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Session 187: FAQ’s About the COVID-19 Vaccines

The Therapy for Black Girls Podcast is a weekly conversation with Dr. Joy Harden Bradford, a licensed Psychologist in Atlanta, Georgia, about all things mental health, personal development, and all the small decisions we can make to become the best possible versions of ourselves.

You’ve likely been following the news related to the recently developed COVID-19 vaccines and if you’re like me, you’ve got lots of questions. I recently had the opportunity to chat with Dr. Boghuma Kabisen Titanji who is an infectious disease physician and clinical researcher pursuing a fellowship at Emory University School of Medicine here in Atlanta, Georgia. During our conversation, Dr. Titanji shared how this vaccine is different than others we may have taken, how the vaccine was able to be developed so quickly, and what we might expect after taking the vaccination.

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Session 187: FAQ's About the COVID-19 Vaccine

Dr. Joy: Hey, y'all! Thanks so much for joining me for Session 187 of the Therapy for Black Girls podcast. You've likely been following the news related to the recently developed COVID-19 vaccines and if you're like me, you've got lots of questions. Last week, I had the opportunity to chat with Dr. Boghuma Kabisen Titanji who's an infectious disease physician and clinical researcher pursuing a fellowship at Emory University School of Medicine here in Atlanta, Georgia. Our conversation was made possible through our partnership with Med-IQ through an educational grant from the Coverys Community Healthcare Foundation.

Dr. Titanji shared how this vaccine is different than others we may have taken, how the vaccine was able to be developed so quickly, and what we might expect after taking the vaccination. I definitely learned a lot and hope that it will be enlightening for you as well. Here's our conversation.

Dr. Joy: Thank you all so much for joining us today. I hope that as many people as possible will be able to join us for this conversation. If there's somebody in your family, in your circles who you know could benefit from this conversation and perhaps be able to ask a question to get some answers, then please invite them and share this on your pages. I am Dr. Joy Harden Bradford, I'm a licensed psychologist in Atlanta, Georgia, and also the founder of Therapy for Black Girls and I'm very excited to be in conversation today with Dr. Boghuma Kabisen Titanji. She is an infectious disease physician and clinical researcher pursuing a fellowship at Emory University School of Medicine here in Atlanta, Georgia as well.

Dr. Titanji is passionate about how clinical research can be directly translated into policies that impact the lives of vulnerable patient populations. Super thrilled to have you with us today, Dr. Titanji. This is such an important conversation as today we're going to be talking all about the COVID-19 vaccines. And this conversation today is brought to us in partnership with one of our incredible sponsors, Med-IQ, and it is through an educational grant from the Coverys Community Healthcare Foundation. Dr. Titanji, if you could start by just telling us what is a vaccine and how do they work?

Dr. Titanji: Right, I think that that's an excellent place to start just to set the stage for this conversation. I like to think about vaccines as products that allow our bodies to make defenses against germs like bacteria and viruses. That's the simplest way of explaining what a vaccine is. And these products can either be made from a modified form of the virus or the bacteria, or it can be made from a piece of the virus or the bacteria, or it can be the information that allows the body to make a piece of the virus or the bacteria.

And generally, what a vaccine does when it's introduced into the body is that our body's natural defense mechanisms are able to recognize that product and mount a defense, and produce defensive antibodies that can then allow us to fight the actual germ (be it a bacteria or virus) when we eventually encounter it. And the vaccine itself doesn't cause disease; it just allows our bodies to build the defenses that protect us against disease when we encounter it.

Dr. Joy: Can you tell us... We of course are hearing a lot about the COVID-19 vaccine. The Pfizer vaccine I believe has already been approved for FDA emergency use authorization and you shared that the Moderna vaccine will be discussed today to see if that one will also be able to be used. But can you tell us about the new technology that is used in this vaccine and how it's different from our typical flu shot that we get yearly?

Dr. Titanji: When we were faced with the pandemic that we've all been struggling with for the past almost a year now, scientists and researchers started immediately working very hard to try to figure out a way to develop a vaccine that could help us fight the virus that causes COVID-19, SARS-CoV-2. The two initial vaccines that were shown to be efficacious are, as you mentioned, the Pfizer and the Moderna vaccines. And these vaccines are made from a new platform which is called the mRNA platform, so they are mRNA vaccines.

