Welcome to the 5 Things Digest from the NTTAC Clinical Practice and Health Care Transformation Team. This issue brings you 5 Things to know right now about vaccines for COVID-19.
#1: The COVID-19 vaccine is a new type of vaccine, different and potentially safer than earlier vaccines. 
Previous vaccines were created from weakened forms of a virus. People receiving those vaccines received a dose of this weakened virus so that their body would make antibodies to then fight off stronger versions of it; still, people were being injected with an active (but weaker form) of a virus. The newer vaccines, including the COVID-19 vaccine, do not expose individuals to a weaker form of a virus, and live virus particles are not injected into a person, so they cannot give someone a “weaker version” of COVID-19 sickness. The outside of our cells have a “spike” that the COVID-19 virus seeks to attach to (so it can then invade and hijack the necessary parts of your cells to make more COVID-19 virus particles). So, the new vaccine only includes the mRNA (messenger RNA) that tells a person’s cells to make antibodies to the spike on the outside of your cells that the COVID-19 attaches to. 

Some people have feared that this mRNA would change their genes or DNA; this is inaccurate--mRNA is outside the nucleus of your cells, where it can make proteins, such as antibodies to fight viruses like COVID-19. DNA unwinds inside the cell nucleus to send RNA outside the nucleus to use mRNA to make proteins, but mRNA cannot go inside the cell nucleus to alter your DNA.

The most common side effect to the vaccine is mild pain or soreness at the injection site, and sometimes headache or fever; about 1 in 10 people report some mild, transitory side effect. Some people who may have had allergic reactions to receiving a vaccine before may also have an allergic reaction to the COVID-19 vaccine. This is because vaccines include substances to hold the vaccine together, such as polyethylene glycol, that some people react to, similar to some people having allergic reactions to wearing rubber gloves. Therefore, you may be asked to wait 15 minutes after receiving the vaccine to monitor you for any such reaction while you’re still in a medical setting. If someone has had a severe allergic reaction to a previous vaccine, then the current recommendation from the CDC is for them not to get the COVID vaccine.

A smartphone-based tool (V-safe) has been created by the Centers for Disease Control and Prevention (CDC) to provide personalized health check-ins after you receive the vaccine, and for you to alert the CDC if you detect any unusual or side effects to the vaccine.

This is the frequently updated CDC fact page about COVID-19 and the vaccines.

This is the website for individuals to register after taking the vaccine to receive personalized information about the vaccine they took, and to provide the CDC with any information about side effects or other complications they might experience.
#2: The vaccine is about 95% effective, but we ALL should still use safety precautions to diminish the impacts of COVID-19. 

The COVID-19 (Pfizer) vaccine was 52% effective after the first shot, and 95% effective after the second shot given 21 days after the first shot. The Moderna vaccine, and three others in the last clinical phase trials, all require 2 injections at different times. The first shot helps the body recognize the virus and prepares the immune system, and the second shot strengthens the immune response. If one misses the planned date of the second shot, it’s important to still get it, even if late, to increase one’s immune response.

Even though the vaccine is highly effective, it takes time for your body to produce the antibodies to the COVID-19 spike proteins, so you should continue to wear a mask, socially distance, wash your hands often, and avoid crowds, particularly indoors or in enclosed places. While a vaccinated person should not become sick from COVID-19, it’s still unknown how long a vaccinated person might carry COVID-19 “germs” that could be transmitted to another person. While these practices may be personally inconvenient, they are similar to waiting at red lights or stop signs, where the benefits for everyone’s safety show consideration for everyone and make these practices worth doing.

If you have previously tested positive for COVID-19, and/or been sick from COVID-19, you should still take the vaccine since we know that individuals can get reinfected, and we don’t know how long after a person may have been infected or sick with COVID-19 before they may again become reinfected or contagious. The flu vaccine protects against different viruses, not the coronavirus, so the flu vaccine will not prevent one from getting COVID-19.

The CDC’s frequently asked questions website, frequently updated, about the COVID-10 vaccine.
#3: The risks and benefits of the vaccine are becoming more clear, to help everyone make better-informed choices about receiving the vaccine.

Most people should receive the vaccine. These COVID-19 vaccines (Pfizer, Moderna) do not include eggs, nuts, or heavy metals, sometimes associated with allergic reactions, but anyone who has had allergic reactions to vaccines before, or who might have unusual sensitivities, should discuss the vaccine with their medical providers. Pregnant and breastfeeding women should discuss the COVID-19 vaccine with their medical provider; however, both the CDC and the American College of Gynecology have stated that the COVID-19 vaccine should be offered to pregnant and breastfeeding women.

