What you need to know about the COVID 19 vaccine

Q&A with Touro President Dr. Alan Kadish and Touro Bioethicist Dr. John Loike, conducted by Ms. Elisheva Schlam.

Q. Some in our community have expressed skepticism about the COVID-19 vaccine’s safety, concern about the speed with which it was developed and the testing that was conducted only on healthy people. What can you tell us about the safety of the new vaccines?

Dr. Kadish: The vaccines are remarkably safe. It’s true the testing happened quickly but the extent of the testing and the number of people tested was not at all compromised. These vaccines have been studied in tens of thousands of patients. In fact, one vaccine was studied in a sample of 44,000 and another was studied in 28, 000 and as best as we can tell, the rate of serious adverse effects was less than .5%. This vaccine will be given to millions of people and there might be rare side effects such as pain at the injection site or chills for a day in a few patients but overall, the data shows it’s very safe.

Dr. Loike: As with any vaccine, allergic reactions could be a concern. We have seen a few instances in those who have received the vaccine already. All have recovered but people should speak to their physician and check to see if they are allergic to any of the ingredients in the vaccine before taking it. Most side effects would emerge within 30-60 days and we already passed that mark for those enrolled in the phase III clinical trials. So the news is encouraging.

Q. Can you describe the technologies used to create these vaccines? Have they ever been tested?

Dr. Kadish: The technology used to create the vaccine is not new. It’s been around for 20 years, but it’s the first time vaccines have been released using this technology.

Like other vaccines, this one works by trying to influence the body to create antibodies and other immunity against the virus. The vaccine presents viral proteins that the body recognizes as foreign and responds by making antibodies. In the past, vaccines were created by damaging or killing the virus before injecting it into the patient. In this manner, the vaccine recipient is inoculated by a virus that cannot cause disease.

In this case, genetic material is introduced called RNA. The RNA encodes for a specific viral protein, call the spike protein and immune cells process this protein to generate specific antibodies. These antibodies prevent the virus from infecting the person. The advantages with this technology is that it is easy to design, and we never inject the whole virus into the body.

Dr. Loike: In the history of all vaccinations, very few vaccines can elicit a greater immunological response than actually getting the disease. There is one exception to that and that is HPV, or the human papilloma vaccine. The HPV vaccine gives people greater immunity than they would get from actually being exposed to the virus and it seems that COVID will be the same. Immunologists and biologists believe that this RNA vaccine may also confer a greater immunity than then one would normally get by being exposed to the virus. So there's a lot of hope, but of course, time will tell.

Q.Do different people react differently to vaccines?

Dr. Loike: Based on all of the other vaccines that we've given, I can say there are very, very few differences in terms of genetics, age or gender and how people react to vaccines. The main parameter, of course, is immune response so people who are immunocompromised might have a different challenge than people who are not. More research needs to be done to determine whether these new vaccines can be administered to immune-compromised people.

Q. What about those who already had COVID and have antibodies? Should they be vaccinated?

Dr. Loike: Yes, they should get it. The immune response in human beings is designed to protect you. If you’re exposed to a virus for a second time, your immune system will re-ignite and destroy the pathogen, and it doesn't matter whether you're exposed to a natural virus or a vaccine. Your immune response will be effective, and more so, if you get exposed a second time through the vaccine. Sometimes, we see that a second booster vaccine can enhance your immune response. One of the theories as to why COVID infections in children are not as serious as in adults is because children are all taking other vaccinations- against measles, mumps and rubella, and that boosts the immune system.

There’s also another reason people with antibodies should get the vaccine. And that is, we don't know whether you can transmit the virus to others after you're vaccinated. Once a vaccinated person is exposed to the virus the immune system will protect you. But during those first couple of days when your immune system is being cranked up to protect you, you may be capable of transmitting the virus to somebody else. So, for that reason alone, everybody who can be vaccinated should be.

