Vaccine Trials

[Telly]

Key issues still to be determined are vulnerability to infections and whether the vaccinated can still spread the infection to others.

When I read about this Infection vs. Disease concept in the newspaper, it took me a bit to grasp it. I don't know if there have been other diseases that a vaccine has been created for that brought up this issue before. I'd never heard of it.

If I'm understanding it correctly, if someone were vaccinated and the vaccine prevented them from the "disease" but not the "infection", they would have no disease effects, but they would be spreading the virus with no ill effect to themselves. In other words, an asymptomatic person. So we could have asymptomatic people running all over feeling fine but spewing virus. Till someone gets hit out of the blue. I don't know where this leaves all the talk about "antibodies"... would they be relevant at all in these asymptomatic people?

 

[Telly]

Order of Priority for Vaccination

There is a long(!) thread on vaccines, but I did not see one on this facet.

The ACIP (Advisory Committee on Immunization Practices) studies the vaccine issues, and makes a recommendation, that the CDC then publishes as its recommendation. Like the recent change on the Pneumonia Vaccines.

In the last day or so, have seen different articles basically saying the same thing. That the going idea being mulled over is 4 groups:

Health care workers: Vaccinating roughly 20 million US doctors, nurses, lab technicians and other health care providers helps protect both the country's front-line COVID-19 responders and the patients they care for.

Essential workers: Approximately 87 million US workers provide the basic goods and services we need to survive. Most can't work from home and many jobs require interacting with the public, so guarding against COVID-19 among this population would have a ripple effect across the whole country while also reducing critical service interruptions.

People with underlying medical conditions: Specifically, the 100 million or so people with conditions putting them at high risk for illness or death from COVID-19. Any disease affecting the lungs, but also anything that could compromise a person's immune system, like cancer or HIV.

Older adults: Risk of severe complications from COVID-19 increases with age. The CDC's ACIP recommends the approximately 53 million US adults age 65 and over be among the first to get vaccinated.

I copied this list from https://www.cnet.com/how-to/covid-1...be-last-in-line-heres-who-will-get-one-first/ just to save me typing it. The same list with the same numbers appears on many different websites, including ones with more medical pedigree. But it is prioritized from top to bottom. Adding 20 + 87 + 100 + 53 million = 260 million. Which with a US population of 330 million, leaves the remainder, 70 million, in a last and unnamed group.

I realize that not everyone can be Priority 1 (aww), but if us 65 and older folks are down in the fourth group, maybe it would be wise to send us coffin kits via UPS. Once people start being vaccinated, I expect the whole mask-wearing, distancing, rules on capacity and what is open etc. to be ignored and all fall apart. And there for quite awhile will be us un-vaccinated older folks with no idea who had the vaccination regimen, did they actually have both shots or did they skip the second shot just like not taking antibiotics anymore 'cuz "I feel better now", or are they un-vaccinated? We won't know, how would we tell? And we supposedly, and the stats in our big-city newspaper bears it out county by county, are more susceptible to death from it.

Now personally, I'm OK with dying if it isn't drawn-out. But Covid-19 is not on my list of ways to prepare me to be sent across the river Styx. Now if I was lying in ICU, and there was a shortage of ventilators and I was about to be intubated, I might well wave it off and tell them leave me, give it to someone younger. But that would be MY choice.

When the ACIP votes soon, if this indeed is the priority order they end up recommending, then maybe it will also be the solution to the ~2035 SSA problem.

Here, take the flowers Bud! Oh, and thanks for helping on the SSA solution!

 

[explanade]

When I read about this Infection vs. Disease concept in the newspaper, it took me a bit to grasp it. I don't know if there have been other diseases that a vaccine has been created for that brought up this issue before. I'd never heard of it.

If I'm understanding it correctly, if someone were vaccinated and the vaccine prevented them from the "disease" but not the "infection", they would have no disease effects, but they would be spreading the virus with no ill effect to themselves. In other words, an asymptomatic person. So we could have asymptomatic people running all over feeling fine but spewing virus. Till someone gets hit out of the blue. I don't know where this leaves all the talk about "antibodies"... would they be relevant at all in these asymptomatic people?

The covid infections occurs through nose and mouth. Then it spreads to your lungs and other organs.

Vaccine would raise antibodies and T cells to kill off the virus but only after it reached the lungs and organs.

