COVID Transmissions for 3-12-2021

Biden's orders: availability of vaccine for all adults by May 2021

Mar 12, 2021

Good morning and welcome to COVID Transmissions.

It has been 480 days since the first documented human case of COVID-19. In 480 CE, the Western Roman Empire really “ended.” Julius Nepos, the last Western Emperor, who had ruled only the province of Dalmatia for some years, was killed by his own troops. King Odoacer, who we mentioned in an earlier issue, actually captured these troops and had them prosecuted with support of the Roman senate. The Eastern Emperor, Zeno, abolished the East-West divide after these events, which marks the transition to what is today called the Byzantine Empire.

We are also in a period of transition, and not just to the weekend. I react to President Biden’s remarks from last night today, and then based on those remarks, I check in with my predictions from July about the vaccine timeline.

This weekend is supposed to be beautiful here in New York, and I hope it’s the same wherever you are. No matter the weather, please be kind to yourself and enjoy the weekend.

As a heads up, there is a chance that I will skip writing COVID Transmissions on either Monday or Tuesday, because I am moving at the beginning of next week. This might lead to a slight interruption in either my literal physical uptime, or in my Internet uptime. I’ll do my best not to miss both days, though, and minimize the interruption.

As usual, bolded terms are linked to the running newsletter glossary.

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Now, let’s talk COVID.

Biden administration requests unrestricted vaccine access by May 1st for all US adults

Last night, President Biden made a speech in which he discussed the pandemic and noted that he expects all states to make COVID-19 vaccines available to all US adults by May 1st. His administration will be directing all states to meet this goal—though I am not sure exactly what the federal vs state authority is in this case. I’m a virologist and science communicator, not a health policy lawyer.

There were some other interesting points in Biden’s speech. One thing he noted is that he is hopeful for the vaccination campaign to allow a return to relative normalcy in American life by July 4th of 2021, a somewhat ambitious goal, but one that seems possible given that vaccination could become widely available to all American adults two months earlier.

Since it takes about 2-6 weeks to get fully protected, depending on the vaccine administered, it really seems possible to achieve this.

One thing that is really encouraging to me is the check-in with President Biden’s goal of distributing 100 million doses of vaccines—originally enough to vaccinate 50 million Americans, but now slightly more considering the one-shot J&J vaccine being in the mix—in his first 100 days in office. His administration also announced yesterday that we are on track to meet this goal by his 60th day in office.

This is fantastic progress.

However, a note of caution. The pandemic is NOT over. The vaccines are NOT perfect. There is still risk. I do not agree with any state lifting public gathering restrictions or fully opening at this time, nor do I agree with lifting of mask mandates. We have the incredible opportunity to end this pandemic in the US, and not too long after that, in many other countries around the world. However, we can still screw it up. So let’s not, please?

Keep yourselves safe, because the danger will soon pass if we remain vigilant.

What am I doing to cope with the pandemic? This:

Completing a major project

Today, I finalized the draft of a major scientific manuscript I have been responsible for at work. We got all author approvals, and we are finalizing the other approvals that we require. I have been working on this project through a pandemic, an FDA rejection of my company’s lead product, and a layoff. It is finally done, and I am ecstatic.

I was also invited to participate in a working group that will recommend employee vaccination policies to our executive team. In pharma this is especially important, because our field salespeople and field science representatives enter healthcare settings where vaccinations may be required as part of institutional policies. It’s interesting stuff—to me at least.

Revisiting my predictions from July 2020

I do not like to make predictions in science communications. I think it’s better to give the information I have than to guess. However, in the second-ever issue of this newsletter, I decided to make a few predictions about the future of the pandemic:

So, summarizing the milestones, here’s the future I see:
Approval of a vaccine candidate by December 2020 at the earliest
Availability of doses for high-risk people and healthcare workers by January 2021
Availability for most adults beginning in February or March 2021, but with shortages resulting in gradually increasing availability through May 2021
Supply that fully meets demand and allows wide vaccine coverage by June 2021

I have revisited these over the past 8 months, but with the end now forecast by the President, I wanted to check in on how this bore out. How did I do?

So, summarizing the milestones, here’s the future I see:
Approval of a vaccine candidate by December 2020 at the earliest — The Pfizer vaccine was given Emergency Use Authorization on December 11th, 2020. Dead on.
Availability of doses for high-risk people and healthcare workers by January 2021 — Rollout to high-risk people and healthcare workers actually began in late December, but efforts considerably accelerated in January. Pretty close!
Availability for most adults beginning in February or March 2021, but with shortages resulting in gradually increasing availability through May 2021 — Here I am benefited by having written a vague prediction. Expansion of vaccine availability has continued according to risk groups, but the population included has substantially grown over the course of February and March. Shortages have occurred, and as a result there is indeed gradually increasing availability through May 2021. I think I got this pretty right!
Supply that fully meets demand and allows wide vaccine coverage by June 2021 — Keep in mind that I wrote this before knowing that any vaccines worked, or that it would take one month to reach full vaccination for many of the final designs. However, if indeed wide availability for all US adults is reached by May 2021, then June 2021 would be about the time that there is wide vaccine coverage. Additionally, the Biden Administration recently projected late May as the date that they would be certain to have enough vaccine doses for all American adults. I think, if by nothing other than sheer luck, I made a prediction here that we are on track to meet!

