How the Microbiome Could Play a Role in Covid-19

After a year of darkness, vaccines really are the light at the end of the Covid-19 tunnel. Yes, vaccination programs take time, and yes, they don’t fix anything immediately. There’s also a huge issue with wealthy countries hoarding vaccine doses and something of an ethical nightmare about how we effectively distribute these life-saving interventions across the globe.
All that being said, the Covid-19 vaccines are nothing short of a scientific masterpiece. We should all be immensely grateful to be potentially getting one in 2021, rather than years from now.
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The Covid-19 vaccine development is quite literally the fastest such effort in human history. Impressive stuff. Photo: SELF Magazine
But despite the generally fabulous nature of the situation when it comes to vaccines, many of us are now faced with something of a difficult question: Which vaccine should I get?
Now, granted, this isn’t a problem for much of the globe. In many countries, the answer will simply be “whichever vaccine is available” because the luxury of multiple vaccines is not something that everyone can afford.
Forget society for a moment, because here I’m talking about you and me, the people actually getting the vaccine. What matters to us?
That being said, it’s an interesting question to answer. Everyone has started discussing efficacy, with the headline numbers from vaccine trials thrown around every time the discussion begins. Do you want the AstraZeneca vaccine, with only 62% efficacy, or would you rather get the much better-sounding Moderna immunization that works 94% of the time? It seems like an easy choice, and I think ultimately that it really is.
The answer, at least in my opinion and for myself, is that I would get whichever vaccine I am first offered.
Let me explain.
Safety
The first point to note is safety. I’ve written before about how impressive the vaccine development process is, but I think it’s worth noting again that, thus far, the safety data from all approved vaccines is very good. Not only were there few major safety concerns from the scientific research, there is now a wealth of data showing that millions of vaccines have been given with relatively little ill effect. Singaporean data suggests that about three in 100,000 people who receive a vaccine dose (in this case Pfizer-BioNTech) have a severe anaphylactic reaction, which is extremely unpleasant but so far not fatal.
While it’s too early to be entirely certain about the very rare vaccine side effects, it is very likely that, at least for the three main vaccines for which there is ample safety data — Moderna, Pfizer-BioNTech, and AstraZeneca — the safety is excellent.
So safety (at least for licensed vaccines already approved) is not a major concern. What about efficacy?
Outcomes
When we talk about efficacy, we often mean many different things. There’s the public health view, which takes a population approach and views everything somewhat impersonally. From this perspective, whether one individual gets sick is less important than whether we can reduce infections in society as a whole, and in this context, minor differences between vaccine efficacy are vitally important.
But that’s not what this blog is about. Forget society for a moment, because here I’m talking about you and me, the people actually getting the vaccine. What matters to us?
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Aside from our cats, obviously. This is Luna
Well, generally speaking we’d rather not get the disease. But really, that’s something of a proxy measure. The thing we really don’t want is, firstly, to get really, really sick, and secondly, we don’t want our friends and relatives to get that sick either. To me, as an individual, the most important point is not whether public health is ultimately improved, but that my family and I are protected from serious disease and death.
And the thing is, all of the vaccines appear to hold this promise. While the data is fairly slim, every vaccine in the bunch looks similar in terms of efficacy when we consider preventing severe disease and death.
To me, and I suspect many others, that is really the crux of the matter. If the vaccine largely eliminates the possibility that I and my family will be at risk of hospitalization and death, then the question of whether it completely prevents an infection is far less important. As an epidemiologist, the question of whether each vaccine is enough to mount a neutralizing response against infection is key; as a relatively healthy person on the street, I’m mostly concerned with being in an intensive care unit struggling for breath.
This calculus is clearly not going to be the same for everyone. For elderly people, those at great risk, and people like grocery store workers and nurses who have enormous exposure to the virus, there is a heavier weight on not getting the disease at all. And from a public health standpoint, it makes sense to ensure that the most effective vaccine goes to people who are A) most at risk and B) most likely to spread the disease.
But for most people? The choice, at least in my mind, is relatively simple. Take the vaccine you are offered. If it’s been approved, it’s pretty safe, and is almost certain to make you far safer against the things you really care about than you would be otherwise.

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