There's a lot of questions surrounding how well these vaccines will work.
We have to be looking at the safety first and foremost. We've done phase one
and two trials. They seem to do pretty well, but these
are small trials by design, because they're safety
trials, but what we did see with many of them is that
there were a lot of mild adverse effects things, like fevers,
but nothing severe per se. But when you start introducing
the vaccine, not to hundreds of people but to hundreds of
thousands or millions, then you have to be really
aware and concerned about fringe effects, what happens on the edges of
the distribution. Do you end up seeing that certain
individuals with certain pre-existing conditions, for example,
maybe have a severe side effect. So that's
number one. We have to ensure that we have the right surveillance system set
up to make sure that when they are
really in phase three, and that's going to be
very good surveillance during phase three, that's the purpose,
but then post-market (once they come to the market) we have to ensure that
we are continuing to monitor the situation of who gets vaccinated.
If any severe adverse effects are occurring, we need to know about them
and quickly dig into them to understand: was it a result of the vaccine or
coincidence? And many times actually it is coincidence.
If you're giving a vaccine to millions of people,
on any given day many people, for example, have heart attacks and so
sometimes you can get confounding.
So that's number one.
And then we need to ensure the vaccines work.
And these are still essentially
in some ways experimental vaccines. But not "in some ways." They ARE experimental vaccines.
We've never created a vaccine that was
used widely for a coronavirus, and we don't have any good vaccines
for viruses that don't create what we
call "sterilizing immunity." There are some. Pneumococcus,
the pneumococcal vaccine, is a good vaccine,
but pneumococcus is actually bacteria that leads to very good immune responses
in people. We know that coronaviruses aren't the
best viruses to lead to really robust immune responses,
and that's why sometimes people get them multiple times.
Ideally, the second and third and fourth time that somebody might get
them the the infection severity goes down and down and down.
But the point is this is kind of new territory for us. We know how to
vaccinate for polio and measles and rubella and mumps.
These are all infections that lead to
very strong immune signals and immunity, and so they were kind of the "low-hanging
fruit" of the vaccine world, and so I would say we are keeping
our eyes open and trying to understand just how well these vaccines will
work, but then we have to add even another layer to it.
Most of the technology that the leading vaccine candidates are using
is not incorporated into most of the vaccines that are in common use today.
So, not only are we trying to to sort of push a new vaccine into the
market against a new bug, but even the technology we're using to
do that is fairly new.
It has huge promise though.
And in terms of scalability, things like the Moderna vaccine
RNA and DNA vaccines can be produced in a whole different
way than than traditional vaccines, and so they could scale a lot better.
So, there's a lot of good reasons why these experimental approaches to
vaccination are being, these are more modern day vaccines I
would say, but there are many,
many questions about just how effective they will be,
how long will the immunity last from them. And so
I'm very optimistic that they will work okay.
I think they will probably work well enough to keep people out of the
hospital, for example, and keep people from dying.
But we don't know how well they'll work to stop transmission,
for example, and if they don't stop transmission,
then they may not help a tremendous amount with herd immunity.
So, there's a lot of pieces here to consider.
As these vaccines progress through the phases of trials
and actually get approval from the FDA, or authorization from
the FDA, it's not like we're going to
have all the vaccines we need and be able to distribute them right away.
So, how's this process going to work where there's a limited number of
vaccines? How will they be distributed, and how
long do you think it'll take to really scale these up to where the average
person is able to get the vaccine if they want to?
Yeah, it's it's one of the pretty vexing questions of the day:
Who is going to get the vaccine first? And not just who, but what countries are
going to get the vaccine first? How will we make this equitable?
There's billions of people on earth, and we can't immediately just start making
billions of vaccines. So, the the federal government, at least
in the United States, the federal government
really needs to, and is setting up task forces, essentially to evaluate these
questions. How can we fairly distribute vaccines in
an equitable way. In general, what's going to happen is
that the first people to get them are going to be the people who
are placing themselves at risk
in order to help people who are infected. And so these will be
the first responders people, like emergency medical individuals,
physicians, nurses, people who are dealing with
coronavirus-infected individuals and putting themselves in harm's way,
but who also could themselves, if they got infected, put their patients in
harm's way. So it goes in both directions:
Vaccinating these individuals first is, generally, I think, considered a pretty
obvious first step in terms of the first people to vaccinate.
It gets kind of murky from there and some of it
has to do, for example, with whether or not these vaccines prove to
block transmission. If they don't block transmission, for example,
then you don't want to bother giving them to really little kids,
who don't get sick anyway, because you wouldn't really gain much from it.
And you would want to give them to vulnerable people if the vaccines work
really well to prevent people from getting sick, but
don't necessarily prevent people from spreading the virus.
You want to give them to older individuals who are
hit most, who have been hit hardest with this virus,
people with comorbid conditions. The big question that exists
is how well will these vaccines work in the most vulnerable populations? The
individuals in nursing homes, the individuals in
very elderly categories. These age categories are
famous for not having good immune responses. It's why people get sick
as we get old; they get pneumonia, you know. All these
infections tend to be the reason that we die. We get infected, and that's
because our immune systems generally don't work as well.
So, if giving the vaccine to certain age categories
is essentially a waste because their body can't
make an immune response, you know it becomes very ethical.
Do we do we try to prioritize to the people who have the most to gain
like 60- and 70-year-olds over 90-year-olds?
I don't have the answers for that, but I think these are the kinds of questions
that need to be informed by science. We need to make sure that
we're making the optimal decisions for society, and it's going to
be a very difficult task. There's a question of distribution, too,
in terms of how quickly can these tests
get scaled up? I think that we should anticipate seeing
some vaccines come to market this fall,
potentially October, November, December. They will be in limited supply.
I don't think that the average person can go into their Walgreens and get a
vaccine anytime this year, probably not even in
the first quarter of next year. I think it's going to be spring
of 2021 at the earliest before the average individual
can actually gain access to a vaccine. And so we still have quite a few months
to go before before these become really readily available to everyone.