5 Questions: Roshni Mathew on advantages of COVID-19 vaccination

Roshni Mathew, a pediatric infectious disease specialist, discussed the race to inoculate as many people as possible against COVID-19 to prevent the emergence of variants that could increase disease rates.

- By Tracie White

         Roshni Mathew

With one-third of the country now inoculated against COVID-19, infection rates are dropping, and the vaccine has been shown to be safe and effective, according to the Centers for Disease Control and Prevention

With plenty of vaccine doses available, public health officials have turned their attention to the recent slowdown in demand. It’s now a race between widespread vaccination of the population and new variants of the virus that could once again send infection rates soaring, according to Roshni Mathew, MD, clinical associate professor of pediatric infectious diseases at Stanford Medicine and associate medical director of infection prevention and control at Lucile Packard Children’s Hospital Stanford.

Recently, science writer Tracie White spoke with Mathew about some of myths about the vaccines and the importance of getting vaccinated as soon as possible.

1. What are your concerns about people taking a wait-and-see approach before getting vaccinated for COVID-19? 

Mathew: My goal is to tell people we have enough information at this time to show that vaccines work, that they are safe and that it’s necessary to get vaccinated now. Most pressing is the concern that this virus, like all viruses, is constantly undergoing mutations. Many of these mutations are harmless. Others may be more resistant to the vaccines or more deadly to those who get infected. The faster you can get the population immune to this disease through vaccinations, the less of a problem variants are going to be. We are in a race against these variants. We need to be ahead of that.

As we look to what is happening on the world scene right now, these concerns only get multiplied. India, where they are experiencing a devastating second wave, is a very good example of a place where most of the population was unvaccinated. The contribution of the new variant there — whether it’s affecting transmission, severity of disease or vaccine responsiveness — is not yet clear. 

One thing about the pandemic that has humbled us over and over again is how we are not good about predictions. All I can say with certainty is that the vaccinations have been very helpful. Vaccines are saving lives.

2. What evidence is there that these vaccines are safe? Was the science rushed to get them to market quickly?

Mathew: The three vaccines available for use in the U.S. — those from Pfizer-BioNTech, Moderna and Johnson & Johnson — have all been given emergency use authorization by the Food and Drug Administration. There is an abundance of scientific evidence to show that these three vaccines are safe. It’s true they were developed at a pace that was unprecedented. Usually, it takes more than a decade to go from preclinical testing to full approval before they can be injected into arms. And while the pace has been impressive, no steps in the approval process were skipped. There were many, many vaccine candidates, and only these three have been approved for use in the United States so far. The front-line candidates went through extensive clinical trials. Once those were complete, the results were sent to the FDA for rigorous review. Next, they went to the Centers for Disease Control and Prevention’s Advisory Committee for Immunization Practices for further review before it was rolled out to the civilian population of the United States. 

Since the rollout of the vaccines began back in December, the CDC and the FDA have had several mechanisms in place to further follow and study the vaccines. The three approved for use in the U.S. have now been delivered to millions of people through mass vaccinations, and results have once again shown them to be extremely safe.

3. For those people not at high risk of dying from COVID-19, particularly those who are young and don’t have any underlying medical conditions, why is it so important to get vaccinated?

Mathew: Beyond the concern of spreading the disease to others and suffering through the unpleasant symptoms of COVID-19, which include severe flu-like symptoms, there is the possibility of lingering effects from contracting this disease. They can be quite serious. We know COVID-19 can have complications, such as the multisystem inflammatory syndrome in children. Most children recover, but there are children who have had serious consequences. There are also people who do not recover quickly and can have a long duration of symptoms — fatigue, loss of smell or taste, dizziness, heart palpitations, chest pain — that we are still trying to understand. We don’t know who might end up having these long-term symptoms — another reason to protect yourself from getting infected in the first place.   

4. Can the vaccine give you COVID-19? 

Mathew: All three of the vaccines use unique technologies to stimulate an immune response in your body to fight off the virus, but none of them involve actually injecting a live virus into your arm, so they cannot make you sick with COVID-19.

That said, it does take up to two weeks after receiving the second shot of the Pfizer or Moderna vaccine — and two weeks after the single dose of the Johnson & Johnson vaccine — before they are fully effective. You could still catch the virus during that two-week period. Also, none of the vaccines are 100% effective, so you could get infected after being vaccinated, and it might appear as if it was the vaccine that made you sick. But only the SARS-CoV-2 virus can give you COVID-19.

I’ve heard worries that the vaccines can change your DNA. None of the vaccines can do this. They don’t change or interact with your DNA in any way.

5. Is it safe for pregnant women, people with chronic illnesses and those with allergies to get vaccinated?

Mathew: The vaccines are approved for use during pregnancy. The decision to get vaccinated while pregnant is an individual one made with consideration of your health status and risk of exposure to the virus. COVID-19 infection during pregnancy can be quite severe. Ultimately, talk to your doctor before making a decision. Overall, though, there are no reasons for pregnant women to not receive vaccines.

People with conditions such as diabetes, obesity or heart disease are at higher risk of dying from COVID. It’s very important that people with chronic illness get vaccinated to protect them from the virus.

As for immunocompromised patients, it’s not so much a safety issue as an efficacy issue. There are no specific safety concerns, but the vaccines may not work as well — we don’t really know.

About Stanford Medicine

Stanford Medicine is an integrated academic health system comprising the Stanford School of Medicine and adult and pediatric health care delivery systems. Together, they harness the full potential of biomedicine through collaborative research, education and clinical care for patients. For more information, please visit med.stanford.edu.

2024 ISSUE 1

Psychiatry’s new frontiers