And what does this mean? mRNA is genetic information, in this case (for the SARS-CoV-2 virus that causes COVID-19) it is the information that is able to tell our bodies to make one piece of the virus. And that piece of the virus that the body is able to make is then shown to our body's defense system, which generates those protective antibodies so that if we do encounter the whole virus itself, we are ready to attack it and make sure it doesn't infect our bodies.

How is this new platform different from the flu virus that we get every year? Remember, when I was introducing what vaccines are and what vaccines do, I said vaccines are products that allow our bodies to mount a defense. And these products can be presented in different ways, we're trying to mimic an infection to try to get the body to mount a defense. In the case of the flu vaccine, a lot of the flu vaccines that we get every year are actually modified through viruses which are weakened so that they don't cause disease when they’re injected in us in a form of the vaccine, but allow our bodies to generate those defenses that allow us to then fight the flu if we encounter the unmodified virus.

This is just a different platform, it’ just another way of making a vaccine, and the reason why the mRNA vaccines are kind of the first that were able to come through the door is, although they're a new platform, they are a platform that lend itself to making the vaccine quickly. We were faced with a pandemic that was infecting millions of people, literally around the world, and it’s still killing and infecting thousands of people on a daily basis, so there was a need for speed. This technology has been studied for over 10 years but when this pandemic came to be, there was immediately an urgency to try to use the platform that would allow us to get to the point of a vaccine in the quickest way. And that's how we got to the mRNA vaccines, which are now being evaluated for emergency use authorization.

Dr. Joy; And I just want to clarify because there is a question in the comment section. This vaccine, the COVID-19 vaccines that currently exist, do not have any live virus in them. What they do is give a signal to your body to make the antibodies to protect yourself, should you come in contact with the COVID-19 virus.

Dr. Titanji: Absolutely correct. The Pfizer vaccine and the Moderna vaccine do not contain any live SARS-Cov-2 virus. They essentially are a message or a recipe for the body to be able to make one tiny piece of the virus. Your body recognizes that tiny piece and then makes the defenses against it. And just to give people some context, the SARS-Cov-2 itself has 29 pieces, it needs 29 different pieces to form a complete virus, but the vaccine is only information for one tiny piece. So in no way is that tiny piece able to then become a full virus in your body if you get the vaccine. It's just a tiny piece of information to allow our bodies to get that response going so that if we encounter the full virus with all of its 29 particles, we're able to attack it and it would not make us sick.

Dr. Joy: Thank you so much for that explanation, Dr. Titanji, that is super helpful. Of course, there is a lot of concern about how quickly and you've already talked about this–how quickly the vaccine was able to be developed when we know that vaccines typically take quite a long time to be developed. But should we be concerned about how quickly the vaccine was developed? Were there some steps that were skipped? Was this a rushed kind of a thing?

Dr. Titanji: First of all, I'd like to say that I acknowledge that the speed with which this was developed can be something that causes some unease and anxiety in the general population. But I also want to just kind of lay out why we were able to actually arrive at a vaccine so quickly, and to emphasize why the speed with which we are able to develop these vaccines do not in any way mean that the safety, the ethics around it, were compromised in any way.

Things that happened during the development of the COVID-19 vaccines that we now have coming into availability for the general population were, for one, there was already research that had been done when the first SARS virus was introduced into the human population way back in 2003. The National Institutes for Health funded by the federal government started a research program to develop vaccines against coronaviruses, and this program was established since 2003. So when we had a new outbreak of a new coronavirus that was introduced into the population and was causing a pandemic, scientists all over the world were able to draw on years of research on the first coronavirus outbreak that happened back in 2003, and use that information to speed up a process in getting this vaccine developed.

Secondly, mRNA vaccine platform, as I mentioned to you, lends itself to speed and to being able to go from identifying the virus to developing a vaccine against the virus. That particular platform, although this is the first time that we're using it widely, it has been studied in much smaller studies for vaccines against rabies, against Zika, against influenza, but these vaccines have just not made it through to the stage where they've been used widely for a number of reasons. They were still trying to figure out ways in which to be able to deliver this platform and make it easy to use in vaccine format and the current situation, the pandemic situation, increased the amount of funding into this type of research to allow these steps to be done a lot more quickly than when, for instance, companies are trying to generate the funding by themselves to get these processes done.

