Do COVID-19 Vaccines Cause Infertility?

One question that has come up regarding COVID-19 vaccines, especially among young women of childbearing age, is, 

Is it possible that this vaccine or these vaccines could affect fertility, could affect my ability to get pregnant?

The answer in short is, NO..! 

And let me explain why and where this whole false notion came from. This false notion was born of the letter that was actually written to the European Medicines Agency, which is like the European equivalent of the  Food and Drug Administration, claiming that there was similarity between the SARS-CoV-2 spike protein, which is what you're making an antibody  response to when you get these vaccines, and a  protein that sits on the surface of placental cells called syncytin-1. 

So the thinking was, if you're making an antibody response to that spike protein of coronavirus, you're also inadvertently making an antibody response to this syncytin-1 protein on the surface of placental  cells, which would then affect fertility.

First of all, that wasn't true. Those two proteins  are very different. It's like saying you and I both have the same social security number because they both contain the number five. So that was wrong to begin with. 

Plus, you can argue there's two strong pieces of evidence that argue against it. One is that there was two prospective  placebo-controlled trials done before submission for emergency use authorization from both Pfizer and Moderna. During those two trials, 36 women, roughly, became pregnant. Now, if it was true that  this vaccine or these vaccines affected fertility, then there should have been more pregnancies in the placebo group than in the vaccine group, but that wasn't true. There were really 18  instances of pregnancy in the vaccine group and 18 instances of pregnancy in the placebo group. 

So,  therefore, the vaccine didn't enhance fertility and it didn't negatively affect fertility. Also, if you're arguing that antibodies directed against the SARS-CoV-2 spike protein would affect placental cells, remember that about a 100 million people have been infected with this virus over  the past year and a half. During that time, they have been making antibodies to the SARS-CoV-2  spike protein. 

So, if it's true that that would affect fertility, then the question is, 

what's  happened to the fertility rate or the birth rate right in this country, say between 2019  and 2020? 

If it was affecting fertility, if natural infection was affecting fertility, then  birth rates should have gone down, but that's not what happened. Birth rates have actually gone up  slightly. So, those are two pieces of evidence that argue against this vaccine or natural infection in any sense affecting fertility.

Should Pregnant and Breastfeeding Women Get Vaccinated?

Pregnant women are at about three times increased risk of ending up in the hospital in an ICU, and about twice as high chances of being on a ventilator when they get COVID, compared to non-pregnant women.So, it's serious. 

The other thing that can happen with COVID during pregnancy is the illness itself can induce preterm delivery and then you'd have a premature baby, which could have complications. So we think it's very important for pregnant women to be protected against COVID. 

So in the clinical studies, the large Phase 3 studies that were performed prior to the data being submitted to the FDA for the Emergency Use Authorization, all the manufacturers did these studies and they tried to exclude women who were pregnant or breastfeeding just because there wasn't any data on that. And there was little known and everybody's scared of things that could happen during pregnancy or during breastfeeding. 

However, during those studies, some women, either the screening missed them and they were enrolled in the studies or they became pregnant during the study. So there are a handful of women that did become pregnant and some who were breastfeeding during those vaccine studies, and what all the manufacturers found is; no signal that there was any danger to the fetus, nothing unusual between the vaccine group and the placebo groups in terms of the pregnancies and the pregnancy outcomes. In addition to that, the manufacturers have done studies in animals who were pregnant or getting pregnant. And again, giving even twice the equivalent dose, the human equivalent dose, to animals did not result in any dangers that occurred during pregnancy.

So theoretically, these vaccines are very similar to inactivated vaccines that women already get. So we know that they're novel technology with the messenger RNA (mRNA) and the adenovirus DNA vector, but the end result is just a protein-based vaccine, which is very similar to what women already receive during pregnancy, Tdap vaccine (Tetanus, Diphtheria, Pertusis) and influenza vaccine, which are recommended. They protect the mother and they protect the newborn too. So we can say that the CDC, who is very conservative and has recommendations that are considered permissive, that women who have the vaccine available to them, who are pregnant or breastfeeding, may choose to be vaccinated.

It's important, not only for those women to be studied to make sure that it's safe and effective, but on balance, that since COVID can be more serious in women who are pregnant, it is recommended that they should be vaccinated. And that's what one should counsel women, is to strongly consider getting vaccinated. So, researchers don't think that any of the current vaccines will be transmitted through the placenta to the baby. So the baby won't have an immune response. And they don't think that it's going to be dangerous to the baby either. But the mother, of course, we hope that she forms antibodies, and in response to being vaccinated, and those antibodies are transmitted across the placenta and they may protect the baby.

