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Saturday, December 19, 2020

Vaccines and Pyrrhic Victories

                             

The year was 279 BC and King Pyrrhus of Epirus decided to invade Italy and challenge the growing Roman Republic for domination.  He mustered his forces and gathered allied troops in southern Italy.

All went well until they came to Asculum.  There the Roman forces had massed and pitched battle ensued.

History tells us that the Greeks won a resounding victory over the Roman forces.  Casualties on the Roman side were at least double those of the Greek forces.

The only thing was that the Romans could (and did) quickly call up more forces to replace their losses while King Pyrrhus could do nothing to replace his casualties.  Many of his commanders died in the battle and his allies started to lose interest in the war.  He is quoted by Plutarch as saying in the aftermath, "If we are victorious in one more battle with the Romans, we shall be utterly ruined."

Thus was born the term Pyrrhic Victory. 

I think we hear of it most often these days in terms of sporting events.  A team wins a close game only to see its star player go down with serious injury.  They have won the battle, but lost the war.

I have heard many people say variations on the statement, "What does not kill me will only make me stronger."  The reality is something different.

"What does not kill me may make me a lot weaker."

The Diseases of the Past

There is a common misconception about the diseases of the past.  People believe that the danger was that they caused death.  Of course, that was some times true, but more often, they just left an individual damaged for the rest of their lives.

Polio weakened muscles, some times to the point that people required external ventilators, called iron lungs.  German Measles caused children to be born with severe birth defects.  Youth carried hearing and vision loss for the rest of their lives from the remnants of H. Flu meningitis.

These little bodies told the tale of Pyrrhic Victories.  Battles won, but damage so severe that life would never be the same.

Many of these infections were viruses and so even modern medicine with its antibiotics has few tools to deal with them.  It is a blessing that we know few younger people who have walked through these infections. 

From this were born vaccines.  The first true vaccine was the rabies vaccine, created by Louis Pasteur (the small pox vaccine was earlier, but it doesn't really count from my standpoint).  Considering that rabies was (and is) 95 percent lethal, this was a real game changer. 

The concept with vaccines is simple.  Give a person a small dose of killed or weakened virus or bacteria and let their body create antibodies to that infectious agent.  The doses are typically kept small and so most vaccines require multiple doses to be certain that there are protective antibody levels present.

Over the years since, there have been many vaccines created to deal with a variety of illnesses.  With the advent of vaccines has come a fear -- fear of the "secret ingredients" in the vaccines and a belief that it is healthier to get these illnesses the "natural way."  As though God intended children to suffer through Measles, Mumps, German Measles, and Diphtheria on their way to an unhealthy adulthood.

I am going to try to wade through some concerns that people have about vaccines and then touch a bit on the recently released COVID vaccines.

History of Vaccines

The very first vaccine was for Small Pox.  Small Pox was an illness that devastated Europe for centuries.  It was said that ten percent of the population died from Small Pox.  There was no treatment.

Then, in 1798, Edward Jenner had a light bulb moment.  Others had noticed that the milk maids in London had the best complexions of anyone around and figured out that it was because they got infected with Variolae Vaccinae (Cow Pox).  Dr. Jenner had the idea of infecting lots of people with Cow Pox and thereby preventing Small Pox infections.

It worked and death rates from Small Pox dropped considerably.  Unfortunately, it was a bit of a dead end as it was mostly happenstance to find a mild disease that provided immunity against a deadly disease.

The first true vaccine was for rabies.  Louis Pasteur was a genius who had already done work to come up with a vaccine against Anthrax for live stock.  He decided to turn his attention to rabies and managed to grow the virus in the brains of rabbits.  He then killed the virus and in 1898 injected some of the material into a boy who had been mauled by a rabid dog.

Amazingly, the boy did not succumb to rabies and the door was opened to begin work on other organisms.

Since that time, there have been hundreds of vaccines worked on.  Some of the projects have been successful and some haven't.

Everyone is Afraid.

