Pfizer Files for FDA Emergency Use Authorization of COVID Vaccine

Alicia Ault

November 20, 2020

Editor's note: Find the latest COVID-19 news and guidance in Medscape's Coronavirus Resource Center.

Pfizer and its German partner BioNTech have filed an application with the US Food and Drug Administration (FDA) for an emergency use authorization of its vaccine against COVID-19, the disease caused by SARS-CoV-2, according to a company news release.

It is the latest step in what has been an extraordinarily fast-paced development and testing process, with the companies having reported interim results of phase 3 trials on November 9 and final results this past Wednesday, as reported by Medscape Medical News. The vaccine, BNT162b2, which uses a messenger RNA-based platform, was ultimately found to have 95% efficacy and more than 94% efficacy in individuals over age 65.  

"The process of the speed did not compromise at all safety, nor did it compromise scientific integrity," said Anthony Fauci, MD, director of the National Institute of Allergy and Infectious Diseases at White House press briefing yesterday.

"We need to put to rest any concept that this was rushed in an inappropriate way," he said. "This is really solid."

Pfizer and BioNTech said they believe they have met the FDA's safety data requirements for emergency use authorization (EUA). The agency in October outlined its expectations for safety and efficacy to secure an EUA.

"Filing in the US represents a critical milestone in our journey to deliver a COVID-19 vaccine to the world, and we now have a more complete picture of both the efficacy and safety profile of our vaccine, giving us confidence in its potential," said Albert Bourla, MD, Pfizer's chairman and CEO, in its release.

The FDA is expected to hold a meeting of its Vaccines and Related Biological Products Advisory Committee sometime in December to review the safety and efficacy data in the companies' application. The committee will review:

  • Efficacy data from a total 170 confirmed cases of COVID-19 in the phase 3 study

  • Safety data from a randomly assigned subset of 8000 participants 18 years and older

  • Data on 19,000 enrollees who have been followed for a median of 2 months after the second and final dose

  • Data on the manufacturing processes

According to Pfizer, the companies plan to submit the efficacy and safety data to a peer-reviewed journal once they have completed their analysis.

Vaccine Logistics

The companies — which funded their own trials — signed an agreement with the US government's Operation Warp Speed program in July to provide 100 million doses of its vaccine following FDA authorization or approval in exchange for $1.95 billion. The US government has the option to acquire up to 500 million more doses.

Pfizer and BioNTech said they will be able to supply 50 million doses globally in 2020 and up to 1.3 billion doses by the end of 2021. The vaccine must be given in two doses, spaced 21 days apart. Pfizer expects to be ready to distribute the vaccine within hours after FDA authorization.

The US government is still on track to deliver the Pfizer vaccine within 24 hours of an FDA authorization, said Operation Warp Speed's Chief Operating Officer Gen. Gustave F. Perna at yesterday's White House briefing.

Vice President Mike Pence emphasized that point at the briefing: "The moment that the FDA concludes that that vaccine is safe and effective, we have a system in place to begin within 24 hours shipping that vaccine to hospitals, healthcare facilities and, 24 hours after that, literally injecting that vaccine into Americans," he said.

The vaccine will be pushed out through 64 jurisdictions already part of the Centers for Disease Control and Prevention's vaccines for children distribution program, and will likely be divided up according to population, said Perna.

Pfizer's vaccine must be shipped and stored at -70°C (-94°F), which has presented logistical and storage issues. The company is testing out delivery methods, including a pilot delivery program in New Mexico, Rhode Island, Tennessee, and Texas that will be active after an FDA authorization. States, hospitals, and pharmacy chains are also buying special freezers.

The National Academies of Sciences, Engineering, and Medicine issued recommendations in October that healthcare workers, first responders, older Americans living in congregate settings (eg, nursing homes), and people with underlying health conditions be the first to receive a coronavirus vaccine. The CDC's Advisory Committee on Immunization Practices will also be issuing recommendations as soon as the FDA authorizes a vaccine.

Pfizer and BioNTech are also seeking approval for the vaccine with several regulatory agencies around the world, including the European Medicines Agency and the Medicines & Healthcare Products Regulatory Agency (MHRA) in the United Kingdom.

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