What Goes Into the Decision to Be Vaccinated for COVID?
mRNA Vaccine
Credit: Database center for life services. Used under CC 4.0 International License.
A few weeks ago my fellow Hivean @mobbs wrote about his COVID experience in China. After the country's relaxation of COVID restrictions he decided he wouldn't get vaccinated because he thought the vaccine wouldn't offer him much protection. I reflected on my own decision to receive the original, basic vaccine series (2 shots of Pfizer), but to decline the booster shot. Both @mobbs and I came to our decisions after consideration of our personal risk/benefit ratios.
There is a risk/benefit ratio for every medical decision we make, isn't there? Even taking a simple aspirin carries a risk.
Vaccination is a personal choice that has social implications. Not only is every one of us a potential link in the chain of infection, but every one of us who becomes hospitalized is a burden on the healthcare system. It would be interesting to look at why I decided to get the primary two doses, but not the booster, because I seem to represent a lot of people in the U. S. According to the Morning Consult, the percent of people who received two doses of the 'primary' vaccine series in the U. S. ranged from 91% in several Northeastern states to 63% in Alabama.
Booster rates are dramatically different. They range from a high of 27% in Vermont to a low of 4% in Alabama. I live in New York. Our booster rate is 15%.
Why are booster rates so low?
(I created this table with information derived from KFF.)
In the U.S., resistance to vaccination and boosting is partly cultural, reflecting an ingrained tension between individual rights and government authority. How does COVID vaccine reluctance in the U. S. compare to countries around the world?
Morning Consult, an information/intelligence gathering company based in Washington DC, did a comparative analysis of vaccine reluctance in 14 countries. They base their findings on surveys they conduct through interviews. The results of such a survey may reflect a systematic bias. For example, only literate people were surveyed in India.
Still, since we are not fashioning public health policy but are simply trying to understand vaccine reluctance, there is minimal harm in referring to the survey.
Of the 14 countries sampled, the U.S. had the second greatest unwillingness to be vaccinated: 22%. Only Russia had greater unwillingness: 36%. India and China had the lowest rates of unwillingness: 2%.
(I created this table with values derived from the Morning Consult)
Where do you fall in the two tables posted? Where do I fall?
As for vaccine unwillingness: I fall in the 88% of U. S. residents who were willing to get the vaccine. As for booster unwillingness, I fall in the vast majority of people who have declined the booster. My reason for declining the booster is not a vague suspicion of MRNA technology, although I don't really understand it. My reluctance is based on a very specific assessment of what I hope to get from the booster and the risk of side effects I may experience.
As is always the case with me, I did my research and tried to process as much as I understood. If I come down with a severe case of COVID, I might regret that decision.
Here is some of what I discovered in my reading.
Drug Induced Case of Pemphigus Vulgaris
An April 2022 issue of Pathology Research and Practice reports the case of a woman who experienced a 'rare' side after receiving a SARS-Cov-2 vaccine. She developed symptoms of pemphigus vulgaris. As you can see in the photo above, pemphigus vulgaris is a blistering disease. The immune system attacks two layers of skin called Dsg1 and Dsg3. When this happens the skin essentially falls apart--the layers cannot hold together and blistering results. Pemphigus vulgaris is quite serious and before modern treatments existed, was often fatal. Today there are powerful medicines to treat the condition, but these medicines carry their own risks.
As I have written in the past for the StemSocial community, I was once diagnosed with pemphigus vulgaris. Never did I have a lesion that looked like the one in the picture. But there is no doubt about the diagnosis. My immune system has attacked Dsg1 and Dsg3. My single lesion cleared up with a powerful topical steroid.
As I read further in the Pathology and Research Practice article, I learned that there were in fact 35 identified new cases of pemphigus that were triggered by the COVID Vaccine. Pemphigus is a very rare disease. It can be easily misdiagnosed. Were there other cases? Were there cases and the association with the vaccine was never established? One would have to imagine that might have happened.
