Vaccine mailbag: Answers to questions you had about the COVID-19 vaccine

Editor's note: These answers are based on interviews and information current as of the time of publication. Please be aware that new information may be discovered by health experts after publication. We're working to keep this information as up-to-date as possible.

SALT LAKE CITY — Wednesday marks the first anniversary of when COVID-19 was originally discovered in the United States.

A full year later, over 400,000 Americans have reportedly died as a result of the coronavirus; that includes more than 1,500 Utahns. The term "social distancing" is likely burned in our memories forever, and we all know what it's like to parade around our communities wearing masks.

One of the more promising advancements one year later, however, is the development of a vaccine. More than 170,000 vaccines have been administered throughout the state since Dec. 15, according to Utah Department of Health data. This week, Utahns aged 70 and up became eligible to receive the vaccine.

Given the many questions KSL.com has received about the vaccine in recent weeks, it felt like the perfect time to bring back the mailbag series we launched for questions about COVID-19 about the same time the pandemic reached Utah in March 2020. In this initial installment, we dive into questions you asked us about vaccine supply, duration of vaccine immunity, side effects and more.

Here are answers we've found to some of your questions.

How many vaccines does Utah anticipate getting every week?

Gov. Spencer Cox reaffirmed last week that Utah remains steady on an estimate of about 33,000 doses per week for the next little while; that's 33,000 of the Pfizer-BioNTech and Moderna combined. This doesn't include second doses, which are needed separately to reach max efficacy; those doses will be delivered on time specifically for individuals who already got the first round of the shot, officials said this month.

Incoming President Joe Biden said he would authorize the Defense Production Act to speed up vaccine manufacturing; however, it's possible that the number will grow even if those two drug manufacturers don't increase output. That's because Johnson & Johnson and AstraZeneca are nearing the end of their clinical trials.

In an interview on NBC's "Meet the Press" on Sunday, Dr. Anthony Fauci, the country's leading infectious disease expert, said he believed the two drug companies might release their trial information results by the end of the month. From there, they would work with the Centers for Disease Control and Prevention and Food and Drug Administration, who would ensure the vaccines are safe. The federal agencies could approve the drugs for emergency use authorization shortly after that.

All of it, Fauci said on the show, meant that the two companies were "weeks away" from potentially receiving final approval.

"We're weeks away not months away, for sure," he said.

Where/when can I get the vaccine?

State and federal leaders split up the responsibilities for vaccinations across the country. So far they have fallen under the following umbrella:

• Hospital employees: Health care providers
• Long-term care facility staff and residents: National pharmacy chains through a federal partnership
• School employees: School districts
• Emergency response employees and residents: Local health departments

As it currently stands, only residents age 70 and above, health care employees, long-term health care staff and school district employees can receive the vaccine. The dates of when more groups will get the vaccine has ranged but it's still believed that all adults who want a vaccine will have access to them by the summer or fall. The state will make an announcement every time a new group becomes eligible for the vaccine.

Most people will fall under local health departments when the state announces new groups; Cox tweeted over the weekend that this even includes him once his age range is reached. Check with your local health department to see how to schedule a vaccine appointment.

Take the Utah County Health Department, for example. It launched a website for residents within the county to sign up for a vaccine once they are eligible. Some, TriCounty Health Department, set up a hotline for eligible residents of Daggett, Duchesne and Uintah to reserve a spot.

Both the Pfizer and Moderna vaccines come with a second, booster dose. In places like Salt Lake County, individuals who got vaccinated Monday were handed a card showing the date to get their second vaccine along with the vaccine manufacturer they got it from. They were instructed to schedule a second appointment through the same system or after the date on their card. Pfizer vaccines require a 21-day wait between doses, while the Moderna vaccine is spread out 28 days.

Does the vaccine only last three months?

We took this as a question about the length of protection. As many might know, the CDC currently lists COVID-19 immunity as 90 days, or about three months, after the onset of an infection. What's unknown right now is how long immunity from the COVID-19 vaccine is once administered.

So we brought this question to Dr. Brandon Webb, an infectious diseases physician at Intermountain Healthcare, to get a better idea of how long medical experts believe the vaccine could provide protection. He said the vaccine could provide at least a year's worth of protection, at least.

"The clinical data does suggest the two-dose format of the mRNA vaccines stimulate a very robust response from the immune system and, because of that, the vaccine should give at least 9 to 12 months of immunity — and perhaps more in some patients, perhaps less in others depending on the health of your immune system," he said, in a press briefing Tuesday. "But that two-dose vaccine series does appear to have a very effective response. And time will tell as we get further into this how long that immunity lasts beyond that 9 to 12 months."