That's how vaccines would prevent you from getting sick.

But you may still have the virus in your nasal passages and mouth and you could still be infectious.

I've read it described as turning covid into something like the cold. You can pass it on to others and if they're vaccinated, they would at worst suffer some cold symptoms. But if they're not vaccinated, they'd be vulnerable.

I think public health experts said that situation wouldn't be ideal but it would be a worthwhile tradeoff, as long as most people got vaccinated.

There are vaccines in development which would be administered through the nose or mouth, so it would try to have antibodies in those areas as well.

Or they may have to come up with antiviral drugs which could be delivered in those areas, while the vaccines would protect the rest of your body.

One article I read said the whooping cough vaccine also prevents sickness but not necessarily infection.

 

[Ronnieboy]

The information I have been given so far (which changes almost daily with such a fluid topic) is that the FDA isn't meeting to make the emergency use authorization for the vaccine(s) until 12/10/20 so the soonest a vaccination can be given will be 12/11/20. Why they don't move the time up? Who knows. Maybe all the data won't be available until then....you would think in a rational world that the date would/should/could be moved up if they had everything in place.

The vaccine(s) are expected to be approved. Some of the vaccine(s) have been or are currently being shipped out to phase 1 - hospitals as we speak, based on the belief that approval is going to happen. Phase 1 is going to be given to 1st line workers and high risk patients. Theoretically ICU workers, doctors, nurses, basically hospital employees dealing with covid infected patients on the daily. Possibly then nursing home type of situations.

Being in retail pharmacy who does immunize, we are told we'd be in phase 2 of the vaccine delivery. We wouldn't be getting the ultra frozen vaccine but the one(s) that can be controlled at realistic temps (-5F up).
The suggested protocol for us is to make appointments to give the immunizations and to have both 1st and 2nd shot on had for the patient (i.e. the second shot would be held) as you cannot mix manufacturers for 1st and 2nd shots. As of this time we haven't been told to hold the vaccine for 'older' adults.
And that the immunization would be free. If insurance allows, we would try to bill an immunization administration fee but either way for the patient it is $0.

The majority of the general public will be able to be immunized in the 2nd quarter of 2021. (April-June)

Of course this is all subject to change on a moments notice.

 

[Badger]

There is a long(!) thread on vaccines, but I did not see one on this facet.

The ACIP (Advisory Committee on Immunization Practices) studies the vaccine issues, and makes a recommendation, that the CDC then publishes as its recommendation. Like the recent change on the Pneumonia Vaccines.

In the last day or so, have seen different articles basically saying the same thing. That the going idea being mulled over is 4 groups:

Health care workers: Vaccinating roughly 20 million US doctors, nurses, lab technicians and other health care providers helps protect both the country's front-line COVID-19 responders and the patients they care for.

Essential workers: Approximately 87 million US workers provide the basic goods and services we need to survive. Most can't work from home and many jobs require interacting with the public, so guarding against COVID-19 among this population would have a ripple effect across the whole country while also reducing critical service interruptions.

People with underlying medical conditions: Specifically, the 100 million or so people with conditions putting them at high risk for illness or death from COVID-19. Any disease affecting the lungs, but also anything that could compromise a person's immune system, like cancer or HIV.

Older adults: Risk of severe complications from COVID-19 increases with age. The CDC's ACIP recommends the approximately 53 million US adults age 65 and over be among the first to get vaccinated.

I copied this list from https://www.cnet.com/how-to/covid-1...be-last-in-line-heres-who-will-get-one-first/ just to save me typing it. The same list with the same numbers appears on many different websites, including ones with more medical pedigree. But it is prioritized from top to bottom. Adding 20 + 87 + 100 + 53 million = 260 million. Which with a US population of 330 million, leaves the remainder, 70 million, in a last and unnamed group.

I realize that not everyone can be Priority 1 (aww), but if us 65 and older folks are down in the fourth group, maybe it would be wise to send us coffin kits via UPS. Once people start being vaccinated, I expect the whole mask-wearing, distancing, rules on capacity and what is open etc. to be ignored and all fall apart. And there for quite awhile will be us un-vaccinated older folks with no idea who had the vaccination regimen, did they actually have both shots or did they skip the second shot just like not taking antibiotics anymore 'cuz "I feel better now", or are they un-vaccinated? We won't know, how would we tell? And we supposedly, and the stats in our big-city newspaper bears it out county by county, are more susceptible to death from it.