Not bad! I wouldn’t give myself 100%, but I didn’t expect to be this close, either. This was originally my best-case scenario prediction, as you can see from the December approval being “at the earliest,” but we were very fortunate.

Also, I think I originally imagined that vaccinations would not necessarily be two-dose affairs, so I was expecting manufacturing to catch up to demand in June, with vaccine coverage (ie, protection) being pretty rapid after vaccination. In the end this has turned out not to be the case, so while I was a month late on my predicted supply target, this was offset by the fact that two of the vaccines take about one month to achieve full immunity.

It’s nice to feel like we are getting ahead of the virus. But we still need to stay strong, be safe, and get the vaccine when it is available to each of us. It’s every person’s—and every country’s—responsibility to put an end to the COVID-19 pandemic.

Reader Pete Lambro asked the following question, which I think is of great importance in achieving vaccination goals:

Do you have any easy to understand resources I can share with some vaccine skeptical family? They have said things like "its so new" as a reason to hold off getting vaccinated.

We are entering a phase in the fight against the pandemic where questions like this are of the utmost importance, because the success of vaccination depends upon people’s willingness to get vaccinated. So, I will be revisiting this topic, but here is my answer for the time being:

Good question, Pete. I've been meaning to either look for, or write myself, a resource of the type you're asking for. I haven't seen one yet that I find very satisfying. Perhaps I will have time to write one myself next week after I've moved.
That said, I want to myth-bust one thing here. "It's so new" isn't really true of any of these vaccines. The basic designs of these vaccines were in development for years before this pandemic. I think that it really did a disservice to the vaccines that the name "Operation Warp Speed" was chosen for the vaccine manufacturing program under the prior administration, because it has given people the sense that the trials were rushed in some way.
In reality, clinical trials often take a long time because enrollment is very slow and because the resources don't exist to speed up the conduct of the trial. If you think about it, this makes sense--they had to vaccinate tens of thousands of people for each trial. Under normal circumstances, this would be done in the course of usual business for the trial investigators, who are just normal physicians who happen to also do research. So it can be very slow to enroll, randomize, and vaccinate everyone for a trial. And then you have to do that for all three trial phases.
With a big boost in money, you can do things a lot faster, though. To bring a vaccine to market typically costs between hundreds of millions and just over a billion dollars. To bring these vaccines to market, around 20+ billion dollars were invested by both private entities and the government. That cash influx provided a lot of capacity for running the trials. The actual follow-up was not much shorter than I would expect for the conduct of a clinical trial in an acute infectious disease.
The safety follow-up might have been about 6 months under normal conditions, however, whereas here it was only 2 months. But this is not a matter of major concern, because safety monitoring continued in the trials after the initial results were released. We are now reaching that 6 month point and no remarkable or unusual safety signals have appeared. It looks like these vaccines cause short-term and minor reactions in most people.
However, data and logic are not always the best ways to make a vaccine-supporting argument. The best approach is often personal stories. People who are concerned about a medical treatment are often reassured by knowing that someone they respect received it, and that that person had a good experience. If you've been vaccinated, it might help to talk with your family about how it went and how easy it was. That really helps a lot.
You can also mention other people you know who have been vaccinated and the experience that they had. These anecdotes tend to be more reassuring than tables of numbers.

Next, reader Deborah Bass asked about immune reactions in previously-seropositive people getting the vaccine:

Love this--ER husband was speculating on exactly this over the last few weeks. A non-medical colleague of mine asked this pertinent question: " I would have thought it might have been the other way around since the person had seen the virus before and their body knew what to do with it. Does that mean that every time we come in contact with the virus going forward, reactions could get worse? " Can you comment on this?

The vagaries of the adaptive immune response are not quite my area of expertise—I’m more able to comment on the first 24 hours of infection, since my PhD was on rapid innate immune responses—but I’ve done my best to answer:

Interesting question! A little outside of my wheelhouse, but here's what I think:
I don't think that it would get worse every time, though. I think in this case the strength of the reaction is based on the rapid expansion of the immune memory cells involved. At some point after repeated exposures, the immune system responds so quickly that the response doesn't last very long at all. Otherwise we would have more and more extreme reactions each time we get a common cold coronavirus, and we don't. I think there's an upper limit. I am not 100% sure of the exact reason for that upper limit though.
What a good question, really! Probably you could get a more detailed answer from an immunologist who studies viruses (like Akiko Iwasaki at Yale) than a virologist who studied innate immune activation by viruses (such as me).

You might have some questions or comments! Send them in. As several folks have figured out, you can also email me if you have a comment that you don’t want to share with the whole group.

Join the conversation, and what you say will impact what I talk about in the next issue.

Also, let me know any other thoughts you might have about the newsletter. I’d like to make sure you’re getting what you want out of this.

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