HJAR Sep/Oct 2021

DIALOGUE 14 SEP / OCT 2021 I  HEALTHCARE JOURNAL OF ARKANSAS Editor With this variant, are the people who are vaccinated actually carrying it, but they just aren’t getting as sick? Isn’t new research showing that? Dillaha With the Delta variant, we are see- ing an increase in the proportion of people with breakthrough cases and also hospital- izations and deaths, but the vast majority of people who become cases and end up in the hospital and die are people who are unvaccinated. Editor Do you think we will ever have herd immunity? Dillaha COVID-19 is a new illness, and we don’t know yet what herd immunity would look like for it and even if we can achieve it. We do not achieve herd immunity for the other coronaviruses that humans get. Editor Can you explain in layman’s terms, why, say, polio is nearly eradicated in the world, but SARS-CoV-2 most likely will not be? Dillaha One of the advantages we have over eradicating polio is that polio is a disease that occurs only in humans. When you erad- icate it, you can’t get it back from another animal. That’s not the case with COVID. In addition, the polio virus does mutate but not at the rate that the coronavirus has been. You have a stable target for a vaccine. There’re three types, as you know, of polio virus, and the vaccines are very effective against all three of them. I think it will be possible to eradicate all three types of polio. The type two is the one that has been the most likely to mutate, so they have taken it out of the oral vaccine, and now they have a new special oral vac- cine to treat cases of type two. Type two has actually been eradicated as the wild type, but there are still vaccine-derived polio viruses circulating, and we would need to eradicate those. I think that the new vaccine that was recently released (I think they started using it this last spring) will address that problem. The issue with eradicating polio is going to be getting access to all of the children who need the vaccine. The two endemic coun- tries where it has not been eradicated from the wild type are Pakistan andAfghanistan. Part of the problem there is that the vac- cinators are not able to go in and vaccinate the children. Editor One question we’re hearing from people who are vaccine-hesitant is, “Why is the vaccine being pushed over antibody testing?” Dillaha It’s because when you test someone with antibodies, we don’t know yet what it tells us. It can tell us if that person has had COVID-19, but it cannot yet tell us if that person is immune from COVID-19. Editor Isn’t the vaccine we’re giving created for a variant of SARS-CoV-2 that is genera- tions-old in viral years? Even with its “warp speed” creation, do you think the current vaccines are a solution to herd immunity? Dillaha Well, I think if enough people get vaccinated and suppress the spread of COVID-19, then it is possible that we will catch up, and then we can make sure that the variants that are circulating around the globe are, in fact, well covered by the vac- cine. It will take us some time, but I’m con- vinced we can get there. Editor One of the concerns we hear of the COVID-19 vaccine is coming very loudly from women of childbearing age, which is affect- ing a lot of the healthcare facilities as well. Many of them feel like they’ve already had COVID and they don’t want to risk unknown side effects of a vaccine using technology that has never been used before. What would you have to say to this group? Dillaha I would encourage them to learn more about the effects of COVID-19 on women, especially pregnant women, and children. I would also encourage women to get vaccinated, even those who are pregnant. The American College of Obstetricians and Gynecologists, as well as the American Society of Maternal and Fetal Medicine, both came out with recommendations for getting the vaccine, saying that the current experience after so many doses have been administered, that they have been shown to be safe and effective for pregnant women as well as women in general. Editor I think they’re more concerned about what we don’t know long-term. There just hasn’t been enough time. There haven’t been enough children born and that have gone past the age of five that have been infected. Dillaha I think one of the issues is we don’t know yet the long-term effects of COVID- 19 on children. We do know that the vac- cines are safe and that it only takes about six weeks after a person is vaccinated for any of these side effects or severe side effects of vaccinations to appear. It’s very unlikely that these vaccines are going to have long-term side effects in the future. When someone gets vaccinated, the vaccine doesn’t stay in the body. The body takes care of it and it’s gone. Months down the road, there’s no vaccine there for it to do something new that’s unknown to the body or unknown to people. Those effects are immune-mediated, and they will show up within six weeks or less. They don’t show up months down the road without having started within the six weeks after vaccination. Editor The side effects that we know of. Dillaha That’s been true for other vaccines as well. From the clinical trials, we will not be able to identify all of the rare side effects. Those get identified by monitoring for safety and effectiveness in the population after a