CDC Finally Publishes Unified Vaccine Access Website

  Recently, the CDC published a much needed website where users can find an appointment to get vaccinated. An issue many people are facing as they become eligible for vaccination is not knowing where to go to get their vaccines. Initially, several websites were put up to tackle this need for local areas and there was confusion about which resources to use. Until a few days ago, there was no central source of information. 

        According to the CDC’s website, the new so-called Vaccine Finder “allows healthcare providers to list their vaccine locations in a centralized, searchable database and to track vaccine availability.” Now that this resource is available, it will be incredibly helpful for people who are looking for a place to get vaccinated. But one question we all might be asking is why did it take so long for the CDC to provide this resource to assist with the vaccine rollout? More broadly, is this a reflection on how the entire vaccine allocation process has been going nationwide? 

Although the first COVID-19 vaccine was licensed for Emergency Use Authorization in early December of 2020, vaccine allocation did not really pick up until mid January, 2021. NPR has been tracking efficiency of vaccine usage in each state by dividing the number of vaccines administered in those states by the number of vaccines distributed to that state. Shockingly, only a handful have passed 80% with most states falling below 75%. A few states are even below 60% efficiency in vaccine usage. With the huge demand for vaccines, there is no reason why usage efficiency should be below 90%. What gives? 

Perhaps the long wait for Vaccine Finder is a clue. It’s no secret that the U.S. was unprepared for the pandemic, and this naivatae has shown itself in many ways such as the flip-flopping of orders to shelter in place and the completely disjointed response to the pandemic. While some of this fault lies on the shoulders of the previous administration, the truth is that a pandemic was just not the first thing on most people's mind, and a well formed pandemic response plan was likely being perpetually pushed down the to-do list in DC. The longer vaccination takes, the more people are becoming sick and dying. Maybe with COVID fresh on our minds, we will do a better job of preparing for inevitable pandemics of the future. 

- Renata

NPR: How Is The COVID-19 Vaccination Campaign Going In Your State?, accessed 2/25/2021
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References

CDC: VaccineFinder: COVID-19 Information for Jurisdictions and Healthcare Providers, accessed 2/25/2021

Potential Herpes Simplex Vaccine is Making Noise

  Herpes simplex viruses type 2 is a sexually transmitted disease with a worldwide estimated prevalence of over 535 million people and an annual incidence of 24 million infections. Sexually transmitted herpes is infamous for the genital lesions it gives rise to, however its lesser known transgressions include neonatal herpes which is associated with high morbidity and mortality. It also has a major role in perpetuating the HIV epidemic by causing genital tract inflammation that increases the risk of HIV infection by threefold. 

        Among the ten herpesviruses that can infect humans, Varicella Zoster virus (the etiological agent of Chickenpox) is the only one with an effective licensed vaccine. There has been debate about whether it is possible to develop an effective Herpes simplex virus vaccine with existing scientific technology. The existence of two different types of Varicella Zoster vaccines acts as proof of concept for vaccine development, especially since Varicella Zoster and Herpes simplex are closely related alphaherpesviruses. Also, the highly efficacious Human Papillomavirus vaccine is proof of concept that a vaccine given intramuscularly can successfully develop genital mucosal immunity in the patient. 

        The WHO has been keeping track of potential Herpes simplex vaccines that are in the drug development pipeline. As of their 2014 report, there were 14 candidates in the pipeline, 5 of which were in clinical trials. But truthfully, hope for a herpes vaccine has been fading. Herpesviruses are large, complex viruses that may have multiple ways of getting into host cells. This means that vaccine-induced antibodies specific for one region of the viral surface may not be altogether efficacious in preventing infection. 

        In November 2020, a new candidate, R2, was found to induce protection against HSV-2 and HSV-1 infection in a guinea-pig animal model, and this made waves in biotech media. This vaccine was developed following the failure of several subunit vaccines and is itself a live attenuated vaccine that was engineered to be unable to infect the sensory system. Since HSV-1 and 2 become latent and indetectable by the immune system in neural tissue, in principle, the virus could be eradicated from the body following acute infection from vaccination, leaving behind memory B cells to protect against future infection by wild type virus. 

        The R2 vaccine has only been tested in the guinea pig model of HSV-2, and yet the accomplishment of making a live attenuated HSV vaccine candidate is immensely promising for the future of HSV vaccine development. 

