Coronavirus (Covid-19) and vaccines: The ABC’s right now

Filed Under: Costs, Patients, Providers

Gustavo Fring via Pexels
- photo by Gustavo Fring via Pexels

By JEANNE PINDER and VIRGINIA JEFFRIES

Who is making the vaccines?

While dozens companies and organizations are in the process of testing and manufacturing Covid vaccines, five appear poised to have their shots ready for the public in the United States within the next six months:

Pfizer (in partnership with BioNTech)
Moderna
AstraZeneca (in partnership with Oxford University)
Johnson & Johnson subsidiary, Janssen Pharmaceuticals
Sanofi (in partnership with GlaxoSmithKline)

When will they be available?

As of today, no vaccines have been approved for general use, but Pfizer submitted an application to the Food and Drug administration for an emergency use authorization for its vaccine on Nov. 9. If all goes well for the company, a limited supply of the vaccine could be available as early as mid-December.

Moderna planned to submit an emergency use authorization with the FDA for its vaccine on Monday. The New York Times reported that Moderna’s vaccine could potentially begin a limited rollout as early as Dec. 21.

Vaccines by AstraZeneca, Janssen Pharmaceuticals and Sanofi and GlaxoSmithKline are in various phases of clinical trials and could be ready in the first half of 2021.

Who will get them first?

The CDC is meeting on Tuesday to make up a schedule for dispensing them. They are expected to make a schedule that gives priority to those most at risk such as healthcare workers and those over age 65.

I’ve heard that there are differences in the effectiveness of the vaccines. Can you explain?

Three of the U.S. vaccine manufacturers have announced results from clinical trials. Pfizer’s vaccine is reported to be 95% effective while Moderna’s is 94.5% effective. AstraZeneca’s vaccine is between 62% and 90% effective.

How will they be administered?

The first two expected to be made available, by Moderna and Pfizer, require two shots at slightly different intervals. That means if you get the Moderna one first, you have to get the Moderna one second. Someone is going to need to keep careful records on this to make sure this happens on a very large scale.

Dr. Shiv Pillai, an immunologist at Harvard University, said in a video interview that many insured people will have access to a patient portal through their insurer or provider that should be able to keep track of this. For uninsured people, recordkeeping at this level of detail will be less certain — and some people might fall off the regimen.

So I get my first shot and then I’m immune, right?

No, you get your first shot, then wait a month or so — depending on the manufacturer — to get the second. Then you wait as long as the manufacturer suggests you wait to benefit from the vaccine (some reports have said 14 days after the second dose, depending on the manufacturer).

In the meantime, you’re not actually protected yet. So: Stay home, wear a mask, do all the things you have been doing to stay safe.

How long will they last — forever?

We don’t know yet, but Pillai said that based on the limited data he has seen, it could be on the order of years.

“When you look at the titers, which are pretty good,” Pillai said, “you will see that maybe it’s going to last for at least a year, at a minimum, maybe more.”

I heard that one of the vaccines needs to be stored at some unbelievably low temperature, while another one does not. Can you explain?

In order to preserve its active molecules, Pfizer’s vaccine has to be stored at -70℃ (-94℉) — which you can think of as colder than winter in Antarctica.

Moderna’s vaccine has to be kept cold too, but at -20℃ (-4℉) the temperature is much less extreme.

Where are the scientific papers on this?

The public has so far not been privy to the actual research behind the vaccines. Pillai noted that the data so far has been “reporting by press conference. So we really don’t know the facts.”

Scientific data for the first two vaccines, he said, will be presented at public meetings held by the FDA’s advisory committee on Dec. 10 for Pfizer and Dec. 17 for Moderna. At that point, Pillai said, “we’ll see what the data is.”

I heard that there are two kinds: “messenger RNA” and “hybrid.” Can you explain?

Both Pfizer and Moderna’s vaccines use a molecule called messenger RNA (or “mRNA”) to stimulate the immune system process to eventually create antibodies to the coronavirus. The pharmaceutical company Novavax is also working on a vaccine based on mRNA that is expected to begin Phase 3 clinical trials in December.

Hybrid vaccines, like AstraZeneca/Oxford University’s, use a virus — one that has been emptied of its genetic material and is no longer dangerous — to set off the immune process. Janssen Pharmaceuticals is also working on a vaccine using the hybrid technique.

Both AstraZeneca and Janssen Pharmaceuticals paused their research in recent months following safety scares when volunteers became ill. Both companies resumed research in October after concluding that the incidents were not directly caused by the vaccines.

Which kind is better?

The jury’s still out on this. Each company is saying theirs is the best. As Pillai said, when the data is in, we’ll know more.

It’s also possible that specific groups, say immunocompromised people, may fare better with one type or another. We’ll have to wait for the science on that.

What role will the states play in this?

State departments of public health are likely to play a big role in governing shipment and distribution. Find your state’s department through the CDC’s gateway here.

Will there be people who refuse to get the vaccine?

Almost certainly. For example, a bill has already been introduced in the Kentucky Legislature seeking to give Kentuckians the right to refuse the vaccine. Anti-vaccine forces have already made some strange suggestions — that Bill Gates is using the vaccine to inject microchips into us, for example — and we don’t imagine they will stop quickly.

Will I have to pay for it?

The Centers for Medicare and Medicaid Services says on its site: “The Administration is committed to providing free or low-cost COVID-19 countermeasures to the American people as fast as possible. Any vaccine or therapeutic doses purchased with U.S. taxpayer dollars will be given to the American people at no cost.”

But not all vaccines were purchased with U.S. taxpayer dollars.

Also, you might be charged for an office visit or similar administrative fee attached to the administration of the vaccine. That fee might be paid by your insurance company, or by the fund set up for Covid relief for uninsured patients, according to the Centers for Disease Control and Prevention.

The short answer is: Probably not, but we don’t know for sure. We all know our healthcare system has a way of making you pay for things that are supposed to be free.

I already had Covid. Can I just skip the vaccine? Presumably I have immunity.

No one knows if a previous case of Covid can give full or partial immunity or how long that immunity may last. Some research suggests that you might have immunity for 6 months, but the virus is just too new to us for any conclusions about immunity.

There are increasing credible reports that people are getting re-infected with Covid, and not just a few people.

The best science suggests that a vaccine will protect you better than any natural response from a previous infection.