Kind: captions
Language: en
i just kind of want to start with a
bird's eye view of what's happening
right now
we are talking so much about the trio
pfizer moderna
astrazeneca and the real challenges of
trying to
rapidly vaccinate millions of people
has the u.s ever seen or done anything
like this before
certainly not in my lifetime no
[Music]
today as the production of coven 19
vaccines is finally kicking into high
gear
we're talking with two vaccination
experts about the challenges ahead
nobody is vaccinated so it's like a
sports car
like you have to go zero to sixty in a
few seconds
some people are calling this the
greatest public health effort of our
generation
so no i've never seen anything anything
like this
coming up we'll talk cold storage
pharmacy deserts conspiracy theories
hotlines
and why no you cannot ditch the mask and
start partying quite yet
this is nova now where it's our job to
give the news a little
booster shot of science every couple
weeks i'm alok patel
[Music]
i want to start by talking through three
of the most promising vaccine candidates
in the order that they're likely to roll
out
yeah so i can talk about the pfizer and
the moderna vaccines
because we've really been focused on
them and i know a little bit about
astrazeneca which might be coming a
little later
claire hannon is the executive director
of the association
of immunization managers or aim they're
a non-profit that helps to share
information among state and local health
officials who are on the front lines of
vaccination efforts in the u.s
our members are all throughout the
country
working on immunization and they don't
necessarily know how
others are getting through these
challenges so we connect the dots for
them
now the two vaccine candidates we've
been hearing about from pfizer biontec
and moderna may be battling each other
for news headlines
but actually they have a lot in common
they both use the same basic technology
it's a messenger rna platform so the
concept is the same
basically each vaccine contains a
biological code
in the form of an rna molecule that
molecule is a blueprint for building a
piece of the coronavirus one of the
little spikes that sticks off of it
and this should teach your immune system
how to recognize and defend against the
real virus
if it ever gets in your body tell me
that isn't awesome
they both require two doses the schedule
of that double dose
is pretty similar as well um the pfizer
is 21 days apart the moderna is 28 days
apart
and based on early data they both seem
to be about 95
effective which is really good better
than the vaccine developers were
expecting actually
where they differ is really in the
storage and handling
which complicates the logistics so the
pfizer vaccine requires
ultra cold storage minus 70 degrees
celsius
a concept that you know most of us have
never even
thought of or contemplated i'm one of
those yeah
right by the way minus 70 celsius is
minus 94 fahrenheit
the reason the vaccine has to be kept so
cold is that rna is inherently unstable
and it breaks down quickly at room
temperature or even in a refrigerator
it's only uh stable at refrigerator
temperatures for five days
so once we get it thawed it's got to be
used in the five days
and when you go to administer it it has
to be mixed it has to be diluted
um so that's you know that's really
important to consider too it's not
something
we haven't done before but it's not
something generally we do with vaccines
okay wow so given the complexity
involved
and the fact that this vaccine could be
shipping out this month
i think it's time for what the cool kids
call a proper unboxing
hey subscribers so today we'll be
unboxing pfizer and biontech's brand new
mrna based vaccine candidate
bnt 162b2
and no unboxing is complete without
asmr sound effects
ah the tingling sound of vaccinology
a hospital or provider if they're
getting the pfizer vaccine
would actually get three different
shipments
three boxes even better
okay claire lay it on me so they would
get
what's called a thermal shipper box
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it has what they call a pizza tray in it
with 195 vials
on top of that pizza tray is the dry ice
to keep the vials super cold and
in the top part of the box there's a
digital data logger
so they're going to open the box they're
going to check the digital data logger
make sure that
you know the cold chain has been
maintained
meaning the vaccine never got above
minus 94 degrees fahrenheit
during its journey okay on to box number
two
they're separately going to get a box
that comes with the supplies
for vaccinating they will get the ppe
syringes all the supplies they need to
do the vaccinating
with the pfizer vaccine they're gonna
get a third box
which comes with the gloves to take out
the dry ice to handle the dry ice
i love that sound
and they will get the dilution kit as
well
so to dilute the vaccine they get
a large syringe that they mix it in they
pull the vaccine out
and the dilution out
and they're supposed to not shake it
but stir it and then from that they're
gonna
draw into five syringes the actual doses
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so it's quite a lengthy checklist
actually of what what they're getting
i mean just hearing you describe what's
in the box intimidated me if i were to
get that box right now and look at it
and and now you know why we can't just
ship
these boxes with uh instruction flyer in
it
we actually need to train people um and
we need to have a hotline
so that they can call and you know they
don't just leave the vaccine sitting out
on the dock because
um they can't figure out the
instructions and for claire
and many others this is a real point of
concern
especially given how much money the us
government has spent
on developing a number of chronovirus
vaccines we invested 10 billion dollars
in the production of this vaccine
and there's only been 340 million spread
to state and local public health
agencies this is not
enough for a vaccine campaign of this
size
because even though pfizer is handling
the distribution of all these
vaccination kits
it'll ultimately fall to those local
agencies to enlist and train the actual
healthcare providers
who will be getting needles into arms
you know this takes time
and these providers have to be vetted
they have to be trained and we want to
make sure we get all of this right
claire raised one other concern specific
to the pfizer biontech vaccine
the packaging is 975 doses
and if you were doing the math earlier
which i know you all were
the thermal shipper comes with at least
195 vials and each vial is diluted into
five doses third grade math that's how
we get to 975.