- Renata

References

WHO 2014 Report on HSV Vaccines, accessed 2/9/2021

Bernstein et al., The R2 non-neuroinvasive HSV-1 vaccine affords protection from genital HSV-2 infections in a guinea pig model, npj Vaccines 2020

New COVID Vaccine by Novavax Proves its Efficacy

  Many vaccines against COVID have been in the works since it became clear that SARS-CoV-2 was not going to fade away quietly like the previous MERS and SARS outbreaks did. Three days ago, Novavax announced that its phase 3 clinical trials from the UK showed their vaccine to be 89.3% effective, making it the third company to produce a highly effective vaccine following Pfizer and Moderna. This vaccine is different from the Pfizer and Moderna vaccines in that it consists of nanoparticles formed from artificially synthesized virus spike proteins. This vaccine development strategy has been used to make many other vaccines such as those for influenza and HPV. 

An important complication to note is that this vaccine was tested in a small group (~4,000 people) in South Africa and was found to be only about 60% effective. Of those who contracted the virus during the South Africa trial, more than 90% were infected with the region’s new variant. This is concerning because as the virus gets more exposure to vaccine-induced immunity, the odds that it mutates to the point that it can fully escape the vaccine increase. Even if the vaccine is less effective against new strains, however, 60% protection can make a critical difference in efforts to slow the virus’ spread especially when vaccine availability is a problem. Novavax, however, has acknowledged that it may need to return to the drawing board. 

For Novavax, returning to the drawing board means another round of a long, expensive design and production process. Synthesizing protein for their vaccine is done biologically using cells whereas the RNA vaccines created by Pfizer and Moderna are synthesized chemically which is usually faster and cheaper. It’s interesting to note that RNA vaccines are a new technology making their debut in the attack against SARS-CoV-2. The development of this novel type of vaccine is likely just one of many scientific developments that will arise from the huge amount of effort, funding, and motivation that has been directed at this virus.

- Renata

NYT: Novavax’s Vaccine Works Well — Except on Variant First Found in South Africa, accessed, 1/31/2021

Novavax: Novavax COVID-19 Vaccine Demonstrates 89.3% Efficacy in UK Phase 3 Trial, January 28th, 2021, accessed 1/31/2021

The Conversation: How mRNA vaccines from Pfizer and Moderna work, November 18th, 2020, accessed 1/31/2021

More Bang for Our Buck: Extra Vaccine Supply Soon to be More Accessible

     In mid December, a week after vaccinations began, pharmacists across the country reached out to authorities and to Pfizer in confusion. The vaccine vials they were getting were supposed to be enough for only five doses, but many pharmacists were finding that there appeared to be enough vaccine for a sixth dose. Initially, much of the extra vaccine was thrown out which is understandable given the strict regulations around vaccines and the potential for trouble if a pharmacist was giving vaccinations against FDA protocol. Pfizer filed the paperwork required to approve usage of this extra dose so long as the amount left was above the 3mm level required for a full dose. Combining extra vaccine from different vials was not approved because of risk of contamination during the process. Regardless, this extra dose per vial boosted the estimated vaccine availability in the U.S. by 40% according to Politico. But there was still a problem. Some syringes have needles that aren’t able to extract that last dose from the vial. And the special syringes that can do so? They are in short supply. 

This brings us to today, a day after President Biden has taken office. In his first day and a half, Biden has signed a slew of executive orders aimed at combating the COVID pandemic. In a stoic speech, he told America that things will get worse before they get better, but that we can face this pandemic as a united front. His policies to address COVID which include mandatory mask wearing in any space with federal jurisdiction and the creation of a health equity task force may not be appealing to everyone, but one thing he signed off on might be -- His order allows enactment of the Defense Production Act, part of which will be used to increase production of the syringe needed to extract that last dose from Pfizer vials. With increased vaccine availability and a hopefully soon-to-ramp-up vaccination plan, the U.S. could finally start getting to where we need to be in terms of this pandemic response. 

