PHOTO COURTESY ADVENTHEALTH ONE MORE DOSE — An AdventHealth worker prepares a dose of COVID-19 vaccine during a shot clinic in Daytona Beach in 2020.
ONE MORE DOSE — An AdventHealth worker prepares a dose of COVID-19 vaccine during a shot clinic in Daytona Beach in 2020.

Epidemiologists and DeLand residents Dr. Allen Johnson and Dr. Asal Johnson answer questions for us this week, as COVID-19 cases surge locally, and Volusia County’s vaccination rate hovers at just more than 50 percent. 

Allen Johnson is an assistant professor of public health and director of the Master of Public Health program at Rollins College. 

His wife, Asal Johnson, is an assistant professor of public health at Stetson University, where she has taught epidemiology and global health for the past six years. 

Q. What do you see happening in our community today with regard to the COVID-19 pandemic? Can you sum it up for us? 

A. COVID-19 cases are increasing exponentially in Florida and also in Volusia County. In fact, the situation in Volusia County seems worse than in Florida overall, as the recent positivity rate was reported to be 20 percent for Volusia County, compared to 15 percent in Florida.

Unfortunately, there has also been a sharp increase in death and hospitalization because of COVID-19 in Volusia County. The vast majority of new cases, hospitalizations and deaths are among unvaccinated individuals.

Q. If the COVID-19 vaccine is safer than other vaccines because it doesn’t use live virus, why do people who get the vaccines still experience COVID-19 symptoms? 

A. Unlike vaccines that use live viruses, the COVID-19 vaccine is what’s called an mRNA vaccine.

Although it is extremely rare, vaccines that use live viruses in some instances may cause the disease itself. It is not possible for the COVID-19 vaccine, however, to cause the disease, because it does not use live virus.

It is important to understand how vaccines work. Medications release chemicals into your body that cause some biological response for some duration of time. This is why we have to take cholesterol medicine, for instance, every day.

Vaccines, however, work differently. They contain some component that is structurally similar to the virus itself. This is typically a protein. The body’s immune system then recognizes this protein and thinks it is a virus. This triggers an immune response.

In general, when we feel sick, it is actually the body’s immune response to some virus or bacteria or allergen that makes us feel bad. This may be a fever, sore throat, a cough, etc.

With vaccines, although the protein is not able to cause the disease, it does trigger an immune response. For some people, but not all, this may come with symptoms, such as a fever or a headache, for example.

This is not the disease; rather, it is the vaccine doing precisely what it is supposed to do. After a short period of time, the immune system eventually clears the body of the vaccine’s components and creates memory cells that will immediately recognize the real virus if you were to become infected in the future.

When a vaccinated person comes into contact with the virus that causes COVID-19, it clears the body of the virus so quickly that it does not have time to spread throughout your body and give you the disease.

A lot of vaccine hesitancy stems from a misunderstanding of how vaccines work. Unlike medications, no known vaccine has ever had long-term side effects. This is because how they work in the body is fundamentally different from medications.

Ironically, the only long-term effect of vaccines is immunity.

Q: Could you explain how a mRNA vaccine works? 

A. When we say that mRNA vaccines are new, we mean new relative to older vaccines. The technology has been researched for decades and, in this context, new does not mean that we started working on them a year-and-a-half ago when the pandemic started.

Unlike some other types of vaccines, mRNA vaccines do not use live, killed, or parts of actual viruses. Instead, they use a strain of messenger ribonucleic acid (mRNA). This mRNA is injected into the muscle, similar to other vaccines, and is taken up by muscle cells.

Once the mRNA is inside the cell, the cell uses it to make a spike protein that attaches to the outside of the muscle cell that is similar to those found on the outside of the virus that causes COVID-19.

This mRNA does not enter the nucleus of the cell, where DNA is located, and does not incorporate into the cell’s DNA. Rather, it floats around in the cell’s cytoplasm (the space outside the nucleus) and is directly used by the cell to make the spike proteins.

Once a protein is made, the cell breaks down and discards the mRNA. The immune system then recognizes the protein spike on the outside of the cell, removes it and makes memory cells that will recognize similar spikes in the future. These memory cells are what give you immunity when you get exposed to the real virus that has similar spikes on the outside of it.

There seems to be some confusion about the use of nanotechnology in this process. The nanotechnology, in this case, is the use of RNA, which is extremely small and is measured in nanometers.

Sometimes when people hear the word nanotechnology, they think of very tiny robots or machines. For COVID-19 vaccines, this is not the case. The nanotechnology scientists refer to is the use of the mRNA itself, which is a natural biological molecule found in the body.

mRNA vaccines do not contain any mechanized nanocomponents, nor do they affect, alter, or even come into contact with DNA in any way.

Q. Development of the COVID-19 vaccines was rushed. What in your personal experience as a public health expert enables you to trust the vaccine, anyway? 

A. There seems to be a good bit of confusion around the vaccines’ development. It is important to understand that their development was not rushed; rather, several factors contributed to the speed of their development.

