debate over vaccine rollout, efficacy and immunity impacts
One of my favorite childhood memories was sitting in the back of my dad’s SUV (his chief’s SUV from the fire department) eating a box of popsicles with my siblings as we watched dad on a working fire – a call that came in while we were picking a movie from Blockbuster.
I remember thinking what a cool job he had and how excited I was to tell the kids at school the next day what I’d seen. While I knew the job was dangerous, it wasn’t until I started researching firefighter health more than a decade ago that I really understood that the risk of being burned, which I had been so worried about, was really the least of the dangers.
My research on firefighter health started more than a decade ago with funding from the American Heart Association. At the time, the CDC’s report about on-duty deaths had just been published and the rate of cardiovascular deaths made a compelling case for the organization. A broad qualitative review of the health concerns of firefighters led to more research questions that have evolved to include everything from behavioral health and cancer to modifiable risk factors and the health of female firefighters.
Like everyone, when COVID-19 hit, I was uncertain about how bad it would be and what the implications would be for me, my family and my community. My focus quickly shifted to the implications of the virus for the fire service given fire and EMS personnel are even more “out front” than the front-line workers in hospitals and clinics – and in far less controllable and predictable settings.
Hearing the concerns of those I worked with led us to develop a project – ultimately funded by FEMA’s Fire Prevention and Safety Research and Development Grants – focused on understanding how COVID impacted and continues to impact the fire service, and to identify future steps and lessons learned at the national, department and individual level.
Of course, with the turmoil and stress of 2020, many hoped that 2021 would be the year that the vaccine turned everything around. And while 2021 really is the “Year of the Vaccine,” it could be more accurately named, “The Year of the Great Vaccine Debate,” with the opinions about vaccination turning fierce.
The fire/EMS impact
More than 100 firefighters in the United States have died of COVID. To scientists, this is not surprising given that firefighters were found to be 60-100% more likely to contract COVID than other healthcare workers. Adding to the urgency for firefighters to get vaccinated is the high rate of those who are unvaccinated who experience Long COVID – a condition classified as having symptoms for four weeks or longer – which some department physicians report is occurring in more than 10% of firefighters. Many of those firefighters have had such deficits that they have had to leave the job due to an inability to handle the physiologic strain of the job.
While mitigation measures such as distancing, masking, ventilation and aggressive attention to hygiene have some impact on decreasing spread of COVID, no measure is as effective as vaccines for reducing the toll of death and disease on firefighters. But even still, there remains concern among fire and EMS personnel about the safety, efficacy and impact of the vaccine. There has been wide concern about how quickly the vaccines were developed, mixed messages about how vaccines work and how effective they are at preventing infection and severe illness, and how serious the disease is – or can be – for otherwise healthy firefighters.
[Read next: ‘I moved my lawn today’: A forced change in perspective due to Long-COVID by Lt. Tom Walker]
Operation Warp Speed
Regarding the speed with which the vaccines were brought to market, some have suggested that it was rushed and skipped approval stages typical of other, more common vaccines. In truth – the speed of the process can be attributed to several factors and is a testament to how fast the process can be when all the barriers are removed. Success in this instance was based on key factors:
- Existing research in the field of mRNA vaccines. mRNA has been used in cancer treatment for over a decade. Further, vaccine development for SARS that has occurred since 2003 provided a head start for the COVID vaccine, as scientific teams already had the foundation for how to tailor the vaccine to this particular coronavirus
- Expedited funding. Companies are typically cautious to invest funds in testing and bringing drugs and vaccines to market unless they are certain there will be a need. In this instance, the clear, present and persistent need made meant dedicated funds for development.
- Study recruitment. While many clinical trials require concerted efforts for recruitment, vaccine trials had more volunteers than they needed as soon as trials opened.
- Effective vaccine/rapid spread. While many trials require a long period of follow up to determine if the active vaccine and the placebo produce different effects, the difference was quickly apparent in the vaccine trial data, given both the highly effective vaccine and the rapid spread of disease.
