| Oct 08 2020

Getting Ready for a COVID-19 Vaccine

Andrew Halpert, MD
Clinical Innovation Leader
Dave Zieg, MD
Clinical Services Leader, Total Health Management, Mercer

The race to develop a COVID-19 vaccine is in the news more or less continuously, and with good reason: We are all aching to return to a more normal way of life and a vaccine will help contain the virus and get us there sooner. If all the coverage has left you with more questions than answers, you’re not alone. In this post, we will share what we know and what we don’t, and why it’s not too soon for employers to start planning for the release of a future vaccine.

How would a COVID-19 vaccine work?

Think of a vaccine as teaching the body to recognize one or more key features of a virus before the actual virus invades the body. The body’s immune system then creates a “memory” which allows it to recognize the actual virus in the future and fight it off.

Coronaviruses got their name because they have protein spikes on their surface that look like a crown. The vaccines being developed and studied for the novel coronavirus, named SARS-CoV-2 (which causes COVID-19), are designed to teach the body’s immune system to recognize these unique spike proteins on the surface of the virus. The immune system can then quickly recognize the actual virus (should it invade the body), interfere with the virus’s ability to multiply, and call into action other parts of the immune system to continue the fight. This should keep the virus from getting into cells, replicating itself and making a person sick.

The different vaccines in development use different approaches. Some use RNA or DNA as genetic instructions that tell the body’s own cells to make a protein that looks like the SARS-CoV-2 spike proteins. This is uniquely different from other, more typical vaccines that use inactivated viruses or other viral technologies that already contain these spike proteins. Most of these vaccines will require two doses spaced 21-28 days apart.

How soon will a vaccine be available to the general population?

Even if a vaccine is approved for use this year, it will likely be 9-12 months or more before doses are available to the average American. Groups like healthcare workers, first responders, vulnerable populations, critical risk workers, and teachers will probably receive the vaccine first. In addition, logistical challenges -- for example, some vaccines will require cold storage as low as -80℃ -- may slow down distribution and make administration more complex. Employer-sponsored vaccine events will be challenging due to COVID-19 restrictions and the two-dose protocol that requires that both doses come from the same vaccine manufacturer. All of this will make the days of the one-shot flu vaccine in the company cafeteria seem like a memory from simpler, happier times.

Will the vaccines be safe?

In general, vaccines are very safe (you can read what the CDC has to say about vaccine safety here). When we consider the impact of COVID-19 on health, well-being and the economy, we believe the benefits of a rigorously studied vaccine will outweigh the risk of rare side effects.

To be considered for approval by the FDA, vaccines developed in the US must be carefully studied via a three-phase clinical trial process. Phase 1 includes a small number of volunteers, usually less than 100, and focuses on safety and dosage. Phase 2 involves several hundred volunteers and focuses on safety, side effects and immune response. Phase 3 involves thousands of volunteers and focuses on safety and efficacy – how well it works.

Vaccine trials typically take years to complete before the vaccine is considered for approval by the FDA. However, clinical trials for a SARS-CoV-2 vaccine have been significantly accelerated. Although the FDA has stated that scientific rigor will not be compromised, there is some evidence that the American public is skeptical. A survey conducted by the Pew Research Center in September found that only 51% of US adults would definitely or probably get a SARS-CoV-2 vaccine if it were available -- a significant drop from 72% in a Pew survey conducted in May. Yet another poll conducted by Axios and Ipsos found that only 39% said they would be likely to get the vaccine when it is first made available.

How much will the vaccine cost – and how long will it last?

The vaccine is likely to be cost-free to the general public since it is a preventive measure. It’s not yet clear what the cost will be to employers and other payers, but the vaccine is likely be subsidized or covered by government funds. However, employers/payers may be responsible for the cost of administration and materials.

At this point, no one knows how long the vaccine will protect against COVID-19. It is likely we will all need boosters at some interval to maintain immunity. It’s also important to keep in mind that the vaccine may induce partial immunity, where some will still get sick even after being immunized. However, if it’s like other vaccines, those with partial immunity would be expected to experience a less severe illness than those who did not receive the vaccine.

What can employers do to prepare?

While there are still many unknowns, it is never too early to start planning. Form a subcommittee of your COVID-19 task force to develop vaccine strategy. Ask your health plan and other pertinent vendor partners what role they might play in vaccine administration. Consider a spot survey of your employee population to ascertain vaccine receptivity, and use those results to develop a communication campaign. Finally, if you are a multi-site employer, develop a geographic roll-out strategy (under the assumption of limited supply). And -- as always in the age of COVID-19 – prepare to be flexible and evolve your plan as new information emerges.

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