Now personally, I'm OK with dying if it isn't drawn-out. But Covid-19 is not on my list of ways to prepare me to be sent across the river Styx. Now if I was lying in ICU, and there was a shortage of ventilators and I was about to be intubated, I might well wave it off and tell them leave me, give it to someone younger. But that would be MY choice.

When the ACIP votes soon, if this indeed is the priority order they end up recommending, then maybe it will also be the solution to the ~2035 SSA problem.

Here, take the flowers Bud! Oh, and thanks for helping on the SSA solution!

+1 I don't have any confidence in most people being rationale thinkers.



Cheers!

 

[RetireBy90]

The vaccine(s) are expected to be approved. Some of the vaccine(s) have been or are currently being shipped out to phase 1 - hospitals as we speak, based on the belief that approval is going to happen. Phase 1 is going to be given to 1st line workers and high risk patients. Theoretically ICU workers, doctors, nurses, basically hospital employees dealing with covid infected patients on the daily. Possibly then nursing home type of situations.

Being in retail pharmacy who does immunize, we are told we'd be in phase 2 of the vaccine delivery. We wouldn't be getting the ultra frozen vaccine but the one(s) that can be controlled at realistic temps (-5F up).
The suggested protocol for us is to make appointments to give the immunizations and to have both 1st and 2nd shot on had for the patient (i.e. the second shot would be held) as you cannot mix manufacturers for 1st and 2nd shots. As of this time we haven't been told to hold the vaccine for 'older' adults.

Lots of "authoritative" information out there and I'm not even talking the internet. Great hearing what someone on the ground has been told so far.

I heard the Warp Speed General at a news conference say they would ship the first dose when approved, that they can't ship until is is approved. I also heard him say they would ship the 2nd dose to the same places the first was sent so the 2nd dose doesn't have to be kept frozen or ultra frozen for the period between doses. Perhaps he was thinking of only the Pfizer product with the ultra frozen requirement when he said they would track and make 2 shipments.

Each state has provided a plan on how to distribute the vaccine so I would expect some confusion in that one state could include nursing home residents and staff and another could just include the staff, thinking the staff would be the ones bringing infection to the facility.

It will be interesting to watch this play out. I expect some bumps along the way of course but hope with all the planning that it works out. Let us be gracious in our judgement and understand how difficult this can be for over 300 million people to get vaccinated.

 

[JoeWras]

Judging by our situation with toilet paper, ground beef, and cleaning wipes, I expect people to be act with the kindest compassion during this distribution.

Yeah, right.

I guess I'm in the last 53 million, unless I get certified as essential when we restart our disaster relief efforts. Which begs the question: how does one be certified "essential?" I would guess through the honor system.

 

[Nemo2]

I know nothing about this beyond what I've read here:

https://www.cbc.ca/news/canada/edmonton/alberta-researcher-award-salt-masks-covid-1.5813921

Ilaria Rubino, a recent PhD graduate from the department of chemical and materials engineering at the University of Alberta, said a mostly salt and water solution that coats the first or middle layer of the mask would dissolve droplets before they can penetrate the face covering.

As the liquid from the droplets evaporates, the salt crystals grow back as spiky weapons, damaging the bacteria or virus within five minutes, Rubino said.

"We know that after the pathogens are collected in the mask, they can survive. Our goal was to develop a technology that is able to inactivate the pathogens upon contact so that we can make the mask as effective as possible."

The reusable, non-washable mask is made of a type of polypropylene, a plastic used in surgical masks, and could be safely worn and handled multiple times without being decontaminated, Rubino said.

The idea, she said, is to replace surgical masks often worn by health-care workers, who must dispose of them after a few hours. Rubino said the technology could potentially be used for N-95 respirators.

The salt-coated mask is expected to be available commercially next year after regulatory approval. It could also be used to stop the spread of other infectious illnesses, such as influenza, Rubino said.

 

[Aerides]

Each state has provided a plan on how to distribute the vaccine so I would expect some confusion

This is very important. Each State will be determining priority and distribution logistics. So what you read here (and anywhere) must be taken with a location context.