As I read posts about vaccines, it is clear to me that there is a large group of people who is more afraid of getting a vaccine than getting the diseases they are designed to prevent.  

This says that vaccines have worked.  We don't see people in iron lungs any more from polio.  We don't have members of our community dying from Lock Jaw.  We haven't seen children with Measles related encephalitis.  This is not because we have treatments for these infections.  We don't.  We just have shots that are remarkably effective at preventing them from happening.

At the same time, we still don't have great treatments for these illnesses.  A six year old boy last year spent 57 days in the hospital after getting Tetanus with treatment costing over 800,000 dollars.  Perhaps the shots would have been better.  https://www.cdc.gov/mmwr/volumes/68/wr/mm6809a3.htm

Secret Ingredients in Vaccines

Vaccines do contain preservatives, they contain tiny amounts of formaldehyde and aluminum.  This all sounds terrible and many have claimed that they are dangerous.  The only thing is that we live in a world that is pretty toxic.  A breast fed baby will get more aluminum in a couple of days than is present in any vaccine on the market.  Fortunately, our bodies break down the tiny amounts of toxins present in our environment and diet very quickly.

Mercury is notably absent from most vaccines at this point -- only present in multi-dose vials.

Vaccines typically contain adjuvants as well.  Adjuvants are designed to deliver an antigen in such a way that it gets the maximum effect from the immune system.  When you feel achy after a vaccination or get a low grade fever, it is typically because the adjuvant is "doing its thing" and revving up your immune system.  Adjuvants: Introduction | British Society for Immunology

All of these ingredients are kept to as tiny an amount as possible and none of them are secret at all.  Vaccine Ingredients .  Vaccine Additives

Vaccines Don't Work?

Many people have the perception that vaccines don't work.  Rates of childhood illnesses fell due to better care of drinking water and better health care.  We have antibiotics and even a few anti-viral agents.  I have seen many post this sort of statement (mostly related to the possibility of COVID vaccine), "We don't have any effective vaccines against viruses." or "We have a flu shot and still have lots of deaths from influenza."

Of course, this ignores the fact that polio, measles, mumps, rubella, Hepatitis A, Hepatitis B and Chicken Pox are all viruses and we have effective vaccines against all of those.  

We are actually pretty good these days at creating vaccines against viruses.

Influenza is an exception.  The issue with influenza is that it is a virus that mutates a lot from season to season.  It lives in poultry and pigs in China and as it transitions back and forth each year, the virus changes quite a bit.  Each year, the CDC makes a judgment about what strains of flu will be most common.  Sometimes they guess right and sometimes they are off, but for a typical year, the flu shot may be anywhere from 20 to 60 percent effective against the common strains.

(I still recommend the flu shot for those who can take it -- it's the best we have and it generally is somewhat effective).

Why There Aren't More Vaccines

So if vaccines are so wonderful, why don't we have more of them?

As with everything, there are multiple reasons.  The most important thing for a vaccine to work is that humans have to be capable of long term immunity to an organism.  So, with infections like Measles and Chicken Pox, people get a single infection and then are immune for life.  This is an ideal scenario.  We only have to simulate this to get the same type of response without the infection.

Unfortunately, our bodies are not able to handle many viruses.  HIV and Hepatitis C are not infections that are typically cleared by our immune systems.  People who have these viruses have chronic infections for years and while those patients do form antibodies to these viruses, the antibodies are not protective.

Then, there are infections that we only form short term immune responses too -- things like RSV.  Vaccines against those sorts of infections are difficult and often require regular boosters to be effective.

Some things, like the common cold are caused by lots and lots of different pathogens and so it becomes difficult to design a vaccine that would cover even 70 percent of the most common causative organisms.

Finally, the disease has to cause enough health issues and be wide enough spread, to make it worthwhile for someone to invest money to come up with a vaccine.  For instance, Ebola causes a lot of death and devastation, but each time there was an outbreak, it was controlled with public health measures before a vaccine was developed and so the matter would be dropped till the next outbreak.  We do have an Ebola vaccine now, but it took many years to develop mainly because Ebola was "controllable" with public health measures.  The common cold, while very contagious and prevalent, doesn't cause serious enough health issues to warrant investment in a vaccination.

