Experts see progress on a COVID vaccine, but worry about who gets it first and how it gets to them

Public confidence in effectiveness and delivery of COVID vaccines must be established for battle against the pandemic to succeed, says our panel.

Acoronavirus vaccine or even several could be ready in just a few months, so experts are beginning to worry about howto get it into people’s arms.

“Vaccines don’t save lives. Vaccinations save lives,” said Daniel Salmon, the director of the Institute for Vaccine Safety at Johns Hopkins Bloomberg School of Public Health.

USA TODAY’s expert panelists, increasingly optimistic about the prospect of a readily available vaccine, are concerned about who will get it first, how doses will be shipped, and what messages the government must send so Americans trust getting one.

As the tantalizing prospect of an immunization for COVID-19 comes into focus, educating the public about how the vaccines will work and the painstaking process required to approve them will be key to getting people to line up once they’re available.

It will take “messaging the integrity of the research system,” said Sam Halabi, a law professor at the University of Missouri and expert on global health law.

If this doesn’t happen now, the more than $10 billion in tax dollars spent on vaccines will have been wasted because not enough people will get them to matter.

The agencies that decide if a vaccine isready and who gets it first – the Food and Drug Administration and the U.S. Centers for Disease Control and Prevention – need to be front and center and as transparent as possible, said Dr. William Schaffner, a professor and infectious disease expert at Vanderbilt University School of Medicine in Nashville, Tennessee.

“It is vital that the U.S. government communicate clearly with the American people about the data and science behind any new COVID-19 vaccine,” said Dr. Michelle McMurry-Heath, president and CEO of the Biotechnology Innovation Organization.

And a few public officials gettingimmunizations wouldn’t hurt, said Pamela Bjorkman, a structural biologist at the California Institute of Technology.

“If/when there is a vaccine, government officials should be filmed getting the vaccine,” she said.

This has to happen atfull throttle. A vaccine or vaccines could be ready within months, so time is of the essence, they said.

Dawn is breaking on a virus vaccine

To understand when pre-COVID-19 life in America can resume, USA TODAY created a panel of experts in medicine, virology, immunology, logistics and supply chain issues to estimate how close we are to securing a vaccine against SARS-CoV-2, the virus that causes COVID-19.

Every month, these experts estimate where they think things stand and what time it is on the USA TODAY vaccine clock. Midnight is the starting point of the pandemic in the USA, and noon is the time a vaccine will be widely available to Americans.

For August, the clock’s hands stand at 6 a.m., two hours closer to noon than in June, the first month of estimates. Dawn is breaking but the security of a vaccine against the disease that has ravaged the world is still far away.

This month the 15 estimates ranged from 4 a.m. to a highly optimistic 10 a.m. The median was 6 a.m.

Don’t put all vaccine eggs in one basket

It’s far too soon to presume victory, panelists said.

There’s still a real possibility that none of the current vaccine candidates will pan out. The typical success rate for vaccine development is 6%, according to The Lancet, a British medical journal.

“We simply cannot assume the outcome at this stage,” said Dr. Kelly Moore, associate director of immunization education with the Immunization Action Coalition.

“The government should hedge its bets and put more money into basic vaccine research. If these don’t work, then we’re going to be back to square one. Getting square one started now is important. And even if they do work, that that kind of research work on new vaccine platforms is not a waste,” said Dr. Otto Yang, a professor of medicine and chief of infectious disease at the David Geffen School of Medicine at UCLA.

This may not be one-and-done either, said Dr. Greg Poland, director of the Mayo Clinic’s Vaccine Research Group.

Just as the common cold and flu mutate a little each year, coronavirus could do the same. Funding new vaccine development that can fill the void in case of viral mutation/recombination will be critical, said Poland, who is also editor-in-chief of the journal Vaccine.

It’s the home stretch but a long one

With at least 10 possible vaccines now in the final Phase 3 clinical testing stage, two looming questions remain: Will they work and will they work long enough?

There’s still no data to show that any of the candidate vaccines provides immunity to COVID-19. That’s what Phase 3 clinical trials test for, which are only now starting.

“This is a new virus and we are just beginning to unravel the protective immunity,” said Prakash Nagarkatti, an immunologist and vice president for research at the University of South Carolina.

Phase 1 testing is done on small numbers of volunteers to ensure the candidate vaccine is safe and doesn’t havecommon, serious side effects. Phase 2 increases to a few hundred volunteers and sets a safe dose. But it isn’t until Phase 3, set at 30,000 volunteers by the National Institutes of Health, that actual data showswhether it protects people against COVID-19.

Dr. Monica Gandhi, an infectious disease expert at the University of California, San Francisco, says data from people who’ve recovered from COVID-19 makes it seem likely that immunity is possible.

“Natural infectious always gives you a clue to immunity and I think natural infection with this virus seems to be giving people immunity,” she said.

Even if immunity only last a year, booster immunizations can be given if vaccine efficacy wanes over time, said CalTech’s Bjorkman. The only way to know for certain will be to evaluate data from Phase 3 trials, she said.

Even so, simply having a vaccine that worked for a year at a time would turn COVID-19 from a pandemic into something manageable, just like theseasonal flu, said Erica Ollmann Saphire, a structural biologist and professor at the La Jolla Institute for Immunology.

“We’re willing to take a seasonal coronavirus vaccine if that’s what it takes until something universal and lifelong is developed,” she said.

Securing a vaccine not a slam dunk

Finally, the public needs to remember that life isn’t going to suddenly zip back to the way it was in January, when we all lived blissfully unaware of the virus or its effects, the experts said.

It’s not likely anyvaccine will be 100% effective and it could be that people who are immunized might still get sick, but less severely.

“I think we’d have the chance of having a vaccine that substantially blunts the frequency of severe disease and therefore reduces mortality,” said Schaffner.

That alone will be a huge win, but the need to keep wearing masks and socially distance might still be there.

“I don’t think we’ve communicated that,” he said.

This Month’s Panelists

Pamela Bjorkman, structural biologist at the California Institute of Technology

Dr. Monica Gandhi, an infectious disease expert at the University of California, San Francisco

Sam Halabi, professor of law, University of Missouri, scholar at the O’Neill Institute for National and Global Health Law at Georgetown University. 

Florian Krammer, virologist at the Icahn School of Medicine at Mount Sinai in New York City

Dr. Michelle McMurry-Heath, president and CEO of Biotechnology Innovation Organization (BIO)

Dr. Kelly Moore, associate director of immunization education, Immunization Action Coalition; former member of the CDC Advisory Committee on Immunization Practices; chair, World Health Organization Immunization Practices Advisory Committee

Prakash Nagarkatti, immunologist and vice president for research, University of South Carolina 

Peter Pitts, president of the Center for Medicine in the Public Interest, 

Dr. Gregory Poland, director, Mayo Clinic’s Vaccine Research Group, editor-in-chief, Vaccine

Arti Rai, law professor and health law expert at Duke University Law School

Daniel Salmon, the director of the Institute for Vaccine Safety at Johns Hopkins Bloomberg School of Public Health

Erica Ollmann Saphire, structural biologist and professor at La Jolla Institute for Immunology 

Dr. William Schaffner, professor of preventive medicine, Department of Health Policy, and professor of medicine, Division of Infectious Diseases, Vanderbilt University 

Prashant Yadav, senior fellow, Center for Global Development, medical supply chain expert

Dr. Otto Yang, a professor of medicine and chief of infectious disease at the David Geffen School of Medicine at UCLA 

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