October Town Hall: Vaccines, Science, Safety and the Path to Protection

Well, thank you everybody for joining us tonight. This is another installment of NVFB’s town hall, and we really appreciate you all coming tonight. Before we get started, I think this is a very timely opportunity to let you all know that we have COVID and flu vaccines, and this is a great time to go and get them. If you haven’t gotten yours yet, please go to either your local pharmacy, the health department, or obviously give us a call. We have flu clinics on Tuesdays and Thursdays. You can do it for a regular nurse’s visit, however you want to get it. We certainly want to make sure that you get your flu and your COVID shots this year, preferably before the beginning of December. Just give us a call if you’re not sure if you need to get it or if you’re not sure how to get it, but we’re happy to give it to you or tell you where you need to go. We highly recommend it.

With that said, we are also giving this timely talk today because there is a lot of information out there in the news, regardless of where you get it. I’m hearing a lot of questions from people, skepticism about vaccines, lots of questions. People aren’t sure what to believe, what they hear, where they get their information. We decided that this would be a good talk to have because as physicians, we get all our vaccine information from things like the New England Journal and from JAMA and from research papers. Getting your vaccine information from Fox News or MSNBC is probably not a great resource for you. So, we decided to have a presentation to hopefully cut through a lot of the misinformation or unfortunate things that are out there and just go straight to the science. We invited Dr. Nita Swami to join us today. She is an allergist and immunologist in the Arlington area and a wonderful allergist and immunologist at that. Dr. Swami went to UT Austin for undergrad and then got her medical degree from the University of Chicago School of Medicine. She did her residency at Texas Health Presbyterian Hospital and then did a fellowship as well. She is board certified in allergy and immunology, and the best compliment I can give Dr. Swami is that I am a patient. So, I’m very happy to have her today, and I appreciate you coming and looking forward to what you have to say.

Hello everyone. Welcome. I’m giving a talk on vaccines as Dr. Zwag said. I’m going to go through the basics, the science of it. It’s going to get into politics a little bit, and then we’ll go into how vaccine safety and the guidelines and things like that as well. Just to start, the objectives of this are to go over why vaccines matter, explain the core immunologic mechanisms, go over vaccine surveillance safety, the process that vaccines go through before they’re approved, interpret US immunization trends, discuss barriers, hesitancy, programmatic challenges, and apply strategies to improve vaccine uptake, and finally, the future of vaccines.

Do you mind if I just interrupt one second? I forgot to mention that if anybody has any questions, you can go ahead and feel free to put them in either the chat or the question and answer section. We’ll wait till the end hopefully and then try to get to them as much as we can, but feel free to put them in as we go. Sorry about that. Sorry to interrupt.

No, not at all. So, why do vaccines matter? Essentially, they rival clean water in terms of public health impact. They’ve saved over 154 million lives in the past 50 years and are credited with dropping 40% of infant deaths due to their success. They prevent diseases like COVID-19, measles, whooping cough, influenza, HPV, among others. A lot of these illnesses can lead to severe complications and even death, especially in infants, the elderly, and those who are immunocompromised. They also induce something called herd immunity, which means that enough people in a community or area have achieved protection or immunity against an infection to make it very difficult for the infection to spread. It also protects those who can’t be vaccinated, like newborns and those with certain medical conditions. They have a high return on investment, preventing disease, which is far less expensive than treating it. They reduce hospitalizations, long-term complications, and even improve economic productivity. The CDC estimates that $1 spent on child vaccines saves over $10 in healthcare costs.

In basic terms, vaccines mimic natural infection without causing disease. In complicated terms, they produce an antigenic component, which is just the part of the pathogen that activates the immune system, which activates types of white cells called memory B and memory T cells. The immune system remembers the pathogen, so upon reexposure, it mounts a rapid and robust response, neutralizing the infection before the illness even develops. That’s the basis of protective immunity. We have antigen-presenting cells that process the vaccine proteins, present them to other types of white blood cells called B and T cells, and trigger certain lymphocytes that are memory B cells and memory T cells. These cells remember the vaccine protein and elicit the antibody response when you’re exposed to the infection, leading to long-term protection after vaccine exposure. Memory B cells maintain the protective antibody titers. Vaccine efficacy depends on host immune status, antigen characteristics, and vaccine formulation. Immunization schedules are designed to optimize the timing for boosters needed for those with waning immunity or underdeveloped immune systems like in infants or immunocompromised individuals. Understanding these immunologic mechanisms is important for evaluating vaccine responses and interpreting the level of protection for some vaccines.