- Expedited review. Review of documentation was prioritized, with organizations such as the FDA hiring additional staff to ensure standard protocols were followed.
- Manufacturing ramp-up: Concurrent ramp up for manufacturing occurred given the early positive promise of the vaccine efficacy.
[Additional resource: ‘Warp-speed vaccine’: Addressing firefighters’ concerns over the quick vaccine rollout]
Research on the number of doses that will eventually be needed in the series is ongoing, as scientists study how long immunity is elevated. Many past vaccines have required a series of shots. For example, a full polio dose is a series of four vaccines.
The CDC has recommended that individuals who received an mRNA vaccine get a third shot if they are 18 years old or older and work as a first responder, depending on their individual risk factors. (Please check the CDC website for regular updates.) With the discovery of the omicron variant, the recommendation has been now changed to include everyone over the age of 18. This should be another mRNA vaccine at least six months after the second shot. It is recommended that anyone who received the Johnson & Johnson vaccine and is 18 years old or older receive a booster two months after their shot.
Some have questioned whether the COVID vaccines are truly vaccines given that some people will still become infected after being vaccinated. By definition, vaccines are designed to prevent or decrease symptoms when the immune system is challenged by the infectious agent. Vaccines teach the immune system how to fight the infection, which is what the COVID vaccines were designed for and do well.
Importantly, vaccines do not have to be highly effective to save thousands of lives and prevent millions of infections. For instance, polio in the United States is largely eradicated. The high rate of success is partially due to the vaccine and partially due to the high rate of vaccination – there are fewer people contracting the disease so less chance of coming into contact with someone who has it.
By comparison, the Measles, Mumps & Rubella (MMR) vaccine is 93% effective after one dose and 97% effective after two doses. Rates are similar to pre-Delta effectiveness of the mRNA vaccines. Flu vaccines are between 40 and 60% effective, a rate lower than the COVID vaccines available in the U.S.
In comparing the vaccines, current data during the ongoing Delta surge suggests the mRNA Moderna vaccine is 92% effective in preventing hospitalizations from COVID and results in a 67-90% reduction in the transmission of COVID. Similarly, the Pfizer vaccine has been found to be 78% effective in preventing hospitalizations five months post-second dose and results in a 72-95% reduction in transmission of COVID. Johnson & Johnson vaccines have been found to be 60-81% effective in preventing hospitalizations and results in a 74% reduction in transmission of COVID.
Weekly trends in standardized incidence of COVID confirm that vaccinations decrease cases, hospitalizations and deaths. Learn more about weekly COVID numbers:
- Your Local Epidemiologist: Vaccine Tables
- CDC: Monitoring Incidence of COVID-19 Cases, Hospitalizations, and Deaths, by Vaccination Status
Many have argued that their healthy lifestyles and immune systems mean they do not need the vaccine. While it is true that co-occurring disorders make for a higher risk for severe outcomes and death from COVID, living a healthy lifestyle cannot prevent being infected and does not guarantee a lack of symptoms or Long COVID. Even among professional athletes, a small number exhibited myocarditis (inflammation of the heart) tied to their infection.
While infection with COVID does produce an immune response and can promote immunity, studies of people post-infection have determined that the level of immunity varies across people, and the amount of time the immunity lasts is also inconsistent. If you have had COVID before and are not vaccinated, you are twice as likely to be infected with COVID again, compared to those who have had both infection and the vaccine. A large study conducted across nine hospitals found that prior COVID-19 infection does not protect as well against reinfection as the vaccines. Currently, it is recommended that those who have been infected with COVID also get vaccinated (called hybrid Immunity) to maximize protection.
