Assuming someday you have the luxury of choice
There are several Covid-19 vaccinations already being administered, as well as a number of vaccinations in the final stages of testing. If you are not first on the list and eager to be vaccinated, then by the time you choose to be vaccinated, you might find you have two or more options from which to choose. There are a multitude of factors that might influence your choice.
Two features that are consistent amongst all the vaccinations reviewed for this article are that they all require two injections to be given approximately 21 days apart and they have all been tested on animals. While there is some possibility that Jenssen Pharmaceutica’s vaccination will be a single injection, UK testing is underway to determine if two injections would be more effective.
There are four technologies being employed to create the vaccinations. The two older technologies have been used in prior vaccinations and the two newer ones have not. Interestingly, none of vaccinations that use an existing technology has completed Phase 3 testing and been approved. Vaccinations using both of the two newer technologies have completed phase 3 testing and been approved.
The two new types of vaccines involve a significant amount of genetic engineering, with the goal of causing the vaccine to stimulate a T-cell response in the body. All previous vaccines have sought to stimulate a B-cell response. Therefore, the world has very limited practical experience with vaccinations that target T-cells. Additionally, the newer nucleic acid technology uses polyethylene glycol as an adjuvant. Prior to Covid-19 vaccines, PEG was never used as an adjuvant in a vaccination.
While new technology often raises concerns, reputable fact-checkers, including Reuters, AP News and the BBC have concluded that there is no truth to the suggestion that these vaccines will alter human DNA. Rather, these vaccines merely use the RNA of the virus (as opposed to the whole virus or a protein subunit used in pre-existing vaccine technology) to trigger an immune response in the patient.
While we frequently refer to vaccines and vaccinations interchangeably these terms are not synonymous. A vaccination is the totality of all that is injected into the body. Historically, vaccinations have often been comprised of two key parts — a vaccine and an adjuvant. The vaccine is the primary mechanism for triggering the immune response in the body. However, where the amount of the vaccine injected is below that which will trigger a sufficient immune response, an adjuvant may be used to appropriately increase the body’s response to the vaccine. There have been a wide variety of adjuvants employed since vaccines were created, which have included mercury-based products, formaldehyde and aluminum-based products. For some people, the desire not to be injected with a specific adjuvant may be a critical factor in choosing a Covid-19 vaccination or in a decision not to be vaccinated.
Some doctors caution that there is a risk that the two new technologies may create a hyper-inflammatory response in immune-compromised patients. In addition, there is some concern about patients developing autoimmune syndromes as a result of the nucleic acid type of vaccine. As studies to-date have not involved subjects with compromised immune systems or autoimmune concerns, there is no meaningful data yet on these questions.
Nucleic Acid Technology
The first type of Covid-19 vaccine relies on nucleic acid. This is commonly referred to as mRNA technology. Covid-19 vaccines are the first vaccines to employ this technology. The Pfizer-BioNTech vaccination Comirnaty, and the Moderna vaccination MRNA-1273 both rely on nucleic acid and both have been reported to be approximately 95% effective. Each of these vaccinations use polyethylene glycol for the adjuvant and neither uses any animal products in the vaccination. There have been some reports of people with allergies having adverse reactions, including anaphylaxis, upon being given this type of vaccination. There has been some suggestion that the PEG adjuvant may be responsible for triggering the allergic response as PEG has been associated with anaphylactic responses in other medical contexts.
An FDA advisory committee advised that MRNA-1273 may cause immunological side effects for those with cosmetic fillers. Six patients reported swelling and inflammation in the areas where the filler was injected. Of the six patients, some had fillers injected six months prior to the vaccination and one had filler injected two days following the vaccination. All reactions were resolved through treatment with steroids and anti-histamines.
Until more information becomes available, this may cause those who have fillers, tattoos (ink deposits) or have had foreign objects of any sort inserted into the body (e.g., cosmetic implants, medical implants like rods, pins, pacemakers, replacement joints) to obtain medical advice regarding whether or not to obtain a nucleic acid based vaccination.
Adenoviral Vector Technology
The second type of Covid-19 vaccine is an adenoviral vector vaccine that relies on an adenovirus to trigger systemic inflammation. To-date, this technology has only been employed in the rabies vaccination for wild animals. While this approach to vaccines has been in development for decades, concerns about hyper-inflammatory responses observed caused many researcher to seek alternative approaches.
