COMMENTARY

Let's Not Get Too Excited About Having a Vaccine Really Soon

Arthur L. Caplan, PhD

Disclosures

October 27, 2020

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This transcript has been edited for clarity.

Hi. I'm Art Caplan. I'm at the Division of Medical Ethics at New York University's Grossman School of Medicine.

Have you heard enough about vaccines lately? The news about vaccines is everywhere. We have the president hoping and promising that a vaccine will be around soon to work our way out of this pandemic. Other health officials, like Tony Fauci, Dr [Deborah] Birx, and many others think that vaccines are coming — maybe not by the election date, but hopefully soon.

We hear about pressure being put on the FDA to allow for early approval of vaccines. We even have — imagine this — pharmaceutical companies making vaccines, signing pledges that say they're not going to try to get approval for anything until they're convinced that the science holds up for efficacy and safety.

Who would have thought that, at the end of the day, it might be the manufacturers who are holding the line about when to say a vaccine is ready to go? But remember, aside from doing the right thing, their reputation is on the line and so is their liability. I'm sure they want to make sure that the FDA is satisfied and that they're satisfied before anybody gets the vaccine.

Well, despite this vaccine obsession, I don't think vaccines are going to be working our way out of the pandemic anytime soon. There are some practical reasons for that that don't get enough attention. Among the leading vaccine candidates, a couple of them have never actually been used to make a vaccine; they are new platforms that involve RNA. We'll see if they work. They may not. We can't be sure that the first vaccines out of the box are going to be effective.

Second, [regarding] how effective they're going to be, what if they only gave immunity for 2 months or 3 months and then it faded out? That would not be useful for large percentages of the population. That might be something we would try if you are a frontline nursing home worker or a frontline anesthesiologist having to intubate people on a regular basis. However, a short-duration vaccine is not the answer.

We also have a number of these early vaccines that require extreme refrigeration and are difficult to handle. They require almost liquid nitrogen temperatures. Many places can't store them and many trucks can't move them. There's no guarantee that even if they got approved, that they would be widely available anytime soon because they're very difficult to handle.

A number of these vaccines require two shots, maybe a month apart: a primer and a booster. Although that's okay, it slows down the ability to get the vaccine out.

It's well known that many people, having got a first vaccine, don't come back for the second vaccine. We've seen that with the cervical cancer vaccine for HPV. That has been a three-shot vaccine around the world. Many women and some men who get it fail to appear for the second and third shot. It's hard to get good compliance when you require more than one shot.

Now, some of the vaccines are just one shot and don't require super-refrigeration, but they are behind. They're not moving along as fast in the process as some of these other ones.

From a practical point of view — forgetting the arguments about who should go first and whether we should share vaccine supply with other countries — the reality is that the early contenders have practical limits on manufacturing them in big amounts, moving them around the country, having enough vials and needles to administer them, refrigerating them, and making sure that, if it's a two-dose situation, people come back and get the required second dose.

We also don't know how long they'll last. That could collapse the ability of vaccines to really make a big dent in the pandemic.

I hope we get a vaccine that works. I hope we get one that works at 50% or better. That would really start to build us toward herd immunity. Whether it's the first one that comes out for approval, the third one, or the fifth one remains unknown and unclear.

Even if we do get an approved vaccine, forget about Election Day, forget about the end of the year. We're well into next year before you could have large amounts of vaccine out and available to use in large numbers of Americans, much less people around the world.

Let's hope there's a vaccine. But remember, we're probably stuck with masking, distancing, isolation, handwashing, and behavior change for some time, even after a vaccine gets approved. That's just the practical reality of vaccine manufacturing, vaccine distribution, and the fragility of some of the new forms of vaccines that are being pursued now.

I'm Art Caplan at the Division of Medical Ethics at New York University's Grossman School of Medicine. Thank you for watching.

Arthur L. Caplan, PhD, is director of the Division of Medical Ethics at New York University Langone Medical Center and School of Medicine. He is the author or editor of 35 books and 750 peer-reviewed articles as well as a frequent commentator in the media on bioethical issues.

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