Others may resist taking the vaccine because they do not perceive that the benefits exceed the risks. The longer term risks of not vaccinating are becoming increasingly clear. Over 200,000 people have already died from COVID-19. Of those who have been hospitalized for COVID-19 treatment, at six months, 76% still had persisting symptoms, such as:
  • 63% with fatigue/muscle weakness
  • 26% with sleep problems
  • 23% with depression and anxiety symptoms
  • 22-29% with breathing or respiratory abnormalities
  • 13% with decreased kidney function
In addition to the physical risks, COVID-19 is associated with multiple mental health impacts in those of all ages. The direct impacts of COVID-19 illness are associated with negative impacts on mental as well as physical health. Current estimates are that 1 in 5 people diagnosed with COVID-19 will develop a psychiatric illness within 90 days, usually anxiety, depression, or insomnia. COVID-19 may increase our feelings of isolation, and increase rates of depression, anxiety, and substance abuse. The Kaiser Family Foundation reported in mid-July 2020 that 53% of adults in the U.S. reported their mental health was negatively impacted by stress/worry from COVID-19, including difficulties sleeping (36%), eating (32%), increased alcohol/substance use (12%), and worsened chronic conditions (12%). These numbers appear higher in college students, whose social lives may be particularly disrupted. Similarly, children and youth across the globe have reported increased anxiety and depression since this pandemic, increasing from junior to senior high school, and greater in females. 
Parent resource toolkits to ensure the social, emotional, and mental well-being of their children (by age level: early childhood, childhood, adolescence, young adulthood)

The Lancet (medical journal) published this study January 8, 2021, clarifying the persisting impacts and symptoms of COVID-19.

The Kaiser Family Foundation website and early (July 2020) mental health findings related to the stress of COVID-19.

A review of global studies of the impacts of pandemics on mental health in youth.

Findings from early research on after-effects of COVID-19 on mental health conditions.
#4: Access to the COVID-19 vaccine is not the same for everyone, but cost should not be a barrier. 

Each state will identify its own process for providing the vaccine, so people may receive the vaccine at different times in different places; however, cost of the vaccine should not be an obstacle to getting vaccinated for COVID-19. The vaccine doses have been purchased with U.S. taxpayer dollars and will be given to the American people at no cost. Vaccination providers may be able to charge administrative fees for giving the shots. Accordingly, any fees for receiving the vaccine will need to be addressed and publicized to ensure equitable access/interest in receiving the vaccine.

Addressing other obstacles to vaccine access, such as transportation, follow-up, tracking, etc., will also affect access to being vaccinated. While 99% of Americans live within 50 miles of a pharmacy expected to provide the COVID-19 vaccine, over 20% do not live within 5 miles of a pharmacy. Efforts will be needed to ensure that everyone, particularly those who may be more rural areas or who do not drive, are provided viable opportunities to receive the vaccine.

CDC page with information on the COVID-19 vaccine.
A description of barriers (and solutions) to COVID-19 vaccination in the U.S.
#5: Different individuals and groups may have different concerns about the COVID-19 vaccine, so information will need to be tailored to their specific concerns.

Racial disparities in study populations of the vaccines and other variables impact trust in the vaccine, and also willingness to be vaccinated for COVID-19. While approximately 75% of Whites and Latinx are willing to get a COVID-19 vaccine if available, only 54% of Black Americans report willingness to get the vaccine. Only 14% of Black adults and 34% of Latinx trust vaccine safety, and 75% of both groups are reluctant to get a vaccine approved by the FDA for emergency use. Ensuring that different racial and ethnic groups are included in vaccine/treatment trials, that there is transparency in such trials, that expert advice is used in prioritizing different groups for receiving vaccines/treatments, and that there is effective communication (by those respected by diverse groups, and that address issues important to them) will remain important for diverse groups to trust and obtain such treatments. These efforts also decrease everyone’s risk of COVID-19; herd immunity (where a virus cannot spread because it keeps encountering people protected against infection) works best when maximum numbers are vaccinated.

A review of CDC trials and findings about vaccinations in different groups, and recommendations to increase receptivity to vaccines/treatments.

The Kaiser Family Foundation recommendations to address racial equity in COVID-19 vaccine distribution in the U.S.
A review of some of the reasons some groups are cautious about vaccinations, and some strategies to address pertinent issues such as distrust.
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Disclaimer: The views, opinions, and content expressed in this email do not necessarily reflect the views, opinions, or policies of the Center for Mental Health Services (CMHS), the Substance Abuse and Mental Health Services Administration (SAMHSA), or the U.S. Department of Health and Human Services (HHS).