key: cord-0786501-uv40rkjz
authors: Laine, Christine; Cotton, Deborah; Moyer, Darilyn V.
title: COVID-19 Vaccine: Practical Clinical Considerations
date: 2021-03-26
journal: Ann Intern Med
DOI: 10.7326/m21-1260
sha: f632b0b95a96cf2dc62a96ad745df0e9869c0468
doc_id: 786501
cord_uid: uv40rkjz

This article summarizes the ACP/Annals COVID-19 Vaccine Forum IV held on 24 March 2021.

T here remain many unknowns about COVID-19 vaccine, but there has been great progress since Annals of Internal Medicine and the American College of Physicians hosted our first COVID-19 vaccine forum in October 2020. That initial forum described the science, approval process, development of clinical indications, and policy environment of vaccines that were in initial phase 3 trials (1). Subsequent forums in December 2020 and January 2021 addressed promoting vaccine acceptance (2) and distribution (3), respectively. Now only 5 months later, the discussion during our most recent forum on 24 March 2021 centered around questions about the 3 vaccines that have received emergency use approval by the U.S. Food and Drug Administration (FDA) and that are, thankfully, being administered with increasing rapidity in the United States.

As of 22 March, the Centers for Disease Control and Prevention reported that 17.4% of U.S. adults are fully vaccinated and 32% had received at least 1 vaccine dose (4). The FDA review of a fourth COVID-19 vaccine appears to be imminent. As vaccination continues to expand, physicians and other clinicians have many practical questions about the vaccines and the postvaccination world.

Are there people who should not receive COVID-19 vaccination? How should we advise pregnant women about vaccination? If someone develops COVID-19 after their first vaccine dose, should they receive monoclonal antibody? And what about the second dose? Does vaccination reduce viral transmission? If it does, why do we still need to wear masks and socially distance ourselves from others? Will booster vaccination be necessary and, if so, with what frequency? Should the identification of SARS-CoV-2 variants temper enthusiasm that the current vaccines will end the pandemic? When will international travel be safe?

The forum held on 24 March 2021 aimed to address the issues on many clinicians' minds. Panelists included infectious disease experts Dr. Deborah Cotton (Annals Deputy Editor and Professor of Medicine and Epidemiology at Boston University), Dr. Carlos del Rio (Professor of Medicine, Global Health, and Epidemiology at Emory University), and Dr. Paul Sax (Professor of Medicine at Harvard University). View the program in the Video that accompanies this article (available at Annals.org) to learn how the experts answered these and other questions. They also raised the vexing issues of health inequities both within and beyond U.S. borders.

As we move past the pandemic's 1-year anniversary, the panelists offered welcome optimism. There are very few absolute contraindications to COVID-19 vaccination. The vaccine likely not only reduces COVID-19 morbidity and mortality but also transmission. The panelists noted that changes in infection control practices that health care settings initiated because of the pandemic have also reduced other respiratory illnesses. As data emerge to suggest that some patients have symptoms that persist long after their initial COVID-19 diagnosis, the panelists reminded us that by reducing the numbers of people who develop COVID-19, vaccination will consequently also reduce the numbers at risk for postacute sequelae. They contrasted the rapidity with which we learned about SARS-CoV-2 to the slower scientific progress during the emergence of HIV infection 40 years ago.

While we have much more to learn about SARS-CoV-2 and the virus is certain to continue to present challenges going forward, the progress that the scientific, health care, and public health systems have made thus far warrants celebration.

COVID-19 vaccine: what physicians need to know

COVID-19 vaccine: promoting vaccine acceptance

COVID-19 vaccine distribution and allocation: what physicians need to know

See also: Web-Only Video: COVID-19 Vaccine Forum IV CME/MOC activity