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  • Writer's pictureRyan Allen

Vaccine safety and utility

Having discussed the mechanism of vaccines at a micro level in my last post, let’s go over what can be extrapolated from all of this at a more macro level. This is a rather complicated and controversial subject, so before I get into it I just want to recall how important it is to acknowledge a lot of preconceived notions or biases we might have in this space, and try to look at it objectively.

With that said, I will state my bias outright, which is that while I view each vaccine with a case-by-case, cost-benefit analysis (as I would any drug), I am in the medical field and trust the process when it comes to vaccine production and efficacy. My colleagues design and test vaccines, I see the rigor and attention to detail that is involved, and I also see the harmful effects of avoiding vaccines manifesting in several illnesses clinically. For these reasons, I have pretty much been consistent with getting vaccines my whole life. Before any further conclusions are made about my intentions here, let me say this: I take this (again, general) stance despite the significant possibility that I experienced a life-altering adverse effect from a vaccine. So, ahead of addressing some of the history around vaccine hesitancy and safety, let me quickly share what may have happened in my own case.

As many of you know, I was only recently diagnosed (in June 2021) with type 1 diabetes (T1D), which is an autoimmune condition, meaning one’s immune system mounts a response against oneself. You may recognize that date and begin to realize that this was shortly after the first rollout of the COVID-19 mRNA vaccine. And in fact, it was virtually concurrent with my initial COVID-19 mRNA vaccine series. What’s more, as the health freak I am, I had occasionally tracked my blood sugar (which becomes elevated in diabetes) prior to my diagnosis just for general metabolic health and prevention purposes. Having last measured it just a few weeks before receiving my first dose, it was excellent. (For those who want precise details, I measured ~100 mg/dL around an hour after having an incredibly high-carb meal and dessert. To anyone who is unfamiliar with blood sugar numbers, I can tell you that nowadays with T1D this is absolutely impossible for me to see; I’d estimate the same meal would at least put me in the 300s today without insulin.)

Now, before you suspect conspiracy on my part and find this all to be a probable, unfortunate coincidence (which it very well could be), let’s think about why I might consider this possibility. There are many ways in which autoimmunity can come about, and a lot of the fine details around the origins of T1D actually remain unknown. One thing that is clear, though, is that a major inflammatory event can trigger a strong immune response. (Going back to my last post, this was the whole concept of an adjuvant in a vaccine, which is to intentionally ramp up our innate inflammatory components so that we can produce a quality adaptive immune response.) You can get plenty of systemic inflammation from countless things, like an infection, a vaccine, or even exercise. Any one of these things could have triggered my T1D, including contracting COVID-19 itself. If the vaccine were the source of inflammation to push me over the line, this could have been its only role in precipitating this disease process: unmasking an immune response that was actually already there, accelerating something inevitable for me. It could also be that the vaccine produced something called molecular mimicry, meaning an element of the vaccine resembled my own self-antigens, and the adaptive immune response to the vaccine was actually the same one against myself. Of course, we will never know the truth, or if the vaccine even played a role at all.

But if this seems suspicious, why do I still get COVID-19 mRNA vaccines, and have zero regrets about getting the dose that potentially did the damage? Because no vaccines, drugs, or treatments, come with zero risk. This is all a statistical odds game, not a binary “good-bad,” and each step we take should be analyzed for its pros and cons. Note a common misconception with this framework, which is that we should only look at the pros and cons of taking an action. Well, what about not taking an action? Not taking an action is still a decision, not some neutral default stance. Therefore, if one decides not to take a certain drug, or get a certain vaccine, that decision must also be looked at for its pros and cons.

Let’s look at the pros and cons for the COVID-19 mRNA vaccines specifically. The pros are perhaps clear, which is that they lessen the impact of COVID-19 the disease. Your body has a pre-existing immune response to the coronavirus antigens, and thus if you encounter the virus, you already have an army of immune cells ready to fight it. The cons of the vaccine are any potential side effects or risks posed, such as the severe one I may have had. Thinking statistically, this outcome was highly unlikely, and in fact it even seems more likely from the literature to happen to someone who gets COVID-19 itself, not the vaccine. The most common alarm bells for the mRNA vaccines (that I have heard) seem to be autoimmune conditions (such as autoimmune arthritis, autoimmune hepatitis, new-onset type 1 diabetes, etc.) and heart complications (i.e. myocarditis). The literature is imperfect on these, and one must be cautious with which studies they selectively view, but the consensus for each of these conditions appears to be that they are statistically more likely to result from COVID-19 the illness than COVID-19 mRNA vaccination. Since “zero risk” is never an option, I will take the much smaller risk of vaccination if it reduces the much bigger risk from infection. This was my analysis for the COVID-19 mRNA vaccines specifically, but it applies to any drug, vaccine, or health-based decision of any kind that I make.

Finally, let me just highlight why vaccines were initially demonized. The anti-vaccine movement was largely founded upon the work of a British physician named Andrew Wakefield, who published an infamous, now retracted study in a highly reputable journal, the Lancet, which linked MMR vaccines to autism. As it turned out upon lots of investigative work, this study was beyond invalid, and actually intentionally fraudulent. We won’t get into details here, but if you are interested in seeing how Wakefield went to great lengths to deceive, I’d direct you towards investigative journalist Brian Deer’s book The Doctor Who Fooled the World. This study has of course been removed, completely debunked, widely discredited and invalidated, and Wakefield has lost his medical license. Not to mention, no other studies suggesting such effects from vaccination have since been published (and usually, when there’s really a signal and something is actually true, many people and studies will be onto it).

What to take from all of this put together? Well, to conclude, I would advocate not for blind, universal acceptance of all vaccinations, but for true, objective examination of your options and the pros and cons. For myself so far, I have found the net benefit of vaccination to typically far outweigh the net benefit of avoiding vaccination, often because the net risks of the latter are far more common and more serious. I would encourage everyone to utilize this framework, and recognize the personal significance of both action and inaction.


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