Thirdly, the clinical trials that look at these vaccines, because we have so much infection going on in the community, we are able to get answers much quicker. Because normally when you're studying a vaccine, once you have a vaccine candidate that is being studied in thousands of people, you have to give them the vaccine and then allow people to be exposed and see if the vaccine protects them. We're currently having over 200,000 cases of COVID-19 in the US per day. That means that if you take people and you vaccinate them in a trial to see if a vaccine works, you're going to get the answers a lot more quickly because there's so many infections happening in the community, that we're able to arrive at the answer of whether this vaccine works or it doesn't work.

That was the case for the Pfizer vaccine and for the Moderna vaccine. Combined, both trials included about 70,000 people and they were able to recruit people quite quickly and get the results, and get the answers that told us about the efficacy of the vaccine. Once we get all of this information, at the Food and Drug Administration (the FDA) a completely independent panel of scientists who do not have any financial stake and will not profit from these vaccines, look at all of the information to make sure that it is safe, to make sure that it is efficacious.

And for the Pfizer vaccine, we also now have their initial data that has allowed the emergency use authorization published in a major scientific journal (the New England Journal of Medicine) and providers, health care providers like myself, have been able to read this paper and look at the data ourselves so that we can also know to advise our patients on what we think about the safety. In no way has the accelerated process compromised the ethics and the safety of the vaccine. It has been thoroughly assessed and it is safe to be administered in the population.

Dr. Joy: Thank you. We have a really important question, I think, from the comments section: Given the history of medical apartheid in this country, why should I trust the medical profession, even if the professionals look like me?

Dr. Titanji: Yes, and we cannot have a conversation around vaccines and therapeutics without remembering that there have been medical atrocities that have been committed, especially against minority populations in this country, and people rightfully have a justification to have a certain degree of anxiety. But I think that, despite the historical precedents that have happened, because of the conversations that we're having and because of the conversations that are constantly ongoing, there has also been an evolution in making sure that these historical wrongs are not repeated.

You have diversification in the scientists that were a part of the teams that developed these vaccine and just to kind of plug a black female scientist, one of the leading scientists at the NIH, Kizzmekia Corbett, who led the development of Moderna's mRNA vaccine, is a black female. And even when you look at the trial participants and the people who led a lot of these trials, there are minority physicians involved as well as participants. A lot has been done to make sure that throughout this process, the science is transparent. The participation involves representation of voices that come from minority communities that may have been mistreated, and have been mistreated in the past, to ensure that a lot of these things that sow distrust in our communities are not repeated.

Again, that is why we have this platform where I'm able to have a conversation with you, Dr. Joy, and present to the audience, myself as a black female physician who is an infectious diseases doctor, to vouch for the transparency of that process. And to say that there's a lot of work that has been done to ensure that this is not something that is targeting minority communities in a negative way. I trust vaccines and I can't wait to take it and I will be taking it the moment it becomes available in my institution.

Dr. Joy: Thank you for that, Dr. Titanji. There are reports that there are multiple strains of the virus circulating just similar to the flu shots. Are the vaccines likely to be effective against multiple strains of the virus?

Dr. Titanji: For now, based on the information that we know... And remember that a lot of these phase three trials that have allowed the emergency use authorizations to happen, started in July of this year. And the participants were really followed up since the moment that they enrolled in the trial and we're still kind of gathering information. It's going to take time to determine whether the virus changes over time to the point where this vaccine remains efficacious, let's say, one year out after you get the shot. The information we know now is that in the short term that they've been able to look at this, in the two-month follow up after the second dose of the vaccine, people who participated in the trial have a protection that protects them against the circulating strains of the virus that we have now.

Viruses are tricky organisms, tricky germs, and they tend to change over time and that is why we continue to monitor the people who get the vaccine during the clinical trial. And also, when you get it as an individual outside of the clinical trial, there will be some degree of continued monitoring, to continue collecting information that would inform us on how long the efficacy of these vaccines would last. It's too soon for us to definitively answer that question now but it is certainly something that we will be able to provide more clarity on over time, and we will know if these vaccines will protect for a long time or if we would need to get a booster shot every year or every other year as time progresses.