Covishield, Sputnik V , Convidicea and JNJ-78436735 are all adenoviral vector based vaccines. Each uses one or more adenovirus strains comparable to the Covid-19 virus. The adenovirus strain(s) would be derived from cells taken from an infected human or chimpanzee. The adenovirus is cleansed and weakened or inactivated before it is included in the vaccine.
According to an article that appeared in Chemical and Engineering News, the systemic inflammation triggered by an adenoviral vector vaccine may be substantial enough to eliminate the need for an adjuvant. None of the information reviewed indicated whether or not Sputnik V, Convidicea or JNJ-78436735 employs an adjuvant. All are reportedly similar in design to Covishield which does not use an adjuvant so it is possible that no adjuvant is necessary for these vaccines. However, if adjuvants are a concern for you, further inquiries should be made.
Covishield uses the modified chimpanzee adenovirus ChAdOx1. It has one of the lowest efficacy rates reported to-date at 70.4%. Sputnik V, uses human adenovirus 5 and human adenovirus 26 and is reportedly 94% to 95% effective. Convidicea uses human adenovirus 5 and interim phase 3 results reported on December 20, 2020, indicate it is approximately 79% effective. JNJ-78436735 uses human adenovirus 26. There are currently no reports on how effective it is but while this was initially proposed as a single injection vaccine, given the general consensus that two injections are more effective, UK trials have begun to test the effectiveness of two injections of this vaccine.
Whole Virus Technology
Whole virus technology is employed in many existing vaccinations. In the case of the Covid-19 vaccinations in development, an inactivated version of the SARS-COV-2 virus is used. For of Covaxin, adenovirus ChAdOx1 is used, while for CoronaVac, the adenovirus is sourced from the cells of the kidneys of African green monkeys infected with SARS-COV-2. Both of these vaccinations use an aluminum based adjuvant and neither has completed phase 3 testing.
Protein Subunit Technology
In the final category of vaccine technology, neither of the two vaccines reviewed has completed phase 3 testing. Both are manufactured using an adjuvant. For this purpose, S-Trimer uses a combination of alum plus Dynavax by GlaxoSmithKlein which is made using squalene. Squalene is frequently derived from shark liver oil but may also be derived from certain vegetable oils. The vaccination NVX-COV2373 includes Matrix-M, a saponin-based adjuvant. Saponin may be synthetically formulated or derived from plants such as the bark of the Quillaja saponaria.
Both of these vaccines are created using animal products. In the case of S-Trimer, the nature of the mammalian cells used to create the protein subunit has yet to be identified. These cells could be human (e.g., HEK-293) rather than animal. However, the squalene is highly likely to be partially or fully derived from shark liver oil. For NVX-COV2373, an invertebrate of some sort is the source of the cells used to create the protein subunit.
Making a data-based decision in 2021 of whether or not to consent to a particular vaccination will be difficult given the gaps in available information. Consulting a knowledgable physician may be an important part of the decision-making process.
For people with multiple relevant considerations including allergies, foreign substances in the body, and specific health concerns like diabetes or autoimmune conditions, selecting the appropriate vaccination involves an assessment of the features and potential side effects of each available vaccination.
Choosing the nucleic acid technology means consenting to new vaccine technology and a new adjuvant. This may be risky for those with allergies or foreign substances in their bodies.
The adenoviral vector technology may pose a higher than normal risk of having a hyper-inflammatory response but at present, information necessary to determine whether this concern is accurate is simply unavailable. However, the adenoviral vector technology is admittedly attractive as it eliminates any adjuvant risk.
For those who have eliminated the newer technology vaccinations and prefer an aluminum-free vaccination, the only remaining option from the reviewed vaccinations is the NVX-COV2373, provided it is ultimately approved.
At the present time, most individuals who are eligible to be vaccinated will not have a choice of vaccination. For those of us who are fortunate enough to reside in countries that have approved and sourced multiple vaccinations, we may someday have the luxury of choosing between the options at a time when there is adequate information to enable us to make an informed decision.
Charts Summarizing Key Vaccine Features