Vial of mRNA Vaccine
Credit: Spencerbdavis. Used under CC 4.0 international license
At the end of the article describing the link between pemphigus and the COVID vaccine, the authors acknowledge the link but encourage doctors to recommend the vaccine "in order to assist the public health systems to overcome the COVID-19 pandemic."
That last statement puts all of us on notice that we are responsible for assessing our individual risk because public health policy has a potentially conflicting focus.
Vaccination and Autoimmunity
Pemphigus (described above) is an autoimmune disease. It, however, is not the only autoimmune disease that has been associated with the mRNA vaccine. There are reported cases of systemic lupus triggered by the vaccine. This disease is notoriously difficult to diagnose. It can take six years from the time of onset to diagnosis. The cases reported in the journals were apparently acute onset with frank symptoms. This is not usually how lupus develops so there can be a mountain of 'silent' cases as yet undetected.
There is also a strongly suggestive association between COVID vaccination and Guillain-Barre syndrome (GBS). A 2022 article Immunologic Research states that there is a "...growing body of evidence suggestive of an association between various COVID-19 vaccines and the occurrence of GBS." While the association is strongest between the J&J vaccine, it is still evident in others, especially the Pfizer.
Nerve Damage in Guillain-Barré Syndrome
Credit: Doctor Jana. Used under CC 4.0 International license
In September of 2021, the Journal of Autoimmunity stated that, "Autoimmune phenomena and clinically apparent autoimmune diseases, including autoimmune hepatitis, are increasingly been reported not only after natural infection with the SARS-CoV-2 virus, but also after vaccination against it." In this article the authors describe specifically a case of autoimmune hepatitis.
Why do I go on about autoimmunity and my own reluctance to get a booster? Because, besides pemphigus I have another chronic autoimmune disease, SLE. While this puts me at higher risk for COVID complications, it also puts me at higher risk for mRNA side effects. Obviously, I have to make a choice. I have to weigh risks and benefits.
I did that when I received two doses of the original vaccine. The original vaccines showed 95% efficacy. In my case that would be lower because of SLE and also because I take a daily dose of glucocorticoids. The results of research published in Nature shows reduced immunogenic efficacy of the vaccine in people with my condition who are on glucocorticoids. The authors state: "Usually, people with SLE have a reduced response to vaccination". Also, " A multivariate analysis pointed to Glucocorticoids as the most associated factor with declining nAB levels (75% decrease) in treated SLE".
Paxlovid Anti-Viral Pills
Credit: Intellec7. Used under CC 4.0 International license
To Boost or Not to Boost
There are treatments now for COVID. Rapid, early treatment is helpful in preventing hospitalization. Prompt treatment with Paxlovid is reported by Mass General Brigham Hospital to reduce hospitalization of vaccinated individuals: "the drug is associated with a 44% reduction in hospitalization or death in a highly vaccinated population of adults over the age of 50".
Protection from the booster begins to wane after several months. And I will have limited benefit from that booster. What am I to do? Keep getting boosters? Keep exposing myself to risk? It doesn't make sense, for me.
So far, I have used what I consider the barrier method successfully. I always mask with an N95 or KN95 when I'm among people. I don't go into stores or other closed spaces with lots of people. I'm scrupulous about cleaning surfaces. One day this bug will likely get me. When that happens, I'll keep my fingers crossed and hope there are even better therapeutics.
I'm sure there are doctors who will read this and disagree with me. But I'm the one who will get sick, not them, so the decision and risks are mine. As they always are.
I end with a lovely picture of a beautiful bird accompanied by flowers. These are a lot more upbeat than the blog I just wrote :). Both images were derived from the LMAC Image Gallery. For the bird I thank my friend @yaziris and for the flowers I thank my friend @muelli.
Thank you for reading my blog. As always, Hive on!