These are the most common types of vaccines available. There’s the live attenuated, which have weakened pathogens that replicate the infection and mimic a natural infection, eliciting robust, long-lasting immunity. They can’t be used in immunocompromised or pregnant patients because it’s a live vaccine. Then there’s the inactivated or killed vaccines, which have proteins inactivated by heat, chemicals, or radiation. They cannot replicate, and the immune stimulant relies on antigen recognition, the protein presented. They elicit a weaker immune response and often require multiple doses or periodic boosters to sustain the response. They are safe in immunocompromised patients. Examples include hepatitis A, polio, and rabies vaccines. Then there’s the subunit recombinant polysaccharide and conjugate vaccines, which have a good safety profile. They have specific antigens like proteins or polysaccharides derived from the virus or pathogen. They don’t have the entire organism, so the immune system is highly targeted to that immune response. They require certain proteins called adjuvants to enhance the immune response. Another effective treatment is toxoid vaccines, which have inactivated bacterial toxins that stimulate the production of protective antibodies against the toxin, not the bacteria itself. Examples are the diphtheria and tetanus vaccine, effective for toxin-mediated diseases, but you need boosters every 10 years to stay up to date. The mRNA vaccines, like the COVID vaccines, deliver messenger RNA encoding a pathogen-specific antigen, usually a viral surface protein. Host cells translate the mRNA into antigen, triggering B and T cell responses. They are non-infectious and a non-integrating platform, rapidly adaptable to new emerging pathogens, but often require boosters. Finally, vector vaccines use a non-replicating viral vector to deliver genetic material to the target antigen. The problem is the immune system can target the vector itself, leading to a weakened immune response.
Vaccines go through an extensive process before release, starting with cellular and animal models, followed by phase one to phase three clinical trials with progressively increasing populations. After approval, vaccines undergo continuous safety monitoring to detect rare or delayed events not seen in trials. Safety monitoring systems are in place by the FDA, CDC, World Health Organization, and now active monitoring systems through electronic medical records.

Looking at vaccine safety, vaccines have dramatically reduced or eradicated many deadly and debilitating diseases like smallpox, measles, polio, and meningitis. A person is far more likely to be harmed by a vaccine-preventable disease than by the vaccine itself. Minor side effects are more common but generally short-lived, often a local reaction like a sore arm, localized redness, muscle aches, joint aches, headache, fatigue, and mild fever. More serious side effects are extremely rare, including severe allergic reactions, Guillain-Barré syndrome, nerve polyneuropathy, and seizures. The benefits of vaccinating far outweigh any risks by preventing disease, hospitalizations, or death. There’s no credible evidence linking vaccines to autism, autoimmune disease, or infertility. Multiple large-scale studies show their safety.
This is a summary of the vaccines recommended throughout the lifetime as it is now, but I won’t go into too much detail on this. To summarize vaccine coverage trends in the US, adolescent vaccines like HPV, diphtheria, tetanus, and meningitis are trending upward, reflecting effective school and provider programs. However, early childhood vaccines like MMR, diphtheria, tetanus, and varicella have concerning declines. National coverage is now around 91 to 93%, and typically 95% is recommended to induce herd immunity, so we’re below that. For adults, coverage of the COVID-19 vaccine increased, as did shingles, but there have been declines in COVID boosters and influenza boosters. Pneumonia vaccines in adults 65 and older have decreased but remained stable in at-risk adults 19 to 64. Along with declines in vaccine coverage, there has been a resurgence of several vaccine-preventable diseases post-pandemic that were previously near elimination. Measles and pertussis stand out with the steepest increase, with measles rising over a 100-fold from very low case counts in 2020, and pertussis shows an eight-fold jump. Pertussis can increase due to waning immunity from the vaccine, but the majority are due to missed childhood vaccines. Influenza and RSV also increased once COVID precautions were lifted, exposing an immunity gap where lack of exposure to these viruses led to low to absent natural immunity. The new RSV vaccines introduced in 2023 are helping curb that incidence, but it hasn’t reversed the upward trend. Hepatitis A continues to cause outbreaks, particularly among unvaccinated adults and in high-risk settings such as homelessness or substance use. Pneumococcal disease is seeing a modest increase, more likely reflecting declining uptake in older adults. There was also a delayed rollout of the newer pneumococcal vaccines, PCV 15 and PCV 20.

