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Vaccines to prevent Covid-19 infection are hurtling through development at speeds never before seen. But mounting promises that some vaccine may be available for emergency use as early as the autumn are fueling expectations that are simply unrealistic, experts warn.

Even if the stages of vaccine development could be compressed and supplies could be rapidly manufactured and deployed, it could take many more months or longer before most Americans would be able to roll up their sleeves. And in many countries around the world, the wait could be far longer still — perpetuating the worldwide risk the new coronavirus poses for several years to come.

That reality is being obscured by reports that some of the earliest vaccine candidates — including one from the biotechnology company Moderna and another from University of Oxford — may within months have enough evidence behind them to be administered on an emergency use basis.

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Michael Osterholm, director of the University of Minnesota’s Center for Infectious Diseases Research and Policy, is worried people aren’t preparing for the possibility of a fall wave of infections — which some experts fear will be bigger than what we’ve seen so far — because they expect a vaccine will be at hand.

“I’ve actually heard higher education experts say, ‘Well, you know, we’re kind of counting on the vaccine maybe by September because we keep hearing about that.’ And of course, in their mind, they’re equating [that to mean] colleges and universities will have the vaccine,” he told STAT.

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Osterholm and other experts make clear that there will not be enough vaccine for college-age students in that time frame, even in the best-case scenario. It’s likely any supplies that will be available — if any of the vaccines prove themselves to be protective by the fall — will be designated for health care workers and others on the front line of the response effort.

“I don’t think we’re communicating very well at all with the public, because I keep having to tell these people, you know, even if we had a vaccine that showed some evidence of protection by September, we are so far from having a vaccine in people’s arms,” Osterholm said.

Assuming a vaccine can be developed quickly, the issue of manufacturing is not a small one. Production of some vaccine candidates could be more easily ramped up than others, noted Emilio Emini, who is leading work at the Bill and Melinda Gates Foundation on the issue.

Should some of the more “scalable” vaccines prove to be protective, it’s conceivable that they could be made at existing plants, rather than require the construction of whole new facilities. Production of this type of candidate could reach hundreds of millions of doses within about a year, Emini said. But any vaccines that would require bricks-and-mortar construction is obviously going to take longer to reach those output levels.

The World Health Organization, which is closely monitoring the field of candidate Covid-19 vaccines, lists more than 100 projects, though many are being designed in academic laboratories without commercial production capacity. Of the total, eight are already being tested in people, four of them in China.

Among the others is an RNA vaccine project being developed by Pfizer and partner BioNTech, which began testing four possible vaccines in a compressed Phase 1/2 trial in the U.S. on Tuesday. The companies estimate they will be able to produce millions of doses this year, in facilities in the United States and Europe; by 2021, production could reach hundreds of millions of doses — though final figures will depend on how much vaccine it takes to protect each person, said Philip Dormitzer, Pfizer’s vice president and chief scientific officer.

“We’ve set a goal that we’re pursuing. And the data are going to tell us to what degree that’s an easy goal or very difficult goal to meet — but it’s not going to be very easy,” Dormitzer said.

The WHO has called for equitable sharing of Covid-19 vaccines, insisting they should be seen as a global resource. But there have been concerns from the earliest days of this pandemic that countries that are home to vaccine production facilities will nationalize any output to ensure domestic needs are met before vaccine can be exported for use elsewhere.

Robin Robinson, who led the Biomedical Advanced Research and Development Authority from 2008 to 2016, said the agency has spent billions of dollars building up vaccine production capacity in the United States based on that assumption.

A recent recipient of BARDA funding is Moderna, which is expanding production capacity at its Norwood, Mass., facility. “We’re going to be making millions of doses per month in 2020, ramped to tens of millions of doses a month in 2021,” CEO Stéphane Bancel said recently.

“We are highly aware that given almost everybody on the planet needs to be vaccinated, we’re going to need a lot of capacity. And we are discussing with a lot of parties how to get there,” Bancel said. “Are we going to get to a place where we can do seven billion doses next year? The answer is clearly no. But are we in a place where we could be even doing another five-times, ten-times increase from the tens of millions of doses per month? We’re working very hard and when we have a clear plan we’ll communicate about it.”

The Cambridge, Mass.-based company announced last week that it had signed a deal with Swiss pharmaceutical company Lonzo to help produce 1 billion doses of the vaccine in the U.S. and in Switzerland.

While China has extensive vaccine production capacity and several developing countries — including India, Indonesia, and Brazil — are among the world’s largest vaccine producers and exporters, a sizable amount of the manufacturing capacity belonging to pharmaceutical companies that sell vaccine in North America and Europe is based in the United States.

