I select topics for the blog based on the type and quantity of questions that I receive from all of you. Off the charts, everyone wants to know about vaccine availability. I will answer the question describing what we currently know and what we hope to learn in the coming weeks.
First of all, three large scale Phase 3 vaccine trials have reported remarkably strong results. Pfizer and Moderna, both mRNA vaccines, reported greater than 90% efficacy in reducing the rate of symptomatic infection. A third study from AstraZeneca (an adenovirus vaccine), reported interim results suggesting the possibility of 90% efficacy as well. The three studies taken together provide reassurance that basic immunologic principles are solid. Our bodies respond well to the spike protein antigen that is created by all three of the vaccines.
Everyone has the same question: “When will I be able to get the vaccine?” At this point, there is no definite answer. I can present a general outline of the distribution plans to date, with the plans changing daily. First of all, there is a shortage of vaccines. Pfizer expects to have emergency use approval (EUA) within days and will be able to distribute its limited first batch of vaccines. Early estimates of 40 million doses (enough to supply two doses to 20 million people) available in 2020 have been scaled back due to manufacturing supply shortages. As of December 4, California has been slated to receive only 327,000 initial doses. The second mRNA vaccine manufacturer Moderna hopes to have an EUA before year’s end but again supplies will be limited. More vaccines are completing their phase 3 trials, but approval and distribution will not begin until 2021. Realistically, I do not expect significant quantities to reach our community until early 2021.
The challenge will be how to allocate this scarce resource. The CDC has laid out general principles: First priority will go to health care workers and residents of skilled nursing facilities included in phase 1a. Defining who should be in the next phase 1b remains contentious, trying to balance saving lives by vaccinating elderly against opening the economy by vaccinating essential workers such as teachers. There is no consensus on how to structure the exact order. However, younger healthier adults with the ability to work remotely will be placed into later groups. Also, we will need to await the results of vaccination studies for children before vaccinating them.
At present there is no consensus at the federal level. Furthermore, the authority for final allocation priorities rests with each state. The state of California has not released a complete list of priorities and has only subdivided the federal phase 1a heath care workers into three sub-tiers: tier 1 -hospitals, nursing homes, EMTs, tier 2- primary care clinics and urgent care clinics and tier 3- lab, dental and pharmacy staff.
Thus, we do not know the exact list of priorities for vaccination groups, nor do we know when larger quantities of vaccine will become available. Nor do we know where and how the vaccine will be distributed. In prior years, when there was a shortage of influenza vaccine, such as the H1N1 epidemic in 2009-2010, allocation was directed to larger healthcare institutions. I suspect the local hospital and pharmacies will play a leading role in administering the vaccines. Most likely my role will be in monitoring the situation and directing patients rather than having any vaccine to administer in our clinic.
Given the many, many uncertainties, we are following the developments closely and will be in a position to keep you informed and direct you to the appropriate locations when the time comes. I am aware that this blog will take on a new level of importance.
In the meantime, we all need to keep up our vigilance as the months drag on and we enter another period of lockdown. The stunning and rapid success of the vaccine technology gives me hope that we have the tools to end our struggle with COVID-19 in the not too distant future. I am confident that 2021 will be a much better year than 2020 (a very low threshold to cross)!
Please contact me with any questions or concerns.
Barry Rotman, MD