Temporality Doesn't Equal Causality

Children are very prone to magical thinking.  They blinked three times quickly and then someone broke a plate immediately afterward and they think they caused it and are careful not to blink again.

Adults are often the same.  They got an injection and immediately thereafter they got sick.  Their child got an injection and developed an illness.

With vaccines, we do large studies with thousands of people to see if there are things that are more common in the vaccinated patients compared to the normal population.  It is really hard to prove a negative, but we can say that in studies of thousands of children who have gotten the MMR vaccine, there is not any increased rate of autism compared to unvaccinated children (actually studies indicate 7 percent lower incidence in vaccinated children).  'No link between MMR and autism,' finds major study - NHS (www.nhs.uk)

The issue is that MMR vaccine is typically given around 15 months of age and that is also the age that most parents begin to notice issues with their children who have autism.  Autism is about 90 percent genetic.  There are some environmental factors that can be identified, but vaccination does not seem to be one of them.  Link Between Genetics and Autism (verywellhealth.com) 

Fetal Cell Lines

One of the biggest ethical issues with vaccines has to do with use of fetal cell lines to make vaccines.  There are a number of cell lines made with cells taken from babies that were aborted in the 1960s through the 1980s.  There are no ongoing abortions done to produce vaccines, and the infants were not aborted for the purpose of making these cell lines, but obviously this taints our view of these particular vaccines.

The vaccines that are commonly used that are grown on these cells are the Rubella (German Measles), Varicella (Chicken Pox), and Hepatitis A vaccines Vaccines Grown on Fetal Cell Lines.  I do still recommend using these vaccines.  To me, it is akin to organ donation from someone who was murdered.  Not using these vaccines will not change the abortion, but perhaps some good can come from the prevention of disease.

Others will differ from me on this and that is understandable.  I think these are two different view points on the subject of Fetal Cell Lines that look at the ethics from a Christian perspective.  This one is by Dr. Amy Givler:  Am I My Brother's Keeper  This one on the Gospel Coalition:  Are Fetal Cells Being Used for COVID Treatments

With the COVID vaccines that are coming, the Charlotte Lozier Institute put together a nice table looking at which of the vaccines were made using fetal cell lines and which not.  Fortunately, most were not made with these.  Charlotte Lozier Institute

Many medicines (including these vaccines) have some testing on these fetal cell lines during development, although they do not continue to use the cell lines to produce the vaccines.  Among the medications tested on these cell lines (at some point) seem to be ivermectin, monoclonal antibodies, and Remdesivir.  It must be understand that while these have been tested with virus made in fetal cells, they are not manufactured using these cells.

Ethically, any time there is an option, I think we would do well to steer away from vaccines made with these cell lines and go to other options.  

Not All Sources of Information are Equal

In today's climate, everybody has an opinion, the problem is that not all of them have facts behind them.  Someone like Robert F. Kennedy Jr. is trained as a lawyer.  I am sure that he is well meaning, but he doesn't have insight or understanding necessary to give an informed opinion.

While personal stories have impact and people who come across very strongly seem like they should have evidence on their side, that may not be the case.  It is useful to look at actual statistics from places like the CDC.

I will do my best to share things are true and researched, but even here, it is wise to check up on me and make sure I have data behind my opinions.

COVID Vaccines

Operation Warp Speed has been in full gear since the beginning of the year.  Three vaccines are in the process of being launched and several more are in line behind them.  I would like to finish by briefly mentioning those.

mRNA Vaccines

Messenger RNA is a hot topic lately.  mRNA is what takes messages from the DNA to the ribosomes, where proteins are manufactured.  The DNA never leaves the nucleus, but it generates mRNA that tell what proteins are to be made.  https://www.modernatx.com/mrna-technology/science-and-fundamentals-mrna-technology 

Till recently, vaccines involved growing a bacteria or virus and then either weakening or killing it and then giving small doses of it to patients to generate antibodies.  

