When the pandemic started back in February 2020 I was fascinated – a whole new disease to learn about and already so much conjecture h

ad begun about it. Was it leaked from a lab, what does the disease do to the body, who does it attack, what sort of virus is it, and how it started to mutate from its early forms into what it is now, an even more virulent and potential

ly even more deadly one? What else could happen here? Then followed the different potential treatments, what herbs could we potentially use, how was SARS1 treated, our amazing elimination of it in Aotearoa and the feel of freedom as the rest of the world laid low which we are now learning was relatively short lived. As I studied the physicality of it I also f

ound the psycho-social nature of it nearly as interesting. I watched as we all did firstly in Italy, then the US and many other countries including Sweden, countries with good modern health systems who were turning away people and having to choose who would die. I took advantage of the graphs produced by Wikipedia and John Hopkins University 

on Covid cases and deaths as we watched curves rising and falling with strict measures imposed.

This led me down the path of also studying vaccination as this came up over and over again, we learnt that there were nearly 200 companies trying to develop a vaccine as fast as they could, and finally a few vaccines that had made it into phase 2 trials on humans and then phase 3 trials.  As the initial numbers came out stating 95% efficacy I thought this m

ight change over time as more and more people particularly in the US ventured out into the world. How could they tell what was working, the vaccine or other measures in place? But the number stayed relatively similar throughout, particularly for the 2 mRNA vaccines produced by Moderna and Pfizer. I started to focus only on the BioNTech/Pfizer vaccine as it was announced we would 

order 5 million in for our use and for the purposes of this article will refer to the BioNTech/Pfizer/BNT162b2/Cominarty vaccine unless otherwise stated. What was happening here was relatively amazing in that in a short time, clinical trials continued through the phases and before they had even finished phase 3 trials governments were buying up these vaccines with the assumption that they would make it through. This fuelled thinking that big pharma and governments were in bed together but it was a risk many countries were willing to take as more and more people became susceptible to the Covid-19 disease and hospitals struggled to keep up with demand.

 

The fascinating thing about Covid is its ability, like most viruses to spread before symptoms fully appear, and how it behaved differently to other viral illnesses like the flu. People would feel fine at home and then eventually go to hospital with a cough and shortness of breath only to find their oxygen levels were well below range. Some of the first literature I saw on Covid were the images of the ground glass opacity that showed lung damage – Acute Respiratory Distress Syndrome – even occurring in mild to moderate infections, this is what put me off wanting to experience Covid for myself and treat it herbally to wanting to do anything I can to avoid infection and lessen the severity in the first place.

(Image – Ground Glass Opacity in the lungs after Covid-19 disease via chest x-ray) (1)

As Aotearoa New Zealand goes from a Covid naive population to an immunised one (at this point in time we are 81% fully vaccinated and 90% single dose vaccinated) it is worth considering how this particular vaccine was studied and what these studies and real world trials have shown. As I watched this in real time I was amazed about how phase 3 trials are undertaken. People are randomised into groups who get the vaccine or not and, (I would have thought) exposed to the disease and analysed who develops antibodies to it, but I discovered that after the 2 groups are chosen they are merely sent into the world, purposeful exposure does not get past ethics committees in the 21^st century. (2) The placebo group is given saline and they are monitored for side effects and followed up for many months to compare those who ended up in hospitals and with symptomatic infection and those who didn’t – this is where the 95% comes from (we now know that delta has changed this number due to the 1000 x higher viral load), but hospitalisation remains the clear goal for governments who get voted out for failing the general populace health needs. Some people with a distrust of modern medicine and governments have taken to a cynicism of the vaccine but many of these fears can be answered with relatively logical rebuttals.

 

Where do mRNA vaccines come from? mRNA vaccines have been in development for around 10 years mainly studied as immunotherapy for cancer treatment, as well as for vaccines against flu, zika, rabies and cytomegalovirus (CMV). (2, 3, 4) Scientists have also researched past coronavirus infections (SARS and MERS) which were bat-borne viruses which potentially transmitted from one animal host to another. Once scientists identified the genetic code for SARS-Cov-2 they adapted their technology. The BioNTech/Pfizer vaccine is being used worldwide and is still being monitored for effectiveness and safety. The company BioNTech founded by a German couple who were researching cancer immunotherapy of cancer vaccines. I encourage you all to read and learn about them, here is an interesting video on their discovery here (https://www.youtube.com/watch?v=VdqnAhNrqPU&t=44s ) (5).