Dr. Kadish: I agree completely, I would just add that if you've had COVID and you have antibodies, I wouldn't rush to the front of the line, and the primary reason for that, is that we want the people who have no immunity at all to get the vaccine first.

Q. What would you say to people who feel that vaccines inject toxins into the body and they cause people to transgress the Torah prohibition of v’nishmartem l’nafshoseichem? What about those who believe that the only time a vaccine should be taken is if it’s necessary to prevent an illness to the person, and here, this isn't the case because COVID can be prevented and treated with medications and vitamins?

Dr. Kadish: The latter part of this question is based on a completely false premise. There are no treatments that prevent COVID, and there is nothing that treats early COVID. Even the treatments for more severe cases of COVID are only of moderate effectiveness. Some of these treatments may decrease the severity of the disease, but, overall, we don't have anything truly effective.

With regards to “toxins,” the body is exposed to foreign antigens all the time, and the body makes antibodies, and there's nothing different about this general exposure than exposure to the components in the vaccine. There are rare allergic reactions to it, but referring to the substance in vaccines as toxins is completely inaccurate. The bottom line is this--we know how many people COVID has killed. We know what the risks are if you get COVID. Given the data we've seen about the very rare side effects of the vaccine, there's no question that it's safer to get the vaccine than to risk being exposed to COVID.

Q. Should those who are not in the high risk categories take the vaccine if it becomes available to them?

Alan Kadish: I think everybody who can get the vaccine should take it, unless you've had an allergic reaction to vaccines in the past and then you should check with your doctor about taking this one.

Q. Some are content to let others take the vaccine and assume herd immunity will be achieved without necessitating their participation. Is this the right approach?

Dr. Loike: Herd immunity is a calculation based on the “infectivity of a person” or the rate in which one person infects others. In the case of measles, where one person can infect 12 to 18 people, you need a lot of people to be vaccinated to achieve herd immunity, and that is usually around 85 to 95% of the population. The problem with COVID is that we can’t yet make that infectivity calculation. We don’t know whether a recovered person can transmit the disease. In Brazil, for example, there's a study just published that showed 79% of the people in a certain city had contracted anywhere from mild to severe COVID, and they thought they should have achieved herd immunity and they did not. People there are still contracting COVID in that city, and maybe that's because of transmission by asymptomatic patients to non-vaccinated people. So right now, we can’t make any predictions of what percent of the population needs to contract COVID or take the vaccine in order to reach our goal of herd immunity. So the greater percentage of the population gets vaccinated, the more likely we are to achieve herd immunity.

Q. In the case of the pandemic --whose rights should take precedence-- the rights of individuals and families to control what happens to their own bodies or the rights of the government to make decisions for a society?

Dr. Loike: From a religious perspective, one may in certain instances endanger his own life. If you want to be a fireman or a policeman, you are allowed to take certain risks, for parnasa.But what's really unacceptable is to endanger other people, and if you refuse to take a vaccine, you are endangering others and I think that is against halakha.

Q, Should there be a religious or personal exemption to the COVID vaccine?

'If people don't take the vaccine we will all have to continue to suffer because some people have irrational fears of vaccines.
Dr. Kadish: I don't think that there is any moral, ethical or scientific basis for a religious or personal exemption and the vast majority of poskim have already declared that one should take the vaccine as soon as it becomes available.

Dr. Loike: Most of the leading rabbinical scholars in the world will agree that if you can take a vaccine, you should get it and protect your community. Every Jew should be thinking about the impact of their actions on the health of others, not just themselves. We know that some of the “signatories “ who have signed decrees not to take the vaccine have publicly stated that their names were used without their consent – and have advised that everyone should follow their doctors’ guidance.

Q. As we endure the second wave of COVID, Jewish communal life continues. Families are sending children to school, praying within guidelines and people are getting married. How can and should we protect against the virus as we try to create a semblance of normal life?