It is not necessary that vaccinated women would have the vaccine itself, any part of the vaccine, be transferred via breast milk to the breastfeeding infant. However, if this does occur, presumably it would be totally degraded in the child's stomach, with the acid and digestive enzymes. So the child wouldn't get exposed to it in a meaningful way. It can be assumed that the child would benefit either from being exposed to a mother who's breastfeeding and been vaccinated, so they won't get any of that vaccine dose.

Is Sinovac (and Other Covid Vaccines) Effective Enough?

 Is Sinovac (and Other Covid Vaccines) Effective Enough? & Do We Need Booster Shots FOR DELTA VARIANTS?

We know that the first covid19 vaccines 

were a welcome development during the pandemic because they were the ones that offered hope to an end for this pandemic. But, what we know is that these vaccines would keep us safe and protected against severe disease but there's a lingering question among us as to how long will the production last would variants make these vaccines available to us less effective? 

Another question would be, Would everyone need a booster shot in six months or in a year or in two years so could some people get away without that boost? or it is advisable for all these are actually the same questions that headlined the meeting of the Centers for Disease Control and Prevention Advisory Committee on immunization practices. 

What we know of as of now that the group isn't making recommendations around covid-19 vaccine boosters, but the discussion shows how leading health experts are thinking through these issues. So, let's go through them one by one. 

Here's what we know so far that the vaccines authorized by the World Health Organization (WHO) based on clinical studies work extremely well at protecting the majority of people from coronavirus infection. We know that the protection seems to last a while but, we're not sure quite how long. What we know so far that protection lasts longer than flu vaccination of which we give flu vaccination to our patients with diabetes every year. 

So far, data at present also shows that the shots still work against coronavirus variants even the fast moving delta variant. However, there are special groups of people where the vaccines don't work as much as we want them to work and these include people who are immunocompromised, particularly, people who had organ transplants. These people often don't produce antibodies after regular doses of covid19 vaccines and thereby neuro research have shown that third booster of covid19 vaccine could give more protection to these groups of immunocompromised people. That's the group that CDC seems to think could be the first to get a booster because we have clear signals that it could help these groups of people to protect against covid-19. Then after we learn more about how long the protection lasts for everyone else or if new variants emerge experts could hammer out details about boosters for the rest of us. 

In short at present, there's really no data to support recommendations for booster doses except for the caveat in severely immunocompromised hosts who are not able to mount a strong immune response. For other patients especially the general population, what we know for now is that the data will come later and that ongoing studies are tracking the durability of covid-19 vaccine protection and the CDC is watching to see if any variants evade the vaccine at present. 

Ongoing studies are tracking the durability of covid-19 vaccine production. For example, the CDC is watching to see if any variants invade vaccines and second several studies are present are ongoing  to check if people should get a third dose of the covid19 vaccine that already exists or a new shot with an updated form of the vaccine that targets specific variants. Most experts do agree however that if we start to see an uptick of infections or re-infections for people or new infections in people who have been vaccinated, that's a clue that we need to move quickly. 

Covid-19 vaccines are likely to be rolled out in UK in the fall to avoid another winter surge. Seven different vaccines are being tested in volunteers in England in the world's first booster study. So we have to await the data of booster shots. What we also know is that more transmissible variants including the Beta strain that emerge in South Africa require higher antibody titers to prevent infection. Prompting vaccine makers including Pfizer and Moderna to test whether tweaked versions of their existing shots will provide broader immunity. 

We also have data that one dose of the Novovax variant directed vaccine may provide sufficient protection against these strains in individuals previously immunized with against covid-19. So the modified shot has also the potential to provide broad protection against various strains if used as a primary vaccine regimen and this is one exciting new vaccines that soon will hopefully be rolled out across the world which is Novavax.   

As for SINOVAC, it is the primary vaccine that we're given that has been given to most of the general population. We now know that based on a second phase clinical trial produced by synovac company the third dose of Sinovac's inactivated vaccine can increase antibody response tenfold in a week. The study showed that the volunteers who had received two doses of Sinovac covid-19 vaccine and then received a third shot after three to six months, the antibody response inside the body's soared tenfold in a week and 20 fold in 15 days. It has been shown that after completing the two shots clearly, our body is producing very robust immune memory. 

Sinovac vaccine and the company will however conduct more thorough and longer periods of research to determine the best time to receive the booster for the general public based on the analysis of early vaccinated groups to combat the threat of mutant strains. Data from people vaccinated six months ago is now being analyzed and preliminary results show that antibody levels and about half of them are still good within that specific period. But the general concern at present is not whether to give booster shots or not. 