This is a big slide, so I don’t think we have time to discuss all the barriers to vaccination, but I’ll try to summarize them the best I can. The World Health Organization identifies vaccine hesitancy as a top 10 global health threat due to misinformation from social media and pseudoscientific resources, distrust towards the government, pharmaceutical companies, and healthcare institutions. There’s also an imbalance in the perceived benefit versus risk ratio, with significant fear of vaccine side effects. There are imprecise beliefs on natural immunity. We are in a scary time for policy and regulatory barriers. The federal government has made drastic changes to vaccine policy and funding. This past year, they weakened some vaccine recommendations for children and adults, halted research funding for vaccine development, and slashed funding for federal, state, and local public health practitioners working in immunization efforts. Some states are likewise implementing anti-vaccine policies, reconstituting advisory panels with members who have more anti-vaccine views, raising concern about the evidence-based nature of future recommendations for these vaccines.

How do we get past these barriers? We first need to strengthen our access and infrastructure. We need to make vaccines more available in pharmacies, workplaces, and community clinics. We need to implement reminder recall systems, like text and EMR alerts, and eliminate cost barriers through programs like Vaccines for Children or externally funded adult immunization programs. We should target special populations like the underinsured, immunocompromised, older populations, and pregnant individuals. One of the strongest things we can do as healthcare professionals is to build trust and communication with the patient. We have to lead with empathy and respect, acknowledge the patient’s concerns, and try to address any misinformation directly and calmly, emphasizing the data and the benefits over the risks. In terms of policy and system support, we’ve lost some highly educated evidence-based experts from the organizations responsible for guiding these vaccine policies and mandates. It’s a challenging thing to go up against now, but we should do our best to support the clinical evidence when we can, endorse school and workplace vaccination requirements, streamline state immunization registries for better tracking and reminders, and use technology and outreach by employing digital registries, educational videos, and mobile vaccination teams to reach a wider audience. I feel cautiously optimistic that we can make a difference even when it is an uphill battle.

What should we expect to see in the future? We have the COVID-19 mRNA vaccines, but they are being studied to treat various infectious diseases like all coronaviruses, HIV, malaria, tuberculosis, hepatitis C, and C. diff. They’re being studied to treat food and environmental allergies, autoimmune conditions, and malignancies. The goal of these vaccines is to produce more durable immunity with smaller doses. In August 2025, the HHS terminated 22 mRNA vaccine development projects and cut nearly $500 million in grants and contracts administered through BARDA, affecting mRNA vaccine research in the US. DNA vaccines use engineered bacterial plasmids that carry a gene encoding a specific antigen. Once injected, those cells take that up and produce the immune response. This has shown good potency in animal models but hasn’t shown as strong in human studies. They’re working to see if they can improve that. Vector vaccines use a harmless virus or bacterium to deliver genetic material into the body, stimulating an immune response. They can target a wide range of pathogens, including bacteria, viruses, and parasites. VLPs mimic the viral structure but lack the viral genome, making them safe and effective at presenting the viral protein antigen to induce an immune response. They induce it in the virus’s native configuration, providing a more targeted and accurate response. Nanoparticles can display multiple antigens, target specific immune cells, and enhance durability. Vaccinology is using more computational approaches, and they’re developing universal or multivalent vaccines designed to protect against multiple strains or variants of an infection, such as influenza or coronavirus. Therapeutic vaccines are being examined to move beyond prevention and actually treat existing diseases, including cancer and chronic infections. Innovations like microneedle patches, biodegradable implants, intranasal, sublingual, and oral vaccines are being developed. Hopefully, those needle-free options may enhance vaccine acceptance too. Overall, emerging vaccine technologies represent a paradigm shift: faster development, broader immunity, greater adaptability, and improved access. For practitioners, understanding that platform is key to optimizing vaccine use, patient education, and policy integration as well.