Priority and scheduling in FL will not be the same as that in GA, and so on. Perhaps by the later batches, some best practices will be baked in, but that may be wishful thinking. Some states will be getting the 2 shot versions, some the 1. It's all speculation until your individual county tells you what to expect.

 

[kcowan]

When I read about this Infection vs. Disease concept in the newspaper, it took me a bit to grasp it. I don't know if there have been other diseases that a vaccine has been created for that brought up this issue before. I'd never heard of it.

If I'm understanding it correctly, if someone were vaccinated and the vaccine prevented them from the "disease" but not the "infection", they would have no disease effects, but they would be spreading the virus with no ill effect to themselves. In other words, an asymptomatic person. So we could have asymptomatic people running all over feeling fine but spewing virus. Till someone gets hit out of the blue. I don't know where this leaves all the talk about "antibodies"... would they be relevant at all in these asymptomatic people?

I think it is that mRNA is fundamentally different than previous vaccines. The only protection for the Unvaccinated seems too be wearing masks.

 

[CaptTom]

how does one be certified "essential?" I would guess through the honor system.

I'm wondering this too. I half-jokingly said recently that I should join the local volunteer fire department so I'll become a "first responder." I do hold a TWIC Card which technically makes me a "transportation worker." I wonder if that's worth anything. My wife's in a high-risk group. If she gets it, can I get vaccinated as a spouse? What if I call myself her "caregiver?"

Yeah, I want this vaccine.

 

[JoeWras]

I just found out one of my volunteer disaster relief workers went wildcat with another work crew down to Alabama.

He got COVID.

This guy was pretty "out there" on mitigating covid risk, i.e. he didn't care much for any of the rules. So I'm not super surprised. Luckily, he also brought his own housing (camper), so apparently he kept the infection to himself, and may have even gotten it on the road home. It will ruin their Thanksgiving they had planned with the larger family. Oh well.

This incident brings home to me that our efforts are risky and I'm really wondering if we can't get in line for distribution group 2 or 3.

 

[Amethyst]

As the slightly under-65 wife of a very much over-65 husband, I have similar concerns. I remember our doctor in MD insisting that I get the flu shot "so you'll protect your husband." Should think the same rationale would apply with respect to COVID vaccine.

Meanwhile, all we can really do is what we've been doing. Wearing masks and staying home. Indeed, I will insist on masks for a long time after we finally get the vaccine.

IMy wife's in a high-risk group. If she gets it, can I get vaccinated as a spouse? What if I call myself her "caregiver?"

Yeah, I want this vaccine.

 

[SecondCor521]

Although there will be prioritization, it seems to me that the first three vaccines are going to be produced in pretty impressive quantities, so even if you're in the "everyone else" group I think that'll mean waiting another few months for the shot. And there may be more vaccines on the way after the first three, and they may figure out how to make more faster.

And some states and people are not as enthused about the vaccine and even if they're ahead of me in line they may defer for a while, which just moves those of us who prefer to get vaccinated earlier in the calendar.

I know mRNA vaccines are new technology, but from my understanding of how they work they seem safer in principle than live or weakened virus vaccines, and the latter kind have been deemed safe enough to take throughout my lifetime for various things (MMR, TDAP, flu, shingles I think are all of that type but I'm not 100% sure on that).

 

[skipro33]

I have a related question, so hope it's appropriate to post it here;
I've seen on the news how high the positivity rate is; over 20% in many areas and states. Now, this virus has been in the public since February at least. 9 months. At even a 5% positivity rate, wouldn't it be fair to assume that 45% of the population is now positive with the antibodies and likely to not be at risk? And if that's true and the positivity rates have been escalating, wouldn't that rate be getting greater quicker? In my opinion, it sure wouldn't take long at 20% positivity before everyone has been exposed.
If, let's say, 50% have been exposed and now has the immunity, shouldn't we be seeing the positivity rates falling quickly?
The bottom line is; would it be possible a vaccine is given credit for slowing and stopping positivity when in fact, it's just been so long now that at least half the population has been positive at some point in the past 9+ months, (at least 12 by the time the vaccine goes public) and the #'s would naturally drop anyway?

 

[kyzymurgist]

I don't really understand the theory that being innoculated with a 95% 'effective' vaccine will not prevent you from spreading the disease..

As a trial participant, we are required to have periodic nasal swab PCR tests. From everything I read, effective means no positive PCR test.

How can one be contagious with no detectable virus in the upper respiratory system?

