COVID-19 Vaccine: An Outlook for Immunity

by Raymond Yuan Li


What You Can Do:

1.     Follow the CDC guidelines on health and safety during the 2020 pandemic: https://www.cdc.gov/coronavirus/2019-ncov/index.html

2.     Frequently monitor for any update on the novel coronavirus vaccines: https://www.washingtonpost.com/graphics/2020/health/covid-vaccine-update-coronavirus/

3.     Stay informed on all potential treatments for COVID-19: https://www.coronavirustoday.com/covid-19-treatments


As the pandemic rages on to take an agonizingly uncertain toll on everyday life, it has led to high expectations of a Food and Drug Administration (FDA) approved COVID-19 vaccine. Early on, President Trump insisted that a vaccine will be available in the United States before Election Day on November 3rd, but public health experts and the federal government deem this timeline highly unlikely. Later, in the last 2020 presidential debate, on October 22nd, he modified the expected timeline and claimed that a COVID-19 vaccine will “be announced within weeks”. Many experts fear that political pressure and unrealistic timeline in the vaccine approval process will taint the good science of vaccines. 

Historically, the earliest timeline that any vaccine was made available in the United States took at least 4 years, with the clinical testing being the hardest round to push through [2]. Yet, the Trump administration expects the arrival of a vaccine in about 12 to 18 months. To achieve such an ambitious goal, the FDA has issued guidance that provides for the Emergency Use Authorization (EUA) of a COVID-19 vaccine, warranted with a placebo-controlled efficacy trial of at least 50%. However, there are concerns about the EUA itself. One of them entails the required duration of the follow-up interim analysis on patients post-inoculation. The current guideline requires only two months of follow-up analysis. Yet, World Health Organization experts call for at least three months of data to ascertain safety and efficacy [10]. Regardless, under the appeal of EUA, big pharmaceutical companies such as AstraZeneca, Johnson & Johnson, Pfizer and Moderna have pushed through phases 1 and 2 of vaccine testing and are currently in phase 3, efficacy trials. In phase 3, the vaccine is administered to a thousand people in order to measure the infectious rate in comparison to those receiving a placebo. It is also the phase where most companies fail to proceed. Recently, AstraZeneca and Johnson& Johnson had to pause their trials due to volunteers becoming seriously ill [3]. Although it is not uncommon for vaccine testing to pause its trials, risks become significantly higher as companies are attempting to streamline and expedite the research progress into months as opposed to at least 2 years [4]. Pfizer and Moderna, among other prominent pharmaceutical companies, declared that they will not seek EUA until late November of this year [1].  

To dampen soaring high hopes, the official issuance of a vaccine might not be the cure poised to immediately eradicate the pandemic once and for all. Once a vaccine is authorized by the FDA to be deployed, figuring out the logistics of its distribution will be a strenuous process. Public health officials are still in the process of designing an effective system to administer the vaccines, at the early stage, across the country–given that the doses will be limited [5]. There is also a lack of sufficient funding. Robert Redfield, the director of the Centers for Disease Control and Prevention, stated that states would need approximately $6 billion budget to distribute the vaccines. However, funding from the Coronavirus Aid, Relief, and Economic Security Act (CARES) has only awarded $200 million to 64 jurisdictions so far.  

Another challenge in the administration of the vaccines is a lack of public trust. A vaccine is fully effective only when herd immunity is achieved, where at least 70% of a given population must be immune to the SARS-CoV-2 virus—either through infection or vaccination [6]. Yet, the unprecedented rate of vaccine development has led many Americans to be skeptical of the vaccines’ safety and effectiveness. According to a Wall Street Journal/NBC News poll survey, 50% of registered voters indicated that they will wait for a while after the vaccine is made available, in order to examine its effectiveness and if any side effect incurs. More notably, 17% of those surveyed are not willing to get a vaccine at all. According to another poll by the Washington Post-ABC News poll, around 27 percent of adults would either “probably” or “definitely” not get the vaccine [7]. If a large population refuses to be vaccinated, it means that achieving herd immunity is unlikely in the near future and without the guarantee of public safety,  national establishments and infrastructures would not reopen anytime soon. As evidence suggests, challenges will arise in regard to the distribution of vaccines once made available. Dr. Anthony S. Fauci, the director of the National Institute of Allergy and Infectious Diseases stated that “It’s not going to be the way it was with polio and measles, where you get a vaccine, case closed, it’s done. It’s going to be public-health measures that linger for months and months.” Concerted efforts should be made nationally to ensure and advocate for the efficacy of a vaccine once made available, in order to guarantee herd immunity in the long run. 

Once achieved through vaccination, herd immunity will mean a slow progression to the next normal. The country will gradually rebound and reopen.  Emergency public health measures will be lifted, but revaccination and the continual monitoring of COVID-19 will be required to maintain immunity. The public will be able to gain confidence in going out safely as mortality and hospitalization rates due to COVID-19 decrease [6]. That would mean that the travel, transportation and hospitality industry will steadily restore to a sense of normality. The transition to the next normal will not happen overnight, but rather it will be a process that takes global effort and collaboration amongst members of society. 

While the United States awaits the impending COVID-19 vaccine, alternative treatments should be considered. One of them being the antiviral drug developed by Gilead Sciences,Inc. On October 22nd, the FDA approved the antiviral drug Veklury (remdesivir) as a treatment for hospitalized patients who are 12 years of age and older and weighing at least 40 kilograms (about 88 pounds) [8]. The drug is proven to reduce recovery time and reduce disease progression among extremely ill patients. Another action that should be taken by the general public in the meantime is to monitor and follow the CDC COVID-19 health and safety guidelines, such as wearing a face covering and maintain physical distance [9], to contain the cases of COVID-19 infections. There isn’t a single solution that will end the pandemic once for all, do not count on it. Rather, slow yet steady recovery from the pandemic will take time, and it demands patience and collaboration from all walks of life.


Sources

[1] https://www.politico.com/news/2020/10/16/pfizer-no-vaccine-trump-election-429843

[2] https://www.nytimes.com/interactive/2020/04/30/opinion/coronavirus-covid-vaccine.html

[3] https://www.nytimes.com/2020/10/14/health/covid-clinical-trials.html

[4] https://www.statnews.com/2020/07/30/a-huge-experiment-how-the-world-made-so-much-progress-on-a-covid-19-vaccine-so-fast/

[5] https://www.npr.org/sections/health-shots/2020/10/16/924247360/facing-many-unknowns-states-rush-to-plan-distribution-of-covid-19-vaccines

[6] https://www.mckinsey.com/industries/healthcare-systems-and-services/our-insights/when-will-the-covid-19-pandemic-end   

[7] https://www.healthline.com/health-news/covid-19-vaccination-refusal-mandate

[8] https://www.fda.gov/news-events/press-announcements/fda-approves-first-treatment-covid-19?utm_medium=email&utm_source=govdelivery

[9] https://www.cdc.gov/coronavirus/2019-ncov/index.html

[10] https://www.idse.net/Covid-19/Article/10-20/Rushing-COVID-19-Vaccination-Could-Undermine-Overall-Success-Vaccine-Experts-Warn-FDA/60954