Updated: Jul 31, 2021
This is Part 5 of a multi-part series. Part 1 covers foundational information about how the vaccines work and common questions / myths related to vaccine technology. Part 2 covers questions related to vaccine ingredients and potential toxicity. Part 3 covers questions regarding the safety of the Covid vaccines. Part 4 discusses how effective the vaccine is, especially compared to natural immunity after getting Covid.
In this section I will cover questions and issues related to the necessity of getting vaccinated.
If you would like to navigate directly to the other posts you can click below.
Why Getting Vaccinated is So Important
It is not about you. I can't stress how much this is not about you.
I have struggled quite a bit with this post. I know that the perspective I share on this topic will be very unpopular with some people. I have decided to go forward with writing anyway, mainly because the language I am hearing in my local community feels like it is missing the central point. Many people seem to be focusing on what is "right" for themselves, and their only concern is that they make the choice that is right for them. Most of the language I hear revolves around self and individual (and individual rights). I am not hearing as much about how these decisions affect the people around us, our community, our country, or the global community. I am not hearing much about how the health of the community affects each of us. The voices discussing the impact on the economy if this pandemic continues (and how that affects us all) are few and far between.
The central point is that we are all in this together. We have been from the beginning. The actions of even a few individuals during this pandemic affect us all. A small percent of people choosing to hoard toilet paper drove months of shortages that were not even real (the shelves were empty each day and got re-stocked each night, but panic would drive people to empty the shelves the next day). One person choosing not to mask, and spreading the virus to 10 others, cascades into thousands being infected in a matter of weeks. We will not find our way through this pandemic if we only consider ourselves. The only way out of this is for us to honor the truth that we are all connected and act accordingly.
I need to make one other really important point before I move to the Q & A. There are people who truly cannot get vaccinated for medical reasons. I want to acknowledge that fact, and acknowledge that those who can't get vaccinated are our most vulnerable community members. I am writing this post in the hope that it will inspire those who can get vaccinated to get vaccinated. I feel a personal obligation to protect those most vulnerable in our communities. One thing I can do to protect you is to get vaccinated myself (done!). Another is to share my knowledge with the hope that information will overcome fear and prejudice.
Some of the analogies I make in this post are harsh. They will make some of you uncomfortable but I think they are solid comparisons and I think these points need to be made. Those of you who are too ill to get vaccinated, please know that these analogies apply to people who are healthy and are choosing not to get vaccinated for reasons of principle.
OK, deep breath. Here we go.
Q: Why is this vaccine more important than other vaccines?
A: This vaccine is more important than most other vaccines for several reasons. The central reason is that stopping the spread of Covid is essential, and we cannot stop the spread without a significant portion of the population being vaccinated.
Why is Covid a bigger concern than other infectious diseases? First, Covid-19 spreads more quickly and easily than a lot of other infectious diseases. Second, Covid-19 is significantly more deadly than other diseases with a similar spreading pattern. Third, Covid-19 can be spread even if you are asymptomatic or only have a mild case. Fourth, and to me this is the biggest issue, Covid-19 can cause long term health issues (even in very mild cases). The lung, heart, brain, and kidney damage caused by long-term Covid-19 is not only debilitating for millions of people, but it also sets them up for many other long term health issues (like dementia, cardiovascular disease, hypertension and autoimmune disease). This vaccine is more important than other vaccines because it is much more about protecting the community (local, national, global) than it is about protecting yourself.
Stopping the Spread
Covid-19 has an Ro (pronounced "arr naught") of 6. That means that each infected person infects about 6 new people, then those 6 people, infect 6 more people EACH. So with just 2 degrees of separation you have gone from 1 person with Covid to 43 infected people. Imagine what this looks like after 6 degrees of separation. Oh wait, it looks like a global pandemic with millions of people dead and disabled, lockdowns, travel restrictions, and no hugs for a year.
This is what the spread looks like in an unvaccinated population for a virus that has a Ro=6 spread rate. Yeesh, scary right?
Now, imagine that same diagram when 70% of the people are vaccinated. Four or five of the second tier people would be immune and would not pass the virus on. In the third tier, four or five of the people in each group would also be immune and not pass the virus on.
Now, instead of 43 people infected after 2 degrees of separation, you have only 6 people infected.
In this second scenario, the virus can still spread a little bit, but it cannot take off like a wildfire. In this scenario, viral infections are something that can be easily managed by our healthcare system, and does not necessitate travel restrictions, or lockdowns.
What is Herd Immunity?
Following the idea of slowing the spread brings us to the idea of herd immunity. So what is the difference? Herd immunity occurs when there are so many people immune to a disease that the disease can no longer spread through a community. For a disease to spread, people who are not immune must come into contact with each other while one of them is infected. Imagine there are 100 people in a room, 1 is infected with measles and only 9 other people in that room are not immune to measles. For measles to spread, those 9 other people would have to be standing very close to the sick person. If they were not, the measles would not spread. Even if all 9 vulnerable people did get infected, the virus would not be able to spread to the rest of the room because everyone else is immune. After infection, the 9 possible hosts would be immune or dead. The virus would have no other hosts to infect. This is herd immunity. Herd immunity often means that a disease will die out for lack of hosts. This is how we eradicated smallpox and polio.