During the early days of the pandemic, clinical trials were able to recruit volunteers quickly because of widespread interest in the pandemic. Keep in mind, this was during the early stages of the quarantine, and many people wanted to do their part by volunteering to be in vaccine trials.

This was not the case only here in the U.S., but in many countries across the world. Typically, this recruitment stage takes a lot longer.

Another reason is that the Food and Drug Administration prioritized the vaccines for review. This dramatically shortened the development time.

There are several stages to vaccine and drug development. At the end of each stage, the FDA reviews the study results for that particular stage of the study before it can move forward to the next stage. If the FDA determines the vaccine or drug is safe and effective, only then can it move to the next stage.

Typically, this process can take time, and a vaccine or drug must get on a list with other medications waiting for review. This can take a lot of time — in some cases, even years.

What the FDA did in this case was move the vaccines to the front of the line for review, and essentially reviewed them immediately after each stage was completed. This greatly reduced the time of development.

It is important to note that the vaccine development did not skip any steps or stages in its research and development; rather, the FDA cut out some of the bureaucratic processes that slow drug and vaccine development by moving the vaccines to the front of the line for review at every stage.

The FDA’s emergency-use authorization is in place precisely for situations like this to allow them to approve effective vaccines or medications quicker by prioritizing them over other medications that are already in line for review.

It is important to note that the emergency-use authorization does not mean that any scientific or safety steps were skipped; rather, that the vaccines were given procedural priority over other drugs that otherwise would have been reviewed first.

DELAND FAMILY — Drs. Asal and Allen Johnson walk in Downtown DeLand in 2020 with their daughter, Arianna, who is now 4. The Johnsons also have a son, James, who is 13. The Johnsons point out that, because children under 12 aren’t eligible to receive the vaccine, those who choose to be vaccinated are helping protect the children in their community.

Q. So, we keep hearing about “breakthrough” cases, where vaccinated people get COVID-19. What do people need to know about that? 

A. No vaccine is 100-percent effective. With any vaccine, it is still possible for vaccinated people to get the disease when they are exposed to the virus.

For example, according to the CDC website, three out of 100 people who receive two doses of measles vaccine may still get measles if they are exposed to the disease. But because many children are getting measles vaccines, these three out of 100 individuals are not very likely to be exposed to the virus, and so we do not hear much about them.

This is also the case with the COVID-19 vaccines. However, because a large proportion of people have not received the vaccine, the small number of people who have received the vaccine but did not acquire immunity are now more likely to come into contact with someone who has COVID-19.

Additionally, because the vaccines are so heavily reported on in the media, we are more likely to hear about COVID-19 “breakthrough cases” as opposed to “breakthrough cases” of measles or mumps, for instance. Unfortunately, it gives the perception the vaccine is not working.

Meanwhile, we need to know about the difference between vaccine efficacy and vaccine effectiveness. Vaccine efficacy refers to the vaccine performance in clinical trials. Vaccine effectiveness is the performance of the vaccine in real-world populations.

If a clinical trial shows that a vaccine has 95-percent efficacy, that does not necessarily mean that it works 95 percent of the time in the general population. It is not uncommon for vaccine effectiveness to be lower in real-world scenarios.

It seems now that the effectiveness of the Moderna and Pfizer vaccines is around 90 percent. The more people who get vaccinated, the fewer breakthrough cases we will have, as these people will have protections by being around more vaccinated people.

Also, we need to remember some individuals with immunocompromised conditions, and children younger than 12, are not able to receive the vaccine.

Higher rates of vaccination in the community means more protections for these groups, particularly younger children.

If people realized that getting the vaccine protects younger children who can’t get it, they would be less reluctant to do so.

Q. Who in public health is studying the long-term effects of vaccination? 

A. A national surveillance system monitors adverse events following immunizations, using the Vaccine Adverse Event Reporting System (VAERS).

VAERS aims, not to monitor for known side effects, such as soreness in the arm, for example, but rather to identify unusual patterns and problems over time. This system is an excellent safeguard for providing data-driven reassurance of vaccine safety in the United States.

People who are concerned about the long-term effects of vaccines should also consider the long-term effects of infection with the virus. Many millions of people have received the vaccine safely.

However, the alternative of getting the disease itself is not safe at all. One in every four cases of COVID-19 develop long-term effects, including chronic headaches, reduced cognitive ability and fatigue.

We are still studying the effects of this virus on our neurological systems and brains, even when we get mild cases.

It is always better not to be infected with a disease, and I hope parents will not take this infection lightly for their children. Their children may not get severely ill, but they may develop other problems related to this infection later in their lives.

Q. Some people, who’ve gone a year-and-a-half without contracting COVID-19, despite exposures and other risks, may assume they are somehow naturally immune. What would you say to them? Is anyone in public health studying that possibility? 

A. Some people may be exposed to the virus but not contract the disease. They should never assume, however, this means immunity or that this will necessarily be the case for the next exposure. 