 

Ingredients in the vaccine are very simple – there are only 4 main compounds in it – a lipid nanoparticle coating, salts for the pH at injection site, sugars to stop it from freezing solid and a piece of mRNA that codes for the top of the spike protein in the case of the BioNTech/Pfizer vaccine. For reference the Moderna mRNA vaccine has a larger piece of RNA from the spike protein. The way these work is to find their way into a cell from the deltoid muscle injection site (not the bloodstream) and from there the relatively unstable RNA has to jump onto the cellular machinery – I had to delve back into some cellular physiology to remember that it is the ribosome where protein and viral synthesis takes place.

Here is the full ingredient list (1):

Fats	·         (4-hydroxybutyl)azanediyl)bis(hexane-6,1-diyl)bis(2-hexyldecanoate) ·         2[(polyethylene glycol)-2000]-N,N-ditetradecylacetamide ·         1,2-distearoyl-sn-glycero-3- phosphocholine ·         Cholesterol	These ingredients make up the lipid nanoparticle which is the transport mechanism for the active ingredient to make it inside a cell without being broken down.
Salts	·         Potassium chloride ·         Monobasic potassium phosphate ·         Sodium chloride ·         Dibasic sodium phosphate dihydrate	These help make sure the vaccine pH is close to that of human cells.
Sugar	·         Sucrose	This ingredient protects the lipid nanoparticle at very cold temperatures (-80 degrees Celsius that the vaccine is stored at due to the instability of the RNA)
Active ingredient	·         30µg of a nucleoside modified messenger RNA	This encodes part of the viral spike (S) glycoprotein of SARS-CoV-2

 

As you can see there are no preservatives or heavy metals present and this is in fact a very simple vaccine ingredient list.

 

Criticisms of the fact that the trials are still being under taken are used from some people who don’t want to take the vaccine until it is fully tested. The length of these trials is to understand the long-term efficacy and safety of the vaccine, participants in the clinical trials are being tracked for a further two years after their second dose. This will give more information on the stability of the antibodies, the type of immune response and how long we can expect immunity to last and any safety information that may differ from the short term effects. It is also a pandemic meaning the cost/benefit analysis on population deaths versus waiting until the trials are over meant that vaccines were approved based on the data already seen in the first part of the phase 3 trial. What they discovered in the first phase trials was that after the first dose the antibody levels were lower to those seen after natural infection with COVID-19. However after the second dose, the antibody levels were higher than those seen after the first dose, and higher than those seen after natural infection. (1) (MOH https://www.health.govt.nz/our-work/diseases-and-conditions/covid-19-novel-coronavirus/covid-19-vaccines/covid-19-how-vaccine-works)

 

Side-effects – as of November 17th 2021 – 52.2% of the world population has received at least one dose of a COVID-19 vaccine, this is 7.54 billion doses of a Covid-19 vaccine and in New Zealand 90% have had their first dose (from https://ourworldindata.org/covid-vaccinations#which-vaccines-have-been-administered-in-each-country) (6) and (Ministry of Health 21/10/2021). I encourage you to look at this resource on a computer to take advantage of the graphs and visual data available. It is important to understand these numbers as they pertain to the majority of our population who are also our clients.

 

The vaccine is not without side-effects, and they should be, in some ways, expected, however most of them are temporary and mild. (8) How side-effects are measured comes down to several things. What was found in the trials, comparing rates of events i.e. when myocarditis a rare event from the vaccine started to appear in vaccinated individuals from real world follow up data, the way these are worked out is by comparing this with the general statistical analysis of myocarditis pre-pandemic, and the likelihood of there being a mechanism which could cause any given side-effect, in this case myocarditis. From the FDA America website “Post-marketing data demonstrate increased risks of myocarditis and pericarditis, particularly within 7 days following the second dose. The observed risk is higher among males under 40 years of age than among females and older males. The observed risk is highest in males 12 through 17 years of age. Although some cases required intensive care support, available data from short-term follow-up suggest that most individuals have had resolution of symptoms with conservative management.”  (7)

 

Due to it being a pandemic and the real world data being released as we go, side-effects are being communicated through the media – causing some fear among people. What is clear is that these same effects are likely to happen with Covid-19 infection the same genetically susceptible people. Spacing apart doses anecdotally appears to reduce side-effects and also to improve and elongate immune response.