Great. Well, good. I think that was terrific. Thank you so much. Of course, that’s great. As we said before, if anybody has any questions, I see there’s already one there, but if you want to add any questions into the Q&A section on the bottom of your screen or put it into the chat, we’d be happy to answer them however we can. I have a couple of questions myself. Before we start, there’s one from one of the patients that says, “I don’t know if you can answer this, but with the government shutdown, is there a concern that the CDC is not able to monitor and track viruses?”

Not really. There are still people in play that are monitoring, but there have been several that have been cut back and not able to do so. I don’t know the extent of the monitoring. I just know that there’s been some effort to maintain that, but I’m not sure. There definitely have been some cutbacks, of course, too. My understanding also is that there are some cutbacks, but the states are still functioning. The Virginia Department of Health is still doing it. It’s not as adequate across state lines, but at least in our local area, the Department of Health, the Arlington, Alexandria, and Virginia Department of Health are still functioning to monitor for vaccines that are going to be a problem. I guess only time will tell, but hopefully, it will be just fine.

I had a question for you. Obviously, the mRNA, one of the concerns for it is that they say that it changes your DNA or it does things that are permanent alterations to you. If you wouldn’t mind speaking to that because it’s one of the concerns that a lot of people have about the mRNA vaccines.
Yeah. So those do not affect our own DNA or our genome. They essentially contain the viral mRNA particles, and that is what just induces an immune response. Just like with other antigen-producing vaccines, you’re inducing this antibody response by exposure to the actual RNA of the virus, but it doesn’t affect our RNA, DNA, or genome whatsoever. It’s just more targeting the immune response and it targets specific immune cells involved in antibody production and creating that. It has a more robust response than the other vaccines that have been on the market, which is why it’s being used for coronavirus, and it’s easily adaptable as well. We are able to modify when needed, as we have been with the COVID boosters or as they have been with the COVID boosters.

I always liken it to a car factory. The factory makes a bunch of cars, and let’s say it’s making a bunch of red cars, and this is a signal that says, “Hey, make blue cars.” So, all of a sudden, you get a bunch of blue cars. You haven’t done anything to the factory. Nothing else has changed. Just what’s changed is coming out for a period. And then as soon as that signal goes away, it goes back to the way that it works.
Yeah. It’s only affecting the immune system that’s producing those antibodies. It’s not going into any other part of our organs or anything like that.

Ed Ward is asking regarding emerging therapies, what is the prospect for them in the current DHS funding philosophies?

So I think these are getting tricky about outside the medical realm, I guess. But yeah, that’s a good question. I’m not sure. A lot of those cuts to funding have been pretty recent. I think the one cut to the mRNA was just in August, and I think there were a couple of studies that were allowed to go through, but there were quite a few that were cut back. To the extent of what that’s going to mean, I think we have yet to see, but it’s definitely not a good thing. My take is it’s certainly going to be new vaccines, the research and whatnot, it’s going to be significantly slowed and set back, at least in this country. I think we’re going to be able to have access to all the vaccines that we’ve had access to all along, but as a matter of coverage and whatnot, that remains to be seen as well because commercial insurances tend to follow Medicare’s lead, so it really depends on what Medicare does with these. We’ll have to wait and see, but we’re certainly big fans and will do everything we can to help our patients at least to get the vaccines that they need and that they want.

Another question I had for you is, let’s say a lot of these vaccines have two or three vaccines that are needed as boosters over a scheduled series. What happens if you don’t follow the schedule exactly or you miss your third dose? What can you do at that point?