It is unclear if we will be able to achieve herd immunity with Covid. Part will depend on how quickly we get people vaccinated. Part will depend on vaccination rate. Part will depend on how long natural immunity lasts (current studies are showing that immunity after infection is not consistent enough to count on). Part will depend on us slowing the spread enough to stop viral mutation into new variants.
Even if we cannot achieve true herd immunity, getting close will mean freedom to go back to normal life. The closer we can get to herd immunity, the more "normal" we can enjoy.
If you want to be able to eat in restaurants or enjoy a cocktail at a bar with your friends - get vaccinated.
If you want daily life to go back to normal, kids in school, meetings in person - get vaccinated.
If you want to enjoy live sports events or parties again - get vaccinated.
If you want to enjoy concerts, theater and dancing again - get vaccinated.
If you want to be able to travel, go on vacation or visit friends and family - get vaccinated.
Slowing or Stopping variant mutations
Viruses mutate inside of people or animals that they infect as a way of adapting to different immune systems. The more hosts a virus infects, the more pressure there is on the virus to mutate, and the more likely it is that new variants will evolve. The longer Covid is allowed to spread, and the more people it infects, the more likely it is that new variants will form. New variants can be more contagious or less contagious, cause more severe disease or milder disease.
With each new variant comes the risk of the virus being different enough that the vaccine (and our natural immunity from past infections) will not work. Vaccinations that work against the current strains prevents these from spreading and possibly mutating into new strains. This is one of the most urgent reasons for people to get vaccinated. Stopping the spread means stopping new variants. If we can stop new variants, then we can get ahead of this virus and hopefully get to a level of group immunity that allows us to get back to normal life. If enough people choose not be vaccinated and the virus is allowed to continue, new variants will continue to form. If a vaccine resistant variant evolves, we could be starting at the beginning of the pandemic again.
graphic by Thom Heileson (edited and used without permission - sorry Thom)
Preventing medical system collapse
This is a point that people have had a particularly difficult time getting their heads around. We take hospitals and access to care for granted in the western world. However, our medical system is actually quite fragile, and is not set up to handle a sudden influx of millions of very sick people. The total number of hospital beds in the US is 920,00. That is ALL hospital beds. Not ICU spots, or ventilators, but ALL beds, in the entire country.
Because of the cost of operations, most hospitals have actually cut back on the number of beds, trying to have "just enough" to meet the need of any given community during normal times. If we fill even half of those beds with Covid patients, then lots of other people will die from other things because there is literally no place to put them. Heart attacks, car accidents, shootings, emergency appendectomy or gall bladder surgery? Need surgery or chemo for cancer? Having an asthma attack? Anaphylaxis from a bee sting? If the system is maxed out with Covid patients, then there is no way to also help all of the other people that usually need help.
It becomes a feed forward problem as people can't get care. Overwhelmed health care workers become ill and die, then there is even less care for everyone. New infectious disease problems arise when there are so many dead that we can't dispose of the bodies safely. We saw glimmers of this last year in the US. The worst case scenario is currently playing out in India and Brazil. This was the purpose of the lockdowns early in the pandemic, to slow the spread and flatten the curve so that we did not overwhelm our health care system (we did not succeed in the earliest hot spots such as Seattle and New York). The closer we can get to population-wide vaccination, the safer our health care system will be.
Post Covid Syndrome
Post Covid Syndrome is a chronic, multi-system inflammatory condition that occurs after having Covid-19. Sufferers from this condition have severe fatigue, brain fog, weakness and difficulty breathing. Some have new onset of headaches, depression, insomnia and anxiety. Some have body aches, joint pain or long term loss of taste and smell. Symptoms begin four to eight weeks after initial Covid infection. For some this syndrome lasts 3 months, for others it has been over a year and they show no signs of improving. These people are no longer contagious and no longer have Covid, but their symptoms persist.
Symptoms appear to be due to ongoing inflammation in the body that can affect multiple body systems. Inflammation has been found in the hearts, brains, lungs, joints, and kidneys of those with post Covid syndrome. A study published in JAMA Cardiology found 60% of people recovering from severe Covid had persistent heart muscle inflammation.
Inflammation is part of our immune response to illness. In Covid long-haulers, this inflammatory response gets stuck and does not go away after the infection. While we need inflammation at the beginning of an injury or illness, if it persists, it begins to damage our own tissues. Long term brain inflammation increases risk of dementia and Alzheimer's. Long term inflammation of the lungs can lead to fibrosis (scarring) of the lungs and partial but permanent loss of lung function. Long term inflammation of the heart can lead to cardiovascular disease, and an increased risk of stroke and heart attacks.