The CDC is pretty worried about the troubling rates of vaccination in the world. Only 17.7 percent of the world is vaccinated. In fact, if you look closely at the data clearly we have a long way to go in terms of vaccination but there are certain areas in the world like Israel where in majority of the patient population have already been vaccinated. We still have a long way to go to get the population protection. 

We know that unvaccinated people don't need the boosters because they really need their first shots and we need to convince this unvaccinated people to help protect the community by getting their shots having more people vaccinated will definitely slow the spread of the virus and prevent new variants. It will protect people who are immunocompromised too, when everyone around them is far less likely to have covis-19. Therefore, they are at far lower risk of catching it. Figuring out boosters definitely is important but getting unvaccinated people their shots right now is a very critical way to protect everyone prior to going around giving vaccines or giving everyone boosters we really need your help in convincing your friends and your relatives that hopefully they can get their vaccines and we can in general improve the overall vaccination rate.

How mRNA Vaccines Work?

Developing vaccines is usually a very lengthy process. Taking, on average, 8 years to get approved. Since a few years, we have the ability to create mRNA vaccines which can be developed much faster.

So how do these vaccines work?

Are they safe? 

And, how do they compare to traditional ones?

But first, you must understand how the immune system works. When a virus enters your body, it will attach itself to one of your cells and inject its DNA or RNA into it. This is like a blueprint for your cells: containing instructions on what the cell has to make. So, in this case, the virus's RNA will tell your cell to make more copies of the same virus. They become virus factories, pumping out new copies of the virus that can infect even more cells.

Naturally, our bodies have a defense system for foreign intruders. The immune system attacks any protein, virus, or bacteria that do not belong in our bodies. But it takes a few days for it to learn how to attack the intruder. Meanwhile, the virus factories are running non-stop, quickly replicating the virus and spreading it in your body. In other words: you start experiencing symptoms of whatever has infected you. 

After a few days, however, your immune system has figured out how to attack the virus and will start to produce antibodies. These attach themselves to the virus, preventing them from infecting more cells and marking them for destruction. As you can see, the immune system is remarkable, but it's also slow to mount an attack. That's the reason why we get sick in the first place. So to give it a helping hand, we developed vaccines. 

The main idea is to train your immune system to recognize and fight off an infection before it has occurred. Almost like showing your immune system a mug shot of the virus and saying: 

"if you see this, kill it." 

There are various types of vaccines, but let's take a look at mRNA vaccines, the new kid on the block. To understand how they work, let's take the COVID19 pandemic as an example. You might have seen pictures of the virus, with its distinctive spikes. These spikes allow the virus to attach to specific cells in your body (ACE2-(in lungs) and infect them. Now here's the key idea for the COVID19 vaccine: what if we could train our immune system to recognize these spikes by having our body produce them? To do that, researchers took the virus's blueprint, its RNA, and isolated the part responsible for producing the spikes. Armed with this blueprint, they created mRNA or messenger RNA. This is a special form of RNA that can enter your cells and give them instructions. In this case, the RNA contains instructions to build the spikes of the coronavirus, not the virus itself, just the spikes.

So mRNA vaccines contain instructions for your cells that tell them to build a part of a virus in large volumes, almost like giving them a recipe to follow. Once this is happening, your immune system kicks into action and start learning how to attack these intruders. Again, it takes time for the immune system to fight off these spikes, but you won't get sick because it's only the spikes, not the virus itself. And that's it! Your immune system has learned how to attack the spikes of the coronavirus. It destroys all the spikes and even breaks down the mRNA vaccine itself. 

The only thing left in your body are special "B cells" or memory cells. These can linger around for months or years until the same virus infects you again. When that happens, the B cell can produce the correct antibodies right away, preventing the virus from spreading and making you sick. What's interesting about this mRNA technique is that it's relatively quick to develop a vaccine as soon as we know the DNA or RNA sequence of a virus. And secondly, because the vaccine only makes our body produce a part of a virus, we can't get sick. 

More traditional vaccines use weakened versions of the actual virus. This also triggers an immune response but could also give you mild symptoms.

Now you know how mRNA vaccines work, what about their safety? The biggest misunderstanding about this technology is that the mRNA in the vaccine can enter our cells and changes our very own DNA. But that's not true. mRNA is very fragile and only survives a few hours in our bodies.

New Covid-19 Cases Raise Concerns About Immunity

Throughout the pandemic, athletes have been the most tested population on the planet, sometimes providing examples of emerging theories about COVID-19. And as countries around the world continue to fight back COVID-19, attention has turned to Tokyo where the Olympics are under way. One challenge some athletes are facing: testing positive for the virus, despite having been vaccinated. This isn't the first we've heard of this.

