Big Books & Bold Ideas with Kerri Miller

So you’re vaccinated — now what?

People sit at table and fill out paperwork.
Veterans fill out forms while waiting in line to receive their COVID-19 vaccination on Feb. 17 at the VA Medical Center in St. Cloud, Minn.
Paul Middlestaedt for MPR News file

Dreams of the Minnesota State Fair are inching closer to reality after Gov. Tim Walz promised that every Minnesotan would have access to COVID-19 vaccines by summer and that the Great Minnesota Get Together is “within reach.”

As of last week, only about 14.5 percent of the state’s residents over the age of 16 have received at least one dose of the vaccine.

Appointments remain limited, but the Minnesota Department of Health is planning to broaden access after 70 percent of people ages 65 and over have had at least one dose. Right now, 45 percent of that age group has had at least one shot, and the state anticipates they’ll reach the 70 percent milestone by the end of March.

In the meantime, many of those who have been lucky in the vaccine lottery are wondering what they can and can’t do after receiving both doses of the vaccine.

Host Kerri Miller spoke with two experts about their advice for assessing risks after getting the vaccine.

  • Lindsey Leininger is a public health educator at “Dear Pandemic” and a professor at the Tuck School of Business at Dartmouth College.

  • Dr. Melanie Swift serves as the co-chair of Mayo Clinic’s COVID-19 Vaccine Allocation and Distribution work group.

The following is a selection of questions covered in the discussion, edited for clarity. Listen to the full conversation with the audio player above.

Efficacy percentages of Johnson & Johnson’s vaccine are lower than Pfizer’s and Moderna’s although Dr. (Anthony) Fauci and other health experts say we should get a vaccine when it’s available no matter which one it is. Will you put some context on this?

Swift: Had we not had the wild success of the Moderna and Pfizer vaccines, we would be doing backflips, with excitement over this Johnson & Johnson data. I mean, it is 85 percent effective against severe COVID.

When we talk about the effectiveness of vaccines for adults, we actually often measured their use by how well they prevent the severity of disease. Take flu shots, for example. When you get flu vaccine as an older person, an adult, it's not that it's necessarily preventing you from ever acquiring the influenza virus. But what it's doing is it's keeping you out of the hospital. It's keeping you from dying. So that's the important thing.

And it looks like from the data, it actually builds your immunity builds over time, because after about seven weeks, there was zero new cases of severe COVID in that vaccinated group.

Leininger: In many ways, these efficacy numbers that make for really splashy headlines aren't truly apples to apples comparisons, they were trialed in different settings in different contexts. But as Dr. Swift said, what matters most is that [Johnson & Johnson], like Moderna, like Pfizer is amazingly protective against being hospitalized and or dying from COVID. And that is what we care about.

We’re getting conflicting information about what we can and cannot do after vaccinations. Give us your advice and and give me some insight on why there's confusion about this.

Swift: The confusion arises from a couple of caveats that we have to bear in mind. One is that none of these vaccines are 100 percent effective. Vaccines are both something we do for ourselves, but also something we collectively do to kind of build a wall of immunity.

So it's not that you are fully protected, and you don't need to worry anymore, you need to think about the landscape that you're in and how many other people are also protected.

It's a little bit like saying, “Well, now that my car is in good shape, and I'm a really good driver, I don't need to wear my seatbelt anymore.” There's other crazy stuff going on out there, you can't control the other drivers, you can't control road conditions. So you still need to be mindful of your safety.

The other thing — and I think this is the part that really confuses folks a lot — is that the studies upon which these emergency use authorizations are granted looked for people having symptomatic disease, so they got sick, and then they got tested. And we know the vaccines are very effective at preventing that outcome. What they did not do and could not feasibly do for these 40,000-plus people in the trials, was routinely go and swab their nose every week just to see who got a silent case of COVID-19.

We're still waiting for more data about that. Logic dictates it probably does prevent asymptomatic disease, at least to some degree. But like we said earlier, what they do best is prevent severe disease more so than acquiring the infection. So until we know that we have a widespread vaccination rate of immunity across our community, it's really not safe to rip off the masks and go out to life as normal.

We’re seeing the light at the end of the tunnel, and the isolation feels so restrictive a year in. How do you look at all these competing interests right now?

Leininger: I think it's really important that we hold space for the loss of the intimacy that we all crave and need as human beings. And I think we've all really suffered a lot of loss on that dimension. The wonderful thing about vaccination is that it will permit these types of things that are so important for our sustenance as humans.

One thing about risk: When we think about getting vaccinated and our loved ones getting vaccinated and this “community immunity” that's going to be necessary for life to go back to “normal.” Risk is not an on or off switch. It's more like a dimmer, it's like a dial. If your risk budget is such that you want to spend all those chips on hugging somebody as safely as you possibly can, I think that, you know, the risk reward benefit might be worth it for you, depending on the context.

When I think about my own risk budget, there's three components of it: There's personal risk, how at risk of a bad outcome I am; There's interpersonal risk, so my loved ones, what's their risk level; And then there's community risk. And we can go back to “normal” when all three of those buckets have been beaten back in terms of risk.

So that’s vaccine for me, my loved ones and enough community immunity that we can feel comfortable. We’re not silent, unintentional carriers of the virus. But you relax any one of those dimensions, then it becomes very personal and you have to be your own best judge.

But while you are being your own best judge, it is very helpful to remember the “golden rule.” Treat others like you would like to be treated. I think if we all think about risk as a dimmer or a budget, but we also keep the golden rule in mind, I think that will help us all a lot.

What should you do when you live in a community where a bunch of people are making different individual risk assessments?

