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With outlook positive for COVID-19 vaccines, NH, Vt. eye distribution, public acceptance

  • Elizabeth Talbot, who is an infectious disease specialist at DHMC and a deputy state epidemiologist, answers a call on Dec. 26, 2014, from the state department of health after she returned home on Dec. 19 to New London, N.H., from Sierra Leone, where she was training caregivers in the Ebola epidemic. Talbot is under a 21-day quarantine. (Valley News - Geoff Hansen)

Valley News Staff Writer
Published: 11/21/2020 10:48:01 PM
Modified: 11/21/2020 10:47:46 PM

NORWICH — Amid the recent increase in COVID-19 cases in the Twin States and new restrictions aimed at preventing more, there are signs that the end of the pandemic may be in sight.

“For a change, it’s good news coming from this pandemic,” Dr. Elizabeth Talbot said in the introduction to her portion of a Health Research Live session hosted via Zoom by the Montshire Museum of Science last week.

Talbot, who is New Hampshire’s deputy state epidemiologist and an infectious disease specialist at Dartmouth-Hitchcock Medical Center, and Christine Finley, who directs Vermont’s immunization program, outlined the progress of COVID-19 vaccines, especially those being developed by the drug manufacturers Pfizer and Moderna. They also discussed some of the potential challenges of distributing them.

“The idea that (Pfizer’s vaccine) will be available in mid-December is just amazing to me right now,” Finley said in her remarks on the Zoom call earlier in the week.

Pfizer applied on Friday to the federal Food and Drug Administration for an emergency use authorization to begin providing its vaccine — which it has said is 95% effective beginning 28 days after the first of two doses — to the public. The Cambridge, Mass.-based Moderna, which last week reported 94.5% efficacy for its COVID-19 vaccine, is expected to soon follow in requesting the FDA’s approval for emergency use.

Talbot estimated that the FDA’s review will take two weeks and then a federal Advisory Committee on Immunization Practices, which is part of the Centers for Disease Control and Prevention, will review the vaccines. She said that vaccines could be available as soon as late this month, but more likely by mid-December. While they won’t be widely available at first, Talbot said higher-risk listeners on the call might consider talking with their doctors sometime in the next month about when they might be able to get vaccinated.

Vermont Health Commissioner Mark Levine said during a news conference on Friday that Pfizer’s vaccine, which it is partnering with BioNTech SE to produce, could arrive in Vermont in limited doses by Dec. 10. The CDC advisory committee is set to meet on Monday to discuss Pfizer’s vaccine, Levine said.

Both vaccines have recently completed phase 3 drug trials, which Talbot explained are focused on evaluating whether or not they work, as well as demonstrating whether they are safe.

Pfizer’s phase 3 trial included 43,000 participants, including people from diverse racial and ethnic backgrounds, as well as people of extreme ages. She said the trial found no indication of serious adverse reactions. Some participants reported fatigue and headaches after being vaccinated, but Talbot noted that those symptoms are less serious than some vaccines for other diseases that are already available. Moderna is a week or so behind Pfizer in timing. Its trial included 30,000 participants, Talbot said.

Public acceptance

As these vaccines have been under development as part of what the federal government has labeled “Operation Warp Speed,” manufacturers have been making them not knowing whether or not they would eventually be approved for public use. It’s “very unusual” to have both vaccine development and manufacturing occurring at the same time, Talbot said.

In spite of the speed of the process, Talbot said she has confidence in it. She would have preferred that “warp” be left out of the name of the project to avoid any safety concerns that might arise from it. But, she said, the speed here has shown that in fact vaccine development can and ought to be done faster than it has been in the past.

“This is the time frame that we should have for every lifesaving intervention,” she said. “This is a time frame of going through the usual phases and landmarks that we always do, but just on a faster timeline.”

Finley said that the public’s willingness to accept a vaccine is just as important as its development.

“If the public isn’t ready to accept them, we’ll never be able to reach the herd immunity in order to stop the pandemic,” she said.

Finley emphasized that “safety is assessed at every step along the way.”

During a breakout session on the Zoom call, one participant named Connie said she was listening to the session “hoping to be convinced.”

She said she didn’t like the sound of the vaccines that include nanotechnology — such as the vaccine being developed by Novavax — and said she generally prefers to rely on natural remedies to address health concerns such as the flu.

“I’m pretty much negative on vaccines,” she said.

Talbot, who happened to be in the same breakout session, said she shared concerns about the new technology present in some of the COVID-19 vaccines under development. But she noted that the technology is not necessarily bad. Nanotechnology also is not an element of the Pfizer and Moderna vaccines. Those are mRNA-based vaccines, which Talbot said provide the body with “the recipe” to prepare to respond to the coronavirus.

While mRNA vaccines have “never been proven in humans before,” Talbot said they have been used widely in veterinary science.

Other vaccines are under development, including those by Johnson & Johnson, which uses the same platform as an approved vaccine for Ebola, and AstraZeneca, in whose trials the University of Vermont Medical Center and Larner College of Medicine are participating.

In order to address vaccine hesitancy, Talbot said she and other state officials would work to disseminate accurate information about the vaccines with trusted community leaders of all types, including health care providers, as well as religious leaders. State officials will be “making an effort to reach everybody who might be a spokesperson for this,” she said.

Distribution issues

Both New Hampshire and Vermont have developed allocation frameworks to determine how vaccines will be distributed and who will be first to get them. These are aimed at reducing deaths and also alleviating the societal impacts of the pandemic.

Therefore, first on the list will be health care workers; then those over 65 or those with medical conditions that make them likelier to develop serious symptoms from COVID-19. In the second phase of distribution, those who are key to critical infrastructure, such as teachers and those operating New Hampshire’s nuclear power plant, will be prioritized, as well as those in congregate living facilities, she said. Young adults and children will be in the third phase, with others following in the fourth.

In addition to sorting out who will get the first doses to arrive, there also is the question of how they will be stored. Moderna said last week that its vaccine is expected to be stable at standard refrigerator temperatures of 36 to 48 degrees Fahrenheit for 30 days, up from an earlier projection of seven days.

In contrast, Pfizer’s vaccine candidate must be shipped and stored at ultracold temperatures or on dry ice and can last at refrigerator temperatures for up to five days.

Both the leading vaccines also require two doses, which will mean tracking who has had which dose and when. That may be more challenging in New Hampshire, which is the only state without a statewide vaccine registry to track who has received which vaccines. The registry is currently slated to be up and running by mid-December, said Jake Leon, spokesman for the New Hampshire Department of Health and Human Services. In the meantime, the state has a separate process in place for health care providers to order and track vaccines, he said in an email.

Levine, on Friday, said Vermont has some freezer capacity now for storage and has ordered more.

“All of this is good news, but it’s changing every week,” he said.

Material from VtDigger was used in this report.

Nora Doyle-Burr can be reached at ndoyleburr@vnews.com or 603-727-3213.




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