Let’s all breathe a sigh of relief. Although it will be several months before a large chunk of the population is vaccinated, two COVID-19 vaccines have officially been approved for emergency use in the U.S.
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But unfortunately, the vaccine is not a golden ticket. Sure, it’s a great start and it means there’s an end in sight, but it’s not an automatic off button for the pandemic. The upcoming months ahead might prove to be long, anxiety-inducing and somewhat stressful, as federal and local officials collaborate on the logistics of vaccinating 380 million Americans.
Steven Gordon, MD, Chairman of the Department of Infectious Disease, shares insight into vaccine priority and why being patient about when you’ll receive your vaccine correlates with keeping others safe.
Who is overseeing the vaccine?
The Advisory Committee on Immunization Practices (ACIP) is responsible for overseeing the safe use of vaccines in the U.S. The committee is made up of experts from medical and public health. ACIP works with a variety of groups and organizations to thoroughly review all available scientific information pertaining to vaccines in the U.S. The CDC then sets the immunization schedules based off the recommendations from the committee.
Since March, ACIP has been trying to solve many complex questions regarding the COVID-19 vaccine, even before it started in clinical trials. In the past with other diseases and immunizations, it would take years to provide a vaccine recommendation.
The committee studies three key elements that can lead to potential vaccination:
- Science. It verifies that the vaccine is safe and effective. (FYI: It is.)
- Feasibility. The committee considers the logistics behind how a vaccine would be distributed and how much of the product is available.
- Ethics. How it determines who gets the vaccine, especially the first doses of a limited supply.
And we’re off!
- On December 1, 2020, ACIP recommended that once the FDA passed Emergency Use Authorization (EUA), it should first be offered to healthcare workers and residents of long-term care facilities.
- On December 11, 2020, the FDA issued the first emergency use of the Pfizer-BioNTech COVID-19 vaccine to be distributed in the U.S. to those who are 16 years and older.
- Then on December 13, 2020, after the FDA approved it, ACIP officially recommended the vaccine to U.S. residents, specifically for healthcare workers and those in long-term care facilities.
- And on December 18, 2020, Moderna received EUA from the FDA for its COVID-19 vaccine.
The biggest barrier (at first) will be distribution
Although it’s great news that the FDA approved the vaccine and ACIP reviewed and recommended it, we need to brace ourselves that it will likely be a slow start to distribution. There are still many roadblocks and obstacles to figure out as we go. It’s not as easy as just adding someone to a waiting list.
“It usually takes years and years to roll out a vaccine,” says Dr. Gordon. “From review, to distribution, everything that has happened over the past nine months has been at warp speed. We’ve never pushed out a vaccine this quickly before, so there will be many questions we need to answer as this happens in real time.”
The federal government has basically said it’s going to buy as many doses as it can, he continues, then it will distribute the product to the states. Each state will then partner with healthcare organizations and handle its own distribution. But because each state is different, it’s important to have patience as the logistics are worked out, especially because vaccine priority could differ slightly from state to state.
As a comparison, remember how scarce and limited coronavirus tests were back in March and April?
That’s what the vaccine will likely resemble for the first couple of months it’s available. It will be a process for state and health officials to figure out the safest and quickest way to start distributing the vaccine – and to those who need it most first.
“When we first started dealing with COVID-19, we only had one type of test and we were overwhelmed with the demand,” says Dr. Gordon. “But testing technology evolved as the science evolved. Now we have multiple ways of testing. In fact, every day you have more and more companies coming forward and saying they found another way and can offer it.”
Even though the past nine months felt slow to a normal person (hi, quarantine), the timeline for testing evolution and availability was incredibly short. Now, as more companies seek FDA approval for their vaccines, more doses will become available over the next couple of months, making it more accessible to the U.S. population as time goes on.
Why are healthcare workers and long-term care residents first?
“Thankfully, we now have a vaccine that’s very, very effective,” says Dr. Gordon. “So the first priority is to make sure that the folks who might die from COVID-19 get the vaccine first. The second thing we need to do is make sure that whoever’s taking care of these critically ill patients can continue to do so.”
Long-term care residents only make up about 3 million of the 380 million people in the U.S., which is just a small chunk of the population. But when you look at long-term care residents and COVID-19, the numbers are sobering. Long-term care residents makeup 6% of COVID-19 cases, but this group accounts for 40% of the death toll. That means these residents are the most vulnerable, at-risk population in the U.S. regarding coronavirus, and is why ACIP recommended this group to be in the very first wave of vaccination.
Running parallel to long-term care facilities are the healthcare workers who treat those who are critically ill. Healthcare workers make up about 20 million of the 380 million people the U.S. But as the pandemic marches on, especially as we’re in the midst of a very heavy surge, more and more healthcare workers are becoming infected. In order to stop the tide, we need to take care of them first, so that they can be there to take care of the sick.
Who will be vaccinated after healthcare workers?
ACIP is continually assessing how the waves of the vaccine will roll out. After healthcare workers and residents of long-term care facilities are vaccinated, the committee will look at the next group of people who are at severe risk and exposure to COVID-19.
These groups include:
- Workers in essential and critical industries.
- People with certain underlying medical conditions.
- Those who are 65 years and older.
“The committee will continue to tackle when each group will be next in line for the vaccine,” says Dr. Gordon. “And I say ‘tackle” because it really is a deliberative process with lots of things to consider and many experts will weigh in. Hopefully after the first several groups get vaccinated, production will ramp up and we’ll start to see more availability open up.”
What’s the timeline for healthy people to get vaccinated?
When the vaccine is widely accessible, that’s when it will open up to the general public to anybody who is healthy and wants to get vaccinated, says Dr. Dr. Gordon.
“Realistically, for most folks, it will likely be spring or later for the vaccine to be available to them,” he says. “A lot can change, but we’re hopeful that the majority of adults in the U.S. will be vaccinated by the end of 2021.”
Kids, pregnant women and those recently infected
More research is needed about the vaccine for those under 16 and for pregnant and breastfeeding women. Kids were included in some vaccine clinical trials, but it typically takes much longer to develop a children’s vaccine than an adult version. It’s important to note that in order for the pandemic to be over, kids will also need to be vaccinated.
And when it comes to pregnant and breastfeeding women, the FDA is still deliberating.
“We don’t have clear recommendations for women in this group yet,” says Dr. Gordon. “So while it doesn’t look like it’s a hard stop, it doesn’t mean that if you’re pregnant or breastfeeding that it’s 100% safe either. You’ll need to have a conversation with your provider about the risks and benefits.”
Another group to consider once the vaccine is made available to the general public is those who have had COVID-19 in the last 90 days. This group has potential lingering immunity and it’s recommended for them to wait 90 days before getting vaccinated.
Yes, you will eventually get vaccinated
The ultimate goal is to get everyone vaccinated so that the population reaches a level of herd immunity. We want to offer the vaccine in a safe and orderly way that prevents the most deaths and illness. This will require patience and perseverance from everyone over the next several months.
Every person and every group that gets vaccinated is a small step in the right direction, no matter how slow it may go.
We need to also remember that the vaccine is not the final answer to the pandemic. Instead, the vaccine will now be one of the many layers of protection we have against COVID-19.
“We need to continue wearing a face mask, avoid gatherings and maintain physical distance,” says Dr. Gordon. “As much as we like to think that the vaccine will be a lightning bolt back to how things were in 2019, that’s not the case and it won’t be for many more months still.”
So although a vaccine is hopeful news, we still have a long way to go. Think of it like a light at the end of a tunnel. We’re all on a very slow train moving towards it, but eventually, we’ll all get there.