Your Questions, Answered: Examining Mistrust and Vaccines

Expert panelists respond to audience questions from the first Evenings of Nonconventional Wisdom online event

On Feb. 22, the University of California San Diego brought together a panel of industry experts and esteemed faculty for a unique and thought-provoking event, “The Fear Factor: Examining Mistrust and Vaccines.” Over 1,200 campus and community members registered to participate in the interactive webinar, kicking off the university’s “Evenings of Nonconventional Wisdom” online event series hosted in celebration of UC San Diego’s 60th anniversary.

Throughout the evening, audience members had the opportunity to hear from panelists as they shared their insights on COVID-19 as well as vaccinations and the levels of mistrust around them. The discussion focused on clarifying the negative public perceptions of vaccines, their historical drivers and how we can address past injustices and build confidence in vaccines as society continues to move forward to combat the COVID-19 pandemic.

Event panelists included Keolu Fox, assistant professor in the Department of Anthropology; Danielle Raudenbush, assistant professor in the Department of Sociology; and medical experts, including Dr. Victor Nizet, professor at the UC San Diego School of Medicine and Skaggs School of Pharmacy and Pharmaceutical Sciences; and Dr. David "Davey" Smith, head of the Division of Infectious Diseases and Global Public Health. To learn more about the panelists’ professional backgrounds, please visit the Evenings of Nonconventional Wisdom news story here.

Now, a little over a year after the World Health Organization officially declared COVID-19 a pandemic, the virus, the vaccine and its related effects remain among the most pressing topics in our communities and the media. As cities across the country gradually invite their populations to be vaccinated, many questions and common myths continue to persist surrounding the important health care technology that is critical to addressing a virus that has infected over 28 million Americans to date.

In an effort to continue the timely dialogue around COVID-19 and vaccines, we reached out to a few of the Feb. 22 event panelists plus a leader from UC San Diego’s Return to Learn Program Dr. Robert “Chip” Schooley to answer questions submitted by the audience. Here are their responses:

Understanding COVID-19 vaccines and how they work

Q. Why is it recommended to continue to mask and distance after vaccination? Is it possible to still be contagious?

Dr. Robert “Chip” Schooley

Schooley: We have learned through studies that some people who were infected before they were vaccinated continue to have viral shedding for the first couple of weeks after they are vaccinated. Then as their immunity rises from the vaccination, lower levels of virus are shed. There is good emerging evidence that vaccines decrease the rate of transmission; people aren’t prevented from shedding the virus, they just shed less. Although we recommend that all people continue to wear masks in public, those who have been vaccinated can mingle with others who have been vaccinated in small groups without masks, according to new guidance from the CDC. It is important to realize that full vaccine protection does not develop until two weeks have passed after the final vaccine dose and immunity should not be assumed until that time.

The other reason we recommend that everyone mask is that when you go into a grocery store, you want to see everyone masked. You can’t tell whether they have been vaccinated or not. By keeping everyone masked right now, it protects vulnerable people who have not been vaccinated and reinforces safe behaviors.

Q. How effective are mRNA vaccines at completely preventing disease? Moreover, does the amount of mRNA in a vaccine increase its effectiveness?

Dr. David "Davey" Smith

Smith: mRNA vaccines are around 95% effective at preventing severe disease and around 75% for mild to moderate disease. The dose is standard and increased doses were not evaluated on a large scale.

Q. Given recent delays in COVID-19 vaccine deliveries, can you talk a little about second doses, efficacy and impact of a delayed second shot?

Smith: It is very clear that a delay in the second shot does not decrease immune responses, and in fact, a delay may actually ultimately increase those immune responses.

COVID-19 vaccine reactions and side effects

Q. How does the COVID-19 vaccine affect women who are trying to get pregnant, are pregnant or are breastfeeding?

Nizet: Based on all the available data both in animals and in humans, there is no evidence that COVID-19 vaccination impacts female (or male) fertility. For women who anticipate becoming pregnant in the very near future, the risk of actual COVID-19 infection during pregnancy is the major concern, since COVID-19 infection is significantly more dangerous for pregnant women compared to women the same age who are not pregnant, including the risk of preterm birth. These are risks that receiving the COVID-19 vaccine could prevent.

