COVID Vaccines: Too Risky for Some People?


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Nearly 1.5 million Americans are being vaccinated every day against COVID-19. Allergic reactions have led some to question if they should get the vaccine; and scant data from clinical trials for the currently approved vaccines in vulnerable populations means we don't fully know how those with certain conditions will react.

Does that mean those with certain allergies or conditions like HIV, multiple sclerosis, or cancer should pass on the shot? What about those who are pregnant?

Barbara Alexander, MD, infectious disease specialist at Duke University and current president of the Infectious Diseases Society of America, joins us to explore who should get the shot. Later in the podcast, Mark Turrentine, MD, a professor at the Baylor College of Medicine and co-chair of the American College of Obstetricians and Gynecologists (ACOG) COVID-19 OB Expert Work Group, also joins to explain whether the vaccine is safe for pregnant and nursing women.

The following is a transcript of their interviews with "Track the Vax" host Serena Marshall:

Marshall: Dr. Alexander, thank you so much for joining us. We've heard that getting one of these COVID-19 vaccines, especially the second doses, can be painful and even put you out for a few days. It sort of sounds like the effects of the shot are worse than others, perhaps even the flu. Is this just anecdotal or is there some science behind it?

Alexander: I think there is definitely science emerging now; actually, the most recent safety data was reviewed by the Advisory Committee on Immunization Practices. So that's the committee that advises the CDC on vaccine safety and efficacy. They actually reviewed all of the safety data that has been generated so far.

It's true that it seems the second dose is more reactogenic than the first dose. Most symptoms do occur within the first three days after receiving the vaccine and most spontaneously resolve within a couple, three days. The most common side effects seem to be pain, fatigue, headache and myalgias or muscle pains.

Marshall: Why is it the case though for these vaccines? Is it because of their mRNA technology for vaccinations, or is it something to do with the COVID antibody response that they're generating?

Alexander: That's a good question. I don't know that we know absolutely, but I suspect it has more to do with the antibody response. The first vaccine -- most people don't have too much of a reaction, maybe a little bit of soreness at the side of the injection. And it's after that second vaccine that we see most people developing more side effects. And probably that's because after the first dose our bodies began to make an antibody response or an immune response. And when it gets that second dose, the body's really revved up. So then it's really ready to act against the antigen that the vaccine is providing. In that scenario then, what we're getting is an inflammatory response from the body, right.

Marshall: Those kinds of side effects that you mentioned arm pain or fatigue. Those are normal responses. Those are not allergies?

Alexander: That's right. They are not allergies. They're just normal side effects of the vaccine. And we see those in all vaccines that are administered.

Marshall: What would an allergic reaction to this vaccine be?

Alexander: Well, I think that the most important and worrisome allergic reaction that we think about is an immediate allergic reaction or what the scientific term we use is a type one hypersensitivity reaction. And those are usually early onset, like immediately after receiving the vaccine. The majority of these types of reactions occur within 30 minutes of receiving the vaccine.

And the types of reactions that we're talking about here are urticaria or hives, angioedema, which is swelling in the lower layers of the skin and typically it involves the face and tongue and/or throat, and wheezing. If you see one or two of these symptoms in combination with a low blood pressure or fast heart rate, then in that scenario that is anaphylaxis.