It's still unclear if the vaccine will be a one-time booster or an annual vaccine much like the yearly flu shots.

"Time will tell and right now the top priority is getting everyone vaccinated with their first round," Webb added.

Is there evidence it will actually prevent COVID-19 or only lessen symptoms?

This is a very important and critical question at the current stage of the pandemic.

The clinical trials for the two approved vaccines reported they were about 95% effective after the second booster dose. The New York Times explained last month that it means the difference between those who got the vaccine and the control groups was large but it doesn't necessarily provide a likelihood that you will get sick after a vaccine. Efficiency, which in this case is everyone getting the vaccine, will only be determined with time.

Webb said most people who get vaccinated will likely end up with a less severe case if they do get the virus. But he also advised it's also likely the vaccine will be more protective for some over others. Based on research from other viruses, such as influenza, he said it's possible the vaccine effectiveness might be as much as 30% lower in elderly populations. Webb added that vaccine effectiveness may also range from person to person.

"We need to remember that even as we vaccinate our most vulnerable senior populations, they may not have full immunity from the vaccine and we still will need to be careful when we're interacting with them and when we're creating policies around infection control," he said.

It's also important to know that even if you're vaccinated, it's still possible you can spread COVID-19. As the Harvard Medical School pointed out, the clinical trials for the two approved drugs provided solid evidence that it could prevent the symptomatic spread of COVID-19 but it "did not measure whether a person who is vaccinated is less likely to spread the virus to someone else."

"It's possible that the vaccines protect against COVID-19 disease by preventing a person from becoming infected in the first place. However, it's also possible that the vaccine protects a person from COVID-19 illness, but does not prevent a person from becoming infected," Harvard health experts explained. "In other words, a vaccinated person may have replicating virus in their nose and throat even if they are protected from becoming sick."

That's why wearing masks, physically distancing and good hand hygiene is still strongly encouraged even if you've been vaccinated. A vaccine mixed with the other preventive tools is believed to be the strongest pathway out of the pandemic.

"The vaccine is tremendously helpful but not perfect," Webb said. "We're very lucky that the vaccine effectiveness that we saw in those clinical trials was so high. But everyone's different and the protective benefit of the vaccine does vary from person to person. If you've been vaccinated and are then exposed, it's still highly recommended and highly important that you follow the same quarantine because it's still possible you may have a low-grade virus infection — perhaps asymptomatic or pre-symptomatic — and then inadvertently spread it to others."

If I tested positive and had COVID-19 symptoms, when should I get the vaccine? Do I wait the 90 days? Is it safe to get it?

It is true that the state is pushing people to wait at least 90 days after infection to get the vaccine; however, it's more of a matter of logistics than safety concerns, according to Utah's leadership.

They argue that if you've battled off COVID-19, you have at least three months of immunity to the virus so it wouldn't make much sense to get the vaccine until that's worn off. In fact, the governor said he wanted to work with the CDC to extend the waiting period to six months. And while COVID-19 reinfection is possible and documented, the CDC still lists it as "rare."

"We have to be much more practical about our applications of this (vaccine)," Cox said during a Jan. 8 press briefing. "We have enough data to show reinfection is very, very, very rare. If we want to achieve herd immunity we shouldn't waste vaccines on people who have had the virus already and absolutely have some very strong immunity — we know over at least the first 90 days. … We should use that vaccine for people who have not had the virus and do not have any immunity."

What about the safety component? The CDC points out that clinical trial data indicated that the mRNA vaccines were safe for people who were previously infected. It's recommended that a person has at least recovered before they get vaccinated still.

"Vaccination should be offered to persons regardless of history of prior symptomatic or asymptomatic SARS-CoV-2 infection," agency officials wrote on its website.

Some Utahns may have received monoclonal antibody therapy or convalescent plasma as a part of COVID-19 treatment. While there was no data about safety concerns or issues with COVID-19 vaccine efficacy, the CDC recommends that people who receive this treatment should wait at least 90 days after infection as a "precautionary measure."

"Based on the estimated half-life of such therapies as well as evidence suggesting that reinfection is uncommon in the 90 days after initial infection, vaccination should be deferred for at least 90 days, as a precautionary measure until additional information becomes available, to avoid potential interference of the antibody therapy with vaccine-induced immune responses," it wrote.

