Dr. Elliot Bruhl has served as the Chief Medical Officer at the Southeast Alaska Regional Health Consortium since May 2019. He has over 20 years of experience in both Tribal and non-Tribal health. Dr. Bruhl joined KCAW’s Health Chat host Martha Pearson to answer listener questions about the coronavirus vaccine during the final edition of “Ask a COVID Expert.” This Q&A has been edited for clarity and brevity. To view the entire conversation, including a presentation by Dr. Bruhl, register at https://kcaw.org/covidexpert and then watch “on demand.”
What is the rationale for the age criteria? One vaccine is approved at age 16, and one is approved at age 18.
EB: It really just reflects the criteria that were selected for the stage three trial. The Emergency Use Authorization is based on the stage three trial. In all actuality, there probably is no difference because the vaccines are almost identical. So the Messenger RNA is contained in a little micro droplet of lipid or fat, and then it’s suspended in polyethylene glycol. Really, it’s the content of both of the vaccines. So my guess is that there’s no substantive difference. But I mean the Emergency Use Authorization has to be based on the actual science that was done to prove that it’s safe.
Will the vaccines be specific to variants, or how do we navigate which vaccine will cover which variants of the virus?
EB: I think it’s important for everyone to realize that mutations in viruses are not extraordinary events. They are the norm. So what you’re talking about is a virus that in its wild state out in the many millions of people that have contracted the virus and are sick from it, that the virus is replicating millions and millions of times in every one of those people’s bodies. That means there’s billions of replicas that are occurring, and so the chance of a mutation is not if that will happen, it’s simply when and whether or not the mutations that emerge are going to be a problem.
The variants that have emerged more recently in South Africa and in Great Britain are variants where the spike protein is stickier, so it sticks to cells better than the other variant that has been causing the pandemic, and for that reason when people encounter it, it tends to be more infective or more contagious. Some pretty good data coming out of Great Britain shows that it’s probably not more dangerous or more virulent; it doesn’t seem to kill people more. But more people are contracting it. That’s in spite of what their Prime Minister said the other day, which was incorrect scientifically.
There have been a number of in vitro studies that have been done. In vitro means not inside the body, but in a test situation that’s in a laboratory. What was done is that they took serum, which is the liquid part of the blood, from people that are immune to the virus. Those people were people who were vaccinated. So then they take the mutant virus, and they put them in a test tube essentially with the serum and then they see if the serum attacks those virus particles. In a very well controlled and well conducted study, it’s shown that the Pfizer vaccine and by analogue, the Moderna vaccine, do successfully attack the viruses. And so, by extension, the vaccines should be effective. That paper was published in the New England Journal of Medicine in the last week, and it’s a well-done study.
Some people say let’s just take our time with this vaccine. That is not an option. It’s very important that globally we vaccinate as many people as possible as soon as possible and shut this down before a more virulent strain of this coronavirus emerges. Because that is a real worry. Right now, we have one pandemic, and it’s a pandemic with a virus that is killing millions of people all over the globe, and we need to get it shut down while we have a vaccine that’s effective, and while we don’t have the emergence of a more virulent and more deadly form of the virus.
Do we assume that the new variant of the virus is here in Alaska and/or it will be here by tourist season? And does this mean that because it’s twice as contagious, nearly safe conversations of 15 minutes can now only last 8 minutes?
EB: It is 50 percent more contagious. I mean, that’s the math. The suggestion that the shorter conversation would have an equivalent amount of risk is actually a mathematically correct notion, all other things being equal (the distance between people, people wearing masks, etc).
Something just came out in the news the other day that the surveillance program that our health department has that sends a few of these in to be sequenced does show that it is in Alaska. It’s kind of a rearview mirror picture. So the sample that actually produced this is already about 30 days old. So, is it here? Sure, it is absolutely, no doubt.
One of the problems we have in the U.S. is that we do not have a good surveillance program. This is a really important thing. There has been surveillance in the United States that’s been going on through some independent laboratories through some commercial pharmaceutical biomedical development companies that are looking at what is the drift genetically of the virus because they’re developing vaccines. But we don’t have an institutionalized system like they have, for example, in Great Britain where they’re very systematically sampling all the positives all over the country. And that is something that is underway, and my expectation is in the next 60 days we should see that.
Why is Alaska doing so well with vaccine distribution, particularly since it’s so remote?