 

[braumeister]

At even a 5% positivity rate, wouldn't it be fair to assume that 45% of the population is now positive with the antibodies and likely to not be at risk?

Not at all. You're only looking at the positive results of people who have been tested.

 

[cyber888]

My personal choice would be Novavax. It can be stored at room temperature and normal refrigeration, and is in very stable form. It has 10 X the anti-bodies of Moderna based on the New England Journal of Medicine pub.

Pfizer and Moderna's technique is to alter your DNA .. first vaccines to do this (no thanks). Novavax is protein-based and is the safest traditional type of vaccine. Pfizer has yet to submit it's safety study and so does Moderna.

Novavax, unlike big pharma (Pfizer), also did a primate study. They injected several monkeys with live covid virus, then injected the Novavax vaccine. In 4 days, no trace of the virus even on the monkey with the weakess dose - 5 ug.

The virus not only disappeared in the lungs, but also disappeared in the nosetrils. So while other viruses can make you an asymptomatic carriers, this show that the Novavax vaccine can prevent you from being an asymptomatic carrier.

https://www.sciencemag.org/news/202...ompany-end-producing-best-coronavirus-vaccine

 

[skipro33]

Not at all. You're only looking at the positive results of people who have been tested.

I miss your point.
I've been tested. Needed to have a surgery and they tested me. Then I was tested again when I needed a bone marrow biopsy.

A lot of jobs, now air travel to certain areas, etc require testing. Seems testing would assert a basic demographic of the public. At least that's how it's presented; a 5% positivity rate equates to 5% general population rate is likely positive then.

Are you suggesting that a 5% positivity rate is an inflated number if it's suggested it's 5% of the general population? If so, then what is the ACTUAL positivity of the general population?

 

[SecondCor521]

I have a related question, so hope it's appropriate to post it here;
I've seen on the news how high the positivity rate is; over 20% in many areas and states. Now, this virus has been in the public since February at least. 9 months. At even a 5% positivity rate, wouldn't it be fair to assume that 45% of the population is now positive with the antibodies and likely to not be at risk? And if that's true and the positivity rates have been escalating, wouldn't that rate be getting greater quicker? In my opinion, it sure wouldn't take long at 20% positivity before everyone has been exposed.
If, let's say, 50% have been exposed and now has the immunity, shouldn't we be seeing the positivity rates falling quickly?
The bottom line is; would it be possible a vaccine is given credit for slowing and stopping positivity when in fact, it's just been so long now that at least half the population has been positive at some point in the past 9+ months, (at least 12 by the time the vaccine goes public) and the #'s would naturally drop anyway?

I don't know the answer to your questions.

But I will say that my understanding is the positivity rate is the number of people who are infected as a percentage of the number of tests. This is a different number than the number of people who are infected as a percentage of the number of people in the country. A big reason for this is that not everyone has been tested; another big reason is that on average I think that people who have been tested are more likely to be people who are ill. On the flip side, there are also those who have been infected but were asymptomatic and never ended up getting tested. In your post and questions it seems to me that perhaps you are conflating the two, when in reality the numbers could be the same by chance, or one could be higher than the other.

I think in general it is a fairly contagious virus, and I also think that people who get sick with the virus and then recover generally have immunity for a decent duration of months (maybe longer). As the number of those people go up, that will contribute to herd immunity. And I think that as a partial answer to your last question, as we gain herd immunity via natural infection and vaccination, the positivity rate should drop. Unless the virus mutates faster than we can vaccinate / get immunity through infection, in which case it's an open question.

 

[Aerides]

I have a related question, so hope it's appropriate to post it here;
I've seen on the news how high the positivity rate is; over 20% in many areas and states. Now, this virus has been in the public since February at least. 9 months. At even a 5% positivity rate, wouldn't it be fair to assume that 45% of the population is now positive with the antibodies and likely to not be at risk? And if that's true and the positivity rates have been escalating, wouldn't that rate be getting greater quicker? In my opinion, it sure wouldn't take long at 20% positivity before everyone has been exposed.
If, let's say, 50% have been exposed and now has the immunity, shouldn't we be seeing the positivity rates falling quickly?
The bottom line is; would it be possible a vaccine is given credit for slowing and stopping positivity when in fact, it's just been so long now that at least half the population has been positive at some point in the past 9+ months, (at least 12 by the time the vaccine goes public) and the #'s would naturally drop anyway?