The vaccine wasn't recommended as a tool for outbreak management or to be administered after possible exposure since it wouldn't likely be effective at that point.

What are the long term side effects of the vaccine?

Side effects were probably the most frequently-asked subject within the questions we received.

Let's start with the known side effects of the vaccine from clinical trials. The Pfizer-BioNTech trials pinpointed fatigue, headache, chills and muscle pain as the leading side effects in its report released in early December 2020. Similar results were reported in the Moderna vaccine, according to the FDA. Both found most of the side effects happened after the second dose, which acts as a booster.

The Pfizer trial also found small percentages of more serious side effects of Bell's palsy, myocardial infarction, pneumonia and stroke that ranged about 0.02% to 0.04% higher than the study's control group.

Webb said side effects can be "reassuring" in a way because it indicates the vaccine is creating an immune response like it's supposed to.

"Many of the symptoms that we experience when we have a viral infection like COVID or influenza are actually not from the virus, they're actually collateral damage from our immune system responding," he explained, adding in that effects recorded in the trial study are expected to happen again once people receive their booster dose.

We will know of other adverse events as more and more people get the vaccine through the Health and Human Services' Vaccine Adverse Event Reporting System set up to collect information on other side effects reported during the vaccine rollout.

The CDC published a study earlier this month that found there were 4,393 reported adverse events among the first 1.893 million doses of the Pfizer vaccine administered between Dec. 14-23, 2020. It accounted for about 0.2% of the total vaccinations at that point. The study, though, focused more on 21 cases of anaphylaxis (11.1 per million doses administered), or allergic reaction, that were confirmed from the first 10 days.

Of the 21 cases, 15 reported symptoms within 15 minutes; 17 of the 21 were treated in an emergency department and 19 of 21 received epinephrine as a treatment. None of the 21 died. Most reported having a history of allergies or allergic reactions but it wasn't clear what caused the reactions.

"Based on early safety monitoring, anaphylaxis after the Pfizer-BioNTech COVID-19 vaccine appears to be a rare event; however, comparisons of anaphylaxis risk with that associated with non-COVID-19 vaccines are constrained at this time by the limited data available this early in the COVID-19 vaccination program," the paper stated, adding that further research will be done to look into potential cause and also to review other vaccines.

The study also found 83 nonanaphylaxis allergic reactions reported during the same time period. These included pruritus, rash, itchy and scratchy sensations in the throat as well as mild respiratory symptoms. About 87% were classified as "nonserious."

Meanwhile, the Associated Press reported Monday that epidemiologists in California recommended that officials don't use a specific batch of the Moderna vaccine "out of an extreme abundance of caution" after a group fewer than 10 people from the same community vaccination site needed medical attention over a 24-hour period. The report said that California and U.S. officials, along with the drug manufacturer, were investigating the illnesses.

As for long term effects, it's really difficult to know this early on, much like the long term effects of the virus itself — or duration of vaccine protection. Keep in mind that vaccine trials only began months after the virus was first discovered and were approved by the FDA because they believed the benefits of a COVID-19 vaccine far outweighed the risks.

This is partly why the Vaccine Adverse Event Reporting System was set up; it allows researchers to keep track of all side effects, including their seriousness and duration. Everyone who gets the vaccine can report their side effects to their health care provider, who will then be able to report it to the system for further review.

So when it comes to long term effects, University of Michigan Medicine experts put it this way: "Only time and accurate tracking will tell for sure; scientists have to look for unusual patterns of disease in groups of vaccinated people. That's why everyone who gets vaccinated is being encouraged to track and report any symptoms they may feel in the short and long term, and to tell their health provider."

How does this vaccine affect people with autoimmune diseases?

Continuing on this theme, the CDC does have guidelines for people with underlying medical conditions — something that's factored in severe COVID-19 outcomes, as well.

The agency said the data from vaccine trials were limited for the most part. Individuals who had "stable HIV infection" were included in vaccine trials. Ultimately, the CDC states anyone who is immunocompromised, has any autoimmune conditions or has a history of Guillain-Barre syndrome can receive the vaccine if they don't have any contraindications to vaccination.

Contraindications include severe allergic reaction after receiving an initial dose of an mRNA COVID-19 vaccine or any of its components, immediate allergic reaction "of any severity" to a previous dose of an mRNA vaccine or any of its components, such as polyethylene glycol, or immediate allergic reaction of any severity to polysorbate.

