COVID-19 Vaccination: Prepare to Engage

October 13, 2020

One day, I will once again have a column that is not about coronavirus 2019 (COVID-19). But as 2020 trudges onward, I find it difficult to focus on anything else. However, this month I am turning towards a hopeful area of COVID-19 therapeutics: vaccines.

With all the controversy surrounding statements and misstatements about herd immunity, achieving immunity by vaccinating a sufficient portion of the population really is the way to move past COVID-19. Insufficient control of SARS-CoV-2 transmission has increased the urgency of our need for vaccination as the way forward and a COVID-19 US death toll passing 200,000 accentuates the dangers of this novel disease. Simply put, we need vaccines.

There is good news here. The early sequencing of the virus and response from both the pharmaceutical industry and government has been, to use an overused-in-2020-term, unprecedented. Operation Warp Speed (OWS) may be poorly named, but it has furthered the development of an impressive number of vaccine candidates in ways that would not occur if companies were left to make decisions based exclusively on their own profit-versus-risk calculations. This initiative has funded the research of many vaccine candidates, but as importantly, the agreement to purchase doses ‘at-risk’ allows companies to begin production early before the efficacy and safety of the candidate vaccines is proven.

The risk is financial, and it is likely that not all of the vaccine candidates survive the research process, but I think it is a price worth paying to save lives. It is even financially justifiable since the pandemic has taken an enormous toll on the economy. OWS has also put money into the development and purchase of some logistical aspects of vaccine production, storage, and delivery. I am sure that not all of the aspects it is developing will come to fruition or be optimal, but on the whole, I think it is a good program.

In the meanwhile, there is work to be done. The CDC is working on the logistics of vaccine distribution, which will be challenging if the mRNA vaccines require ultra-low cold chain freezers, as is likely. This is likely to limit these vaccines to closed settings where high-risk persons and essential employees work. However, we also need to begin to work on public education about what is going on with vaccine development. Surveys have shown that the confidence of the public in a COVID-19 vaccine is low, and it is perceived as a political tool that is being rushed forward regardless of safety and efficacy, not because of it. While there is no doubt that it is a political issue, it is also true that what OWS should achieve is a compaction of the development process into overlapping steps, not a skip-ahead that absconds assessments of utility.

I have been a harsh critic of the US response to the COVID-19 pandemic in many ways. Vaccine development is the area in which I feel we have done best. However, trust is a component of vaccination also and we have work to do to restore it. If COVID-19 vaccines live up to the clinical promise that they have shown in early trials, it will be up to infectious diseases clinicians to start spreading the word. Our friends and family need our judgment.

Gallagher is a clinical professor at Temple University School of Pharmacy and clinical pharmacy specialist in infectious diseases at Temple University Hospital, both in Philadelphia, Pennsylvania. He is also the director of the PGY2 residency in infectious diseases pharmacy at Temple.