'Puzzle without the edge and corner pieces': 2 experts weigh in on Pfizer, Moderna vaccine trial news

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Americans have good reason to be encouraged by Pfizer's Nov. 9 announcement that its COVID-19 vaccine candidate can prevent more than 90 percent of infections, even though significant uncertainties about the vaccine's distribution remain.

Pfizer's vaccine uses an mRNA vaccine platform, meaning it seeks to mimic infection in the body by carrying the genetic instructions for cells to produce antigens that fight COVID-19.

Anna Legreid Dopp, PharmD, the senior director of clinical guidelines and quality improvement at the American Society of Health-System Pharmacists, said all healthcare providers and public health officials should be "excited and encouraged" by Pfizer's interim trial analysis, as the good news furthers the possibility that the mRNA vaccine platform can set a precedent for future vaccine candidates against other potential targets. 

"Anyone with some expert optimism with vaccines in the pipeline was really encouraged to hear the 90 percent news — granted it was only from a press release, not from a published trial or from any kind of communication from the FDA," Dr. Dopp said.

She said vaccine experts have been calling for the mRNA platform to be integrated into vaccine production for years, as mRNA vaccines can be developed and manufactured more rapidly than other vaccines. The potential validation of the mRNA vaccine platform means that other COVID-19 vaccine candidates that use it may also be effective. Moderna, which also used the mRNA platform to develop its COVID-19 vaccine, said Nov. 16 its candidate was shown to be 94.5 percent effective in phase 3 trials.

However, the good news is far from a solution to the country's mass COVID-19 infection problem, as significant uncertainties surround the vaccine distribution process.

John Grabenstein, PhD, the 2020 recipient of the American Pharmacists Association's Remington Honor Medal, said efficient vaccine distribution models reduce friction, but plenty of friction still remains as the country formulates plans to inoculate its residents on a mass scale.

"It's all surmountable; it's all solve-able, but it's going to take a lot of extra labor to assure the proper temperature conditions for quality and quantity," he said.

Questions around how the vaccine will be distributed among hard-hit rural communities that do not have access to ultra-cold storage technology and the timing of when vaccines should be thawed in order to remain effective still don't have conclusive answers. These questions mainly concern Pfizer's vaccine, as it must be stored at minus 94 degrees Fahrenheit. Dr. Dopp said healthcare facilities planning for vaccine distribution "are trying to put together a puzzle without the edge and corner pieces."

Healthcare providers will likely piggyback off the country's influenza vaccine distribution infrastructure, which allows around 160 million doses to be administered each year in a timely manner, according to Dr. Grabenstein. Additionally, Dr. Dopp said healthcare providers will need to ensure they are following people's vaccinations using interoperable, real-time information systems so that doses can be accurately tracked.

Another significant problem facing widespread vaccination in the U.S. is the public's growing distrust of the COVID-19 development process. Many residents believe the process has been influenced by politics more than science and are unsure of the vaccine's safety and efficacy.

Both Drs. Dopp and Grabenstein acknowledged that the federal and local governments should focus on providing residents with transparent and consistent information about COVID-19 vaccines. Dr. Dopp also said healthcare workers, who will receive the first COVID-19 vaccine doses, could build vaccine acceptance in the public by expressing excitement and trust about their inoculation. 

Though the country's COVID-19 vaccine program is far from over, experts think recent news from drugmakers is propelling efforts in the right direction. "We still need to be vigilant; we still need to evaluate the research. But I think we can take a moment to be inspired by the innovation," Dr. Dopp said.

 

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