End Illustration
LMAC Image Gallery
Research
https://peakd.com/covid/@mobbs/it-finally-arrived-my-covid-experience
https://studyfinds.org/aspirin-dangers-health-risks/
https://morningconsult.com/2022/12/01/covid-19-vaccines-booster-shot-survey-data/
https://www.kff.org/coronavirus-covid-19/dashboard/kff-covid-19-vaccine-monitor-dashboard/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2267241/
https://www.bloomberg.com/profile/company/1801281D:US
https://morningconsult.com/global-vaccine-tracking/
https://courses.lumenlearning.com/suny-hccc-research-methods/chapter/chapter-9-survey-research/
https://www.sciencedirect.com/science/article/pii/S0344033822000772
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7263783/
https://www.medicaljournals.se/acta/content/html/10.2340/00015555-2611
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8856802/
https://www.lupus.org/resources/lupus-facts-and-statistics
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9469827/
https://www.sciencedirect.com/science/article/pii/S0896841121001141
https://www.nature.com/articles/s41598-022-18996-x
https://www.massgeneralbrigham.org/en/about/newsroom/press-releases/paxlovid-effective-in-reducing-covid-19-hospitalization
https://www.regenstrief.org/article/study-confirms-mrna-boosters-extend-covid-19-protection-but-wane-over-time/
https://ourworldindata.org/grapher/covid-vaccine-booster-doses-per-capita?country=BGD~BRA~CHL~IND~ITA~PAK~RUS~SGP~USA~OWID_WRL
https://twitter.com/416626589/status/1612494259315429379
The rewards earned on this comment will go directly to the people( @agmoore ) sharing the post on Twitter as long as they are registered with @poshtoken. Sign up at https://hiveposh.com.
I think most people avoid the vaccine viscerally, you're one of the few who can back it up with research!
Hard to square such a 'docile' percentage with the recent demonstrations!
Well-written and researched as usual.
Hello @alexanderalexis,
I'm not against the vaccine, or even the booster. I just think, now that the pandemic has waned somewhat (or at least it's not killing as many people) each of us has to consider our own circumstance. My husband has been boosted 3 times (I think that's a little overboard) but he understands my reluctance. Even maybe agrees with it.
Your comments are always appreciated. You and I have always shared one trait when we blog: research😃
As for the stats, from China or anywhere else, the numbers actually vary by source. So, I take them with a grain of salt.
I hope you have been well. Thanks for stopping by.
@agmoore Irrelevant to the topic but I just watched this vid by my favorite, and imo most scientific, nutrition channel on youtube and thought it might be of interest to you. Do I remember correctly that you had issues with digesting fiber, due to the autoimmune and perhaps associated ailments? Anw I've often read that slow re-introduction of foods might cure some issues, but this is the first time this was brought home to me so convincingly, especially with that study where they cured children who had life-threatening peanut allergies.
Note that the nutrition scientist who hosts the channel often repeats that diet can be highly individual, and he always puts personal experience above science conducted on groups and necessarily yielding conclusions that are only true on average. You've had a lot of experience in this, I remember you put out a book about it, but I just thought the topics in this vid and the channel might be up your alley.
Hello my friend @alexanderalexis. I will certainly watch that video. Medicinal intervention is the last route, for me. Lifestyle changes are of course preferable. It's fortunate I'm not fussy about what I eat. I'm usually grateful that I have food and I can eat it :))
Thank you very much for thinking of me. I hope you are well and enjoying the kind of life you choose, whatever that is.
i have two vaccines and i only took it because it was really necesary from a law point of view, i needed them to be able to travel to colombia but i dont think i is worth it
Hello @malos,
I have been vaccinated also. It seemed really important to get that basic protection. After that, I don't know. This virus is evolving and I think we all have to think about what we want to do.
I do believe in taking precautions though. Nothing wrong with a mask (for me).
Thanks for stopping by.
It's usually a big decision. On one hand you may have adverse reactions and on the other hand it helps our immunity.
It is a big decision, and I'm all for the basic vaccine series (unless there is a health reason not to take it). For me, taking more than the basic may be an issue.
Thanks for reading and commenting :)
Thanks for your contribution to the STEMsocial community. Feel free to join us on discord to get to know the rest of us!
