On Stage with the COVID-19 Vaccine

On Broadway, when the curtain rises on Act Three, you can be pretty sure that the end is near.

With COVID-19, not so much.

Act One was optimism (“Nothing to see here”). Act Two was panic (“Nobody knows anything”). Act Three, last week’s announcement of the Pfizer/BioNTech vaccine followed this week by Moderna’s seems to promise a finale, but a closer look shows a few potholes on the road to The Final Curtain.

First the good news. As Mark J. Mulligan, MD, director of the Division of Infectious Diseases and Immunology and director of the Vaccine Center at NYU Langone Health says, “It was very exciting to see the interim results this week find that the vaccine was protective in 90 percent of cases. This is really the best we could have hoped for.” Equally exciting to vaccinologists, says Amesh Adalja, senior scholar and Infectious Disease physician at the Johns Hopkins Center for Health Security, the Pfizer vaccine uses a whole technology, messenger RNA (mRNA), a complex compound that “essentially teaches the body how to recognize and attack the coronavirus.”

So far, so good. Except for the scene stealers.

Pfizer volunteers reported side effects such as muscle aches and fever worse than a typical flu shot, sometimes lasting for two days. This vaccine comes in two shots. William Schaffner, a professor of preventive medicine and health policy at Vanderbilt University Medical Center told the Cincinnati Enquirer that asking people who felt “crummy” the first time to come back for a second round could be a “tough sell.”

Next, even these first two vaccines that promise to protect 9.5 (!) of every ten people still leave that last half-one at risk. Who will that one person be? Nobody really knows because as this is written the Moderna data have not yet been relased and the data Pfizer has released so far doesn’t spell out exactly who was in the volunteer pool: Old people? Young people? Minorities? Men? Women? In other words, social distancing and masks will still be with us for some time to come.

Delivery Questions

Then there’s the delivery problem. Some vaccines can simply be stored on the shelf. Live-virus vaccines such as the ones for chickenpox and smallpox require normal refrigerator temperatures such as your fridge’s 35-40F or your freezer’s -20F. But Pfizer’s vaccine must be stored at temperatures as low as -94F. It will be shipped packed in dry ice which keeps it stable for 18-24 hours, but drugstores and hospitals administering the vaccine may have to invest in hyper-cold units costing up to $14,000 a pop. That gives Moderna an edge because its vaccine can be stored at 36-46F for 30 days in transit or in the pharmacy.

Finally: Who will get the cool stuff? Clearly, the first round of vaccine, estimated at from 20 to 50 million doses depending on which source you read, will go to those at highest risk such as health care workers and maybe senior citizens. The hope is that Pfizer can churn out a billion doses sometime in 2021, but in a country with about 325,000,000 citizens, most of us are going to have to sit and wait.

Anywhere from 20 to 70 percent of us may decide to sit it out entirely. Over the past year, the anti-vaxxer movement has grown to include those who normally get their shots on a regular schedule but have been put off by government officials who seem eager to bypass common safety measures in the rush to produce a protector.

Anthony Fauci is not one of them. “I’m going to look at the data, but I trust Pfizer,” he told an MSNBC interviewer. “I trust the FDA. These are colleagues of mine for decades, the career scientists. If they look at this data, and they say this data is solid, let’s go ahead and approve it, I promise you, I will take the vaccine, and I will recommend that my family take the vaccine.”

As time answers questions about the new vaccine, Fauci may have written the script for an Epilogue. But the drama that may be changing even as you read this. Don’t leave the theater!