Dr. Joy: Got it, okay. And so what should people expect when they take the vaccine? What are the side effects?

Dr. Titanji: In the studies that looked at the vaccine, a lot of the participants who were in the group that received the actual vaccine had some pain at the site of injection, they had low grade fevers, low grade temperatures, some aches, muscle aches and some fatigue, that lasted generally about 12 hours after the first dose. And after the second dose, which is usually given three to four weeks after that first dose, those symptoms lasted for a little bit longer.

I would tell people to expect to feel like they're coming down with a bit of a cold after they get the vaccine but that actually is your body's way of telling you that your defense systems are actually cranking up those antibodies that will protect you in the case of you actually encountering the real virus. That's the body's way of responding to something foreign and making protective antibodies. It's actually a good thing when you get a vaccine and you get a little bit of malaise and feel like you're coming down with a bit of a cold. Usually that goes away within a few days and should not be something that gets you sick enough to land you in the hospital.

It is expected, it's important that people anticipate that this would happen and that should not discourage you from taking the second vaccine, the second dose of the vaccine, because the efficacy data that we have is based on people who completed their shots. So they got the first dose and–three to four weeks after–also got the second dose of the vaccine. Very important to remember that if you decide that you do want to get the vaccine when it becomes available to you, to expect that you would get some mild symptoms. Those would not be long lasting, they would go away and they should not discourage you from taking the second shot.

Dr. Joy: Got it. Because it does require two shots... two doses, sorry. What is the time in between the first and the second dosage?

Dr. Titanji: Three to four weeks. For both the Pfizer and Moderna vaccines, participants were given their second dose of the vaccine three to four weeks after that first dose.

Dr. Joy: Okay. Can you still get COVID even after taking the vaccine?

Dr. Titanji: That's a very interesting question because the studies that looked at these vaccines, the question that they were trying to answer was: Does the vaccine prevent you from getting severe COVID, getting COVID that generates symptoms? So, yes, we know that the vaccine prevented people from getting severe disease 95% of the time, but we do not have the information as to whether it prevented you from getting asymptomatic disease. That is, getting COVID and not having any symptoms at all.

That question is very important because even after you get the vaccine, that is why we are still stressing that you would have to continue wearing your facemask. Because if someone gets the vaccine and they're protected from having severe disease, we don't know yet whether the vaccine protects them from getting an infection which is completely without symptoms. And there's always a risk that if you get an asymptomatic infection, you can still pass on that infection to someone else and get them to be sick.

While we gather the information that would allow us to answer that question, people are still recommended (after they get their vaccine) to continue wearing their mask until we know more. Because the studies that allowed these vaccines to be authorized were not looking at the question of does it prevent asymptomatic disease. It was really just looking at: Does it prevent you from getting sick? And the vaccines do, 95% of the time.

Dr. Joy: Got it. Does the vaccine alter your DNA in any way?

Dr. Titanji: Absolutely not. These vaccines, again, are mRNA vaccines, they are genetic material, but the cool thing about this messenger RNA, it is a messenger. Once your body reads that message, poof! –it disappears like a snapchat message or it disappears like it just dissolves. It basically disappears. Once your body is able to read that message, the message doesn't linger, it doesn't get into the part of your cells where your DNA is, it doesn't in any way modify your DNA.

Dr. Joy: Got it. Okay, thank you for that. That was a question in the comments. Let's see... Can immunocompromised people take them and what about people with things like diabetes?

Dr. Titanji: Certainly, specifically to the question about people with diabetes, in the Pfizer vaccine trial and in the Moderna vaccine trials, they had patients who had comorbidities, so conditions like diabetes. Yes, if you're diabetic, you can certainly get the vaccine and you should, because you are in a higher risk category to get severe disease if you did come in contact with the virus and got COVID-19.

Specifically talking about immunocompromised patients such as pregnant women or people who have had organ transplants, those particular categories of immunocompromised people were not included in the initial studies that led to the vaccine being authorized. Now, the emergency use authorization recommends that if you fall into those categories of immunocompromised persons, you have a conversation with your primary care provider about whether or not you should take the vaccine.