Please consider delegating to the @stemsocial account (85% of the curation rewards are returned).
Thanks for including @stemsocial as a beneficiary, which gives you stronger support.
Thank you, @stemsocial. Your support is much appreciated.
Greetings @agmoore,
It is been quite a while i got to read your posts, i do hope all is well at your end and that you are having an amazing time?
It was an interesting read as usual and what got me was when you said, "I'm sure there are doctors who will read this and disagree with me. But I'm the one who will get sick, not them, so the decision and risks are mine."
As a doctor i can tell you that patients know themselves better than any doctor and so what we do is to advice base on our scientific knowledge and hope that you abide by our instructions but if it is working for you so far then let's keep our fingers crossed on that.
I look forward to reading more of your content, cheer and have a great time.
Nat.
Hello @nattybongo, Very nice to see you here. As always, you are polite, thoughtful and intelligent in your comment.
Yes, please keep your fingers crossed. We never know if we have made the right decision about anything until we are tested.
I hope you and your family are well. Take care🌸
AG
Yes, we certainly do not know, even the scientist themselves experiment until something seems to go right so, yh, everyone is quite well though, thanks for inquiring.
I have moved to another town to work with a new hospital and I am still getting used to their system but the pressure has subsided a bit as it is my 2 week, I am also planning on pursuing a Ph.D. this year if things go well, again, I would have to keep my fingers crossed and see how things go.
I look forward to reading more of your amazing writeups, thank you once again for sharing and I wish you a great day.
As someone who has not gotten the vaccine for health reasons, I really like your article. I think like you do, that the vaccine, and especially the booster, should be a personal choice, not the government's choice. I actually considered the original Pfizer vaccine early on, but decided against it due to autoimmune-type issues like the ones you describe. For me, it is asthma and chronic sinusitis, and like you, I do my research on vaccine side-effects. I have a lot of respect people who got the original vaccine while deciding against the boosters. They do their own research.
Hello @mythcrusher,
I'm glad you found my blog. I try to be straightforward and clear. Often I start a blog in one place and end in another as research proves my original idea wrong. That's the fun of this. It's great to have an audience and to find agreement. The best part though is, I enjoy doing it.
I hope to read your well-researched pieces. I'll follow you but may miss your blogs because I get distracted. I'll try though.
Thanks for reading my blog. All we can do is make the best decision for ourselves and keep our fingers crossed.
Hope 2023 treats yo well.
I have an aunt who is a lot less understanding of me not getting the COVID vaccine, and thinks everyone should be forced to get it by the government. I think your opinion is the majority opinion actually, that people should be allowed to make their own decision based on the risk/benefit ratio, which varies from person to person.
There is a public health part to it. We all should try to limit the contagion, but at this point the vaccine doesn't seem to do that. We still get sick. We still transmit it. So, I agree with you. It should be a personal decision.
Hope you stay well. It is very nice to have met you on Hive, @mythcrusher.
Dear @agmoore,
Our previous proposal expired end of December and the Hivebuzz project is not funded anymore. May we ask you to review and support our new proposal (https://peakd.com/me/proposals/248)?
Thank you for your help!
I am sorry @hivebuzz. However, I have delegated my votes to @lemouth. I wish you well. I really don't know enough about the working of Hive except that I support the platform. I trust @lemouth to make a wise decision, and he actually understands why he is voting for something.
Note that I support them already, so that I don't understand their initial message. I suspect that when a proxy is used, their script does not necessarily check what the proxy does. @arcange?
The script does the check but @agmoore is not using a proxy.
I guess he's confusing it with something else, because he doesn't have Hive Power delegation to you either. 🤔
Hi @arcange, I am confused. Now you know why it is my intention to use @lemouth as proxy. I thought I had done that. I'll figure it out. Thanks for the info
In fact, setting a proxy has a lifetime. You probably need to reset it (once per year if I am not wrong).
😮
I'll get on it when I figure it out. That vote is wasted with me.
Done!