It’s like when a cold goes around in the winter. Some people do not get it. It’s not because they are naturally immune, they just got lucky. 

With a cold, the stakes aren’t as high. If we get it, we may feel bad for a week or so, and that’s it. 

With COVID-19, however, you may become seriously ill, and in some cases even die. It’s not worth testing your luck. 

Q. Should a person be tested for COVID-19 antibodies before being vaccinated? 

A. We do not really know how long the antibodies are present in the body. There has been a wide range of times reported. Because of that, CDC recommends everyone to receive the vaccine. 

Q. Is it really safe for grocery-store and discount-retail employees to administer vaccines? Shouldn’t this be done by trained medical personnel? 

A. People who administer the vaccine should be trained and licensed to do it. It is our understanding that those who administer the vaccine in Publix, Walgreens and other locations such as that, are trained and licensed to do so. 

Q. Can’t the community as a whole become safe after a certain percentage of people who are ready and willing are fully vaccinated? What’s that percentage, approximately? 

A. Yes, although we don’t yet know the exact percentage. Part of the reason why calculating the percentage is difficult is that we are dealing with several variants that are circulating in the same community simultaneously. 

These variants have different levels of infectiousness. That is why the public health efforts have been centered around vaccinating as many folks as possible. 

The more opportunity a virus has to spread, the more likely the virus will change to something more contagious or even more deadly. 

The reason we now have several variants is because this virus has spread around the globe for about a year-and-a-half now. 

More vaccinated people would limit the ability of the virus to spread and further mutate to something potentially even worse.

Florida Department of Health weekly COVID-10 case data for May 14-July 16, 2021.

Q. If vaccinated individuals should still wear masks and practice social distancing, and can still contract and spread COVID-19, why should anyone bother getting vaccinated?

A. As mentioned earlier, not everyone who gets vaccinated is immune. Vaccinated people, however, have a significantly lower rate of contracting the disease. They are 90-percent less likely to contract the disease, compared to unvaccinated people. Thus, the vast majority of vaccinated people are protected against getting and spreading a virus that attacks people’s vessels and lungs and can cause neurological issues.

If enough people get vaccinated, the virus will not be able to spread readily throughout the community, and people who cannot get vaccinated, such as younger children, will no longer be at risk.

Per CDC guidelines, it is an individual choice whether vaccinated people continue to wear masks or practice social distancing. However, we should all still respect and follow regulations of local governments, institutions or local businesses if they are asking us to mask up while we are on their premises.

Q. After a significant number of people became vaccinated, it seems almost everyone abandoned the safeguards: wearing masks, keeping socially distant, avoiding crowds, etc. How do you explain that?

A. There was a period of time that we had public health mitigation measures (such as social distancing and masks) in place while people were still getting vaccinated. We immediately saw the impacts of vaccination.

After the numbers of new cases, hospitalization and deaths kept dropping for a few weeks, people, including many who were unvaccinated, thought the pandemic was essentially over.

Most people abandoned all safety measures, and now we see the results.

The virus is finding opportunities to spread among unvaccinated individuals to the extent that we are now seeing situations worse than last summer among communities with low vaccination rates.

Q. We seem to have so many “new” health problems in society today, including autism and multiple kinds of cancers. What’s the chance that these problems stem from messing around with our natural immune systems; i.e., by troubling those systems with multiple types of vaccines?

A. Scientific studies after scientific studies are showing that vaccines are not linked to autism or any kind of cancers.

However, scientific and technological advancements have allowed us to better identify health problems at earlier stages. This can lead to the perception that there is more of a certain disease, for instance, autism.

Modern vaccines have been around for around 70 years and are one of the most studied things we put in our body. They have enhanced our ability to live much longer and avoid childhood deaths or horrific diseases such as polio and smallpox.

So far, more than 610,000 lives have been lost to COVID-19 in the U.S. Floridians have lost close to 39,000 loved ones.

This disease is now considered a vaccine-preventable disease, and we can save ourselves and others by getting vaccinated.

Q. Are giant pharmaceutical corporations making obscene amounts of money off the effort to push vaccines? How can we reassure people that greed isn’t causing companies to cut corners?

A. Giant pharmaceutical companies are making obscene amounts of money off the vaccine, as they do off their other medications and vaccines that go to market.

The public health community has long been critical of this, and this issue certainly warrants a larger discussion.

To ensure pharmaceutical companies do not cut corners, we have the FDA, which very meticulously and rigorously monitors and reviews clinical trials in the U.S.

As we mentioned earlier, the approval process was sped up during this pandemic by moving these vaccines to the front of every line. However, the scientific process and safety protocols used in the case of COVID-19 vaccines were the same as they have always been.

Although you may disagree with the big-pharma profit model, ultimately, we are very much dependent on the industry’s lifesaving vaccines and medications for diabetes, heart disease, hypertension and other diseases.

Because we do not see much infectious disease in the U.S. today, it’s important not to forget this is precisely because of vaccines that prevent hepatitis B, measles, pertussis, rubella, polio and many others.


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