A perspective on discussing COVID-19 vaccines: Efficacy and adverse effects

Abstract

Not a day goes by in clinic without discussions with patients about COVID-19 vaccines. They are glad that they received their vaccinations but want to know if they can safely attend family gatherings over the upcoming holidays. And those who are taking immunosuppressive drugs may have heard that the medications may blunt their response to the vaccine. I emphasize with patients that the vaccines are effective overall in protecting them from becoming ill with COVID and requiring hospitalization. But because I can't guarantee or accurately measure the degree of protection my immunosuppressed patients achieve after vaccination, I emphasize the need to exercise common sense: to mask when in groups indoors, and to consider asking visitors and family members to get a rapid COVID test the day before any gathering.Not all immunosuppressive medications equally blunt the response to the COVID vaccines. The B cell-directed therapies (eg, rituximab), mycophenolate, JAK inhibitors, and high-dose prednisone pose the greatest concerns, while the anti-TNF medications are not nearly as troublesome. But we cannot count on the available antibody tests to reliably predict the degree of protection. Thus, my recommendations for management of these medications before and after vaccination are for the moment based on immunologic principles and on what I hope is good clinical reasoning.Completely different discussions take place with patients who are reluctant or completely resistant to receiving COVID vaccines. I try to understand their reasoning, but I point out that our overfl owing hospitals are fi lled with COVID patients, most of whom have not been vaccinated, and that this situation cannot be attributed to chance alone (ie, the vaccines work). A few patients just "don't believe it" and believe that hospitals and "the government" are "making the numbers up." But in most cases, actual dialogue with patients is possible. Of course, the dialogue often lengthens the visit by 5 to 10 minutes, but I feel it has the chance to positively impact the health of the patient and those around them in a lasting way. Time well spent.I've found particularly engaging the discussions with patients who say, "We don't know enough about the vaccines," or "The vaccines were developed too quickly." It is true that we do not know the 10-year post-vaccination outcomes, nor do we know 10-year post-COVID outcomes. But as I have thought about this in the clinic and in my role as editor, we actually know a surprising amount or, perhaps more accurately, we have a lot of data. Not all fi ndings and conclusions will turn out to be true, as truth in science is often ephemeral. 1 Hundreds of millions of COVID vaccines have been administered. Due to the virulence and infectivity of the virus, the effi cacy of the vaccines has been relatively quickly demonstrated in both randomized and observational studies. The enormity of vaccine exposure, clinical importance, and the social and political implications have contributed to rapid awareness and study of many possible vac...

Retinol Depletion in COVID-19

“…Vaccines have been developed for prevention of COVID-19 in an unprecedented speed [4,5]. However, the effectiveness of currently available vaccines varies and immunity they induce declines fast [6,7]. In addition, some vaccines may induce side effects in rare cases [8,9] and some vaccinated people are still getting infected indicating incomplete protection of vaccines [6,10].…”