Dr. Kadish: We have to continue to educate people to the fact that, particularly now that vaccines are on the horizon, it's really irresponsible to expose yourself to the risk of getting the disease, when thousands of people are still dying every day. Life will go on if weddings are only for the immediate family and everybody else is on Zoom. For another few months, we can continue to celebrate life events via Zoom.

But life literally won't go on if the masses get COVID. Beyond the safety concerns, when frum people host and attend large weddings or gatherings against government and health guidelines and against rational common sense, it’s a chillul Hashem. So often these events are covered by the media and it casts terrible aspersions on our community.

Dr. Loike: In February of 2020 there was a medical conference in Boston and 100 conference attendees were diagnosed with mild to severe COVID after the conference. When they did contact tracing, those 100 people infected between 200,000 - and 300,000 people upon returning to their communities. That's how dangerous this virus can be..

Q. What are the public health consequences of large groups of people refusing to take the vaccine?

Dr. Loike: Quarantine. Shut downs . Long-term wearing masks. Not returning to normal life. Endangering other people.

Dr. Kadish: The consequences are terrible for society. It will take a really long time in that case to achieve herd immunity and enable all of us to return to normal. If people don't take the vaccine when it’s available and it’s safe, we will all have to continue to suffer because some people have irrational fears of vaccines. It's going to be harming other people.

Dr. Loike: Look at what happened in 2019 with the measles. There were groups of people who refused to take the measles vaccine and an emergence of measles which we hadn’t seen in years, just popped up with thousands of people in our community contracting measles. History and science speak for themselves.

Q. What is the most important message to our community about the vaccine?

Dr. Loike: Take it. Talk to your physician to make sure you don’t have to be concerned about allergic reaction. Take a legitimate vaccine and go back to normal life and enjoy life. Protect yourself, your family, the community, the world.

Dr. Kadish: For those who think they can go out without a mask once they have antibodies, think again. There are a lot of reasons not to do that. One is that antibodies do not offer 100% protection. Second, it affects other people who see you walking around without a mask, who may not know that you have antibodies and assume they don’t need to wear one either. Third, there is still a small chance that you could transmit the virus so it's a big mistake to become complacent just because you've had it. While the vaccine is here and hope for our future is on the horizon, COVID cases are spiking right now so we need to remember it is not over. We need to all take health and safety precautions that reflect that awareness.

Alan Kadish, M.D. is President of the Touro College and University System, the largest Jewish-sponsored educational institution in the United States. A graduate of the Albert Einstein College of Medicine at Yeshiva University, Dr. Kadish received postdoctoral training at the Brigham and Women’s Hospital, an affiliate of Harvard Medical School, and at the Hospital of the University of Pennsylvania, where he was a fellow in cardiology. He is board certified in internal medicine, cardiovascular disease, and cardiac electrophysiology.

Dr. Kadish taught at the University of Michigan and held a 19-year tenure at Northwestern University. He served Northwestern as the Chester and Deborah Cooley Professor of Medicine, Senior Associate Chief of the Cardiology division, Director of the Cardiovascular Clinical Trials unit, and sat on the finance and investment committees of the Northwestern clinical practice plan.

He has published over 250 peer-reviewed papers, and contributed to several textbooks. Dr. Kadish is a past chair of the Clinical Cardiology Program Committee of the American Heart Association, and has been elected to prestigious scientific research and education societies including the American Association of Professors, the American Society for Clinical Investigation, and the American Society of Physicians.

Dr. John Loike is a faculty expert at Touro College and University System. He was the co-director for graduate studies in the Department of Physiology Cellular Biophysics and director of Special Programs in the Center for Bioethics at Columbia University College of Physicians and Surgeons.

His biomedical research focuses on how human white blood cells combat infections and cancer. Loike lectures internationally on emerging topics in bioethics, organizes international conferences, and has over 150 papers and abstracts published in the areas of immunology, cancer and bioethics.

He has published many groundbreaking articles on bioethics and specifically deals with bioethics from a Jewish perspective. Loike has a Ph.D. from the Albert Einstein College of Medicine of Yeshiva University.