A more recent vaccine, called Shingrix, actually took manufactured surface proteins from the Herpes Zoster virus and administered them to patients.  This turned out to give extremely good immune responses -- better than earlier vaccines for shingles.  Shingrix

mRNA vaccines take this a step farther.  They use mRNA to get the cells in a patient to make proteins that look like surface proteins on the COVID virus.  The body then sees this spike protein as something foreign and begins to generate antibodies to it.  Eventually, the mRNA wears out and the cells stop making the protein.

In the trials, these vaccines were very effective -- between 90 and 95 percent effective at preventing any COVID infection after the second dose and 100 percent effective at preventing serious infections.

Side Effects were mostly things like fevers, muscle aches, and fatigue.  There were four people who got the vaccine who developed Bell's Palsy, although it isn't clear if this was related to the vaccine.  Some people had allergic reactions to them.  Side Effects of Pfizer's COVID Vaccine  

While these vaccines have been rushed along, they have already been tested on thousands of people.  And testing isn't over.  The FDA will be doing post-hoc analysis to see if there are any other things that show up.  The most important thing is clarity -- patients need to know what the side effects of these vaccines are.

Do These Vaccines Change Your DNA?

There is a rumor going on that getting one of the mRNA vaccines will change your DNA and once that happens, "even RKF Jr. won't be able to help you."  I think this misses how mRNA works.  

In the human cells, DNA is the software code that instructs cells how to make the different proteins they need to function.  However proteins are made in a part of the cell called the ribosomes, while the DNA never leaves the nucleus.  mRNA is the go-between that takes messages to the ribosomes telling them what proteins to make and how to make them.

With a vaccine that uses mRNA, the mRNA never makes it to the cell nucleus.  It functions in the ribosomes until it is degraded at which point the cell stops making the protein.

Even if somehow your DNA was changed, the worst case scenario would be that some important protein in the DNA would be damaged and the body would do what it normally does, which is take care of that cell with a process called apoptosis.

For those who question evolution, this should be obvious.  Mutations don't randomly create new species, because they don't stick around if they aren't useful.  (See the book Darwin Devolves for more on this subject).

Traditional-style COVID Vaccines

Astra Zeneca, Janssen, and Merck are all working on vaccines that are developed with a more traditional process.  Basically, they grow COVID virus and then kill it.  The Janssen and Astra Zeneca vaccines use fetal cell lines, while the Merck use monkey cells to grow the virus.

It is a little soon to comment about these except to say that the AZ vaccine had some odd things with their trial.  They made a mistake in the trial and gave a bunch of people half a dose of the vaccine.  Those people got a full dose with their second dose and compared to those who got two full doses, they had better results.  https://www.biopharma-reporter.com/Article/2020/12/10/What-next-for-AstraZeneca-s-half-dose-COVID-19-vaccine  I don't know what this means, but the data for the half dose is less than what maybe we would like.

Other Vaccine Candidates

There are many other vaccines coming down the road.  Some others will be mRNA, some with proteins, and some with killed virus.  It is too soon to say much about them except that each one will need to be studied individually before they are given approval to be used.

Were They Launched Too Fast?

The first COVID vaccines came out with less than a year of development.  This happened because world governments threw billions of dollars at the vaccine development and guaranteed the companies making them that they would buy the vaccines, regardless of their effectiveness.  That is to say, if Moderna's vaccine was completely ineffective, the US government would still have bought a bunch of it (but not administered it to patients).

The point was to get the companies to begin manufacturing millions of doses of these vaccines, even before the testing was done.  By taking away the risk from the vaccine manufacturers, they saved a lot of time and fortunately, some of the early vaccines are much more effective than we had ever hoped.

