Ep. 43: Your Vaccine Questions Answered
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Pfizer, Moderna, AstraZeneca—their vaccines and others will dominate the public discussion for months to come. When will they be ready? When will they change our lives? Medcan’s chief medical officer, Dr. Peter Nord, guest hosts with occupational health experts Dr. Jason Abrams, Dr. Matthew Burnstein and Dr. Alain Sotto.
LINKS AND HIGHLIGHTS:
This episode functions as an update to our 31st show, which featured Dr. Jason Abrams explaining the mechanics of mRNA vaccines. That’s here.
Learn about Medcan’s Medical Advisory Services.
Other resources to help stay informed on the vaccine include the New York Times’ Vaccine Tracker website, Plus, here’s a useful explainer on the Canadian vaccine approval process.
Photo source: Flickr. The photo depicts union members receiving a flu shot during the 1957 pandemic.
Your Vaccine Questions Answered final web transcript
Christopher Shulgan: Welcome to Eat Move Think. Executive producer Christopher Shulgan here. It feels like COVID’s last act. Gosh, let's hope so. Every day seems to reveal a new headline about the vaccine. Amid the talk of spike proteins and messenger RNA and ultra-cold supply chain logistics, the tricky thing about it all is determining what it means on a personal level.
Christopher Shulgan: It's really hard to know whether to let oneself get excited. When and how do the vaccines start to change our lives? Can we be confident that we're heading back to a time when things are, if not totally normal, then at least more normal? When can we head south again? Or go to a concert? Or just get back into the office?
Christopher Shulgan: To get answers, Eat Move Think checked in with Medcan's expert physicians. Known as the Medical Advisory Services Team, their entire job description—in addition to their being MDs—involves providing guidance on issues like this to major corporations.
Christopher Shulgan: In this episode, we asked them to outline their thoughts on the vaccine, to provide some direction for regular people as well as businesses on what’s to come. One quick word, in addition to this episode, you may also want to go back and revisit Eat Move Think episode 31, which features Dr. Jason Abrams of Medcan describing the immune system mechanics of how the vaccine actually works, as well as the process of distribution and which population groups are likely to get it first. And with that, here's this episode's host, Medcan chief medical officer and MAST member, Dr. Peter Nord.
Peter Nord: Hi, Dr. Peter Nord here. Today we're going to be speaking with three of our physicians, specifically about something that's highly topical right now, and that's vaccines. So our headline is this: vaccines are a massive step to accelerating our journey to the end of the pandemic, and they will save millions of lives globally. Full stop. And that's for sure going to be true. What it isn't, it isn't the one and done solution to the pandemic. And I think the real takeaway message is kind of like, but don't think that this is the silver bullet, that's going to fix everything, and once you have your shot, you don't have to have masks on, you don't have to worry about anything, you're good.
Peter Nord: Because the number of people are going to actually get vaccinated, multiplied by the efficacy rate, multiplied by the duration of immunity that we don't know, and then multiplied by the mutation of the virus over time, would mean—if the virus mutates, forget the vaccine benefit. You got to start from scratch, you got to develop a whole new vaccine based on the new strain, which is what we do with influenza every year. You put all these things together, it's not the answer. The answer is still going to be distancing and mask use, and we're not going to get away from that for I would say one to two years if I was, you know, pushed.
Peter Nord: Our position is actually a bit of a conservative one. And I'd like to go over our thoughts on this and why we're taking this conservative view. Firstly, the data that we've seen so far, isn't robust. Thus far, we've had some very exciting press releases, some very encouraging numbers that are behind those press releases, but as physicians, we are trained to be very rigorous, and actually skeptical of every study that comes across our desk. So if a drug company creates a new drug and has their own study that says this is amazing, it probably is. But there is the optics of an inherent bias there. Obviously, the drug company is going to win big time if these statements that they're making are true. Their share price depends significantly on how these vaccines are marketed and distributed. So there is a dollar figure that's attached to some of these studies that are that are potentially creating, at least even the optics of some inherent bias.
Peter Nord: Add to that the politicization of this process, especially south of the border, but in other countries as well, where there's a tremendous amount of political pressure that's been applied to come out with these sorts of statements as well. We have to then pause, and with some degree of academic rigor, we need to analyze these studies. And what we're seeing as week and goes after week, we're seeing more data come forward, so we're being encouraged. But at this point, we have to pause and be very conservative as we approach these. Again, most likely, this is a game changer, this is a massive improvement in how we're going to be approaching the entire pandemic, and will likely shorten the pandemic, and will get us there faster and save lives.
Peter Nord: But we still, as of today, need to be slightly skeptical and take a conservative approach. And that's the approach that you're going to hear from our three physicians, that we're going to take a probably 12-month timeline for us to have most of our population vaccinated. So at least for the next year, mask use, distancing, hand hygiene, all those basic things that are going to get us through are going to be held intact.
