It’s probably fair to call the coronavirus pandemic a cavalcade of bad news, but recent weeks have provided the first demonstrable piece of global positivity.
Drugmakers Pfizer and Moderna both announced that their vaccines for COVID-19 were roughly 95% effective at protecting against the disease in large-scale Phase III studies.
“It’s incredible,” said Dr. Marty Trott, medical director for St. John’s Health physician services and a participant in the Pfizer trial.
Based on those promising results, the companies can apply for emergency use authorization from the Food and Drug Administration. That allows them to begin distributing their vaccines before receiving full FDA approval, which requires a deeper, more time-consuming dive into the results.
Pfizer submitted its application for the authorization Nov. 20, while Moderna did so Monday. An FDA advisory council will meet in mid-December to discuss Pfizer’s results, then soon after to consider Moderna’s. If both vaccines receive emergency authorization they could be distributed as early as Dec. 21, The New York Times reported. Between the two, company officials have said they could begin vaccinating roughly 20 million Americans by year’s end.
How the vaccine will be distributed is yet unclear, as the Centers for Disease Control and Prevention met Tuesday to discuss guidance for priority groups, but initial shipments will probably be used quickly.
“I would expect those doses all get used up within a few days,” said Ken Cornell, a Boise State University biochemistry professor with a focus on vaccine development. “Nobody wants to get samples of the vaccine so it can sit in their freezer.”
Though distribution guidance has yet to be set in stone, the general thinking is that health care workers will be among the first wave of vaccinations. Depending on how many doses are included in the initial shipments, high-risk groups like long-term care facility residents may be included.
Cornell said the distribution, at least at first, will be roughly proportional to states’ populations. That would mean Wyoming could see a relatively low number of doses.
The Wyoming Department of Health submitted a vaccine plan to the CDC in October, a working document that may be updated as guidance emerges. That plan says health care workers will be prioritized, along with high-risk groups identified by the CDC and other agencies.
It also says providers must prove they have the storage capability to keep the virus cold. Pfizer’s and Moderna’s vaccines use messenger RNA, a piece of genetic code that teaches the body to produce an immune response to specific proteins. That technology makes them relatively easy to synthesize in a lab, but messenger RNA is unstable, so the vaccines must be kept cold. Pfizer’s vaccine must be kept at minus 94 degrees, while Moderna’s can be kept at minus 4.
Both can keep in a conventional freezer for a bit — Pfizer’s for five days and Moderna’s for 30 — but distribution hubs for the Pfizer version need to have the cold storage capability. St. John’s Health purchased one of the super-cold freezers, so it can store thousands of doses, and it bought regular freezer capacity for the Moderna one.
The state Health Department has made St. John’s the receiving point for Sublette and Lincoln counties as well. How many doses will be allocated locally and to each county remains to be set, as do other details because information is “scant at this time,” St. John’s pharmacy director Ken Jarman said in an email.
The Teton County Health Department is also gearing up to be able to accept some of the vaccines. Using Coronavirus Aid, Relief and Economic Security Act funding, the Health Department upgraded its cold storage earlier than expected and kept the old freezers, too. Though it can’t keep the Pfizer vaccine on-site, the Health Department can store vaccines just before distribution. Director of Health Jodie Pond said the department also brings expertise in wide-scale vaccination.
“On an annual basis ... we practice, usually when we do the senior flu clinic, on how we do a mass vaccination,” Pond said. “So we’ve got mass vaccination plans.”
One wrinkle in the distribution is that both vaccines currently nearing authorization require two doses about three weeks apart to achieve peak efficacy. That’s not uncommon in the world of vaccines, but it does pose a challenge.
“Your patient compliance always drops off if you have to have somebody come in for a second time,” Cornell said. “Now I think there’s a sufficient amount of hype associated with the coronavirus that most of those people are going to come back.”
Wyoming’s vaccine plan tries to ward off the compliance issue. The state has a system that will allow providers to build lists of patients so they remember to send out reminders, and the plan indicates vaccines will be sent with reminder cards to give to patients.
No matter the level of demand, it’s unlikely members of the general population will have access until at least the spring. State officials have said it could be April, Pond said, but that depends on how quickly the companies can ramp up production and how many other vaccines receive emergency authorization.
Pfizer representatives have said they can produce 50 million doses by the end of the year, with about half going to the United States, so enough for 12.5 million people. By the end of 2021 the company says it can produce 1.3 billion doses worldwide.
Teton County is likely to see distribution in “waves,” Pond said. Because the drug companies will produce and ship the vaccine as fast as possible, it won’t show up in one giant batch.
That metering will help both with storage and the operational part of the vaccination process. How many doses the county eventually receives will depend on how many people elect to be vaccinated.
Pew Research Center surveys found that only half of Americans say they are likely to take a vaccine. Trott said the majority of his patients are interested, which he hopes pushes demand higher than the Pew Center finding.
“Maybe I have a biased patient selection population, but they are very enthusiastic about it,” Trott said.
To reach herd immunity, the point at which so many people have been exposed to the virus that transmission stops, estimates say at least 50% of people need to either be sickened with the virus or vaccinated, though the figure is likely closer to at least 70%. As of Tuesday, 6.8% of Teton County had been exposed naturally, according to state Health Department data, so natural herd immunity is far off and would involve many more hospitalizations and fatalities.
To avoid all of that, Pond said, she will be vaccinated, she will tell her friends and family to be, and she hopes most Teton County residents do the same.
“This is not political, people, this is a pandemic. This is a virus,” she said. “And when the FDA says it’s safe, then it’s safe, and we should all get in line and do our part.”