In addition, technology has come a long way.  We know how to grow viruses and kill them.  We know how to make basic vaccines.  The whole genome of the COVID virus was sequenced in March.  These are the sorts of things we can do today that would have been very difficult to do ten or fifteen years ago.

At the same time, there is more testing to do.  As vaccines are given we will be watching for anything concerning.  This watching never stops.  If I see a significant reaction to a tetanus shot, I still report it to the CDC who will track it, even though tetanus immunizations have been on the market for decades.

Take Home Message

I am a big believer in vaccines and vaccination programs.  Some, like the flu shot, are not terribly effective and some that have been tested have caused serious issues (RSV in the 1960s, Rotavirus in the 1990s).  Every one that is released needs testing prior to release and then continued analysis after release to be certain that they are safe and doing what they are supposed to to prevent disease.

The COVID vaccines have been tested on thousands of people so far.  We know that they are very effective at preventing serious COVID infections and hospitalizations.  They have had some allergic reactions and otherwise minimal issues.  Certainly, as we give these vaccines to millions of patients, other things will show up.  There will be more allergic reactions.  Perhaps other side effects or groups of patients that shouldn't get it.

I do plan to get a COVID vaccination.  The issue to me is not my personal risk from COVID -- it is probably small (although we don't know all of the long term implications of COVID infections).  The issue to me is that I could be the conduit whereby someone else gets COVID who does worse than I would.  I have seen all too many situations where a younger person gave COVID to someone older.  The younger person sailed through unscathed, while the older individual ended up in the hospital and came out weakened.

More than anything, I believe in vaccines to prevent Pyrrhic Victories and am glad that we live in an age where we have the option to protect our children from illnesses that could have maimed them in another era.




27 comments:

  1. Thanks for the great vaccine overview, and the details about COVID. I also plan to get the vaccine. dan

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  2. Thank you for your clear, concise information. There are strong opinions and a lot of information from both pro-vaccine and anti-vaccine sides. The challenge is finding credible sources to support the claims. I appreciate the time you took to include links for credible sources to support your information and opinions. God bless you and your family.

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  3. https://www.instagram.com/tv/CI7DhBdnkz_/?igshid=l7ks0fbhqqcz

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    1. He’s not a reputable source from what I can tell. But each needs to judge what is safe.

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  4. 👏👏👏Thank you, thank you very much! You have a fulltime, demanding job, yet you still take the time to inform others.

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  6. appreciated the excellent explanation. I may have had the Covid-19 since I had something in October with many of the symptoms. Have been weighing the pros and cons of getting the vaccine when it becomes available to the general public. There are so many posting who have not medical knowledge or training.

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    1. I would consider getting an antibody test for it. If it is positive you can easily put it off for a month or two anyway. If it is negative I would be a little quicker to get in line for a COVID-19 vaccine.

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  7. I find his comparison of Vioxx and the vaccine interesting, particularly in light of the guaranteed market along with the financial protections from complications for producers of the vaccine. Unfortunately, he is anonymous, but I'm assuming he has good reason to be. https://www.nakedcapitalism.com/2020/12/an-internal-medicine-doctor-and-his-peers-read-the-pfizer-vaccine-study-and-see-red-flags.html?fbclid=IwAR1BylTLeeeehGb3uwvcrLwp_k6uE8Pa2VbxuIvMdKCa7PAp2NM2He4ajQg

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    1. There is a lot of fear there. I have already gotten the Pfizer mRNA vaccine. A little arm soreness on the day of the injection and the next day, little else. The other health care workers I have spoken with have similar stories. Maybe the second injection will be worse, but I am willing to take that risk -- certainly we saw no "smoking guns" in the studies that indicated there were terrible side effects associated with these vaccines.

      I work with a physician who said he will wait two months to see what sorts of things come out about the vaccine and that is a reasonable approach as well, but I don't think there is a big conspiracy here to hide side effects of the vaccine.

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    2. I'm curious if those who fall under the exclusion criteria would have any serious side effects. To me, that would be a greater test of its safety.

