Should I get the COVID vaccine?
As part of a larger conversation, a family member recently reached out to me expressing uncertainty about getting vaccinated to SARS-CoV-2 (the virus that causes COVID-19). She was concerned about the relative speed with which vaccine was produced and about side effects she had read about online. The following was my reply to her. She thought it may help others as well, so I’m posting it here.
Your questions are reasonable: one year is a very fast time to develop and release a vaccine (it often takes more like five years), and none of these vaccines are FDA-approved, which has a very specific meaning. Rather, they are FDA-authorized under the Emergency Use Authorization. So why in the hell would we consider taking them? As with anything in medicine, it comes down to weighing the risks and benefits of the treatment in question (vaccine, in this case) and the risks and benefits of no treatment (no vaccine). Some of these we know, and some we don’t. We know the short-term risks of the vaccine (that’s what the Phase III trials showed us), but we don’t know the long-term risks of the vaccine, as it has not been around for 5, 10, 20 years yet. We also know the risks of SARS-CoV-2 infection — short-term risks such as illness or even death and long-term risks such as multi-organ failure and life-long heart and lung problems (recent reports have even shown that SARS-CoV-2 can cause psychosis).
So, we have to weigh the risks and benefits. The calculation is this: the potential benefits (not getting COVID) out-weigh the known short-term risks and the unknown long-term risks. It is such a horrible disease (over 2 million people have died worldwide already — 4,000 people a day in the US alone — and many, many more will have life-long sequelae) that I accept the unknown future risks. Maybe that’s folly (and we’ll realize it in retrospect), but it’s the best choice we can make with the data right now.
But wait, what about potentially really bad vaccine side effects you may have heard of like Bell’s palsy, Guillain–Barré, or worse. Yes, those are horrible, but a few things: It’s unclear if those were caused by the vaccine, but let’s assume they were. Even if these neurological disorders are part of the risk profile of the vaccine, the benefits of not getting COVID still outweigh the very small risk of these, and this is even truer at the population level. Of note, the flu shot (influenza vaccine) can cause Guillain–Barré, but I and millions of others still get a flu shot every year, and you should too. This is exactly the risk/benefit analysis I’m talking about. Small chance of bad outcome vs big chance of positive outcome. As with any medical treatment, the COVID vaccine is not without risks, but the benefits out weigh the risks.
I have been vaccinated to SARS-CoV-2, and I encourage you to do so as well as soon as it is available to you.
PS: Once you get vaccinated, you still need to wear a mask and keep your distance from others. This is because it takes weeks for your immune system to make antibodies to the virus and because no vaccine is 100% effective. My understanding is that the Pfizer vaccine is 95% effective one week after the second dose, and the Moderna vaccine is 94% effective two weeks after the second dose (of note, 94–95% efficacy is phenomenal for a vaccine; flu shots are more on the order of 60% effective). We also do not yet have data that tell us if getting vaccinated stops us from spreading the virus to others, so that’s an additional reason to keeping wearing a mask.
Wear a mask. Get the vaccine.
M Rameen Ghorieshi, MD, MPH is a physician, psychiatrist, addiction medicine specialist, Adjunct Clinical Assistant Professor at the Stanford University School of Medicine, and the founder of Palo Alto Mind Body.