 

Here is a table of the known side effects taken from MOH (1) but from studies I have read (8) seem to be the main ones we know about:

 

Common side effects reported in every 1/10 to 1/100 people	Uncommon side effects reported in every 1/100 to 1/1,000 people	Rare side effects
pain or swelling at the injection site feeling tired or fatigued headache muscle aches chills joint pain fever redness at the injection site nausea	enlarged lymph nodes feeling unwell insomnia	Temporary one-sided facial drooping affecting every 1/1,000 to 1/10,000 people in the clinical trials. Myocarditis – inflammation of the heart muscle wall. Symptoms of myocarditis can include: new onset chest pain shortness of breath abnormal/racing heartbeat. It’s important that anyone who experiences these symptoms in the first few days after vaccination seeks medical attention promptly.

 

The main way that health authorities decide whether the vaccine is ‘safe’ safe compared to what for example, is to compare effects of the disease to known side-effects of the vaccine. What we now know about the vaccines being nearly 1 year in is that they protect mainly from hospitalisation and death but after a period of time transmission and catching SARS-Cov-2 and therefore spreading SARS-Cov-2 is reduced but transmission can still occur, albeit with a shorter duration of disease. From an article in the BMJ recently “Vaccinated people were 10 times less likely to be admitted to hospital and five times less likely to be infected than unvaccinated people…Levels of protection were lower than were conferred by vaccines offered at the end of spring, the study found. Vaccine efficacy has declined since the delta variant became dominant around 20 June 2021. The decline in efficacy against hospital admission or death was small, but the protection offered against infection has slipped more significantly.” (9)

 

Regarding myocarditis specifically, it often occurs after a viral illness. Some papers I found which drew some numbers to compare found that myocarditis after being vaccinated bore a 0.002% chance, but more likely in males aged between 16-29 years. The risk for myocarditis was 0.146% among patients diagnosed with COVID-19 during an inpatient or hospital-based outpatient encounter and 0.009% among patients who were not diagnosed with COVID-19 i.e. the general population (10, 11, 12). For governments this is a numbers exercise on relative risk. The reason I am also pointing this out is because the side-effects of the vaccine are the same side-effects of the disease, but in lower numbers. Numbers however are hard to keep up with and keep moving, and as always are different for different countries with different comorbidities and risk factors. This is what we deal with in health as we all know. The best way to look at data is to keep on looking at the data. Knowledge is power, so the more we know what to expect the more we can be prepared and not get to scared when it happens.

 

One thing I learned about population level health as opposed to individualised health is that when dealing with populations, numbers matter. This isn’t to say that we are only a number but the sheer amount of people getting the vaccine and/or Covid-19 mean that we can measure things with numbers, so they do matter. If we gave a single herb to 5 million people in a short time frame and measured the outcomes there is every chance a side-effect profile would develop. Take black cohosh as an example – a strong but powerful herb. There would surely be liver damage examples, menstrual irregularities and more, this should not undo the treatment that is working. What I am saying is that for the amount of real world studies on this as well as clinical trials there is an emerging picture of what is and isn’t caused by the vaccine and this will continue to be looked at for many more years to come, it is ok for science to catch up, but that does not necessarily mean we should advocate for throwing the baby out with the bathwater.

 

 

It follows a logical pathway that side effects which are a result of the body making antibodies to the spike protein and therefore a result of the antibody reaction and not from the spike proteins themselves, which are confined to the tissue in the arm and lymphatic system surrounding it. People worry that the spike protein is spreading to other parts of the body and that side effects are from this. In fact the side-effects experienced are caused by the immune response, vaccines and the following inflammatory cascade stays in the local tissue and lymphatic tissue not the bloodstream (13). With this in mind my approach to naturopathic support before and after the vaccine are this:

