mRNA Vaccine
Credit: Database center for life services. Used under CC 4.0 International License.
A few weeks ago my fellow Hivean 
There is a risk/benefit ratio for every medical decision we make, isn't there? Even taking a simple aspirin carries a risk.
Vaccination is a personal choice that has social implications. Not only is every one of us a potential link in the chain of infection, but every one of us who becomes hospitalized is a burden on the healthcare system. It would be interesting to look at why I decided to get the primary two doses, but not the booster, because I seem to represent a lot of people in the U. S. According to the Morning Consult, the percent of people who received two doses of the 'primary' vaccine series in the U. S. ranged from 91% in several Northeastern states to 63% in Alabama.
Booster rates are dramatically different. They range from a high of 27% in Vermont to a low of 4% in Alabama. I live in New York. Our booster rate is 15%.
Why are booster rates so low?
(I created this table with information derived from KFF.)
In the U.S., resistance to vaccination and boosting is partly cultural, reflecting an ingrained tension between individual rights and government authority. How does COVID vaccine reluctance in the U. S. compare to countries around the world?
Morning Consult, an information/intelligence gathering company based in Washington DC, did a comparative analysis of vaccine reluctance in 14 countries. They base their findings on surveys they conduct through interviews. The results of such a survey may reflect a systematic bias. For example, only literate people were surveyed in India.
Still, since we are not fashioning public health policy but are simply trying to understand vaccine reluctance, there is minimal harm in referring to the survey.
Of the 14 countries sampled, the U.S. had the second greatest unwillingness to be vaccinated: 22%. Only Russia had greater unwillingness: 36%. India and China had the lowest rates of unwillingness: 2%.
(I created this table with values derived from the Morning Consult)
Where do you fall in the two tables posted? Where do I fall?
As for vaccine unwillingness: I fall in the 88% of U. S. residents who were willing to get the vaccine. As for booster unwillingness, I fall in the vast majority of people who have declined the booster. My reason for declining the booster is not a vague suspicion of MRNA technology, although I don't really understand it. My reluctance is based on a very specific assessment of what I hope to get from the booster and the risk of side effects I may experience.
As is always the case with me, I did my research and tried to process as much as I understood. If I come down with a severe case of COVID, I might regret that decision.
Here is some of what I discovered in my reading.
Drug Induced Case of Pemphigus Vulgaris
An April 2022 issue of Pathology Research and Practice reports the case of a woman who experienced a 'rare' side after receiving a SARS-Cov-2 vaccine. She developed symptoms of pemphigus vulgaris. As you can see in the photo above, pemphigus vulgaris is a blistering disease. The immune system attacks two layers of skin called Dsg1 and Dsg3. When this happens the skin essentially falls apart--the layers cannot hold together and blistering results. Pemphigus vulgaris is quite serious and before modern treatments existed, was often fatal. Today there are powerful medicines to treat the condition, but these medicines carry their own risks.
As I have written in the past for the StemSocial community, I was once diagnosed with pemphigus vulgaris. Never did I have a lesion that looked like the one in the picture. But there is no doubt about the diagnosis. My immune system has attacked Dsg1 and Dsg3. My single lesion cleared up with a powerful topical steroid.
As I read further in the Pathology and Research Practice article, I learned that there were in fact 35 identified new cases of pemphigus that were triggered by the COVID Vaccine. Pemphigus is a very rare disease. It can be easily misdiagnosed. Were there other cases? Were there cases and the association with the vaccine was never established? One would have to imagine that might have happened.
Vial of mRNA Vaccine
Credit: Spencerbdavis. Used under CC 4.0 international license
At the end of the article describing the link between pemphigus and the COVID vaccine, the authors acknowledge the link but encourage doctors to recommend the vaccine "in order to assist the public health systems to overcome the COVID-19 pandemic."
That last statement puts all of us on notice that we are responsible for assessing our individual risk because public health policy has a potentially conflicting focus.
Vaccination and Autoimmunity
Pemphigus (described above) is an autoimmune disease. It, however, is not the only autoimmune disease that has been associated with the mRNA vaccine. There are reported cases of systemic lupus triggered by the vaccine. This disease is notoriously difficult to diagnose. It can take six years from the time of onset to diagnosis. The cases reported in the journals were apparently acute onset with frank symptoms. This is not usually how lupus develops so there can be a mountain of 'silent' cases as yet undetected.
