Which COVID-19 vaccine should I get?

Should I try and get an mRNA vaccine? They are better than the others, aren’t they? If I show up at the clinic can I choose?

 These are some of the questions that we didn’t even know we would be so lucky to ask just three months ago. 

The speed at which multiple vaccines to choose from has come about is unprecedented. 

The first genome sequence of a previously unknown virus was published in early January 2020 and the Pfizer and Moderna mRNA vaccines, tested over the summer and fall of 2020, were approved for emergency use in early December. 

These are the quickest vaccines ever developed. Their very speed has raised a lot of questions around their safety. It is true that all previous vaccines have taken years to develop and the cumulative experience of their use over time is reassuring. 

Moderate reactions

Nevertheless the COVID-19 vaccines have been tested in very big trials. As a comparison, the widely used and “uncontroversial” Shingrix vaccine for prevention of shingles was tested in 32,000 participants prior to submission for approval in 2017. The total number of patients in COVID-19 vaccine trials that have reported results so far is 170,000 and growing rapidly. 

The safety results have been reassuring — both in the trial participants and now in millions of people worldwide who have been vaccinated and reported to national monitoring systems. 

Rates of severe side effects, mainly anaphylaxis, have been very rare — a handful in every million vaccinated — and the more common reactions such as arm pain, fever, fatigue and muscle aches have been over very quickly. 

The brief discomfort of COVID-19 vaccines seems to be greater than for the annual flu shot. This probably reflects a combination of both the “prime-boost” two-shot strategy to provoke maximum stimulation of the immune system; and the large group of vaccinees who were recently infected naturally with SARS-CoV-2 and already have a naturally primed immune system ready to react. Maybe the single-shot Johnson & Johnson vaccine will have fewer reactions?

Don’t compare the numbers

There are now three vaccines available in the USA (Pfizer, Moderna and Johnson & Johnson) and several more globally, with more to come. 

Inevitable comparisons between the different vaccines, using their “headline” efficacy numbers, is a favorite media story at the moment. This has stimulated “vaccine shopping,” which has reached damaging levels in places like Germany, where the UK Astra-Zeneca vaccine sits un-used in warehouses whilst people wait, unprotected, for the Pfizer vaccine. 

The efficacy numbers attached to the two shots is responsible for this: 95% for Pfizer versus 62% for Astra-Zeneca. 

These numbers are a snapshot in time and can’t be compared with each other. 

Different vaccine trials

The Pfizer number was generated from a trial mainly in the USA, where most of the patients were recruited in the summer and fall of 2020. 

The Astra-Zeneca number was reported from a trial that included a substantial mixture of patients from the UK, South Africa and Brazil. 

The Pfizer and Moderna trials closely adhered to the three- or four-week interval between doses, whereas the Astra-Zeneca trial had a less strict timing. 

The different trials measured infection and symptoms in different ways at different time points. 

In more recent trials — for example the Johnson & Johnson and Novavax trials — there were large numbers of infections with new virus variants included as well. 

The efficacy result of each trial is reflective of the performance of the vaccine WITHIN that trial compared with a placebo — but not comparable OUTSIDE of the trial with the other vaccines.

Real-world results

To emphasize this, we have recent large-scale program results from the Scottish National Health Service. 

The Astra-Zeneca vaccine has been 94% effective in reducing hospitalizations so far compared with the Pfizer vaccine, which has been 85% effective. 

This reversal of efficacy rankings in a real-world observation simply emphasizes that both vaccines are great. 

The most important number of all to remember is that in the thousands and thousands of trial participants who received any of the vaccines there were no COVID deaths and almost no hospitalizations for COVID.

So when you have finally managed to find your vaccine appointment after refreshing the sign-up page a hundred times and been booked four weeks hence, don’t worry about which vaccine you will get. Just pick the one with the smallest needle.

 

James Shepherd, MD PhD, lives in Sharon and is an Infectious Disease physician and epidemiologist who is on the faculty of the Yale University School of Medicine.

Latest News

Club baseball at Fuessenich Park

Travel league baseball came to Torrington Thursday, June 26, when the Berkshire Bears Select Team played the Connecticut Moose 18U squad. The Moose won 6-4 in a back-and-forth game. Two players on the Bears play varsity ball at Housatonic Valley Regional High School: shortstop Anthony Foley and first baseman Wes Allyn. Foley went 1-for-3 at bat with an RBI in the game at Fuessenich Park.

 

  Anthony Foley, rising senior at Housatonic Valley Regional High School, went 1-for-3 at bat for the Bears June 26.Photo by Riley Klein 

 
Siglio Press: Uncommon books at the intersection of art and literature

Uncommon books at the intersection of art and literature.

Richard Kraft

Siglio Press is a small, independent publishing house based in Egremont, Massachusetts, known for producing “uncommon books at the intersection of art and literature.” Founded and run by editor and publisher Lisa Pearson, Siglio has, since 2008, designed books that challenge conventions of both form and content.

A visit to Pearson’s airy studio suggests uncommon work, to be sure. Each of four very large tables were covered with what looked to be thousands of miniature squares of inkjet-printed, kaleidoscopically colored pieces of paper. Another table was covered with dozens of book/illustration-size, abstracted images of deer, made up of colored dots. For the enchanted and the mystified, Pearson kindly explained that these pieces were to be collaged together as artworks by the artist Richard Kraft (a frequent contributor to the Siglio Press and Pearson’s husband). The works would be accompanied by writings by two poets, Elizabeth Zuba and Monica Torre, in an as-yet-to-be-named book, inspired by a found copy of a worn French children’s book from the 1930s called “Robin de Bois” (Robin Hood).

Keep ReadingShow less
Cycling season: A roundup of our region’s rentals and where to ride them

Cyclists head south on the rail trail from Copake Falls.

Alec Linden

After a shaky start, summer has well and truly descended upon the Litchfield, Berkshire and Taconic hills, and there is no better way to get out and enjoy long-awaited good weather than on two wheels. Below, find a brief guide for those who feel the pull of the rail trail, but have yet to purchase their own ten-speed. Temporary rides are available in the tri-corner region, and their purveyors are eager to get residents of all ages, abilities and inclinations out into the open road (or bike path).

For those lucky enough to already possess their own bike, perhaps the routes described will inspire a new way to spend a Sunday afternoon. For more, visit lakevillejournal.com/tag/bike-route to check out two ride-guides from local cyclists that will appeal to enthusiasts of many levels looking for a varied trip through the region’s stunning summer scenery.

Keep ReadingShow less