• Support with appropriate immune nutrients such as Vitamin A, Zinc, Vitamin D, Selenium, and Vitamin C (among others) before and after (at least a week prior if possible, on the day and for the 2 weeks following vaccine administration
• If the person has been or is stressed and or run down support the person for a month or so prior to get back to good health whether that be by reducing stress with nervines and herbs that reduce the cortisol response, or to help recover after a period of stress with adrenal tonics and immune support
• Give immune support if the person has been stressed prior to infection or is run down as the immune system will likely be affected by stress. Antiviral herbs or herbs that have constituents which potentially block spike protein binding are appropriate for vaccination as if this process is affected by herbs the immune response might not be full and complete.
• If the person has heart issues consider supporting with appropriate herbs.
• Rest for the following few days post-vaccination and consider taking the vaccine on their Thursday or Friday so they can rest the following days when they are most likely to experience side-effects.
• If there are side-effects from the first dose consider what approach may end to be taken before receiving the second dose based on the above and individual clinic presentation in conjunction with the patients doctor.

As with any protocol these should be taken into consideration with a qualified Medical Herbalist or Naturopath and based on your individual needs.

 

It is clear that the Delta strain has affected the efficacy of the vaccine and with 1000 x more viral load it makes sense that previous infection and vaccination can only mitigate this rather than prevent it fully.  This makes sense in the context that the vaccine (or prior infection) primes the immune system and then when a person comes into contact with the virus the immense viral load means the immune system needs to re-create antibodies to fight it. Cases who are previously vaccinated or have prior infection generally have a shorter infection the second time around (14). People with a previous infection and then vaccination have the best protection according to some studies (1). In the future vaccines will need to be updated to this particular strain and also need to be able to last for longer so that governments can rely more on their effectiveness against catching and passing on SARS-Cov-2, in other words we need sterilising vaccines which prevent an infection in the first place. We know that the strong immunity after the vaccine lasts for about 5-6 months and then wanes, (15) breakthrough infection can then occur but the 95% hospitalisation still seems to hold up against this (9).

 

I encourage people to look at the vaccine objectively, and through data not through people or through media outlets whether they be mainstream or alternative sites. I found the data on the CDC USA website particularly helpful especially the graphs, please see here (https://covid.cdc.gov/covid-data-tracker/#covidnet-hospitalizations-vaccination)(17) After reading the data I went from hesitant to pragmatic about it because following public health advice is a big part of keeping the most vulnerable in society safe. We know about the risk factors for Covid-19 disease and some of these are modifiable risk factors i.e. obesity. We can directly help with metabolic health and weight management as well as immunity with herbs and nutrition.

 

As herbalists I believe we can focus on helping people achieve good health, preparing people for catching Covid whether vaccinated or not, and not be too afraid to take the vaccine. Until the disease of Covid is better under control with treatments and prevention then we should do everything that is in our basket, including a vaccine. I found this link from Te Ao with Moana (https://fb.watch/99vJlH8TKe/) (18) where Rongoa practitioners discuss their views on the vaccine which I found inspiring. We can support people no matter what – our path is to support the person holistically and in conjunction with allopathic medicine.

 

One thing we can count on is catching SARS-Cov-2 in the near term so we must be prepared for the immune challenge that is coming our way, if we are not vaccinated it may happen sooner, if we are vaccinated once the immunity wanes after 5-6 months we may then still catch Covid and will still need immune support. This is a great opportunity to talk about stress and how this impacts the immune system. And how sunshine, food and laughter also help. We can teach people how to keep weight down and get on polyphenol rich herbs to support the cardiovascular system especially in highly stressed individuals. I feel that it is also our role to reassure the community that you can and will be safe to receive the vaccine and that we can and will deliver herbs after a short 15 minute phone consult for Covid. Contactless delivery is a must for when our patients require our herbal help.

 

Bio: Simone Reddington holds a Degree in Psychology, B Nat Med and Diploma in Herbal Medicine. She runs a group practice in Christchurch as well as a Herbal Apothecary, and is interested in promoting science based Herbal Medicine and integrative practice with the medical system.