Swift: It requires a lot of communication. These are questions that are very individual and personal. But we have to talk about it with each other and not judge each other, too.

While we do have to forbear through the spring, the reason is that we still have a minority of our population vaccinated and we're seeing these new variants that spread more easily emerge in our population. But I think once we get into the summer and we get 70 percent or more of the population vaccinated, that's when we're really going to feel some momentum in moving back towards normal.

I do think that to Lindsay's point earlier that it is reasonable to make those individual decisions and think of things in communication with your friends about having the ability to do small vaccinated-people-only get-togethers, or kind of expanding that bubble. We all have our bubble of our safe people or household members, etc., that we are around once you have close friends that are also vaccinated, and importantly, are at least two weeks out from that final shot, then that could give you the opportunity for a reasonably safe, larger bubble of social interaction.

You said something like about 70 percent vaccinated? Dr. Fauci was talking about numbers like 80 to 85 percent. I wonder if that’s why he’s saying things like ‘we could still be masking and distancing up to 2022’

Swift: I think that the wild card here is going to be the effectiveness of the vaccines against the variants that we have circulating at that time, which, you know, we don't have the crystal ball to tell us. We know that these vaccines still do have effectiveness against some of the worst variants, like the B.1.351 that's in South Africa. But it's not as effective as it is against our predominant strain in the U.S. or even the U.K. or the Brazil variants.

So the lower the vaccine effectiveness, the more people have to take it in order to get that same level of herd immunity. If you have a highly highly effective vaccine, then you get herd immunity and around 70 percent. We have to sort of wait and see what these variants do.

If you’re kind of creating a bubble, how does that bubble work?

Swift: So the rules of the bubble are that everyone in the bubble has to observe all of the public health guidelines outside the bubble, or you pierced the bubble.

Leininger: Just to amplify what Dr. Swift has been saying, one, you must follow all public health guidelines. That's a non negotiable. And the CDC will continue coming out with more guidance.

I want to harken back to something that Dr. Swift said earlier, it's communication is key, communicate, communicate, communicate, communicate. Look, it's a little awkward, right to be interrogating your bubble. But we have to do it. Again, it's like keeping an open mind and an open heart but the bubble becomes a spiderweb so much more quickly than anyone realizes. Just staying in open communication is really the key here.

How would you answer those questions about — ‘do I really need that second dose?’

Leininger: One piece of coaching that we've been trying to apply this entire pandemic, it really is around our mantra that science is a method, not a fixed set of facts. So because science is a method and not a fixed set of facts, we will expect some questioning of guidelines and perhaps even some changing of guidelines.

I've been listening to Dr. [Michael] Osterholm. And one thing he has been really encouraging is let's look at all the data that we have available. Let's look at it, put the scientific method to it as it accrues, and then perhaps call this audible. So I think that the fact that Dr. Osterholm has a point of view and other experts have a different point of view, it’s not an unhealthy thing.

I want to be clear here as an educator and communicator, you need your second dose. The debate around this is whether or not it can be delayed or not delayed, but nobody's advocating for just taking one shot of Pfizer or Moderna and then being done.

We’re getting a number of calls from younger women or their parents who are concerned that the vaccines may in some way affect fertility.

Leininger: We get a lot of those questions that “Dear Pandemic,” and I'll be crystal clear, there's no data to suggest that there's any threat to people's fertility from these vaccines. So there is just no data to support this period. Full stop.

From Twitter: My wife is fully vaccinated. She’s going to fly to Palm Springs and stay with two vaccinated friends. What precautions should we take when she comes home?

Swift: The first precaution is to make sure that on routes, she's ultra careful with all of those precautions that with hand sanitizing mask use and social distancing as much as possible while on the plane.

A lot of that's beyond our control when we fly commercially, though. I mean, you don't get to necessarily stay 6 feet apart from everybody else on the plane. And you can't control the other folks on the plane taking their masks off to eat or drink.

So I think that the greatest risk is really from the conveyance in that travel and not actually spending time with the two vaccinated friends. Harkening back to our earlier conversation, that when we get into these multiple degrees of separation, you know, in your bubble, what her friends who are vaccinated might be doing that incur risk is also an unknown. Again, we’re going back to that theme of communication, it’s really important to talk about and understand the risks and behaviors of not only your wife, but her friends as well.

I think maintaining some separation in the home for maybe 10 days to two weeks after that trip would be the most risk averse approach to take and [also] potentially getting tested about a week after her return [would be recommended].

Caller question: I’m 70, and my granddaughter is 8, and she’s in school full-time. She’s been waiting for this virus to be over to stay overnight. She told me two weeks after I would get my second Moderna vaccine that she wants to come over, she’s marked it on her calendar, but will it be safe?

Swift: So that's not a zero risk to you, even though you'll have your second dose of Moderna . Again, it's not an an on/off light switch risk — It’s kind of a dimmer switch. And it doesn't have to be all or nothing. So if you're vaccinated, it doesn't mean that you couldn't see your granddaughter at all. But it doesn't have to be an overnight situation — because that would be the highest risk kind of exposure with two people for hours breathing the same air unmasked.

But seeing your granddaughter wearing a mask, giving her a quick hug. And then within 15 minutes getting more than 6 feet apart, could be reasonable. So it's going to be a long time before our children are able to get vaccinated. But we're not seeing huge concerns about them being tremendously important vectors.

Leininger: I will note that, you know, Dr. Fauci anticipates high schoolers being able to get vaccinated around the start of the school year, this fall. And younger elementary school aged kids like [her] granddaughter, likely early 2022.

Listen to the full conversation with the audio player above, or subscribe to the MPR News with Kerri Miller podcast on: Apple PodcastsGoogle PodcastsSpotify or RSS.

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