There is also a strongly suggestive association between COVID vaccination and Guillain-Barre syndrome (GBS). A 2022 article Immunologic Research states that there is a "...growing body of evidence suggestive of an association between various COVID-19 vaccines and the occurrence of GBS." While the association is strongest between the J&J vaccine, it is still evident in others, especially the Pfizer.
Nerve Damage in Guillain-Barré Syndrome
Credit: Doctor Jana. Used under CC 4.0 International license
In September of 2021, the Journal of Autoimmunity stated that, "Autoimmune phenomena and clinically apparent autoimmune diseases, including autoimmune hepatitis, are increasingly been reported not only after natural infection with the SARS-CoV-2 virus, but also after vaccination against it." In this article the authors describe specifically a case of autoimmune hepatitis.
Why do I go on about autoimmunity and my own reluctance to get a booster? Because, besides pemphigus I have another chronic autoimmune disease, SLE. While this puts me at higher risk for COVID complications, it also puts me at higher risk for mRNA side effects. Obviously, I have to make a choice. I have to weigh risks and benefits.
I did that when I received two doses of the original vaccine. The original vaccines showed 95% efficacy. In my case that would be lower because of SLE and also because I take a daily dose of glucocorticoids. The results of research published in Nature shows reduced immunogenic efficacy of the vaccine in people with my condition who are on glucocorticoids. The authors state: "Usually, people with SLE have a reduced response to vaccination". Also, " A multivariate analysis pointed to Glucocorticoids as the most associated factor with declining nAB levels (75% decrease) in treated SLE".
Paxlovid Anti-Viral Pills
Credit: Intellec7. Used under CC 4.0 International license
To Boost or Not to Boost
There are treatments now for COVID. Rapid, early treatment is helpful in preventing hospitalization. Prompt treatment with Paxlovid is reported by Mass General Brigham Hospital to reduce hospitalization of vaccinated individuals: "the drug is associated with a 44% reduction in hospitalization or death in a highly vaccinated population of adults over the age of 50".
Protection from the booster begins to wane after several months. And I will have limited benefit from that booster. What am I to do? Keep getting boosters? Keep exposing myself to risk? It doesn't make sense, for me.
So far, I have used what I consider the barrier method successfully. I always mask with an N95 or KN95 when I'm among people. I don't go into stores or other closed spaces with lots of people. I'm scrupulous about cleaning surfaces. One day this bug will likely get me. When that happens, I'll keep my fingers crossed and hope there are even better therapeutics.
I'm sure there are doctors who will read this and disagree with me. But I'm the one who will get sick, not them, so the decision and risks are mine. As they always are.
I end with a lovely picture of a beautiful bird accompanied by flowers. These are a lot more upbeat than the blog I just wrote :). Both images were derived from the LMAC Image Gallery. For the bird I thank my friend
and for the flowers I thank my friend 
.
Thank you for reading my blog. As always, Hive on!
End Illustration
LMAC Image Gallery
Research
@mobbs/it-finally-arrived-my-covid-experience
https://studyfinds.org/aspirin-dangers-health-risks/
https://morningconsult.com/2022/12/01/covid-19-vaccines-booster-shot-survey-data/
https://www.kff.org/coronavirus-covid-19/dashboard/kff-covid-19-vaccine-monitor-dashboard/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2267241/
https://www.bloomberg.com/profile/company/1801281D:US
https://morningconsult.com/global-vaccine-tracking/
https://courses.lumenlearning.com/suny-hccc-research-methods/chapter/chapter-9-survey-research/
https://www.sciencedirect.com/science/article/pii/S0344033822000772
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7263783/
https://www.medicaljournals.se/acta/content/html/10.2340/00015555-2611
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8856802/
https://www.lupus.org/resources/lupus-facts-and-statistics
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9469827/
https://www.sciencedirect.com/science/article/pii/S0896841121001141
https://www.nature.com/articles/s41598-022-18996-x
https://www.massgeneralbrigham.org/en/about/newsroom/press-releases/paxlovid-effective-in-reducing-covid-19-hospitalization
https://www.regenstrief.org/article/study-confirms-mrna-boosters-extend-covid-19-protection-but-wane-over-time/
https://ourworldindata.org/grapher/covid-vaccine-booster-doses-per-capita?country=BGDBRACHLINDITAPAKRUSSGPUSA~OWID_WRL