Peter Nord: So with that, what I'd like to do is introduce each of our physicians: Dr. Jason Abrams, Dr. Matthew Burnstein and Dr. Al Sotto, three of our MAST physicians, experts in these areas. Each of them brings a unique view of this issue. First of all, Dr. Abrams.
Jason Abrams: Hi, I'm Dr. Jason Abrams. I am the associate medical director at the Medcan clinic, and I'm also one of the Medical Advisory Service Team physicians. I was excited by how efficient the vaccine seemed to be at protecting people against the coronavirus. At the same time I was a little bit skeptical because of the short time window in which the vaccines were studied for efficacy. Phase three trials typically can go on for several years before a vaccine's introduced to market, maybe three, four, five years. But in this case, it's more like two to three months.
Peter Nord: So a particular concern is not only the fact that we have compressed a normal process that takes years into months, but also the basic methodology of the studies is something that we're really having to watch closely. Back to Dr. Abrams.
Jason Abrams: For example, in Pfizer's study, they were only assessing people for coronavirus infection if they develop symptoms. But, for example, we know that there are people who get the coronavirus infections and remain completely asymptomatic. So when they looked at the efficacy of their vaccine, they weren't randomly swabbing people throughout the two months that they were being studied to see if there were any asymptomatic infected people who had received the vaccination. If you look under the covers of Pfizer's study approach, they may be missing asymptomatic infections in people who were vaccinated. In reality, it means that the true efficacy rate could be lower because they're not analyzing for asymptomatic carriers of coronavirus infection.
Peter Nord: So take the 95 percent stats with a grain of salt. And then there's the question of when we're actually going to be able to get the vaccine. Here's Dr. Jason Abrams.
Jason Abrams: There's some logistical issues with Pfizer's vaccine right now that have come to light, which is that it has to be stored at extremely cold temperatures, and when it's transported it has to maintain that extremely cold temperature. So with supply chain and distribution, there will be some major logistical issues to distributing it en masse to the world. Whereas Moderna's vaccine can be stored at normal refrigeration temperatures, so it's a much easier vaccine to handle and distribute.
Peter Nord: So vaccines are one strategy among many strategies. Really, it's one more arrow in the quiver that we need to bring to bear to ultimately tamp down the pandemic until it is a distant memory. That also corresponds to Dr. Burnstein's take.
Matthew Burnstein: Hi, I'm Dr. Matthew Burnstein. I'm one of the senior medical consultants at Medcan. Over the next few months, I anticipate that the situation will actually get worse before it gets better. It takes time to turn this ship around with more restrictive measures on behaviour despite the efforts so far. With respect to the vaccination, it's going to be a long, slow process. It's unclear how many vaccines Canada will get. I keep hearing different numbers from our politicians. But even if it is as many as six million vaccines in the first quarter, with two doses each that's only three million people. That's less than ten percent of the population. Because it's one thing to develop a vaccine, it's another thing to distribute it. And it's another thing to ensure that you distribute it in a fair manner, and that you get enough people vaccinated to put this thing to bed. Not get rid of it just dampen it down.
Matthew Burnstein: I am concerned that a certain percentage of the population, and not a negligible percentage of the population, is fearful of vaccines and will not get the vaccination. And getting a vaccination not only protects the individual, but it protects the rest of society. It's a bit of one's civic obligation to get a vaccine, just as people did in the '50s and '60s, lining up to get measles, mumps, rubella, smallpox, chickenpox, all of those vaccinations that allowed us to live free of those deadly diseases in our modern world. A lot of misinformation, a lot of bad science out there that people are grabbing on to.
Matthew Burnstein: We've relied on vaccines since the early 1960s—and maybe even a little bit before—to change our world. Once upon a time—and I grew up with measles, mumps, rubella, chickenpox. Smallpox was still around. You know, and I remember as a child being taken to someone's house to get chickenpox, so we could all get chickenpox at the same time.
Matthew Burnstein: And children died of these diseases. And we all accepted that we needed to be vaccinated. And we all got lined up, we got the vaccine, and we put these diseases to rest. And we still get the odd outbreak of mumps, there was one four or five years ago I remember in Toronto, and everyone got vaccinated. Young people in particular who hadn't received two doses of mumps vaccine were given a second dose. So that's what put these diseases to rest. I mean, you don't see any iron lungs around anymore, okay? Because people accepted that vaccines were important, and that we all had a responsibility to get one. Vaccines have been far more important than antibiotics in changing our world and reducing death rates, particularly among children.
Matthew Burnstein: My understanding is that there's about 40 percent of the population who don't want to get the vaccine, and so it'll remain circulating in our community. And if it's out there in the community, we all remain at some risk—lower risk, but some risk. And because this is still a deadly disease, it's very concerning and will continue to put a strain on our system until we've got a large percentage of the population vaccinated. What percentage that is though, we don't know because we've never been through this with this particular virus before. But it is going to take time. And I think we're going to be at this until the end of next summer anyway, and I'm optimistic that by the end of next summer, we will be in a much better position in Canada.
