Here at Penn Medicine, we've been getting a lot of questions about the mRNA vaccines for COVID-19, and what it means for our patients and the people in our communities. I'm Dr. PJ Brennan, Chief Medical Officer at Penn Medicine, answering some of the most frequently asked questions around the COVID-19 vaccine. 

Let's get right into it.

First, a few questions about how we're handling vaccinations, here at Penn Medicine.

I really wanted to get a COVID-19 vaccine, but I'm not able to get an appointment. What should I do?

Everyone is understandably anxious about how to get a vaccine. Vaccine has been in short supply. I would encourage everyone to go to the websites of the states of Pennsylvania and New Jersey and the city of Philadelphia to determine whether you're eligible to get a vaccine. You can also go to the Penn Medicine website to register your desire to be vaccinated. Those sites will provide information on eligibility, and can notify you when your turn comes up to be vaccinated.

At Penn Medicine, we're trying to administer vaccine as quickly and as fairly as we can, following the guidance provided by the city of Philadelphia, the Commonwealth of Pennsylvania and the state of New Jersey.

How does Penn Medicine decide which order to vaccinate people in?

Well, first we follow the guidance of the Commonwealth of Pennsylvania, the state of New Jersey and the city of Philadelphia. We first vaccinated healthcare workers, who were in a high-risk category because of potential exposure in the workplace and the possibility that they could transmit infection to those who were at high risk or have immunocompromised conditions. 

Next we vaccinate so-called 1B group: Those are people in essential infrastructure roles in our society, people over the age of 65 in the states (or 75 in the city of Philadelphia), and people who have serious underlying conditions that increase their risk of severe illness with COVID-19. There are many people who have high-risk conditions, many more than we have vaccine for at the present time. But as vaccine supplies increase, we'll be reaching out to all of those people to try to vaccinate them as quickly as possible.

What are some of the challenges involved in vaccinating lots of people quickly? 

There are a number of challenges that we face. The first is the supply of vaccine. It has been rolling out slowly, and we expect over the next one-to-two months much more will be available. When we have more available, we'll be able to reach more people. But in the meantime, there's a lot of uncertainty about when we're going to be getting the vaccine, and that creates challenges for us in scheduling people. If we don't know we're going to have a sufficient supply on Monday, it's hard to have a full schedule of individuals to come in and take their shot.

Another challenge is reluctance. There's a tremendous amount of reluctance and hesitancy about the vaccine. We're doing our best to educate the community and encourage everyone to come in and get their shot. 

Then finally, there's active misinformation out there that is really misleading. It's important to come to Penn Medicine or another trusted, reliable source of medical information when making your judgements about whether you should be vaccinated or not.

What kind of progress are you making on getting vaccines to everyone who wants one?

I think we're making great progress. We started in mid-December offering vaccinations to our frontline healthcare workers. It was slow at first, but has really begun to pick up.

Following our frontline workers, we're now offering the vaccine to people in the general population: those over the age of 75 in the city of Philadelphia, those over the age of 65 in Pennsylvania and New Jersey, and those with serious underlying medical conditions that put them at higher risk for severe disease. It started slowly, but has really begun to pick up, and we're hopeful we can get more vaccine quickly into people's arms as the supply increases.

We're also very concerned about the black and brown communities near our hospitals and in Southeastern Pennsylvania and New Jersey – communities that are historically underserved. And so we're reaching out to communities of faith and others to try to help us serve those communities and give them the shots that they deserve.

I've heard that people in black and brown communities are less likely to get vaccinated than others. Does this concern you?

It does concern me. Black and brown communities have been disproportionately affected by COVID-19 and historically have been underserved medically. So, I'm very concerned that we're not reaching those communities to the extent that we should. We have offered vaccine to everyone in our workplace, just as an example, regardless of their position and regardless of race and ethnicity. We're trying to deliver vaccine as equitably as possible, and we've been measuring the uptake in different demographic groups. 

It's very clear that our black and brown staff are not accepting vaccine at the same rate that other communities are. We're working very hard to try to bridge that gap. In the workplace, we have doctors, nurses and other staff as influencers who are reaching out to our communities of color in our health system.

We've made progress, but not enough progress. And I expect that as time goes on we will make more as confidence in the vaccine increases and people see that it's safe and that the side effects are not significant. So I'm hopeful that we will close this gap.

Now, here are a few questions around the safety of the vaccine itself.

Can I still get COVID-19 even if I get vaccinated?

Well, first I want to be very clear: There is no live virus that causes COVID-19 in the vaccines that we have, so you cannot get COVID-19 from the vaccine.

There's still a lot we need to learn about the vaccine; one of the things is whether it actually prevents infection or whether it just diminishes the severity of disease. We hope that it does both, but it may be possible that someone can still get infected and be asymptomatic and shed the virus. For that reason, we're continuing to maintain all of our public health measures until we know more about whether the vaccine actually prevents infection or not.

I've heard the side effects are bad, particularly for the second shot. Should I be worried about that?

I want to distinguish between side effects and reactions. Reactions to the vaccine are pretty common, but they're mild. They may occur more often in some people after the second shot and the first shot. And they seem to occur more often in younger individuals who may have a more robust immune system and be better able to react to it. 

But those reactions are important. Those reactions indicate that you're responding to the vaccine – that you're having a positive effect. It’s demonstrating that your immune system is reacting, and you're going to be protected.

The reactions that we see are generally mild headache, mild muscle aches, and sometimes a low grade fever. They occur more often with the second dose of the vaccine. But I want to contrast that with the virus itself, these are relatively minor, whereas the infection can be very severe. I would encourage everyone to take the vaccine, not to stay away from it because of these reactions that indicate your body is responding to it.

What would you say to someone who doesn't want the vaccine or who prefers to wait and see what happens to others first before they get vaccinated?

Well, the first thing I would tell them is, "I got the vaccine. I'm really glad that I did. I had minor reactions to it – a little bit of fever, a little bit of headache – but it was well worth doing. I think it's important that we all get vaccinated."  

The vaccine's technology has existed for 15 years. We know how the messenger RNA works. It's been safe; we haven't seen significant side effects. I would encourage everyone to get it as soon as possible. It's going to protect you in almost every case. And it's going to bring the pandemic to a close more quickly and help us all return to a more normal life.

What will it take to get to the point where everyone is safe from COVID-19?

Well, I think it’s going to take two things. It's going to take continued adherence to the public health measures that we know work and have helped us bring the pandemic under some degree of control. They include masking, hand hygiene, social distancing, and avoiding large cohorts of people. Those are important, and we have to continue those going forward even as we're vaccinating the population.

The second issue is vaccinating as many people as possible. We're probably going to have to get to a point where 80 to 85% of the population is immune before we get to herd immunity. 

And what does herd immunity mean? Well, that's a level of immunity in the population, a level of ability to fend off the virus by 80 or 85% of the population so that when a case is introduced, it's going to bump into more people who can't spread it or maybe can't become infected. That helps to protect all of us. So that will take time. I expect that it's going to take many more months. A [new] vaccine will roll out, and we'll have more available to us certainly in March, April, and thereafter.

I think it's going to take about six months for us to get to that timeline where we have the level of herd immunity that everyone needs, if we can keep up with vaccine supply and if we all accept the vaccine. I'm hopeful that by the fall we can return to football stadiums, concert halls, and classrooms that are filled with students.

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