EB: We’re a relatively small state, and we receive vaccines through a population-based algorithm like other states through a state vaccination distribution. In addition to that, Native people have a separate trust relationship between their Tribes and the federal government. And there is also a distribution to Tribal health organizations through the IHS, not just in Alaska, but all across the country.
Alaska has a much higher proportion of Tribal health organizations providing health care in our state, and so those additional amounts of vaccine have increased the supply in the state. The coronavirus pandemic has had a really devastating effect in Indian Country all around the country and Native people have been having attack rates within their communities that are much, much higher than in non-Native communities. That’s also been true of African Americans.
Here in Alaska, we have a lot of Native people, and in a lot of our communities that we serve and in Western Alaska, it’s been true that we’ve had much higher attack rates when it has entered some of our villages. We’ve seen deaths in the Native community here. Certainly very true in Western Alaska. There’s a lot of things that contribute to this, but probably the most significant has to do with multi-generational households as well as a general lack of access to healthcare resources. So, the whole point of this additional distribution of vaccine is to target those communities.
How long can we expect to enjoy immunity from the vaccine?
EB: In terms of your immunity following the immunization, we know right now that the Pfizer and Moderna vaccines confer immunity in the range of six to nine months. It may be that they’ll work for years.
If a person is in a vulnerable population such as an elder or someone with medical vulnerability, is it right to assume that they will have more severe side effects upon getting the vaccine?
EB: No, that’s not a reasonable assumption. With regards to older folks or people who have a weakened immune system, they should get the vaccine. The vaccine will be helpful and preventative in terms of them not getting COVID-19. They may not have as strong of an immune response, and they may not have as many side effects as a younger person might. But if you have immune suppression, you should still get the vaccine. It’s safe, and it will still be effective.
The side effects are somewhat unpleasant, but the risks are not significant. No one has died from this vaccine. There have been some very, very infrequent anaphylactic type reactions. People also have other reactions to the vaccine. That includes what we call a vasovagal response. It’s like fainting, and some people have some emotional reactions to the vaccine. Those pass. And any type of allergic phenomenon can be treated, and we have all the equipment and medications available to treat that wherever we give the vaccine.
Is it safe to travel after being vaccinated with the second dose?
EB: There’s a number of things that go into that calculus. Ninety-five percent effectiveness at preventing hospitalization and death means there’s still some risk, right? Five percent. My question there would be in terms of balancing risks versus benefits. Why are you traveling and are you traveling for a good reason? Also, how healthy are you at baseline? Are you a person that has significant medical susceptibility and what are those kinds of conditions? People with impaired immunity, people who have diabetes, morbid obesity, respiratory illness, underlying severe cardiac illness, those types of problems. Those are conditions that are associated with higher morbidity which means how sick you get.
Having said that, I can tell you that for business, I have traveled some in the last few months, both to Seattle and over to Juneau. I think the airlines are doing a pretty good job. I would be certain if you’re traveling to wear an N95 mask, which is more tight fitting than those standard surgical masks or the cloth masks. I would bring something to protect your eyes, whether it’s a face shield or a good set of glasses. And I would bring some antiseptic wipes and wipe down your chair and your tray. I think if you don’t have severe disease, you’ve received both of your vaccines, and it’s been 2 weeks since you’ve received your last vaccine, I do think it’s reasonable to consider travel if the travel is for a good reason.
What contingency plans are there if there emerges a heretofore unknown negative side effect from the vaccine and the majority of all of us have been vaccinated?
EB: Well, it’s an interesting hypothetical question. So, what is being done to monitor for that is that people who are vaccinated have the option, and most people take this option, of getting connected to the CDC. It’s been quite a long time since I was vaccinated, and about once a week, I get a questionnaire that’s texted to me from the CDC asking me questions about how I’m doing to monitor for any potential problems or development of any other side effects. At this point, many millions of people have been vaccinated and are doing fine.
Considering the speed at which the vaccine was developed from mostly off the shelf science and technology, could this be the last respiratory pandemic from a scientific standpoint?
EB: Oh boy, I wish. No, no, sadly no. But there will be some wonderful things that come out of this. It’s like anything in life you go through that’s hard, there’s also often good things that come. There’s things that we’ve learned as a health care system that will yield positive results in the future and certainly medical science is catapulting forward yet again through this process. I think our ability to develop vaccines and treatment medications, that’s where the tough spot is and hopefully we’ll gain more ground on the treatment side.