Peter Nord: That's not to say that COVID is going to be completely gone. Here's Dr. Jason Abrams.
Jason Abrams: A vaccine alone cannot rid the world of the coronavirus 19 infection.
Peter Nord: That also corresponds to Dr. Burnstein's take.
Matthew Burnstein: The vaccine isn't going to get rid of this virus. It's still going to be with us. It's going to be like the flu: in the background. Or measles or mumps. Hopefully, it'll be like measles and mumps: very rare, rather than the flu that comes around every year.
Peter Nord: The Medical Advisory Services Team members, all of our physicians are being asked on a daily basis from corporations right across Canada about the vaccine. What does it mean to them? What does it mean to their employees? How can they distribute it? When are they going to have access to the vaccines? Here's Dr. Al Sotto, nationally-recognized occupational health and safety specialist to talk about this.
Alain Sotto: My name is Dr. Alain Sotto. I work at Medcan as a senior medical consultant and on the Medical Advisory Team for the COVID-19 pandemic. As a corporate physician, having done this for 33 years during the SARS crisis and the H1N1 pandemic of 2009, I can tell you that companies and CEOs need to get their ducks in order to think about vaccine rollout within the corporation. And I use the model of the Sotto's Four Es. And I'll describe the four Es at this time. So companies have to start educating. And that's the first E is educate. Companies have to educate, whether it's through their HR, their occ-health, their nurse at the company, have to educate their employees about the importance of getting a COVID-19 vaccine.
Alain Sotto: And that is super important, because this is a vaccine that will protect you, whether it's 70 percent, 80 percent or 90 percent. You're not only doing it for yourself to prevent disease, or prevent serious disease. When we say it's only 70 or 90 percent effective, that means if you get sick, you're still going to get a reduced form of the illness of COVID-19, and not likely require ICU admission or ventilation, which is a very important distinction, right? Because if you say it's 90 percent effective, well what happens to the other 10 percent? They may get the COVID-19 disease, but it will not be severe, or result in admission to the ICU. So I think that's super important to make that distinction.
Alain Sotto: The second E, which I have coined as part of Sotto's Four Es, is the empowering. You need to empower employees in your workplace to get the right information that's vetted properly. I think that's really important. It's got to be a reliable source, it's got to be without bias, and I think it needs to be communicated properly. The third E is engaging employees about taking ownership for their own health. And I think it's terribly important that employees have a duty not only to themselves and their family members or their elder parents, they have a responsibility to the community. Because if we have the bulk of employees and the bulk of the population subsequently immunized against COVID-19, the sooner we can get back to normal activities without people getting sick.
Alain Sotto: And that's the concept of herd immunity, which we estimate that if 40 to 50 percent of the population in general gets vaccinated towards the COVID-19, that'll give us some herd immunity, and minimize the impact to what we've described as a generalized lockdown and future other restrictions. So I think it's really important.
Alain Sotto: The final E and the most important E that I always coin, is enabling employees to get the vaccine without any barriers of, "Well, I'm not able to take time off. I'm not able to go. I'm not—I have to take this, that and the other off." So if you enable them to get the vaccine, the COVID-19 vaccine in the workplace through the usual channels, you will be more successful and we will have a higher chance of getting more employees vaccinated, and your corporation will return to high-level functioning sooner than later.
Peter Nord: So at the end of the day, there is going to be a post-pandemic world. It's going to be a future where we put this behind us. And that's probably a good place to end. Personally, I can't wait to go to a Leafs game. All the excitement, the shouting, the ambience that comes around being with a group of people all sharing a passion for a sport. And that can be any sport, but for me it just happens to be hockey. Let's hear from Dr. Jason Abrams as to what he's going to do in the post-pandemic world.
Jason Abrams: I take my kid to Canada's Wonderland, because he's been missing it like crazy. I'm hopeful there might be an opportunity to take him this coming summer. I'm not going to consider things to be the way they used to be until I have an opportunity to go to Downsview Park, not far from where I live, for a major concert festival like we did to celebrate the end of SARS in 2003.
Peter Nord: And here's what Dr. Al Sotto's going to do.
Alain Sotto: I'm gonna call in and say I'm on vacation for the next month and travel. Honest to God. Anywhere but here.
Peter Nord: This is Dr. Peter Nord, chief medical officer at Medcan. Thanks so much for listening.
Christopher Shulgan: That's it for this episode of Eat Move Think. Eat Move Think is produced by Ghost Bureau. Senior producer is Russell Gragg, who's looking forward to travelling in Europe, Berlin maybe Helsinki, where he's going to rent an apartment for about a month. Social media support from Emily Mannella, who's looking forward to hugging her grandma. Editorial direction from Chantel Guertin, who's looking forward to a beach vacation. Remember to rate and subscribe to Eat Move Think on your favourite podcast platform. Follow host Shaun Francis on Twitter and Instagram @Shauncfrancis—that's Shaun with a 'U'—and Medcan @medcanlivewell. We'll be back soon with a new episode examining the latest in health and wellness.
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