Marie-Paule Kieny, who formerly led the WHO group responsible for spurring development of epidemic and pandemic vaccines and drugs, said when the global health agency worked on pandemic planning in the lead-up to the 2009 H1N1 influenza pandemic, it was proposed that health care workers around the world have first access to vaccine. That group, she said, is estimated to be about 2% of the global population — roughly 156 million people.

“I think it’s reasonable to say that this should be the first target, because as we’ve seen everywhere, including in the U.S., when you have a health system which cannot accommodate sick people, then everybody suffers,” said Kieny, who is now research director at Inserm, the French equivalent of the National Institutes of Health.

Health care workers would likely followed by people at the highest risk — those 65 and older and people with chronic health conditions, like diabetes, that have been seen to increase the risk of dying from Covid-19, Robinson said.

“I don’t think that the general population will have vaccine probably until the second half of 2021. And that’s if everything works OK,” he said.

The Advisory Committee on Immunization Practices, an expert panel that makes recommendations to the Centers for Disease Control and Prevention on vaccine use, is typically tasked with drawing up the priority groups during pandemics.

Regardless of who gets vaccines when, it’s believed that most if not all of the new vaccines will require at least two doses to be effective, so any estimates of numbers of doses available in the autumn will need to be divided by two to find out how many people could expect to be vaccinated.

Osterholm said the public — both here and abroad — need clearer communications about realistic time lines to Covid-19 vaccine access. When vaccines do start to become available, demand will be enormous and supply will be minimal.

“It’s going to be like filling Lake Superior with a garden hose at first,” he warned. “Let’s just be honest, whichever country gets the vaccine first … is going to both be in the driver’s seat and a very difficult spot.”

“Eight billion people are going to want this vaccine overnight when it becomes available.”

  • No fix is coming anytime soon. Life has to go on and we can’t sit in our houses for the almost the second month. There have been pandemics before and there will be more to come, but we can’t stop all aspect of society with businesses stretched thin. Whats the difference if I walk into a bed bath and beyond to buy shampoo or Walmart. LIFE happens and every person should have the option to work from home if they so choose, but if they are a young and healthy individual why should you sit home all day too?

    • With all due respect there has not, since 1918, been a pandemic like this. Yes, there needs to be a balance but your comment tends to trivialize the fatality count which is higher by almost 20,000 in 2-3 months than the flue for an entire year. Extrapolate the current death rate of roughly 2,000 per day through the end of the year and you may wish to restate / reconsider some of your comments.

  • This makes no sense. Expectations are fueled by reports. The main purpose of reports, for many years now, is to generate clicks and advertising dollars. The public demands nothing more than something that is clickable. If the public raises its standards (which I highly doubt), then something might change. We might have a president other than Trump. Until then, the public is responsible. Give me what I want. Give it to me now. Give me something interesting and new, that doesn’t demand too much attention or nuanced thinking. Feed me junk-food information. Goodbye, USA. It was a good run.

    • God forbid people want to have hope that a vaccine is on the horizon to prevent mass death and ensure the economy can be completely open in order to avoid a great depression. The irony is that the real click-bait is styled more like your comment.

    • JD, to have hope is one thing. To fuel a false belief that a vaccine will be here by / during autumn and save the day allowing for business as usual including school attendance is a completely different animal. The media and others need to provide solid information instead of a political / social agenda.

    • Osterholm and CIDRAP are great resources for understanding better the role of infectious diseases and their transmission.

  • I see a lot of resources been diverted to vaccine development without understanding the virus and pathophysiology. There is not enough data about the immunogenicity of this virus. There is some evidence that the antibody response is very poor in individuals infected with COVID19. It is not clear what part of the virus is more suitable for developing a vaccine against and so many more unanswered questions.
    I think we should focus and divert our resources on the basics, like how important it is to wear masks, social distancing and handwashing. No data available if infected person can work with non-infected people following social distancing and wearing masks. Is there evidence it can spread from foods, groceries and other items? No data if there is community spread from oro-fecal route? No data on pre-clinical (asymptomatic) spread of a virus? Why some individual do not have any symptoms other die from it? I think these questions needs to be answered sooner than later, so we can at least function as society and nation. The vaccines are welcomed, however, i have biased view, it will never work in this particular virus based on my analysis and understanding of the virus.

    • Been thinking along the same lines exactly, and the ‘panicdemic’ that came with it didn’t make things any better! The reality is that a vaccine is to far into the future for us to rely on. Besides it’s still only a big IF!!! Yeah, I strongly think the basic measures are still vital.