What are chances of getting COVID-19 after receiving a vaccine?

Well, you've got a better chance of buying a winning lottery ticket but it happened to Warriors player Damion Lee. He will be out at least two weeks. It was not a false positive as first thought, even though Walman had been vaccinated. Yankees GM Brian Cashman says that three players tested positive and three others are likely infected. About 85% of the team is vaccinated, including those who have the virus.

These examples are known as breakthrough infections, which occur when someone tests positive for COVID-19 at least two weeks after getting their final shot.

Do these breakthrough cases mean the vaccines are failing?

No, the vaccines are not failing. The vaccines are working extremely well, and as expected. They do protect the majority of recipients from severe disease. That's what vaccines are designed to do: Prevent death and severe disease.

But most vaccines, including those created to fight COVID-19 don't completely protect you from infection. So it's not all that surprising that breakthrough infections are showing up. As of July 12th, more than 159 million people in the US have been fully vaccinated. CDC data suggests just under 5,500 have had breakthrough infections, resulting in hospitalizations or deaths. That's one in approximately 29,000 people who have been vaccinated.

Breakthrough infections are something that we want to monitor but in terms of their overall influence in the pandemic, they play a much smaller role than transmission among people who haven't been vaccinated. But these cases raise questions about our immunity to the virus and hint at a future in which it isn't gone completely and we learn to live with it. That's due in part to variants.

Research shows that variants, including Delta, can partially evade the immune response from prior infection and vaccination. We mount a really good immune response against the virus that our body's trying to recognize. Your body is really good at recognizing and neutralizing those specific threats. But when the virus starts to change, sometimes it doesn't recognize the virus as well. And so that's how you sort of see it chip away at that immune response. That's one of the reasons that health officials are really sort of concerned about this global vaccination drive in order to prevent the virus from spreading, both to save lives and to prevent it from further mutating and evading immune response.

The Delta variant is the most contagious version of the virus to be identified, but research suggests that full vaccination is still protective against severe disease and death: the outcomes that have made COVID-19 so devastating. 

What dictates whether someone is more likely to get infected, even if they're vaccinated?

Dr. Hatziioannou says there are four main variables. 

First is the amount of virus that is circulating in your community. So if a great number of people around you are infected, then the possibility of you getting exposed obviously increases. If you're in close proximity with people that are infected, particularly those that are unvaccinated and have generally higher viral loads, then the probability of you getting infected increases.

Second is tied to vaccine uptake, So if a large proportion of the population is vaccinated, then your virus transmission, virus loads, everything decreases. So the chances of spreading the virus amongst this population obviously decreases. That's because vaccinated people act as a kind of shield, even when they do get infected. A recent CDC study found that vaccinated people carried less virus and potentially didn't spread it as much as unvaccinated people. Cases were also shorter and less severe. Vaccines help create a kind of immune memory of what a virus looks like, helping the body fight it off more quickly when it spots it. That makes it harder for the virus to spread overall. Roughly half of all Americans are fully vaccinated but in some states and globally, the vaccination rate is much lower, giving the virus more opportunity to spread and mutate. That's why having large gathering, like concerts or the Olympics can be so challenging from a public health perspective.

Third, individual behavior matters. So as measures have been abandoned, such as masking and social distancing, when you don't have a significant number of the population vaccinated, then the ability of the vaccines to protect you from getting infected decrease.

Finally, even after vaccination, individual immune systems vary in their ability to prevent and fight off infection. Older and immunocompromised people seem to be more susceptible to breakthrough cases, and those tend to be severe. That's why health officials are considering additional doses right now, primarily for people who have a compromised immune system and might not have produced a good immune response after two doses of the vaccine.

Breakthrough cases might be asymptomatic or mild, so people may not know to get tested. But that's not the case for athletes. We're actually seeing breakthrough infections happen a lot more amongst sports teams, like baseball or for the Olympics because those are the people that get tested pretty regularly, even if they're vaccinated.

At the Olympics, organizers of the games are scrambling to deal with a rising load of athletes and officials who are testing positive upon arrival in Japan, some with breakthrough infections. The vaccination rates are low in Japan. Cases there are rising and organizers didn't require those participating to get vaccinated.

Dr. Hatziioannou and many other experts remain concerned that holding a large-scale international event prior to reaching a critical mass of vaccinated individuals has the potential to contribute to the virus's spread around the world. The Olympics is a special event and it's truly remarkable that it brings all these people from all these different countries together but it also poses a perfect ground to mix variants and spread the virus that will then go back to each athlete's country.