Doctors Discuss Considerations about Vaccinated and Unvaccinated People

Doctors discuss considerations about vaccinated and unvaccinated people

Dr. Beachgem10: I am Beachgem10. I am a TikTok creator, and I am a pediatric emergency medicine physician.

Paul Offit, MD: Hi, my name is Paul Offit. I am the Director of the Vaccine Education Center at the Children’s Hospital of Philadelphia and a Professor of Pediatrics at the Perelman School of Medicine at the University of Pennsylvania.

Dr. Beachgem10: Dr. Offit, I wanted to ask you, a lot of people wonder why unvaccinated people are a risk to vaccinated people. Could you talk about that?

Paul Offit, MD: Well, for two reasons. One, because no vaccine is a 100% effective. So even if you're fully vaccinated, you still could catch an infection and suffer it. And two, not everybody can be vaccinated. So, I think when someone makes a choice not to be vaccinated, they're choosing to expose those who really depend on those around them to protect them. The estimate is that about a 3% of people in the United States are immunocompromised to the point that they can't make an effective immune response. That's about 9 million people. So, you have a responsibility to your neighbor.

Dr. Beachgem10: I get a lot of comments about my body, my choice. How is the vaccine argument different than other healthcare-related my body, my choice argument?

Paul Offit, MD: I think you could argue that it does depend on the vaccine to some extent.

I mean, I would argue that if you, let's say you step on a rusty nail and you go to the doctor. The doctor cleans it out and then offers you a tetanus vaccine. If you choose not to get a tetanus vaccine and you get tetanus, no one is going to catch tetanus from you. It's not a contagious disease. You could argue that's a personal choice. It's not a smart choice, but it's a personal choice.

SARS-CoV-2, the cause of COVID, that is a highly contagious virus. So, if you choose not to vaccinate yourself, which is in essence choosing to risk this infection including severe infection, that affects everybody with whom you come in contact.

I mean, the so-called contagiousness index of this current strain, the delta strain, is between 5 and 9. That's like in the chickenpox territory. That's highly contagious. Meaning, if you take a low end of that, if I'm infected and I go about my normal day and everybody I come in contact with is susceptible, I will infect 5 more people. So, it's not a decision you're making for yourself. It's a decision you're making for everyone with whom you come in contact.

Dr. Beachgem10: Yeah, especially being a mom to younger kids, my youngest has not have been able to get vaccinated yet, and I do worry about her and the risk to her of other people. So, other people being vaccinated, you know, it's not her choice yet. It's still everyone else's choice to protect themselves to be able to protect her.

Paul Offit, MD: Finally, we have a vaccine to protect these children. I think people think that 5- to 11-year-olds can't be infected, but they certainly can be. I mean, when the virus first came into this country last year, about 3% of the population that was infected were children. Now, it's closer to 27%. This is a childhood illness.

Dr. Beachgem10: Yeah, I know. Being a pediatric emergency medicine doctor, I've seen plenty of sick kids. Sick kids generally do well with COVID, but we absolutely do see kids that end up getting sicker, unfortunately, and in the ICU. And obviously, we don't want to see that as much as we can.

Paul Offit, MD: No, that's a really good point. It is true, actually, when the virus first rolled into this country, the mantra was correct, which is children get infected less frequently, and when they get infected, they get infected less severely, but they still can be infected severely. I mean, you work in a hospital, I work in a hospital, you know the 5- to 11-year-olds, about 8,300 of those children have been hospitalized. A third have ended up in the intensive care unit. More than a 100 have died. And about a third of those children who've been in the hospital had no other risk factors that would have put them at high risk of having severe COVID. So, therefore, everybody's at risk.

You know, we all like to think it's never going to happen to our children until it happens to our children.

Dr. Beachgem10: Absolutely. As an expert in your field, I'd really like to hear kind of your description of herd immunity.

Paul Offit, MD: So, herd immunity is what percentage of the population needs to be protected, needs to be immune so that the virus can no longer spread easily from one person to the next. And the level of protection in the population, which can occur after either natural infection or immunization or both, depends on the pathogen, depends on the germ. So, the more contagious the virus in this case, then the higher percentage of population that needs to be vaccinated. The more effective the vaccine, as a general rule, then the lower percentage that needs to be vaccinated.

Dr. Beachgem10: That makes sense. Can you, can you talk about the biology of viruses and how herd immunity is important related to that?

Paul Offit, MD: So, take a virus like measles. Measles is the most contagious of the vaccine-preventable diseases. So, if you look at the delta variant of COVID, that has a contagiousness index of between 5 and 9. Measles is close to 20, much more contagious. And so, in order to really stop the spread of that virus, which we did by the year 2000, we needed to have close to 95% of the childhood population vaccinated. And we were able to do that largely through school mandates that started back in the 1970s. So, it really does depend on the contagiousness of the virus, largely.

Dr. Beachgem10: What do you say to people who say their individual rights are more important than the effects of their decision on other people?

Paul Offit, MD: It's not your right to run a stop sign any more than it’s your right to catch and transmit a potentially fatal infection. There's an old line from Oliver Wendell Holmes which is, your right to swing your fist ends at the tip of my nose. You know, you do have a responsibility to those who are standing next to you.

Remember that in this society, there are a lot of people who can't be successfully vaccinated. Actually, there was one moment that sort of capsulized this for me. When California moved to eliminate its philosophical exemption to vaccination for school entry, this is a state that never had a religious exemption, so by eliminating the philosophical exemption; therefore, the only exemptions for school entry would be medical exemptions. And there was enormous pushback from the anti-vaccine movement because this really upsets them. There was a boy who testified at those meetings, whose name was Luke. I don't know his last name, but he had leukemia, so he couldn't be successfully vaccinated. He stood up at the microphone. I think they had to get a chair for him so that he could actually reach the microphone. And he said that, he explained his story and then he said, what about me? Don't I count? I depend on you to protect me. I mean, he to me was the voice of society. It's a voice that shouldn't be so easily dismissed.

Dr. Beachgem10: I agree. We have to protect the kids that aren't able to be protected with a vaccine or, otherwise, the kids that are more fragile or susceptible.

Well, I really appreciate this opportunity to talk with you today. Thank you very much.

Paul Offit, MD: Thank you. It’s so nice meeting you, and I like your shirt, “Superheroes wear masks.” They also get vaccinated. So, good to see.

Dr. Beachgem10: Awesome. Thank you.