Read more about immunity:
- Comparing SARS-CoV-2 natural immunity to vaccine indued immunity: reinfections versus breakthrough infections
- Laboratory-Confirmed COVID-19 Among Adults Hospitalized with COVID-19–Like Illness with Infection-Induced or mRNA Vaccine-Induced SARS-CoV-2 Immunity — Nine States, January–September 2021
Beyond self-protection, vaccines are important to reduce the spread of COVID to others in the community. With the introduction of the Delta variant, the spread of COVID has been significantly faster. While the initial variant had a R(0) – pronounced Rho Naught – an estimate of the number of people each person with the infection will spread the disease to – of approximately two (so each infected two others), the Delta variant estimates are closer to eight.
High community spread can also lead to additional mutations of the virus. Scientists are concerned that allowing the virus the opportunity to mutate may lead to a form that the current vaccines do not protect against.
Although COVID is typically mild in young people, about 30% of youth hospitalized with the virus have no underlying health conditions that would have put them at increased risk. Amid the recent Delta surge, hospitalization rates were about 10 times higher in unvaccinated young people than vaccinated ones.
Treatment advances – and misses
There are treatment advances, including the use of new medications and monoclonal antibody treatment. Some have argued that the progress in treatment approaches is so positive that they do not need to worry about the risk of getting sick. It is important to remember that the treatments are not always available to everyone in every region and often require early initiation. For instance, monoclonal antibody treatment is often given early to people at high risk of hospitalization to decrease risk. In addition, the treatments do not always work.
Ivermectin has been claimed by some to be an effective way to prevent or treat COVID infection. In humans, it is used as an anti-parasitic agent for infestations, such as scabies. While there have been several studies on ivermectin, they have mixed results.
One of the largest studies supporting ivermectin was retracted due to inconsistencies in the data, so many meta-analyses (studies that weigh and combine the results of several smaller studies) are being re-analyzed. Ivermectin is not without side effects, including confusion, loss of control over body movement ("ataxia"), weakness, low blood pressure, seizures, gastrointestinal distress, dizziness, vision symptoms, or rash. These are often a result of high doses and/or medication interactions. Ivermectin is not recommended for treatment or prevention of COVID at this time.
Read more about ivermectin:
- Flawed ivermectin preprint highlights challenges of COVID drug studies
- Ivermectin for preventing and treating COVID‐19
- Drug treatments for covid-19: living systematic review and network meta-analysis
- Toxic Effects from Ivermectin Use Associated with Prevention and Treatment of Covid-19
Making a difference
Vaccines are especially important for fire and EMS personnel for several reasons:
- Fire and EMS personnel are patient-facing and are widely engaged in their communities. While other Americans were encouraged to stay home, fire and EMS were still out in their communities on the most front of the front lines. Their ability to spread the virus to each other and the community as fomites of the infection was higher than the general population.
- COVID continues to mutate. The more chance it has to spread, the higher the likelihood it will mutate to something that cannot be thwarted by the current vaccines and/or mutate into a more dangerous variant, which could pose a serious setback to the pandemic efforts.
- Fire & EMS often interact with the most vulnerable (e.g., elderly, immunocompromised).
An important fight
With the successes and challenges of 2021, the scientific and medical advances that occurred will surely remain some of the most important of the current generation – but the battle continues.
A factor that will be critical in slowing the spread of COVID is slowing the spread of disinformation about the virus and the vaccines. While we will not embark on a political battle here, as a scientist, I want to underscore the importance of being mindful of the difference between information supported by science vs. disinformation rooted in political ideology. It is critical for all of us, including members of the fire and EMS community, to consider the integrity of our sources, including whether they stand to profit from the information, and whether the methodology and data are sound.
With so much misinformation swirling about the internet, it’s easy to become confused. I urge you to find trustworthy sources, like the CDC, and question any claims that seem far-fetched, even if they better align with your personal views. After all, sometimes the truth creates inconveniences that we do not welcome but that are critical to acknowledge.
It’s vital that we do everything we can, together, to stop this virus from claiming more lives. The vaccine is critical in this endeavor.
Now on to 2022.