It should be a shared decision that you have with your doctor, be it your primary care provider, it could be your nurse practitioner, or whoever is the doctor with whom you're having your primary care. And they would review that information with you to make an informed decision on whether that vaccine is appropriate for you. There are pregnant women who are opting even now that we are already rolling out the Pfizer vaccine amongst frontline care workers. It wasn't formally tested in pregnant women, but the EUA allows pregnant women to make that decision after a shared discussion with their provider, and that's the same for other people with other immunocompromising conditions.

Dr. Joy: Got it. And that would be the same for nursing mothers as well?

Dr. Titanji: Nursing mothers as well, that is correct. Again, you have to talk with your doctor about it and then make a shared decision.

Dr. Joy: What about if you've already had COVID? Would you suggest that they be vaccinated as well? Do they need to take the vaccine?

Dr. Titanji: Yeah, that's a very interesting question because one of the things that we don't know yet is... When you get COVID, you get a natural infection of COVID and you recover. We know that people who recover from COVID have a certain degree of immunity to the virus but we don't know how long that immunity lasts. And we also now know that there have been people who have had COVID more than once. There are few cases, but we're seeing a couple of cases that have occurred: people who had COVID, recovered, and then they had another infection.

So because we don't know how long the protection you get from a natural infection lasts, it is still recommended that even if you've had COVID before and recovered, if the vaccine becomes available to you, you should still take it. Now, if you just got COVID, like two weeks ago, and you have the vaccine available to you today, it is reasonable to say that because there are limited doses and I know I have protection at least for some time, I can let people who haven't had COVID yet go a little bit ahead of me on the queue. But that doesn't mean that you should not take it eventually if it becomes more widely available. To answer the question simply, if you've had COVID before, if and when the vaccines become available to you, if you want to get the vaccine, you should definitely get it.

Dr. Joy: And a spin-off of that question: What if you would test positive for COVID-19 now but you don't know it and take the vaccine? Or is there a test that happens before you even get the vaccine?

Dr. Titanji: We're not routinely testing people for COVID-19 before we give the vaccine, just to keep it simple. Right now, we don't have a clear indication as to what would happen if you got the vaccine when you already had COVID. For instance, if you have an asymptomatic infection and you got the vaccine, what would that mean for the vaccine’s efficacy? We don't have that information just because that wasn't specifically looked at in the studies that looked at the vaccine.

But I want to remind our audience that we are continuing to collect information even as we roll out the vaccine, and we’ll gain more clarity on a lot of these questions as we collect information and more people receive the vaccine, and we understand a little bit more the finer nuances which are not the primary focus of clinical trials which were just to answer important questions to get us to the point where we had the vaccine being distributed.

Dr. Joy: Got it. We know that the clinical trials contained all adults so I'm wondering if you can say anything you know about the makeup of the people in the clinical trials? Do we know how many people of color were a part of the clinical trials? And when might we know something about children?

Dr. Titanji: There was actually tremendous effort to make sure that the clinical trials were representative because, obviously, COVID-19 has really impacted on minority communities and they wanted to make sure that these vaccines were efficacious for everyone, not just a particular demographic group. For the Pfizer vaccine, they had 9% of the study participants, which was 9% of about 44,000 participants were African American, and about 25% were Hispanic. For Moderna’s vaccine, they had about 10% of African Americans in the study participants and their trial was a total of 30,000 people.

The trials made considerable effort to make sure that there was representation. For Pfizer vaccine, the trial included individuals older than 16, so children younger than 16 were not included in the study and that's why the emergency use authorization only authorizes the vaccine for people older than 16. Moderna’s vaccine studied the vaccine in people older than 18 and we will know (probably tomorrow) the scope of the emergency use authorization for that particular Moderna vaccine.

Now, when will we know for children younger than 16? Those studies are currently ongoing, Pfizer has just started a study now looking at children between the ages of 12 and 16. And we anticipate that, kind of in the middle of next year, we should start having some of those results for those trials and they plan after that to start looking at children younger than the age of 12. So we will get that information. Those studies are very much ongoing by both Pfizer and Moderna and hopefully, before the end of next year, we should start seeing more information that allows us to be able to know whether these vaccines are safe and can be distributed to our children as well.