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    3. The exclusion criteria mainly have to do with 3 groups of people (1) People who are currently ill or quarantining from COVID -- this makes sense, we don't typically give people who are sick vaccines anyway. (2) Groups that weren't included in the trials. The trials had healthy, non-pregnant, non-breast feeding adults in them. There were 20-odd women who got pregnant during the trials and didn't have issues, but it just isn't enough data to say it is safe. I'm guessing studies on children will be forthcoming. Not sure that they'll be looking at vaccination during pregnancy due to liability concerns. (3) They advise caution if someone has a history of severe allergies. Anaphylaxis seems to be sporadic and hard to predict. It is easy to take care of as long as it is administered in a place that has access to epinephrine. Certainly this a vaccine to get in a physician's office or hospital setting, not in your neighborhood pharmacy.

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  8. https://mobile.twitter.com/libertytarian

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  9. Thank you for a thoughtful and insightful article.

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  10. Funny you’d delete my comment. Is that because I’m telling the truth? Because you know these babies were killed after the abortions and they’d taken from their bodies what they needed? At 16/17 weeks no less? All 76 of them?
    Sad 😞
    As a doctor you should know better than defend such practice.

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    1. I deleted your comment because I didn't feel that it was either factual or spoken in a spirit of love. I added some links to what I have written, but you are incorrect in what you state. There are not 76 infants that have been aborted to create vaccines. Regardless, I have written what I have written. Many children's lives have been saved through vaccines. There were thousands of children who were aborted and miscarried every year because of German Measles that are not now. I would hate to go back to that situation again.

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  12. If you think you've already had Covid would you still advise getting the vaccine?(I'm a healthcare worker and have elderly parents with health conditions)

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    1. I would get antibody testing to be sure. The Red Cross will do it if you donate blood. If you’re positive you can certainly wait awhile although I’d probably get vaccinated eventually.

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  13. Thanks so much for your advice! We as a family have really enjoyed your articles on Covid and the vaccine. It has been very helpful and we have passed them along to friends and family.

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  14. I am curious about the possibility of needing to be vaccinated every year with this. If the manager has the body react to the proteins specific to covid but then stops will the body stop recognizing that protein to fight against? Thank you for such a well written article.

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    1. I don't think anyone know the answer to this yet. There are two possible issues. (1) The immune effect of the vaccine could wane over time requiring a booster. We will know this as they follow antibody levels in the earliest people who were vaccinated. (2) The COVID virus mutates in such a way that the vaccine no longer is protective. This is probably a bigger deal. Influenza mutates a lot -- enough that the vaccine from last year won't be very protective this year. Viruses like measles don't change at all and we can continue to use the same vaccines that were made in the 1960s. COVID is somewhere in the middle. It does mutate, but most of the mutations haven't changed the surface of the virus. There is one coming out of South Africa now that is a bit different and might require a tweaking of the vaccine. That will become clear over time and certainly could require a different vaccination.

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  15. I'm struggling a bit with the use of fetal lines in vaccines. I notice that Moderna and Pfizer are not made with fetal cell lines but are tested with it. Can you explain a little more what that means?

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    1. Sorry. I don't check my blog that often and so I missed your comment. I deleted the other one just so your e mail address wouldn't be out there. As far as your question goes, fetal cell lines are used to grow virus and then they use that virus to judge accuracy of the proteins that they are synthesizing. Once done, it doesn't need to be done in an ongoing basis. I hesitate to say too much because people get so angry over this. I would just say that in this world fetal cell lines are used to test a lot of medications and it is only with vaccines that people delve in deeply to find that out. I don't think that just because at some point someone tested penicillin or ivermectin on a fetal cell line that we should stop using them because they are manufactured without those cell lines. Anyway, that's my perspective.

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    2. I think this is a useful description of it: "The makers of the two vaccines used cells from a cell line known as HEK 293 in an early step known as confirmation testing. In that step, researchers introduce the drug or vaccine in question to the cells to make sure it doesn’t have harmful effects before it’s injected into the first human."

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