- Renata

Politico Article on Extra Doses in Pfizer Vaccine Vials, accessed 1/21/2021

NY Times Article on Biden’s Executive Orders, accessed 1/21/2021

COVID-19 Vaccine Distribution: Competition or Cooperation

It was apparent early on in the pandemic that the world was completely unprepared for SARS-CoV-2. Maybe if we had been better prepared -- e.g. global strategic planning for pandemic response, developing more viral therapeutics -- acquiring vaccines wouldn’t have turned into the feeding frenzy between wealthy nations that it has become. A new global coalition, COVAX, is one arm of a broader effort to provide COVID vaccines, diagnostics, and treatment in an equitable manner to all countries. This aim is noble, but is it really the case that every country needs equal access to vaccines? At first glance it seems just to take an egalitarian approach to resource distribution. Allowing rich countries to stockpile resources desperately needed in other places (take the case of vaccines wherein wealthy nations pre-purchased more than 80% of vaccines that were to be made in 2021 (NPR Up First Podcast)) defies the most intuitive sense of justice that we have. But I would argue that this approach, at least at its most foundational level, might do more harm than good. If we were to distribute vaccines to countries in proportion to their population so that each received a relatively equal share, we would be ignoring the reality that the pandemic situation in some nations is worse off and this puts the entire world at risk. For example, Brazil’s leader, Bolsonaro, talked down vaccines and was long delayed in making efforts to acquire them for his citizens. Currently, Brazil’s death toll is over two hundred thousand, second only to the United States. The virus is spreading rapidly there, and what’s more, there is evidence of at least two different, more communicable, strains of the virus spreading in Brazil. Other countries that are in more stable situations might consider sending their vaccines to a country in a situation like Brazil. This argument hinges on one particular concern: Rampant viral transmission allows for exponential viral replication. Replication nearly always involved mutation. Mutation may change the virus in ways so it is no longer similar to a vaccine. And then we have gone back to square one. Of course, these decisions are multifaceted and this is but one of the very many important things to take into account. But in a world-wide effort, like COVAX, to mitigate the effects of the pandemic, rather than equal distribution of vaccines to all nations, it might be worth considering vaccine distribution based on the current or near future projection of each country’s situation. 

-Renata

Resources

NY Times Article on Brazil Vaccine Situation, accessed 1/20/2021

COVAX Website, accessed 1/20/2021

TB Vaccine (BCG) helpful for COVID-19?

 The Bacillus Calmette-Guerin vaccine is a vaccine used for tuberculosis (TB) disease, and is not widely used in the US and is typically only meant for infants/small children and healthcare workers where TB is most common. Researchers from Cedars-Sinai conducted blood tests on 6,000+ healthcare workers from the Cedars-Sinai health system, and found that among those who received the TB vaccination, there was a "significantly less likely [chance] to test positive for SARS-CoV-2 antibodies". The research states though, that a "large randomized prospective clinical trial" of BCG vaccination is need to understand the confirm if "BCG vaccination can induce a protective effect against SARS-CoV-2 infection. 

Analysis and research is still widely needed in order to see if the BCG vaccination is needed, though, it must be noted that the BCG is not generally recommended, because of the low chance of infection with Mycobacterium tuberculosis. 

-Justin

https://losangeles.cbslocal.com/2020/11/20/tuberculosis-vaccine-could-mitigate-risk-of-contracting-covid-19-study-shows/

https://www.jci.org/articles/view/145157

https://www.cdc.gov/tb/topic/basics/vaccines.htm#:~:text=Bacille%20Calmette%2DGu%C3%A9rin%20(BCG),protect%20people%20from%20getting%20TB.

TB - A Modern Tragedy affected by COVID-19

Unfortunately, for millions around the world, TB (tuberculosis) is still a predominant and persevering threat that is severely underfunded (leading to treatments and diagnosis that wrongfully take the lives of millions). The Stop TB Partnership has stated that many countries that still face the problems of TB, are using methods that are outdated, and that treatment of patients were only going to be further slowed, due to the COVID-19 pandemic.  

Despite TB being a very preventable and curable disease, though, remains "the top infectious disease killer". Many would like to see the responsiveness and urgency given to TB, as is given to COVID - as COVID-19 vaccines have seen roughly 50 human trial phases (all within less than a year), but for TB, only one vaccine has been seen in human trials, over the past several years. 

- Justin

https://www.telegraph.co.uk/global-health/science-and-disease/modern-tragedy-millions-miss-latest-treatments-tb/?utm_source=Global+Health+NOW+Main+List&utm_campaign=f33d9a6b21-EMAIL_CAMPAIGN_2020_11_16_04_09&utm_medium=email&utm_term=0_8d0d062dbd-f33d9a6b21-2870277