key: cord-0064779-3968txe3
authors: Turley, Patrick K.
title: Vaccine: From vacca, a cow
date: 2021-03-29
journal: nan
DOI: 10.1016/j.xaor.2021.02.005
sha: dfd70b8b096e68b04de1a719f2b8833b705a95dc
doc_id: 64779
cord_uid: 3968txe3

nan

I f you had to pick 1 word that sums up the complexities of 2020, it would be coronavirus disease 2019 (COVID-19; caused by severe acute respiratory syndrome coronavirus 2), the largest health crisis to affect humankind in more than a century. If you were going to choose a similarly important word for 2021, it would have to be vaccine.

The topic of COVID-19 vaccines is currently dominating the news and probably will for some time. Because of the world pandemic and the devastating effects of COVID-19, nothing has been anticipated more than the development and deployment of an effective vaccine for this disease. At the time of this writing, there are currently 2 vaccines, Moderna (Moderna Inc., Cambridge, MA) and Pfizer-BioN-Tech (Pfizer Inc., New York, NY), that have been developed and are now being distributed in the United States. The United States Food and Drug Administration granted Emergency Use Authorization for the vaccine produced by Pfizer-BioNTech on December 11, 2020, and for a second vaccine produced by Moderna on December 18, 2020. 1 Johnson & Johnson has recently applied for federal Emergency Use Authorization for its vaccine (February 2021). Many questions surround the delivery of this vaccine. Will it be effective and for how long? Will it be safe? What will be the side effects? When can I get it? Will I get it? Will I protest against it? Are many of the questions being asked regarding this public health measure?

During the initial phase of the COVID-19 vaccination program, dentists are eligible partially on the basis of the National Academies of Sciences, Engineering, and Medicine framework for a phased approach to the equitable allocation of the vaccine, which prioritizes health care workers with the potential for direct or indirect exposure to patients. Not only are dentists now receiving the vaccine as part of the first wave of health care workers, but they are also now being trained to deliver the vaccine.

The Moderna and Pfizer-BioNTech vaccines have shown 95% efficacy, and early reports suggest Moderna's vaccine also protects against emerging variants of the coronavirus. Moderna is taking the precaution of testing a possible booster dose against the strain discovered in South Africa. Using the mRNA technology employed for the Pfizer and Moderna vaccines, pharmaceutical executives say they could retool existing vaccines to handle 1 or more variants in 6-8 weeks. 2 The Johnson & Johnson vaccine was 72% effective in preventing moderate to severe diseases in its United States clinical trial. Not only are the vaccines effective, but they are also relatively safe. Of the 13.7 million doses administered in the first month of the vaccination process in the United States, fewer than 7000 people reported having side effects. 3 Of those, 640 were considered serious, with 62 reports of anaphylaxis, 56 of which were after receiving the Pfizer vaccine; 113 deaths were reported, including 78 patients who live in long-term care facilities. The Centers for Disease Control and Prevention said the relatively low number of reported cases is good news.

As more dentists receive the COVID-19 vaccine in this first wave of distribution, a little history on this medical miracle and the origin of the word vaccine is in order. The word vaccine comes from the cowpox virus vaccinia which derives from the Latin word vacca for cow. 4 The inoculation with cowpox vaccine was done to prevent humans from contracting smallpox.

Smallpox was a devasting disease. 3 Three out of 10 people who contracted the disease died. The survivors were usually left with scars, which could be severe. The basis for vaccination began in 1796 when an English physician, Edward Jenner, observed that milkmaids previously infected with cowpox showed no symptoms of smallpox after being exposed to the virus by intentional variolation. Jenner published his treatise in 1801, "On the Origin of the Vaccine Inoculation." In the following years, the virus used to make the smallpox vaccine changed from cowpox to vaccinia smallpox virus. 5 I remember being vaccinated for smallpox as a young boy in the 1950s. Inoculation was performed by placing lymph from the vaccinia vesicles of a human on the denuded skin. In a few days, a small papule appeared, followed in a few more days by a vesicle. After about 8 days, the vesicle became pustular and was surrounded by a red inflammatory area. Two weeks after inoculation, a scab formed, after which it fell off, leaving a pitted permanent scar.

In 1959 the World Health Organization initiated a plan to rid the world of smallpox, but it was still widespread outside of North America and Europe in 1966. Smallpox was eventually eliminated in North America (1952) and Europe (1953), followed by South America (1971), Asia (1975) , and Africa (1977). Almost 2 centuries after Jenner published his hope that vaccination could annihilate smallpox, on May 8, 1980, the 33rd World Health Assembly officially declared the world free of this disease. Eradication of smallpox is considered the biggest achievement in international public health. I was recently able to get the first dose of the Moderna COVID-19 vaccine. It was an easy process. When we heard that our local Kaiser Hospital was providing them for health care workers, my wife, who is a pediatric dentist, called on a Friday and put our names on a waiting list. We were called back in 48 hours and were given an appointment for the next day. The shot was painless, and neither of us experienced any postinjection symptoms. We were asked to wait in a nearby recovery room for 15 minutes to make sure there were no allergic reactions, of which there were none. We received the second dose 28 days later with a mild increase in symptoms, including a sore arm and general malaise for the following 36 hours.

Although the rollout for initial vaccinations has been slower than predicted, 96% of people vaccinated are receiving their second dose on time. President Joe Biden's plan is to vaccinate 300 million people by July 2021. Can we hope that COVID-19 will be eradicated similar to smallpox? Probably not because of the fact it is a different type of virus that can mutate, producing new problems in our ability to control it. Epidemiologists and infectious disease experts believe the coronavirus might come to behave like influenza. Dr. Adam Lauring of the University of Michigan, in an interview with the Los Angeles Times newspaper, stated, "we might wind up where every year there's a time when there's a lot of severe acute respiratory syndrome coronavirus 2 around, and some people get sick, some very sick, and some may die, but it won't be where we're at now." 6 Dr. Eric Tonner, a senior scholar at the John's Hopkins Center for Health Security, feels COVID-19 will probably become an ordinary part of life-a common respiratory illness like those caused by other coronaviruses that were circulating before the pandemic. People will get a new coronavirus shot every few years. A new vaccine would probably be required less often than a flu shot but more often than the shot for measles, and maybe that will be our goal, not to eradicate it but to be able to live with it, similar to our ability to live with the common flu. While COVID-19 was the word for 2020, and vaccine is the word for 2021, maybe containment is the best we can hope for in 2022 and beyond. In the meantime, wear a mask, practice social distancing, wash your hands frequently, and get vaccinated as soon as you can.

Patrick K. Turley Manhattan Beach, Calif E-mail address: patrick@turleydds.com

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Will new variants prolong pandemic? In: Los Angeles Times; 2021