Dr. Joy: We know that the more Moderna and the Pfizer vaccines are the ones that are both close. Pfizer has already been approved for emergency use authorization but there are tons of others, it sounds like, that are also in the process of kind of getting to that place. Is it the case that there's going to be one that's better than the other?

Dr. Titanji: Right now, we don't know because we're still getting the information trickling in, in terms of the different platforms, the other platforms that they're looking at. The mRNA platforms were the first to get their nose through the door because they lend themselves to being made quickly, like I've said. But we will get information from some of the other platforms, notably like other platforms that may use an inactivated form of the virus or just a piece of the protein of the virus or different ways of delivering a piece of the virus to our bodies.

We will know about those at the beginning of next year and kind of during the course of next year and once we have that information, then we will be able to compare the efficacies of the different vaccines that are coming out. Until we get that information, it's too soon for us to predict whether these will be more effective than the Moderna and Pfizer vaccines. We just have to wait for those trials to be completed, then we'll get all of that information.

Dr. Joy: Will this be something we'll need to have a vaccine for every year like we do the flu? The flu shot that we get every year?

Dr. Titanji: The answer is we don't know. And that's an answer that we will only get with time because, again, we know that the vaccine protects us from getting severe disease but they've only followed up the participants in the trials for a couple of months. We will continue to collect information on these people who were vaccinated within the trial for up to a two-year period to know how long lasting that protection is. It is possible that we would find that maybe that protection decreases significantly after a year or so (I can't predict because only time will tell) and that we might need to have repeated doses of these vaccines, but we just need to give it time to be able to determine this.

Dr. Joy: Got it. And what about people who are not interested in taking the vaccine at all? Is this the kind of thing that's going to be mandatory? Are we not going to be able to go to school or to work if we haven't had the vaccine?

Dr. Titanji: Absolutely not. The emergency use authorization is not a mandate in any way and you can't force anybody to take a vaccine, even a vaccine that is approved. It's not going to be mandated. I think this is why it's very important to have these open forums and discussions because, really, it's about giving people the information to get people comfortable to make the best-informed decisions for themselves. But these vaccines are in no way mandated.

What I can tell you as an infectious diseases doctor and as a scientist is that the vaccines give us a tremendous tool to begin to envision getting out of this pandemic and it would only be a tool that is useful depending on how many people are willing to take it. Even if you have a vaccine that is 100% effective, that vaccine is useless if people refuse to take it because you can only get the protection if you actually take the vaccine.

Dr. Joy: I wonder if you can say more about that, Dr. Titanji, because I've seen things talking about, like 70% of the population needs to have the vaccine for us to really see any kind of benefits. What happens if we never get to that 70% of people are actually taking it?

Dr. Titanji: When you hear about that 70 to 80% number, that's usually referring to what we call herd immunity. What is herd immunity? Herd immunity is enough people in the population either get the infection and develop immunity or enough people get a vaccine that provides them immunity against the infection, to a point that there are so many people who have protection against the infection that it prevents the infection from spreading further in the community. That's really what that 70 to 80% threshold means.

Now, if you were to try to achieve this by just letting the infection run free in the community and infect as many people, that comes at a tremendous cost. Right now, we're losing 2,000 to 3,000 lives daily from COVID-19 infections and we also do not know the full scope of the long-term effects for those who don't die from this. So it's too big a cost to say that we will try to get 70 to 80% of the population infected to generate protection and immunity to stop this virus from spreading.

What the vaccine does is it allows us to still build that protection, if enough people take it, to stop the spread of the virus without the mass casualties that we are witnessing. You asked the question of what if 70% of the population does not take the vaccine. Ideally, we want as many people to take it as possible. That is the dream, that is the goal, that is how we get out of this. But people have autonomy and people will make decisions for themselves and we might face a situation where only 50% of the population takes the vaccine.

That doesn't mean that we don't draw any benefit, it just means that that process of getting back to life as we knew it, pre-pandemic, would just be much slower. Because you will still have a huge segment of the population that is vulnerable to the infection, who will continue to get infected, who will still need to go to the hospital, and unfortunately, some of whom may not make it and would die from this infection. For those who take the vaccine, what it means is you get protection. If your loved ones take the vaccine as well, they get protection. Things would change, you may be able to visit your elderly mother who has comorbidities without fear of passing on the infection to her and potentially killing her with a deadly virus. It would restore some measure of normalcy but it's going to take time and it's going to take as many people as possible accepting to take these vaccines.

