COVID-19 Vaccine? Hurry Up and Wait

December 10, 2020
Kevin Kavanagh, MD

Infection preventionists are an important component of fostering trust in the healthcare system and need to actively articulate to both patients and on social media the need to be vaccinated and to follow public health advice.

At last, the vaccines are here! Or are they? There appears to be a shortfall, not enough to initially vaccinate even all of the frontline healthcare workers and nursing home residents against coronavirus disease 2019 (COVID-19). By some estimates only about 20% of the expected doses will be available by year’s end.

As one may recall, Operation Warp Speed invested billions of dollars to manufacture vaccines “at risk” before safety data was known. The hope was to have 50 to 100 million doses by year’s end, if 1 or 2 of the 6 designated companies had an efficacious vaccine. A low bar was set with a minimal efficacy of 50%.

The good news, the Pfizer/BioNTech and Moderna vaccine is 94% effective and new data from Pfizer/BioNTech shows it has a 52% efficacy after the first dose. But the Pfizer/BioNTech vaccine is in short supply. The lion’s share of the doses are not expected to be delivered to the United States until late June or July, 2021. Moderna appears to have more available vaccines but the exact delivery dates are unknown.

Both of these products use a new technology, mRNA, which stimulates the body to produce just the viruses’ spike protein, the structure which needs to be attacked to kill the virus. These vaccines appear to produce a highly targeted immunological response composed of neutralizing antibodies. Because of the very narrow and specific response, the rate of severe complications may also be lower.

In Kentucky, it is expected that the state will only have 148,525 vaccine doses by year’s end. This is far too few for a state which has 1.36% of the United States’ population. If 50 million doses were available nationally, then Kentucky would have expected 680,000 doses. Each vaccinated individual requires 2 doses given 21 days apart. Nationally, there are approximately 21 million frontline healthcare workers and 3 million nursing home residents. Thus, it would take almost 50 million doses to vaccinate these individuals.

There are reports that the United States could have purchased more Pfizer/BioNTech vaccine doses, but the White House has denied this. The United States has purchased 300 million doses of the AstraZenica/Oxford vaccine, but its efficacy rate is approximately 70% and it is still under research. The European Union has purchased 200 million doses of the Pfizer/BioNTech vaccine and England has already started mass vaccinations. China also has produced a vaccine which the United Arab Emirates has tested and reported an 86% efficacy. However, the data is presently not available.

No doubt, in hindsight, the Pfizer/BioNTech vaccine would have been a better pick for the major funding by the United States, but this is similar to wishing you bought a different stock in your retirement fund. At the time, the AstraZeneca/Oxford vaccine appeared to be a safer pick. It used proven technology, relatively low expense, and can be stored in a refrigerator, compare to dry ice.

Until the acute vaccine shortage is resolved, it would make sense to prioritize frontline nursing home healthcare workers and those who work in COVID-19 dedicated facilities, along with EMS workers who transport COVID-19 patients. From there, other frontline workers such as triage and ER personnel of all facilities should be given the vaccine.

Side effects from this vaccine appear to be similar to the shingles vaccine. Patients age 16 to 55 years may experience fatigue in more than 50% of individuals, headaches in 59% of individuals, muscle pain in 37% of individuals, and chills in over a third of individuals. The rate of reactions is lower in those above the age of 55. However, similar to the shingles vaccine, many may need to take off work the day after vaccination.

And once one is vaccinated, you still need to wear a mask and social distance, since it is not known how long the immunity lasts or if the vaccinated can still develop contagious asymptomatic infections.

Although we are facing a vaccine shortage, we are also facing an unwillingness in some of our populace to take the vaccine. Shortages can more easily be corrected, than the combating of anti-vaxxer misinformation. However recent polls have been reassuring, with those willing to take the COVID-19 vaccine increasing to 63%. As the pandemic worsens, many are seeing for themselves the massive devastation which is taking place and learning that they need to trust their healthcare providers. Infection preventionists are an important component of this effort and need to actively articulate to both patients and on social media the need to be vaccinated and to follow public health advice.