Commentary/Opinion: Vaccines — Our best public health tool
How do we effectively protect the public from COVID-19?
COVID-19 has infected more than 90,000 Virginians, and more than million Americans. Each day, the number of cases and deaths climbs. To mitigate this deadly virus, social distancing measures have been advised to prevent the spread of the disease. However, the U.S. has not been able to fully implement social distancing measures and COVID-19 was able to rapidly become one of the leading causes of death in the U.S. Social distancing limits people from transmitting infection, allowing us to slow the virus’s spread. Without these measures, our health care system would become overwhelmed, and relaxation of these guidelines have caused a dramatic increase of patients in many states and cities.
A more permanent solution to COVID-19 is herd immunity, wherein the community has an immunity to the disease, preventing its rapid spread. To accomplish herd immunity to COVID-19, estimates range as high as 70% or more of the population (roughly 200 million Americans) must develop immunity. Even with the current average of new cases this would take many months to years to naturally occur. Vaccines provide large-scale population immunity in a safe and controlled manner, whereas voluntary exposure to achieve herd immunity to COVID endangers our citizens by exposing them to a lethal virus. Herd immunity through vaccination limits transmission and ensures that individuals who cannot receive vaccines due to allergies, weakened immune systems, cancer and other issues can remain safe.
Vaccines are an integral part of public health and have had a profound impact on society. For example,
Although most people recognize vaccines importance for public health, there are still some aspects of vaccinations that are unfamiliar, which often leads to misconceptions. An apprehension for things we do not fully understand is reasonable, especially when some of our first memories with vaccines stem from being stabbed with a needle. However, it is imperative to recognize that vaccines undergo a rigorous testing process to ensure they are safe and effective. For everyone’s health, vaccines are developed and administered throughout society, and are particularly important amidst this pandemic.
The development of a vaccine from conception to production is a long and intensive process. Once a vaccine is initially created, the vaccine undergoes three phases of clinical testing on patients before it can be administered and approved by the Food and Drug Administration (FDA). These three phases consist of gradually larger populations from roughly a hundred patients to several thousand to more accurately assess how the vaccine reacts within our diverse population. Manufacturing can begin on an industrial scale with companies that have the personnel and equipment to produce mass quantities of the vaccine.
When will we have a vaccine and how do I know this vaccine will be safe?
Vaccine development normally can last 10-15 years, but to address the health emergency incited by COVID-19, the entire world is prioritizing the development of this vaccine and has expedited the process through international and national collaborations among researchers and industry in the hopes of delivering a safe vaccine in one year (early 2021). For reference, the fastest prequalification of a vaccine was for Ebola, which still required five years of development and testing. Hundreds of vaccines candidates for COVID-19 were able to be swiftly prepared for clinical trials because of philanthropic donations, private sector and government partnerships and China providing the genetic sequence of COVID-19, as well as, previous research results from studies on diseases similar to COVID-19. By simultaneously testing multiple vaccine candidates like this, we increase our likelihood and speed of finding a successful vaccine.
The expedited development of a COVID-19 vaccine is unprecedented, but not at the cost of safety. Normally, the industrial manufacturing of the vaccine begins after safety and efficacy of the vaccine are confirmed in clinical trials. Instead, manufacturers are beginning the mass production of the vaccine candidates in conjunction to their testing in clinical trials, imposing a financial risk given the uncertainty that the vaccine will be approved. Clinical phases take time as you must: organize the trial and setup the location in an area with high infection rates; find volunteers to be tested and who have not already been exposed to COVID-19; have enough physicians to administer the vaccine and examine the patients; standardize production and dosing of the vaccine to reduce variability in the data; wait to see if the patient develops COVID-19 symptoms; and check antibody levels routinely to see if the vaccine prompts long-term immunity that would protect the individual for months following vaccination. This process has been hastened by compiling data from multiple sites for Phase I trials that test safety and even overlapping Phase I and Phase II trials to assess the safety and efficacy of these new vaccines simultaneously.
Even as vaccines become approved, things will not immediately return to normal. The number of doses will initially be limited and should be prioritized to health care workers and others who have the most risk of being infected. Gradually, the vaccine will be administered, allowing us to remove social distancing measures and facial covering requirements.
What is Virginia’s policy on vaccination?
While we wait for a vaccine to be developed, we need to continue to ensure that steps are taken to administer and follow health guidelines. Fortunately, Virginia’s state legislature has shown confidence in our public health officials even before the COVID-19 pandemic. A bill passed (HB1090) in the recent session of the General Assembly has changed how vaccine requirements are determined for Virginia children. Previously, each addition to the vaccine schedule had to be approved by Virginia legislators. When considering this bill, several legislators were misinformed about the science concerning vaccinations, and believed inaccurate information, such as HPV being a non-communicable disease or that vaccines can cause conditions such as autism spectrum disorder (ASD).
In response, the law was changed so that the Virginia vaccine schedule is now dependent on decisions from the Centers for Disease Control and Prevention (CDC) and judgment from the Virginia Department of Health (VDH). Importantly, the law also expands coverage for many children who typically rely on free vaccinations provided by the VDH, as the agency previously was only allowed to purchase vaccinations approved by the General Assembly. These measures will help ensure the health and safety of children in Virginia from vaccine preventable diseases. The General Assembly still has the power to exempt any vaccines that are listed on the CDC’s schedule; and religious and medical vaccine exemptions are still applicable. If the COVID-19 vaccination is added to CDC’s schedule, barring any exemption from VDH and the General Assembly, the vaccination will be added to Virginia’s vaccination schedule and consequently would be a requirement for children to attend public school. Even during this pandemic, it is vital that our children continue to receive their regularly scheduled vaccines to ensure they are not at risk of developing other illnesses that are preventable through vaccination.
Health and medical professionals devote their time and lives for our safety. They study to be qualified in their profession and spend many late, long hours ensuring our health. Our policies concerning public health ought to be guided by the professionals who have firsthand experience with treating the sick and COVID-19. Their guidance and expertise ensure safety for all of us. If we truly believe they are heroes, then we need to value our heroes experience, trust their work, and follow the guidelines they have provided with our best interest in mind.
Officers of the Science Policy Initiative at UVA
Grace C. Bingham
Robert Dyer
Courtney Rogers