I think the math of infections/positivity/immunity/total-infected is a tricky thing for any of us to understand without deep study.

But there has been no correlation that I've seen that links current-positivity to total-exposure.

And the only state that is perhaps nearing the 50% exposure number is ND. I think I read they were 45% and yes, they are starting to see some decline in new infections. A few other states were high 20's, but most others others are in the teens to mid-20's.

 

[braumeister]

Are you suggesting that a 5% positivity rate is an inflated number if it's suggested it's 5% of the general population? If so, then what is the ACTUAL positivity of the general population?

I doubt if anyone can answer that. But my guess, based on what I've read, is that maybe 25% of the population has been infected. Honestly, I don't think there is a real answer available.

 

[skipro33]

I think the math of infections/positivity/immunity/total-infected is a tricky thing for any of us to understand without deep study.

But there has been no correlation that I've seen that links current-positivity to total-exposure.

And the only state that is perhaps nearing the 50% exposure number is ND. I think I read they were 45% and yes, they are starting to see some decline in new infections. A few other states were high 20's, but most others others are in the teens to mid-20's.

Thank you for that reply. I was hoping it wasn't just me struggling to comprehend just what the news is telling us when they report a positivity rate. Surely math and science must have a model by now that extrapolates the positivity testing as a percentage of the general population contraction. But if they have, I've not heard of it. Which causes me to question the influence of the vaccine. IF a large enough portion of the population already has the antibodies due to exposure, then how can anyone determine that the vaccine is accountable for the percentages they are claiming? Did a test subject develop the antibodies on their own or from the vaccine? How is that determined? What if the vaccine is only 70% effective and the other 20% are immune due to their own internal ability to create an antibody? Is there some way that it is proven that the vaccine gave them immunity or is it just assumed that 100% of those given the vaccine AND were exposed developed the antibody because of the vaccine and not their own immune system?

 

[Gumby]

I miss your point.
I've been tested. Needed to have a surgery and they tested me. Then I was tested again when I needed a bone marrow biopsy.

A lot of jobs, now air travel to certain areas, etc require testing. Seems testing would assert a basic demographic of the public. At least that's how it's presented; a 5% positivity rate equates to 5% general population rate is likely positive then.

Are you suggesting that a 5% positivity rate is an inflated number if it's suggested it's 5% of the general population? If so, then what is the ACTUAL positivity of the general population?

I have been following closely the testing reports here in Connecticut. When they report a 5% positivity rate over the past day, it means that 500 of the 10,000 people who were tested in that day came up positive. Again, that's 5% of the people who actually were tested. We don't really have a good way to know how many of the whole population of the state have been infected, because not everyone has been tested, and the positivity rate doesn't stay constant. In the spring, when the virus was rampant here and few tests were given, the positivity rate was much higher, because only people with symptoms were tested. Over the summer, when testing ramped up greatly but the virus was not as prevalent, the positivity rates dropped below 1%.

 

[skipro33]

Thanks for the replies and the discussion. I have decisions to make. I'm currently on chemo and immuno therapies for cancer. The treatments wipe out my immune system. A vaccine only works IF you have an immune system to begin with; one that can be trained to recognize the virus. If, however, the white and red blood counts are low, and I mean to say mine are extremely low since the treatments severely damage my bone marrow and lymph system, there's no one home to train.
This gives me pause to consider if I even should continue chemo during this time and instead wait for my immune system to recover, 2 to 3 months I'm told, to take the vaccine to train my body to fight the virus.
BUT, even if my immune system is trained up, chemo wipes it out again, with not enough to ward off the virus effects.

Most likely, I will NOT take the vaccine since it's highly likely I won't have an immune system with enough cells to train to recognize the virus until 2 or 3 months after I've completed chemo. That puts me around April or May.
I guess I just gotta live in my plastic bubble until then. Ha!

I'll continue to research the option as it pertains to my individual health conditions. I suggest everyone does the same. Ask your doctor if there are any mitigating reasons that taking or not taking the vaccine should be weighed in making your decision. I'm not an anti-vaxxer by any means, but science looks at medicine like this for it's potential for society, not the individual. Perhaps there are reasons not to take the vaccine that are not presented on the evening news your doctor may be privy to.