The Balancing Act of Vaccines

Vaccines are becoming a greater part of our future beyond the typical annual flu shot of years past. Most often, sea change events in our world’s history lead to new discoveries and tools being created to counteract life’s challenges. And the COVID-19 pandemic is one of those future-changing events.

As pharmacists, it’s important to understand and embrace the science and the tools that COVID-19 has brought to the fore, because, in my opinion, the pharmacy world is going through a dramatic evolution that will change health forever. As pharmacists, as drug experts, and as consumer-facing providers of information and support, we will be leading and communicating this revolution to everyone.

The elementals of vaccines

Let’s think of vaccines as communication tools. A technology (tool) that can communicate to your adaptive immune system to generate a response. To do so, it must get your adaptive immune system to react (think T and B cells), and then follow through with the message or desired response (production of antibodies). This adaptive immune system reaction is the efficacy part of a vaccine, also called the immunogenicity.

Unfortunately, getting the adaptive immune system’s attention to reactis the adverse effect (AE) part of a vaccine, called the reactogenicity. Reactogenicity is purposefully built into each vaccine, via an effector, which communicates to the innate immune system to mount a fast and broad call to duty against any invading foreign substance or toxin.

The mediators released from the innate immune system communicate to the adaptive immune system that an antigen is present. Therefore, the AE profile of vaccines mimic the broad reaction caused by the innate immune system: site-pain (pain, redness, swelling) and flu-like symptoms (fever, myalgia, headache, or rash). In summary, both the innate and adaptive immune systems must work properly and in concert for the communication tool (vaccine) to produce antibodies.

Going deeper on the vaccine reactivity

Vaccine technology has advanced the immunogenicity science of the equation faster than the reactogenicity science of the equation. This has led to great advancements in the number and types of vaccines, but a lack of options for the consumer to mitigate troublesome AEs.

Based on the mechanism of action of vaccines, there is a belief that reducing the innate immune response with pharmaceutical agents (i.e., acetaminophen, non-steroidal anti-inflammatory drugs, antihistamines) around the time of vaccine administration would reduce immunogenicity. Yet, these studies have not been performed.

Prior to COVID-19, such a study was a large and expensive undertaking because antibody formation was not easily quantified or routinely measured—but COVID-19 has changed this. Currently, COVID-19 vaccine immunogenicity (antibody formation) is frequently measured in individuals to determine dosing schedules.

This change in practice allows manufacturers to quickly assess alternative agents that could be either manufactured into the vaccine as an effector, (i.e., lipid nano particle of mRNA vaccines) or to assess pharmaceutical agents that could safely be administered with vaccines to reduce vaccine AEs.

Why is this important? Because trust is at an all-time low across this country and pharmacists are still revered by the public in terms of being one of the last professional groups people still trust.

Our relationship with our patients is based on this often-fragile measure of trust. Pharmacists across the United States have been instrumental in administering a staggering total of greater than 200 million doses of vaccines in the past 2 years.

This has helped to change the course of COVID-induced injury. Yet, we still have no consistent, scientifically determined, pharmacy advice for reducing the AEs of vaccine administration.

This leaves the pharmacist blindfolded, doing a balancing act between the vaccine manufacturers’ products and their patient’s immune system, which is a very precarious position to be in, and could lead to mistrust, vaccine hesitancy, or non-adherence.

About the Author

Jackie Iversen, RPh, MS, Founder and Head of Clinical Development Sen-Jam Pharmaceutical. Check us out on StartEngine.