Dr. Joy: Dr. Titanji, can you say more about what the rollout looks like at this point, if you know anything? We know right now healthcare workers are being prioritized; what is the plan for it being open to the more general public?

Dr. Titanji: The rollout, in the initial phase of the rollout following the emergency use authorization, there were limited doses so the CDC and the FDA had to come up with a way of prioritizing. Immediately, the first people who were prioritized are residents of long-term care facilities who are particularly vulnerable to getting infections, and also healthcare workers who have been on the frontline of this pandemic, basically, since it started.

Going into next year, what's going to happen is that once Moderna also gets, hopefully, its own emergency use authorization this week or next week, both Pfizer and Moderna are planning on scaling up their production by a pretty tremendous amount. It's currently estimated that any American who wants the vaccine and wishes to get vaccinated should be able to have access to the vaccine by the middle of next year and running into fall of next year. Certainly, by the end of 2021 most people in this country who are wanting to get the vaccine will be able to access it. But in the initial phases, because of the limited doses, they are prioritizing those considered to be at highest risk of contracting infections.

Dr. Joy: What can we expect when people do start to take the vaccine? Are we going to be completely back to like a pre-pandemic life? What can we expect?

Dr. Titanji: We are all wishing that this could work like a light switch but keeping it 100% honest, it's not going to work like a light switch. Because remember that in order to get to that community protection, that herd immunity, you need to get about 70 to 80% of the population vaccinated and not everybody is going to get the vaccine on the same day. So when you get the vaccine... When I get the vaccine, hopefully next week or the week after, as a frontline worker, yes, I would still continue to wear my mask, yes, I would still continue to socially distance, yes, I’d still continue to wash my hands and do all the preventative measures. Because there's still so many people in the community who are not vaccinated and we don't know whether this vaccine protects you from having an asymptomatic infection which you can still pass on and infect someone who's vulnerable.

It's going to take time for life to return to normal but I envision a situation where, as they roll out the vaccine in the community and it becomes more accepted and more people take it, we will see a certain semblance of normalcy with more freedom to travel and visit our loved ones, with more freedom to interact with people without the fear that we will infect ourselves or we will infect them. It's gonna take time, but we are going to get there and it comes through making sure that people get the degree of comfort to feel comfortable with taking the vaccine, protecting themselves and protecting their loved ones.

Dr. Joy: Dr. Titanji, a part of why clinical trials for a vaccine typically take so long is that we are wanting to kind of look at long term side effects of what happens after the vaccine. And of course, there is not the time for that in this case because we are trying to like slow down the rate of transmission of this disease. So what about the very real concerns about we have no clue what the long term impact of this is?

Dr. Titanji: That is absolutely true but one thing that we also know about a vaccine trials and vaccine studies for other diseases–licensed vaccines that are out there–is that the most severe and concerning adverse events are usually detected in that short follow up period. It's much rarer to pick up significant adverse effects during the longer follow up period. Can this happen? Yes, but it is extremely rare. There is no way of me or any infectious diseases doctor, any scientist, predicting what would be a long-term effect of this vaccine, two years down the road. These adverse events that happen that far out are exceedingly rare. For vaccines that have been approved and tested through yours, that is exceedingly rare.

That is why when an emergency use authorization is put out like the ones that we have for these vaccines, the conversation is about the risk benefit. They're trying to balance, what is the risk of putting this vaccine out there when we don't yet have that long term follow up information, compared to the benefits of putting it out there. And in looking at all the information that is available on both the Moderna and the Pfizer vaccine candidates, the benefits, by far, outweigh the risk.

As it is being rolled out, there is going to be continued monitoring to detect if there are long term effects. And the same panel of scientists who looked at this information and made that risk-benefit decision to advise on this emergency use authorization, would keep looking at this information to take in new information as more people get the vaccine, to see if there are any alarming signals that can be like, “Hey, wait a minute. Maybe we need to roll back on these emergency use authorizations.” But those take time, the monitoring continues, those sorts of effects are exceedingly rare for vaccines that are licensed and are currently widely distributed in the population.