that really presents challenges for
rural communities
and smaller providers because they don't
have that volume
of being able to store that many doses
and they don't have that patient
population
of that many people getting the vaccine
that means you'd have to split a single
kit
among multiple healthcare providers
while still keeping
all those vials at the right temperature
and now you're looking at really cold
chain
challenges and you've got to
meticulously manage that
so that's the pfizer vaccine really
challenging logistically
all right onto moderna um then the
moderna vaccine
is a little more simple it ships frozen
roughly the same temperature as your
home freezer um it does not ship with
dry
ice so so that's much easier there and
once you've
thought out it's viable for 30 days so
you have a longer window to use it
long story short the moderna vaccine is
more stable
than the pfizer version plus the
modernity vaccine does not have to be
diluted
and then it comes in packaging of a
hundred dose vials
so it's a little bit more manageable you
can spread it out across geographic
areas a little easier
to smaller providers to pharmacies where
they would have the storage capacity a
regular freezer
to store it and they'd be able to use it
in that 30-day window
if we look ahead now to some of the
other vaccine candidates out there from
companies like
astrazeneca johnson johnson or cancino
biologics
many of those could be even easier to
distribute and deliver because they use
a totally different technology
instead of directly injecting you with
rna these vaccines use a delivery tool
known as a viral vector
to safely introduce a genetic blueprint
into your cells
let's take the astrogenic vaccine for
example it can be shipped out at
refrigerator temperature
and it's way cheaper than the madeira
and pfizer vaccines
so it's good to see that's progressing
as well
but we don't have a lot of details on it
because we're really focused on the ones
that
are likely to come out sooner in the
next couple of weeks or so
in fact astrazeneca has faced some
really tough questions about the data
reported last month which could
ultimately delay its approval
so for now the pfizer and moderna
vaccines are leading the pack here in
the u.s
both have already applied for emergency
use authorization from the fda
which brings us to another important
question who gets vaccinated first
the added complexity of this program is
that we have
a nuanced priority scheme
dr saad omer is the director of the yale
institute for global health
in terms of my own research i'm an
infectious disease epidemiologist
with a specific focus on vaccines which
is why when the national academies of
sciences engineering and medicine
created those guidelines for
distributing the coven 19 vaccine
assad was part of the committee they
were epidemiologists
vaccinologists economists communication
experts
bioethicists etc together they created a
plan that works in phases
phase 1a is healthcare workers and first
responders
phase 1b is people with really high
impact co-mobilities and folks who
living in nursing homes
comorbidities could mean cancer
hypertension heart disease kidney
disease severe obesity
anything that puts someone at a greater
risk of severe complications from the
virus
so the strategy is designed and i'm also
part of the who committee that created
the roadmap for the rest of the world as
well
and the idea is the same go directly
after
mortality before transmission
in other words focus first on the people
who are most likely to die from the
virus
rather than the people who are most
likely to spread the virus
then gradually widen that circle so
phase two will include
teachers child care providers and other
essential workers
as well as older adults and people
living in prisons group homes or
shelters
and finally base 3 and 4 will open up
the vaccine program
to all remaining adults and children and
it's important to note
the vaccine will be free for all
americans
terms and conditions may apply please
see your local provider for more
additional details it all depends on
policy and how things go but we really
hope it will be free
i can't believe i did that one take and
then as vaccine doses become available
you start building enough number of
vaccines that you
are starting to interrupt transmission
this is how we achieve the fabled
legendary herd
immunity when enough people have been
vaccinated that the virus can no longer
spread
so if this approach is followed you may
see a reduction in deaths
well before reduction in cases
but this whole plan depends on being
able to
actually identify those people who are
at the greatest risk
there are a lot of disparities in this
country's inequities in diagnosis
so people in communities of color have
substantial under diagnosis and
differential under diagnosis
of their comorbidities so there's a risk
that we're going to miss
those who fall in phase 1b
or phase 2 of the priority so
schemes etc i'm glad you brought up
the issue of inequity you know this
better than most
we have seen in equity when it comes to
access to care preventative care health
literacy
being able to get health insurance and
we're seeing it kind of glare its ugly
face at us during this pandemic when we
look at which communities are hit harder
than others
do you think we're going to be able to
solve this for vaccine distribution do
you think we're going to be able to
bridge the gap
and make sure that everyone has equal
access or are you skeptical
my nightmare is that we may end up
worsening the inequity in protection
if we don't make a an
active active effort for example nursing
homes that get the vaccine early
versus late it could be different if you
don't make an effort
by socio-economic status a society has
to decide
that it is unacceptable that our fellow
citizens
are deprived of life-saving vaccines
just because where they live and what
their demographic background is
whether they live in an urban pharmacy
desert so we identify that concept that