You're welcome
Excellent article @agmoore. Everything about this pandemic gives a lot to think about, in my case, here in Venezuela they were placing the Russian and the Chinese vaccine (Sinopharm), you could not choose which of the 2 to place, it all depended on what the nurses on duty wanted and the availability of vaccines at the time. The anxiety and fear of going to the health center was enormous because of everything that was said about the vaccines, however, in the end I got 2 doses of the Sinopharm. With the first dose I had a skin reaction with small red spots that appeared all over my body after a few minutes, I also felt very sleepy. The second dose did not cause any effect, but then the government notified me that I had to take more doses to reinforce and I did not do it. After 3 months I got COVID, probably one of the worst things I have ever gone through in my life, but I had no respiratory problems, the doctors told me it was thanks to the vaccine, but who knows haha.
Oh no! I'm not a xenophobe but those vaccines do not have good track records. I am very sorry you got that reaction (good thing it wasn't worse!) and that you were so sick with COVID.
What can we do, but cross our fingers and hope for the best? We read, we are careful and then we take our chances. That's life, isn't it?
Thanks so much for reading my long blog. I really appreciate it.
Be well my friend (and friend to all living things🐝), @abneagro.
I just noticed I didn't upvote your wonderful comment. Sorry my friend, @abneagro
Oh don't worry @agmoore :).
On the other hand, here in my country there were also very bad references regarding these vaccines, so there was a lot of fear to go get them, in the end everyone ended up assuming the risks. However, when the vaccination days began I never heard of very strong side effects, everything was reduced to minor discomfort, as happened to me with my skin reaction and the feeling of wanting to sleep. Now, the one I did hear very bad references about in countries such as Mexico was AstraZeneca, but I do not know how true the news of people dying of heart attacks at the time of vaccination were, since there is also a lot of manipulation by the media.
My ears were burning (6 days late). Interesting read!
Given my China life I guess I should add perspective on this part alongside @alexanderalexis:
Though unlikely to be true, it's fairly reasonable to say they do have a high acceptance. Except for the elderly - it seems barely 60-70% of those over 80 got the vaccine, Even among the 60+ bracket it's only 85%.
It seems the further back in time they go with age, the more reluctant they become, and I wonder if this has certain historical and cultural relation to their memories of a time from the CCP's much darker period.
85% is still pretty high, and likely due to there being a constant push for years and years to get them vaccinated. From an authoritarian perspective, this is much more effective than an ad campaign in a democracy. They go much further than simple pleading, although not as far as forcing.
Again for anybody else who catches this comment - I am no vaccine skeptic whatsoever.
My choice not to get it at all is simply a result of several factors I, like @agmoore, weighed up:
Being in a country that only provides a vaccine which was not only far less effective than western vaccines, even less effective against the later strains. (For a long time, I was checking on the updates of their latest breakthrough vaccines I was happily waiting for, but they never came...)
The uber-strict authoriarianism was indeed effective at keeping general outbreaks limited to a matter of dozens or, at worst, hundreds, in a city of 26 million.
The fact that everybody gets treated the same regardless of vaccine status
The perpetual leaked footage of malpractice during the administration of the vaccine here
Having seen my perfectly healthy young friends - triple boosted - suffering as if they never had any such vaccine to begin with
I figured, ultimately, I could just depend on my immune system =D
Very nice read! I do suspect it is the US's massive freedom and access to information that has overwhelmed and therefore misguided many, perhaps in an arguably preferable way to not having any information at all as we had to deal with here.
Thanks for stopping by. You partly inspired this post, as you might have guessed. There is no anti-vax sentiment in here, as you also note. I love the idea of vaccines (although I hate getting them) and am grateful for the brilliant minds that have saved so many lives with vaccines. However, as you and I say, we must all consider the individual circumstances.
My daughter, as is true of your friends, was double vaccinated and boosted. She still became wretchedly ill. So, we're all going to die of something 😄. We just try to make wise decisions and put that inevitable event off as long as possible.
Hope you are well there and COVID never crosses your threshold again.