Dr. Joy: Is there anything we haven't covered, Dr. Titanji, that you think is important for the audience to know about the COVID-19 vaccines?

Dr. Titanji: I think we've actually covered a lot of ground but I would just like to say this to those who have been in listening. I think a question that I often get is, I think people immediately when they think about the COVID-19 vaccine, they ask me: Would you recommend this to your mother or your father? And I say absolutely yes. Based on what we know, based on the information that is out there in the public domain, these vaccines have certainly much more benefit in terms of helping us combat this deadly pandemic. I have seen people my age and younger in the hospital, in the ICU, with COVID-19, and some of them have not made it. And if you get a chance of getting a vaccine that is able to stop you from having severe disease, it is a good thing and I think that you should strongly consider it.

For those who are still on the fence, keep informing yourself. Keep being curious and asking questions and reach out to your health providers to have a shared conversation. I'm hoping that the more you learn and the more you hear about this, you will ultimately arrive at the point where you feel that accepting this vaccine is the right thing, both for yourself and for your loved ones.

Dr. Joy: There is an additional question, Dr. Titanji, about whether there's any evidence that the vaccine can cause infertility.

Dr. Titanji: No, there isn't any evidence of that. I know that that information was kind of put out there by some of the misinformation channels and I’ve seen people ask me if this vaccine alters your placenta in any way at all. The answer is no and I'm reiterating again that the mRNA vaccine is just a set of instructions that tells your cells to make that piece of the virus. The moment your body reads that information (that code) and gets those instructions, that mRNA is destroyed. If you're a pregnant woman and you have a placenta, it doesn't get to your placenta, it doesn't cross to your baby, it doesn't alter your fertility in any way. So that is false information that is out there and I'm trying as much as possible... I hope that this answer provides some measure of reassurance to the listener who is posing it.

Dr. Joy: Mm hmm. Thank you for that. Where can we go, Dr. Titanji, to stay updated with the most accurate information? What websites should we be checking out to kind of stay abreast about what's happening related to the vaccines?

Dr. Titanji: I would strongly recommend the CDC’s website. They have a very accessible information website addressing frequently asked questions about the vaccine in very simple language that anybody can understand and would kind of reinforce a lot of the messages that we've been able to get across to those listening today. Top of my list is definitely the CDC’s website which, besides telling you about what to expect with the vaccine, also kind of tells you more information about how it will be rolled out, how it's prioritized how the monitoring would continue. People should definitely check out the public information on the COVID-19 vaccines on the CDC website.

Also, the National Institutes of Health has a very good page on frequently asked questions about COVID-19 vaccines. That again walks through some of the questions that we've tackled here and maybe some that we've not been able to cover in the hour that we've been on. Those two are certainly good places to start with.

Dr. Joy: Thank you so much for that, Dr. Titanji. (We) had shared those in the comments sections so if you do want to read that further then I’d invite you to check that out. I’m so appreciative for you, Dr. Titanji, of sharing your wealth of information with us today. Thank you to all of you who have joined us and shared your very informative questions. We knew that there were lots and lots of questions out there so we are just glad to be able to able to have partnered with Med-IQ on another opportunity like this to answer so many of the community’s very pressing questions.

The video will be available for replay, so if there’s somebody you know who maybe would like to get somebody this information who wasn’t able to join us, do share that with them as well. You all have a great rest of your Thursday. Take good care.

Dr. Titanji: Thank you.

Dr. Joy: I'm grateful to have been able to chat with Dr. Titanji and want to again share a special thanks to the Med-IQ team for making it happen. Please be sure to share this episode with two sisters in your circle who might also benefit from the conversation.

If there's a topic you'd like to have covered here on the podcast, please submit it to us at TherapyForBlackGirls.com/mailbox. And if you're looking for a therapist in your area, be sure to check out our therapist directory at TherapyForBlackGirls.com/directory.

If you're looking for a place to just be yourself or to connect with other sisters in your area, come on over and join us in the Yellow Couch Collective where we take a deeper dive into the topics from the podcast and just about everything else. You can join us at TherapyForBlackGirls. com/YCC. Thank y'all so much for joining me again this week. I look forward to continuing this conversation with you all, real soon. Take good care.