in the context of flu vaccines that just
like their food deserts
we have pharmacy deserts and vaccine
deserts
where accessibility is worse and these
are not just urban communities they're
native american reservations but also
other rural
communities etc that have access issues
and one thing as part of the national
academy's report we recommended
is that within each priority group
you make sure that you use
this social vulnerability index
which is a cdc index it has
approximately 14
variables such as proportion elderly
transportation access income race
ethnicity etc and other variables that
put you at risk
so you calculate that and then you make
sure if you're a health department that
those groups and those locations are not
left out in your immunization program
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so it's not like sort of taking a
refrigerated truck
from the army corps of engineers and
sort of
you know putting on ice cream truck
music and going to a street and saying
come get your vaccine
it will have to be active it just can't
be passive
still to come how effective is a vaccine
really
if not everyone wants to take it we talk
trust
and also timing of when most americans
can look forward to that shot in the arm
[Music]
drummer what about trust and i bring
that up because
i mean i'm just gonna guess that you've
gotten
maybe one or two angry messages in your
day that comes with the territory i have
a
email folder which i called fan mail and
uh i do get a steady stream of
emails of a certain kind you know
if you put mom and apple pie in a
vaccine
they would even refuse that uh so so
there's this group
of uh i want a mom in apple pie exactly
don't we all but uh but but the thing is
that's not the group that we are really
concerned about there is a group
that is genuinely concerned and the
initial concern is not unfounded
i'll tell you why a lot of it came from
the fact
look the operation wap speed objectively
has done a good job of
sort of nurturing a vaccine development
program but they should have taken a
different name
than wap speed that created
unintentionally
a perception that things are being sped
up unduly which wasn't the case by the
way
because they found efficiencies in the
process
the second thing was that there was a
lot of political documented
interference from the white house to
speed up vaccination based on the
election calendar
so based on that there was this
underlying mistrust
what has changed over the past even
before the election
there was substantial pushback from fda
initially
by the career employees but also they
actually got
backing from political appointees and
they're pushed back against
the white house interference so that is
happening but that hasn't been
communicated
and just like with distribution and
diagnosis there are disparities in that
communication
how do you bridge that gap and how do
you do it at the national level
so we know from science from
communication science what works in
terms of
uh enhancing trust we know that its
perception of competence
its perception of of the fact that
someone has your interest at heart
the third thing is that how similar they
are to you
um not just sort of ethnically but also
do they share
your experience in life etc so the
the approach i've been proposing is to
pair
physicians quote unquote experts with
community validators
like church leaders according to saad
bringing together that combination of
medical expertise and community trust
is crucial for widespread acceptance of
the vaccine
especially in communities of color and
so so that model scaled up at the
national level
there's a concept of elite endorsers
it's not you know people with butlers
endorsing it's
essentially people with specific
characteristics
we actually ran a couple of experiments
and i paired up with our colleagues in
political science
and turns out uh dr tony fauci if he
endorses the vaccine it will move
a broad swath of society to
trust it substantially more it's not
going to solve all problems
but it will have an impact the other
thing that would have an impact
we tried speaker pelosi and president
trump endorsing separately or together
if they endorsed together
that also has an impact so one way of
being apolitical is to be bipartisan um
you know
senator mcconnell mitch mcconnell has a
pretty strong history of supporting
vaccines
uh he's a polio survivor uh so it's not
a sort of a pipe dream to think
uh that it this can't happen but but the
idea would be
at the mass level to have bipartisan
endorsement
of the vaccine with prominent figures
like dr tony fauci so and plus working
with communities and so and so forth
it's worth noting another thing public
health officials and providers need to
communicate
is the potential side effects from these
vaccines things like
fever headache or swelling at the
injection site
based on preliminary data this kind of
response
something called reactogenicity hasn't
been super common in the clinical trials
but unpleasant side effects have been
more common
than what other vaccines people commonly
get like the annual flu vaccine
pfizer found fatigue affected almost
four percent
of their participants and headache about
two percent
in the moderna trial the numbers were
higher fatigue in almost 10 percent
muscle pain and nearly 9 joint pain at
about five percent
and headache and four point five percent
severe fever was documented by both
pfizer and moderna
but in fewer than two percent of
participants remember
if millions of people get vaccinated
which is the goal
then this could mean a lot of people
with intense discomfort
soon after getting their shots and all
these side effects
usually resolve within a week so don't
fret and
they're a sign that your immune system
is working still it's important to be
transparent and warn people
that they may experience these side
effects so be prepared
don't freak out they're expected and
let's be real a couple days of side
effects is way better than actually
getting coven 19.