 

References:

1. https://www.bmj.com/content/370/bmj.m2426.full The role of chest radiography in confirming covid-19 pneumonia. BMJ 2020; 370 doi: https://doi.org/10.1136/bmj.m2426 (Published 16 July 2020) Cite this as: BMJ 2020;370:m2426.
2. MOH https://www.health.govt.nz/our-work/diseases-and-conditions/covid-19-novel-coronavirus/covid-19-vaccines/covid-19-how-vaccine-works Ministry of Health New Zealand
3. https://publichealth.jhu.edu/2021/the-long-history-of-mrna-vaccines The Long History of mRNA Vaccines. Published October 06, 2021, By Chris Beyrer
4. https://publichealth.jhu.edu/2021/the-new-technology-behind-covid-19-rna-vaccines-and-what-this-means-for-future-outbreaks The New Technology Behind COVID-19 RNA Vaccines and What This Means for Future Outbreaks. Published. January 15, 2021
5. https://www.youtube.com/watch?v=VdqnAhNrqPU&t=44s Meet the scientist couple driving an mRNA vaccine revolution | TED
6. https://ourworldindata.org/covid-vaccinations#which-vaccines-have-been-administered-in-each-country Our World in Data
7. https://www.fda.gov/emergency-preparedness-and-response/coronavirus-disease-2019-covid-19/comirnaty-and-pfizer-biontech-covid-19-vaccine#additional Comirnaty and Pfizer-BioNTech COVID-19 Vaccine. Content current as of: 10/29/2021
8. https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(21)00224-3/fulltext Vaccine side-effects and SARS-CoV-2 infection after vaccination in users of the COVID Symptom Study app in the UK: a prospective observational study.
9. https://www.bmj.com/content/374/bmj.n2282 Covid-19: Unvaccinated face 11 times risk of death from delta variant, CDC data show
10. https://www.nature.com/articles/d41586-021-02740-y Heart-inflammation risk from Pfizer COVID vaccine is very low
11. https://www.nejm.org/doi/full/10.1056/NEJMoa2110737 Myocarditis after Covid-19 Vaccination in a Large Health Care Organization
12. https://www.cdc.gov/mmwr/volumes/70/wr/mm7035e5.htm Association Between COVID-19 and Myocarditis Using Hospital-Based Administrative Data — United States, March 2020–January 2021
13. https://pubmed.ncbi.nlm.nih.gov/21683103/ The role of the lymphatic system in vaccine trafficking and immune response Review. Adv Drug Deliv Rev. 2011 Sep 10;63(10-11):909-22. doi: 10.1016/j.addr.2011.05.018.
14. https://ncrc.jhsph.edu/research/comparing-sars-cov-2-natural-immunity-to-vaccine-induced-immunity-reinfections-versus-breakthrough-infections/ Comparing SARS-CoV-2 Natural Immunity to Vaccine-Induced Immunity: Reinfections versus Breakthrough Infections
15. https://pubmed.ncbi.nlm.nih.gov/34002089/ Neutralizing antibody levels are highly predictive of immune protection from symptomatic SARS-CoV-2 infection. David S Khoury # 1 , Deborah Cromer # 1 , Arnold Reynaldi  1 , Timothy E Schlub  1   2 , Adam K Wheatley  3 , Jennifer A Juno  3 , Kanta Subbarao  3   4 , Stephen J Kent  3   5   6 , James A Triccas  7   8 , Miles P Davenport  9. Nat Med. 2021 Jul;27(7):1205-1211. doi: 10.1038/s41591-021-01377-8. Epub 2021 May 17.
16. https://www.cdc.gov/mmwr/volumes/70/wr/mm7034e5.htm#T1_down SARS-CoV-2 Infections and Hospitalizations Among Persons Aged ≥16 Years, by Vaccination Status — Los Angeles County, California, May 1–July 25, 2021
17. https://covid.cdc.gov/covid-data-tracker/#covidnet-hospitalizations-vaccination Covid data tracker – Age-Adjusted Rates of COVID-19-Associated Hospitalizations by Vaccine Status in Adults Aged ≥18 Years, January–August 2021
18. https://fb.watch/99vJlH8TKe/ Te Ao with Moana link to facebook (no link yet provided by Mori TV)
19. https://jamanetwork.com/journals/jama/fullarticle/2786040?fbclid=IwAR2733flFTiepXuZzYFdIJXrZS-HBfPBOFhGygbiY4MadBnYwhnL1f2XjH0 Understanding Breakthrough Infections Following mRNA SARS-CoV-2 Vaccination. Michael Klompas, MD, MPH. JAMA. Published online November 4, 2021. oi:10.1001/jama.2021.19063
20. https://gis.cdc.gov/grasp/COVIDNet/COVID19_5.html Laboratory-Confirmed COVID-19-Associated Hospitalizations