Essentially, if you lose that immunity that you gain from the initial vaccine, you need those booster doses to complete the immunity because there are some pathogens that when we’re exposed to them and produce those antibodies, we lose them over time. To reintroduce those antibodies and reintroduce that protection, it’s important to get those booster vaccines because they’re not a lifelong effective therapy, just like we have turnover in other parts of our body. The same thing with the immune system. Those antibodies over time dissipate, so it’s important to get revaccinated to keep that protection up.
But what if you’re two months late? You could still get it. Yes, you should get those booster doses, even if you’re late, because you can kind of catch up to it. So it’s better to get it than not.

I get that question a lot in my practice as well.

Robert Thompson asks, “Will leadership and vaccine development and knowledge shift to some other part of the world?” It’s a good question if you have a thought about that.

I think so. There’s a lot of interesting studies coming out of India, China, and Europe as well, where they’re advancing. I do think that we’ll see more evidence because polio and measles are starting to outbreak globally as well. There are definitely studies to look into that and protect against that. In Africa, in terms of yellow fever, that has been on the rise, and Ebola, there’s been vaccine development being studied in those countries as well.

A lot of the diseases that we deal with here do start in other countries and migrate to us, so certainly there’s an interest in the whole world getting involved in this. There is good research being done in other places as well. We just hope that research gets done in a reasonable amount of time. We already got through one global pandemic. I think we are probably good for a little while. It’s about every 100 or 200 years, so hopefully, we won’t have to deal with it too much in the near future.

If anybody has any other questions, you can put them in now, or you can always add them afterward, and we can always try to answer them later as well. My last question for you is, I’d like to know which part of Arlington is that photo because that’s at the Grand Tetons. That’s beautiful.

Well, good. It looks like there’s no other questions, but I think that was really helpful. It was a great presentation. I really appreciate it. Hopefully, that was helpful for everyone who attended. Thank you. Her information is there. If you want to get in touch with her, you can email her. You can also contact us, and we can always get you in touch with Dr. Swami. She’s a great resource for us as well. I really appreciate your time. There is a question in the Q&A that we already got to. I think that’s the only question that we have. Looks like that’s the only one. Harry got to that question.

Great. Well, here we go. I’m sorry. Do recommendations for COVID vaccines differ for young adults? In terms of government policies or what the science shows, the science shows that young adults should also be getting the boosters annually and have their vaccines updated so that they are protected to the new COVID antigens that are being produced or mutated.

Actually, if I could make one more point, one of the things that I get a lot is that vaccines are not perfect. As you alluded to, there can be side effects, and they’re not 100% effective either most of the time. One of the things like COVID or flu, certain vaccines, they may only be 40, 50, 60% effective at preventing the disease, but more importantly, what we’re really trying to do with vaccines is prevent complications from the disease. If you get the flu and you’re sick for a couple of days, you miss work, that’s too bad, but it’s not the worst thing in the world as long as you get better. But if you get the flu and have complications, end up in the hospital, or have pneumonia or some other complications with it, obviously that’s a much bigger deal. God forbid death, that’s a much bigger deal. When we hear these numbers that it’s only 50% effective or 60% effective, that’s only 50 or 60% effective at preventing getting the illness. But the flu shot, the COVID shot, a lot of these other ones, what they’re really good at is 90, 95%, 98% effective at preventing complications, long-term adverse outcomes, or death. That’s where some of the misperception comes in, that, “Oh, I got the shot, and I still got sick.” Okay, you missed a couple of days of work, or you may have had something that had nothing to do with the flu or COVID, but it felt like it, and then you got back and you were fine. But shots, these vaccines, what they do very well is keep people out of the hospital, prevent death, prevent long-term complications, and that’s where their best performance is, I think, in a lot of these cases. That’s an important point to make.

Definitely. Good points. Well, I think that is about it. Thank you so much. Some tough questions were thrown your way. I appreciate you fielding those and really appreciate your time and appreciate everybody for joining in. Hope everybody has a great night. Take care. Thanks again.