The Centers for Disease Control states that any of the currently authorized COVID-19 vaccines can be offered to people who are pregnant or breastfeeding, but vaccination remains a personal choice. Clinical trials that look at the safety and how well the COVID-19 vaccines work in pregnant people are underway or planned. The different vaccine manufacturers are also monitoring data from people in the clinical trials who received the vaccine and then became pregnant. 

Q: Does the intensity of an individual’s reaction to the vaccine reflect vaccine effectiveness?

Dr. Victor Nizet

Nizet: While uncomfortable for some people, the “fire” in your arm following the COVID-19 vaccination — more commonly after the second dose of the mRNA vaccines from Pfizer and Moderna — represents the evidence of an immune response. “Germinal centers” are developing in lymph tissue to stimulate pre-existing as well as new B cell clones, which then generate high-affinity, broad, and durable antibodies for considerable immunity. It is a good burn like you might feel after a hard workout in a gym. We do not know whether the intensity of an individual’s symptoms exactly predicts the subsequent levels of antibodies and duration of protection.

We do not completely understand why some people have exaggerated immune responses to this virus and its capsid protein. Those mysterious exaggerated responses are one of the main reasons why over 500,000 Americans have died of severe lung inflammation and related complications to COVID-19 infection. The idea of the COVID-19 vaccine is to deliver a small amount of the viral protein in a nonliving form to prevent a true infection, in which a large amount of virus with the same antigen can spread uncontrolled deep in the lungs, causing that same exaggerated immune response on a whole body level.  

COVID-19 and health disparities

Q. What has the impact of COVID-19 been on Hispanic communities?

Raudenbush: The Latino population in the U.S. has been deeply affected by the COVID-19 pandemic. Compared to whites, Latinos are more likely to become infected with COVID-19. They are also more likely to be hospitalized after contracting the virus and more likely to die from it. The greater rate of infection is attributable to factors such as the large number of Latinos who are essential workers and are thus at risk of exposure through their jobs, as well as household composition and the fact that Latinos are more likely to live in crowded housing conditions. A lower average socioeconomic status, lack of access to healthcare and a greater prevalence of underlying health conditions all contribute to complications of the disease, which leads to greater hospitalization and higher mortality rates.

Q. Are health messages from Black, Indigenous and People of Color (BIPOC) medical personnel viewed with less skepticism? What are trusted sources of public health information among BIPOC communities?

Danielle Raudenbush

Raudenbush: There is considerable evidence that patients have greater trust in medical personnel who are of the same racial or ethnic background. Unfortunately, racial and ethnic minorities are largely underrepresented in medical professions. Moving forward, we should think about how to make medical careers more accessible to people belonging to these groups.

One way to effectively distribute public health information is to collaborate with community leaders and organizations. These entities have an established rapport with community members and are more likely to understand the concerns of those members, both of which are important in effectively conveying health information.

Vaccine skepticism

Q. Can the mRNA in vaccines alter your DNA?

Schooley: Rumors have circulated that mRNA vaccines can change your DNA. This is false. Every cell in our body uses mRNA as a way to instruct cells on which proteins to make. While they enter cells to conduct their work, they do not enter the nucleus where DNA is stored. The vaccines that use mRNA to instruct cells to build the coronavirus spike protein help prepare your body to produce antibodies that combat coronavirus if you come in contact with it later. The mRNA is quickly degraded once it is in the body, which is one reason why these vaccines must be carefully preserved at very low temperatures.

Q. How can we rebuild trust in government-run or government-funded public health institutions?

Raudenbush: In my research in low-income communities — communities in which many people get care through public hospitals and clinics — people frequently report feeling mistreated when seeking care. Feelings of mistreatment arise because of factors like long wait times (oftentimes many hours), limited time interacting with physicians and believing that their concerns have been dismissed by staff and medical professionals. Perceived mistreatment contributes to a sense that hospital and clinic personnel are not interested in their wellbeing. Trust in public health facilities can be improved by addressing the quality of the care-seeking experience related to factors like these.

The second of five virtual “Evenings of Nonconventional Wisdom” will take place on March 24 and is entitled “Full STEM Ahead: The Journeys of UC San Diego Women in Science.” Individuals can learn more and register on the event page. To learn more about the COVID-19 vaccine, visit the UC San Diego Health COVID-19 vaccine information webpage. For more information on COVID-19 vaccine safety and efficacy, please read the recent Q&A news story featuring insight from Dr. Robert “Chip” Schooley, professor in the Department of Medicine at UC San Diego School of Medicine.