  • Hence why this blanket lockdown needs to end and end soon: there is no miracle riding in on a white horse. It was arguably a ridiculous over-reaction when it was instituted in the first place. The virus isn’t nearly as deadly as it was made out to be, and history shows endemic diseases of this nature can not be stopped anyway and will invariably rage through the population. The only hope was to slow it enough so health systems could keep up. We did that. In fact, we did it too well since health systems are on the verge of bankruptcy due to UNDER-use [a few outlier cases aside]. And yet still the virus rages as it will undoubtably do. So better to end extreme social distancing now, institute a few basic social distancing policies, and right the ship before our already weakened system is hit by another wave or another disaster.

    • “It was arguably a ridiculous over-reaction when it was instituted in the first place. ” Not really, because as you yourself wrote … “The only hope was to slow it enough so health systems could keep up. We did that.”

      Your second statement contradicts your first one. Health systems would have been far more overwhelmed – assuming they had not totally collapsed – without wide-ranging social distancing and stay-at-home orders. The desire to flatten the curve has been explained all along as a measure to spread out cases to avoid health system overwhelm. So even though they expected about the same overall total number of cases in the end, they would be spread out in a more manageable time scale. According to all I have learned so far, SARS-CoV-2 will probably end up with a case-fatality rate of at least 10 times the flu. That’s pretty much as deadly as it was made out to be, and rightly so.

      So it was not a “ridiculous over-reaction.” It proved that the initial measures helped a lot. It is reverse logic to claim that because the measures worked, they were not needed in the first place.

      As for “health systems are on the verge of bankruptcy due to UNDER-use” please provide citations for that claim. Certainly that doesn’t seem to have been the case wherever the virus hit hardest (US, Italy, Iran, China).

    • @ShepherdMoon- I know in 2020 nuance is often lost in discussion, but let’s try to keep things sophisticated.

      “Your second statement contradicts your first one.”

      Not really. My point was, is, and will forever be that once it became clear that this virus wasn’t nearly as deadly as it was made out to be, we should have reset our mitigation efforts. Furthermore, once it became clear that hospitals – in a rush to prepare for a flood that never came – were well ahead of the curve, we should have reset our mitigation efforts.

      There is no proof that outside of conjecture that extreme social distancing (rather than the garden variety kind) was required to keep [most] health systems outside of hotzones from being overwhelmed. It just didn’t happen. In fact, when the dust settles, I wouldn’t be surprised if the data shows that this over-reaction (in the form of lost vaccination rates, preventative medicine, and missed surgeries/treatments) may have been more costly.

    • Vaccination and Preventative medicine is still very much allowed in the lockdown. If someone is so concerned about the virus that they wouldn’t visit a doctor, they wouldn’t have done it absent government lockdown either.

    • @MichaelSmith you should consider that the reason for so many contagions to have occurred is that the measures such as social distancing were taken too late. The long incubation time of the virus makes it seem like the measures taken 1 or 2 weeks ago aren’t working, but we’re to a great extent seing the effects of the days prior to that. It’s scientifically proven (and by the use of logic) that being constantly exposed to it will make it more likely for you to get Covid. So it’s not that “the measures aren’t working”, but rather that “without these measures, things would be way worse”. There’s also the fact that young and healthy people without any problem can get a really bad case of Covid-19 if they’re exposed to higher concentrations of the virus. This is happening too. So far it’s happened to an acquaitance of mine who was 27, and he passed away 3 days ago…

  • It will be useless by 2021 – we are applying chronic disease timeframes to global pandemics. If the virus is still ongoing by 2021 all of our economies will have totally collapsed and there will be nothing left to save.

  • Health workers and subjects at risk could have been, and still could be, vaccinated right away with inactivated virus collected from phlegm/sputum of the large pool of infected individuals currently available

    • Ya don’t just whip up a new vaccine in your basement. Even an inactivated virus vaccine requires the full suite of testing. Being sure you’ve inactivated a virus just enough isn’t trivial, there’s no “hold on a bit there” button on a virus.

  • It’s not just production time. How long will it take to actually administer the vaccine under precautions?

  • Article is well written, I think, but having a limited supply vaccine in a few months is still significant. Not everyone needs a vaccine immediately. The at risk group and essentials should be prioritized for certain. However, a combination of vaccine for the key groups, some kind of treatment options (which are likely over the next several months), the population’s knowledge of how to prevent the spread, and the overall recovery rate with NO intervention, should provide enough certainty that the world can get back to business, at least at a 80-90% capacity, until more vaccine becomes available and as more treatments are available. We HAVE to allow some level of herd immunity into this process. But what do I know? I’m just a home game ham and egger. But then again, so are most people, even ones who write articles like this.

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