It is estimated that about 10% (possibly more) of people who are infected with Covid progress to post Covid syndrome (aka Covid long-haulers). Most concerning is that this syndrome is quite common in young, healthy people who had asymptomatic or very mild Covid symptoms.
We do not fully understand post Covid syndrome, nor do we have a reliable way to treat it. To me this is one of the most concerning things about Covid and is one of the most compelling self protection arguments for getting vaccinated.
Q: I'm healthy, and low risk for getting really sick or dying from Covid, why should I bother to get vaccinated?
A: Short answer - it is not about you (except for post Covid syndrome). For all the reasons listed above and below, it is important that we get the vaccine. Partly to protect ourselves from the risk of post Covid syndrome (which affects young healthy people), but mostly to stop the spread, prevent formation of new variants, protect the vulnerable and end the pandemic.
Q: Shouldn't I have the freedom to choose if I get vaccinated?
A: For most other vaccines, sure. For this specific vaccine, at this specific point in time?
My strong opinion is no.
If you stepped on a rusty nail and went to the ER, they would offer you a tetanus shot. They would strongly encourage you to get the shot because tetanus is horrible. But in this instance, it is completely your choice. If you want to risk getting tetanus, go right ahead. That is your prerogative. That decision only affects you.
If you choose not to get vaccinated for Hepatitis or Shingles? No problem. That decision only affects you and your risk of contracting those illnesses. Both are miserable viruses, but they are extremely unlikely to kill you, and more importantly, you are unlikely to spread the viruses to others should you experience them. Adult vaccines for these viruses are and should be optional.
If you work in a hospital or long term care facility with patients who are vulnerable, you are required to get certain vaccinations, let's take the flu shot as an example. Requiring flu shots is not about protecting the health care workers (though it does do that). It is to prevent the health care workers from contracting an illness that they could spread to the people that they are caring for. Just one contagious health care worker can disseminate an illness to an entire vulnerable community very quickly. Incidentally that is also why we wear masks - to prevent spreading our germs to others.
Covid-19 is so contagious and so deadly with such a high risk of long term health impacts for survivors, that we need to think of the whole world as a hospital ward. Half or more of the world population is vulnerable for one reason or another (age, pre-existing health issues, essential workers, poverty, no affordable access to health care, etc).
Choosing not to get vaccinated makes it likely that you will contract and spread Covid to others. Some of them will be permanently disabled. Some will die. To me this is the equivalent of choosing to walk into a crowded building and start firing off a gun at random. Knowing some people will escape the bullets, some will be permanently injured and some will die. Based on statistics, choosing not to get vaccinated is more dangerous to others than driving drunk. Can you choose to do these things? Obviously yes. Do you have the right to harm others or put other people at risk with your actions? My opinion is no, you do not.
We have laws against willful harm to others. Examples are drunk driving, texting while driving, and shooting people. Laws like these exist in all countries and cultures, and have through most of the history of civilization. These laws exist because most societies believe that an individual's rights do not include willful harm to others. Getting vaccinated to prevent spreading Covid to others falls clearly into this category. Getting the vaccine is (mostly) not about you.
Q: If the majority of people get vaccinated, can I get away with not getting it (aka herd immunity)?
A: Considering the number of vulnerable people and the number of people who will refuse to get the vaccine no matter what information they are presented with, we will be very lucky to get near herd immunity vaccine levels. In theory, if you were the only one, yes, you probably could get away with it. Again, that is missing the central point. For this crisis to end, and for everyone to thrive, we have to remember that we are part of a community. If 40% of the population does not get vaccinated, we will probably not succeed. If 30% of the population does not get vaccinated we may not succeed. The virus will continue to spread to enough people that it will continue to mutate. Each new viral variant runs the risk of being different enough that the natural immunity and vaccines will no longer work. It this happens, the pandemic will start all over again.
Think about how your choices and actions affect those around you. Think about your loved ones, your local community, your country and the global community. Think about the essential workers who cannot work from home (and think about how many of them do not have access to health care, decent housing or healthy food). Think about the people who for various health reasons either can't get vaccinated or for whom the vaccines will not work (people with cancer, severe autoimmune disease, immune deficiency, organ transplant recipients, or people on immune suppressant drugs). Think about the millions of people who do not have access to affordable health care. It is up to each one of us that can get the vaccine to get it, to protect those people and to do our part (as individuals) to help the world community emerge from this crisis.
It takes a village.
For those of you who read the whole collection of vaccine posts, thank you. I am honored by your time and attention. My wishes to everyone for health, happiness and healing. I look forward to a world where hugs are safe again! ~Dr. B
Outcomes of Cardiovascular Magnetic Resonance Imaging in Patients Recently Recovered From Coronavirus Disease 2019 (COVID-19). JAMA Cardiol. 2020 Nov 1;5(11):1265-1273. Puntmann VO, Carerj ML, Wieters I, et al.