WHO GETS THE VACCINE FIRST?
I’m sure you’ve heard the wonderful news of the past few days that both the Pfizer and Moderna COVID-19 vaccine candidates have shown efficacy ratings of about 95%. This is far more than most scientists expected. Dr. Anthony Fauci, head of the National Institute of Allergy & Infections Diseases at the NIH, tells us that “from both a scientific and potential public health standpoint, this is an extraordinarily important advance.”
Neither company has yet publicly shared their data but independent clinical trial monitoring boards have reviewed the results. And if all goes well, the FDA will give emergency use authorization and initial doses should be available in December. Between the two companies, we’ll have about 45 million doses for about 22.5 million people (because each person needs 2 doses). As we get into the following months, the number of doses will greatly increase.
Still, there are important tasks ahead. Both vaccines use new technology know as messenger RNA (mRNA). (Please refer to my June 6, 2020 post Find a Vaccine—End the Pandemic.) The downside of mRNA vaccines is that they are extremely fragile. Because mRNA is an inherently unstable molecule it needs a protective bubble of fat, called a lipid nanoparticle. But this bubble is extremely sensitive to temperature. For long-term storage Pfizer’s vaccine has to be stored at -70 degrees Celsius and Moderna’s at -20 Celsius.
Thus, smoothly distributing the vaccines will be a massive logistical challenge. There’s also the question of who gets the vaccine first?
A Tiered Approach
The US National Academies of Sciences, Engineering and Medicine (NASEM) has proposed a five-phase plan to fairly allocate a coronavirus vaccine to US residents. After health-care workers, medically vulnerable groups should be among the first to receive a vaccine, according to the NASEM draft plan. These include older people living in crowded settings, and individuals with multiple existing conditions, such as serious heart disease or diabetes, that put them at risk for more-serious coronavirus infection.
| Phase 1 | Health-care workers and first responders (5%) |
| Phase 2 | People with underlying conditions that put them at high risk of severe COVID-19 disease or death, and older adults in densely populated settings (10%) |
| Phase 3 | Essential service workers at high risk of exposure, teachers and school staff, people in homeless shelters and prisons, older adults who have not already been treated and people with underlying conditions that put them at moderate risk (30–35%) |
| Phase 4 | Young adults, children and essential service workers at increased risk of exposure (40–45%) |
| Phase 5 | All remaining residents (5–15%) |
Note: Phases 1 and 2 might occur in tandem. Per cent is the percentage of the US population to receive a vaccine. Source: NASEM
The End of the Pandemic
We must work at slowing the dangerous trajectory of COVID-19 hospitalizations and death that’s happening right now. We must keep masking and social distancing for the near future.
Yet, if we can adequately distribute the vaccine over the coming months AND if enough Americans choose to get vaccinated—and by extension all populations throughout the rest of the world—we can end the pandemic!