The components of both vaccines are available through the FDA. For instance, Technology Review reported the full ingredients for thee Pfizer vaccine are:

• nucleoside-modified messenger RNA
• (4-hydroxybutyl)azanediyl)bis(hexane-6,1-diyl)bis (ALC-3015)
• (2- hexyldecanoate),2-[(polyethylene glycol)-2000]-N,N-ditetradecylacetamide (ALC-0159)
• 1,2-distearoyl-snglycero-3-phosphocholine (DPSC)
• cholesterol
• potassium chloride
• monobasic potassium phosphate
• sodium chloride
• basic sodium phosphate dihydrate
• sucrose

The CDC also recommended that individuals that fall under these categories should consult their medical provider before getting vaccinated.

"(Individuals) should be counseled about the unknown vaccine safety profile and effectiveness in immunocompromised populations, as well as the potential for reduced immune responses and the need to continue to follow all current guidance to protect themselves against COVID-19," the agency wrote.

So what about people who are pregnant? After all, they were included among those considered immunocompromised at the beginning of the pandemic.

The data there bounces between mRNA vaccines are "unlikely to pose a risk" because they aren't live vaccines but, at the same time, pregnant individuals weren't included in studies. That's why those who are pregnant are encouraged to speak with their health care provider, although that's not required.

Per the CDC: "When making a decision, pregnant people and their health care providers should consider the level of COVID-19 community transmission, the patient's personal risk of contracting COVID-19, the risks of COVID-19 to the patient and potential risks to the fetus, the efficacy of the vaccine, the side effects of the vaccine, and the lack of data about the vaccine during pregnancy."

Does the vaccine cause infertility?

Speaking of pregnancies, it's the subject of one of the top conspiracy theories that evolved from the COVID-19 vaccine. It even gained enough traction online that it ended up on the FDA's frequently-asked-questions sections about the vaccine.

The FDA empathetically states that there is no scientific evidence to suggest this is true.

"(I)nfertility is not known to occur as a result of natural COVID-19 disease, further demonstrating that immune responses to the virus, whether induced by infection or a vaccine, are not a cause of infertility," the agency wrote. "Reports on social media have falsely asserted that the vaccine could cause infertility in women and the FDA is concerned that this misinformation may cause women to avoid vaccination to prevent COVID-19, which is a potentially serious and life-threatening disease.

"SARS-CoV-2 is the virus that causes COVID-19," it continued. "The symptoms of COVID-19 vary and are unpredictable; many people have no symptoms or only mild disease, while some have severe respiratory disease including pneumonia and acute respiratory distress syndrome (ARDS), leading to multi-organ failure and death."

Like the CDC, Harvard Medical School experts said that since mRNA vaccines don't contain the live virus, they won't cause COVID-19. Harvard experts also pointed out that while the mortality risk is still low for pregnant women, it is higher than nonpregnant women in the same age group — hence the concern of contracting the virus or not getting vaccinated.

They added that animal studies didn't show problems in this subject when it came to mRNA vaccines.

"In animal studies, mRNA vaccines did not affect fertility or cause any problems with pregnancy. mRNA vaccines do not contain any virus, so they cannot cause COVID-19 in a woman or her baby. And our bodies quickly break down and eliminate mRNA particles used in the vaccine, so they are unlikely to reach or cross the placenta," Harvard health experts wrote. "On the other hand, the immunity that a woman generates from vaccination can cross the placenta, and may help to keep the baby safe after birth."

When will the vaccine be available for children under 16?

A study conducted by University of Minnesota researchers published last week found that the number of Utahns 19 and younger hospitalized due to COVID-19 spiked 5,067% from May 15 through Nov. 15, 2020. While children remain less likely for severe infection, it was a reminder that they can have severe outcomes on top of the possibility they could also spread it to people who may end up with severe outcomes.

But the reason children under 16 aren't included in current vaccine plans is that children weren't included in the original clinical studies that led to FDA approval.

The Associated Press reported last month that Pfizer testing for children as young as 12 only began in October and is expected to take months to complete. Moderna began enrollment to study the vaccine in 12-to-18-year-olds last month but have only received 800 enrollees — well shy of 3,000 it sought, according to a Bloomberg News report on Monday.

Still, results from studies conducted may be available by mid-year. If those results are as successful as the adult clinical trials were, then certain children's ages could be added to the vaccination list after an FDA approval about that same time,

_If you have questions about the COVID-19 vaccine, please submit them to the KSL.com Google response form below for future installments._

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