The holidays are upon us, albeit the magic of extended time with family and friends, mixed with stories of miracles and wonderful gifts, appears more imagery this year than reality.
COVID-19 is disrupting our gatherings and replacing joyful hugs with masks and physical distance. This year, the glitter of the holidays comes from the scientific community, which is providing some of the most meaningful gifts that we can share with those we love.
The last three weeks have brought news that several highly effective COVID-19 vaccines have arrived; vaccines that have the potential to help end this pandemic and its devastating health, social and economic costs. Two of the vaccines, very similar in their composition and novelty, have demonstrated extremely high efficacy. It is likely that initial distribution of these vaccines will begin under an Emergency Use Authorization by the end of the year. Just days ago, a different type of vaccine was announced to have efficacy, as well, portending that we will be able to address concerns about sufficient vaccine availability.
The development of highly effective COVID-19 vaccines with unprecedented speed has been an astonishing achievement of scientific prowess. This stunning accomplishment built on decades of scientific advances related to other viruses, especially those associated with the quest for an HIV vaccine. For example, the Vaccine Research Center, which discovered the way the COVID-19 virus lands on and infects a cell in our noses or lungs, was established 15 years ago to accelerate development of an HIV vaccine, and then expanded to pandemic flu and SARS research.
Scientists at this government-supported research center solved the landing gear configuration of the COVID-19 virus within three weeks of the virus being identified; a feat enabled by their prior work with the first SARS virus. The gene encoding this SARS-CoV-2 virus spike landing protein was given to vaccine companies, and is being used in five of the six vaccines in the U.S. government’s Operation Warp Speed COVID vaccine program. The safety and efficacy of these vaccines is being evaluated with unprecedented speed and scientific rigor by a vast network of clinical trials sites across the country and around the globe that has marshaled and leveraged preexisting clinical research networks working on HIV and other infectious diseases during the last two decades. This critical assessment harnesses the operations and statistical center at the Fred Hutch and the expertise of many University of Washington clinical researchers.
Eleven months after discovering the virus, we have highly effective vaccines. The Pfizer and Moderna vaccines are scientific gifts of innovation. They take a synthetic piece of genetic material (messenger RNA) that gives our bodies the code to produce a protein that resembles the spike protein without causing disease, and triggers our immune systems to make the antibodies to prevent the SARS-CoV-2 virus from landing. Two randomized controlled trials — the gold standard in scientific evidence — independently conducted and involving 74,000 people — show that this new approach works to prevent symptomatic COVID-19 disease in 95% of people. Importantly, they also showed 95% protection from progression to severe complications of COVID-19, thus providing the evidence that vaccination will reduce the flood of COVID-19 patients requiring hospitalization and ICU care, and the number of people who will die from this disease. This is a gift of personal benefit to every recipient of a COVID-19 vaccine. These results were delivered in less than four months from starting the trials, a stunning achievement as vaccine development usually takes a decade and sometimes longer. The mumps vaccine, which is the vaccine that was developed fastest to date, required four years.
In the coming months, we will be able to answer additional questions that will be critical to controlling the pandemic. We will learn how long protection from these vaccines lasts. We expect these vaccines will eventually transform COVID-19 into a disease like the common cold that does not overwhelm our health systems or shut down businesses and schools. Continued follow-up of people enrolled in the current trials and studies of others who receive these vaccines will tell us whether this hope is realized. The biggest unknown now is whether these vaccines will also protect us from acquiring and transmitting the virus. The current studies do not answer the critical question of whether we will still get infected, not get sick, but continue to spread a potentially deadly infection to others who have not been vaccinated. If this is the case, without extremely high levels of vaccination, community spread will continue, and people will continue to require hospitalization or will die, particularly in marginalized, underserved communities.
Vaccines in freezers don’t end pandemics. Immunizations in people, combined with ongoing prevention strategies — especially until millions are vaccinated — control pandemics, save lives, and enable schools and economies to reopen. The gift of science in a bottle must be made available equitably and utilized resourcefully to provide the maximum benefit. This will be especially important and challenging during the coming year until manufacturing capabilities and logistical supply chains become robust and enable universal vaccine availability. Indeed, there are more than 330 million people in the United States and 7.8 billion globally.
Vaccine will be scarce in the United States for at least the next six months, and vaccine will probably not be accessible in any form in many countries at least until the end of 2021. The 200 million vaccine doses that Pfizer and Moderna plan to manufacture between now and early April 2021 mean that only 100 million of our 330 million people in the United States will get the two vaccine doses that are required in the next three to four months. Achieving high vaccine coverage in the U.S. without high coverage in other countries not only abrogates our social responsibility as global citizens, it will also fail to protect Americans. Furthermore, to contain this pandemic, we urgently need to build robust vaccine delivery capacity here at home and in low- and middle-income countries (LMICs). Even when sufficient vaccine supplies become available, existing systems in many rural or marginalized communities across our country and in many LMICs do not have the capacity to deliver those vaccines to the people who need them.
It is clear we need additional vaccines. Other vaccines, including one made by Johnson & Johnson and one made by AstraZeneca, are in field trials in the U.S. There is reason for optimism about these vaccines from scientific and manufacturing perspectives. They have large scale manufacturing capabilities, lower cost, and less reliance on a cold, temperature-controlled chain for distribution than mRNA vaccines.
None of these vaccines will end the pandemic alone. We will also need to continue to use masks, physical distance, wash hands, and avoid large gatherings until the majority of the population is immunized. Many people will not get vaccinated for many months. During this time, a combination of these prevention strategies, together with vaccines and emerging preventive treatments, will be essential if we want to reopen businesses and schools; if we want to travel; and if we care about our communities and about each other.
This year, there are four very special gifts that each of us can give our children, our parents and anyone else we love. 1) We can seek accurate, up-to-date information about COVID-19 vaccines. 2) We can get vaccinated when a vaccine is available and we are eligible. 3) We can continue to use the prevention tools that Public Health Seattle King County, the Washington State Department of Health, and the Centers for Disease Control and Prevention have recommended, like face masks and physical distancing. And 4) we can support the kind of science that led to these vaccines and the other tools we need to end this pandemic and prevent future ones. Together, these are the gifts of life and well-being for our families, our friends and our communities. They are the most meaningful gifts we can give.