Dr. Shafer, I read your editorial in the October 2020 ASA Monitor and offer the following:

You advocate for the liberal use of teachable moments during the anesthesiologist-patient interaction. We should never stop using these moments to teach or nudge our patients toward healthier tomorrows. However, I worry about our being cheerleaders for COVID vaccination before long-term safety data is available on the vaccine. I am 63 years old, and I have received every vaccine recommended during my lifetime. I recognize that most of the improvement in human longevity over the last hundred years is due to vaccination and infectious disease treatments and not due to the treatment of cancer, cardiovascular illness, or our skills as anesthesiologists.

We have never used viral mRNA to elicit an immune response to an infectious agent. (mRNA was tried about 10 years ago to grow new heart muscle in congestive failure patients and that proved deadly.) There are no long-term (years, not weeks or months) data on this kind of vaccine. It may be that these mRNA vaccines may be the greatest development since the polio vaccine, which prevented millions from suffering through the sequelae of that infection. However, it may be that the vaccine has serious long-term side effects we did not detect in the early “warp speed” trials.

During my years as a clinical anesthesiologist, I have been humbled by the way my patients view my position as their anesthesiologist. Suffice it to say, we are held in high regard by many of our patients and their family members. Our specialty has an enormous amount of credibility with our patients. Should we advocate for the use of any vaccine until and unless we have good, long-term safety data to support its use?

Sincerely,James W. Greenawalt III, MD

Clinical Anesthesiologist, Duke Private Diagnostic Clinic

Clinical Associate, Duke University

Department of Anesthesia-Community Division

Past President, Oklahoma Society of Anesthesiologists

Raleigh, North Carolina