i have one last question assuming
everything goes perfectly well
in terms of finishing out the face
retrials the
emergency use authorizations the buying
and the distribution which obviously
that's a lot i'm assuming right now that
all of it goes perfectly well
what do you see in terms of the timeline
and when we may see widespread
vaccination
it looks like we will have both pfizer
and moderna
you know producing vaccine perhaps 20
million or more doses a month
here again is claire hannon from the
association of immunization managers
so you know we may get the health care
workers vaccinated
in december and and into january and
then
work our way out to essential workers
those over 65
and then perhaps we would have other
vaccine candidates
getting authorized and coming online um
so we could see
200 or 300 million doses by march
so i am hopeful that spring or
may we would have a
a really robust supply of vaccine and it
would be available to any american who
wants it
everyone who doesn't have a medical
contraindication
should get the vaccine in this country
should have a right to getting a free
kobe 19 vaccine so that we reach
a level of herd immunity where people
can go to baseball games or
broadway plays or whatever
what group activity are you most looking
forward to
when we return back to normal that's a
really good question um
i actually have a when this is over list
um
to keep me sane that i started in spring
so i have thought about this i'm looking
forward to
going to new york and watching a play
i'm looking forward to
a jazz performance a small nice uh you
know
and also catching a a baseball game
um it's the usual activities being able
to teach in a classroom
to be able to stand in the line at ikea
and be annoyed by the slow cashier that
i
somehow always seem to get so the usual
normal activities of life
we can't jump on the train right yet we
have to be vigilant
but i do think a safe and effective
vaccine
is the silver bullet i mean we don't see
polio we don't see
smallpox this is what vaccines do this
vaccine will be doing its job
if a year from now we don't have this
virus in our lives
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and i absolutely look forward to
thanksgiving 2021.
um uh it better be a big feast
and it will be if we do this right
[Music]
just yesterday the united kingdom became
the first western nation
to formally approve a coronavirus
vaccine when it gave emergency use
authorization
to the pfizer biotech candidate
distribution will begin as soon as next
week
meanwhile in the u.s the cdc's advisor
committee on immunization practices
has released its own guidance for
vaccine distribution
according to those guidelines which most
states are likely to follow
the first americans to receive a vaccine
will be the country's roughly 21 million
health care workers
including yours truly as well as the
three million people
who live or work in long-term care
facilities like nursing homes
according to pfizer and moderna's own
estimates there's enough vaccine for
most of that top priority group
to receive their first shot by the end
of the year so stay tuned
my arm is already ready
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nova now is a production of gbh and prx
it's produced by ian koss ari daniel
johnson gonzalez isabel hibbard
christina manan and sandra lopez
monsalve julia court and chris schmidt
are the co-executive producers of nova
dante graves is director of audience
development sugi bennett is senior
digital editor
robin kashmir science editor emma uk's
research intern
and nina forzuki is managing producer of
podcasts at gbh
our widely accepted and distributed
theme music which gives you a shot of
energy
is by dj kidd koala and i'm alok patel
we'll be back in two weeks which is more
than enough time for you to read about
all the other vaccines and development
or testing i mean you've got
novavax janssen sanofi vaxart clover
biopharmaceuticals arturous inovio
genexin simvivo
cantino merc right there immunity
biocity of hope there are so many shots
on goal
stay tuned stay safe
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ah the tingly sound of vaccinology
this is so creepy
[Laughter]
i think i've scared everyone away