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Before We Get Our Shot at it: Compare the COVID Vaccines

Joseph Gerald (Jerry) Reves, M.D.
December 28, 2020

Friday, December 11 the FDA approved the first of what promises to be several highly effective COVID-19 vaccines. And on Friday December 18, the FDA approved the second Moderna vaccine. The Pfizer - BioNTech Vaccine was approved and is already in use in this country, Canada, Great Britain and soon to be many other countries. Likewise the Moderna vaccine has just been shipped and in early distribution. The creation, testing and manufacture for distribution of this highly effective vaccines in less than nine months after the virus genome was published is a tribute to the evolution of medical science and the partnership of government and industry unparalleled in history. The U.S. Operation Warp Speed to produce vaccines shows that when the world wants to work together to solve a catastrophic problem, it can. The U.S. Federal Government and the U.S. and German Companies, Pfizer and BioNTech, respectively, and the NIH and the Boston Company, Moderna, have done what many thought impossible – produce a safe, effective and mass produced vaccine in under a year!

When will the general public get their vaccine?

Because the vaccine has just been invented, tested, and approved it will take months to mass produce it for use in the general world population. There are many logistical challenges with rolling out a limited supply of a vaccine that has a limited shelf-life and requires deep freezing for its integrity. Nevertheless, the first vaccine is going into frontline workers and next into the vulnerable population in nursing homes. After that it will be systematically available to others and finally to everyone. It is probably a year until the vaccine is fully available to everyone who wants it including pregnant women and children. When that time comes herd immunity should be achieved as we have written about previously. In the meantime, while we all wait for our turn to get vaccinated it is important to consider the main candidates for your vaccination so that when your time comes you can select the one you want or at least understand why you are being offered a particular one.

Comparison of the Candidate Vaccines

The previous article in this series, "COVID-19 Vaccines, Promise, and Place in the Pandemic" explained how vaccines work by triggering the body’s immune system mechanisms to respond to COVID-19. This is done not using live virus as many vaccines do or killed virus as others do, but by introducing genetic messages that cause the body to produce internally a fragment of protein that is in the COVID-19. So when the real virus comes along through our exposure, we mount and immediate response to blunt or block its effect on us. There are over 100 candidate vaccines in the world.

The table lists seven comparison variables for each of the major vaccines under consideration at this time. Two of the vaccines use messenger RNA to create proteins internally that mount an immune response. The three other viruses use fragments or genetically altered weakened common cold viral material to trigger an immune response. All of the vaccines require 2 shots that can be thought of an initial action followed by a booster to make sure the response to the real virus is robust. All of the vaccines should be available by summer. The estimated price for each varies from $3 to $37, and as of this writing they would be “free” to U.S. citizens although there could be a slight cost for the administration of the injections. The apparent effectiveness of all vaccines is very high. Most are in the 90% range, meaning that they would produce protection/immunity to 9 out of 10 people who are vaccinated. All are safe so far in the phase III clinical trials have shown. The usual side effects are soreness at injection site, short-lived fatigue, occasional fever, headache, chills, aches and pains, but generally very mild reactions similar to the influenza vaccines administered each year.

The biggest difference in the vaccines is an important logistical one. Pfiizer-BinNTech requires extreme cold for storage while the AstraZeneca may be transported and stored at normal refrigeration temperatures of 35-46o F. Thus the AstraZeneca vaccine will have greater utility around the world since few countries have the ability as the U.S. does to keep vaccines at the very cold required. This advantage to the AstraZeneca vaccine is significant as is its relatively low cost to produce. There is one issue with the AstraZeneca vaccine and that is that the lower dose seemed to confer greater protection than the higher second dose. This issue will be the subject of a great deal more study before it is released.

Russia’s Sputnik V Vaccine is a bit more mysterious than the others and there are more questions marks about it than those of the West. It is very unlikely that Sputnik V will ever be used in the U.S. since there are other vaccines about which a great deal more information is known. The Russian virus will be used in the Eastern block of countries and possibly in India, Korea, Brazil, China and Hungary.

The Bottom Line

Most of us are in a long waiting line before we will receive one of the vaccines. The great news is that one is already being used and most of the others will be approved by late spring. The bad news is that it will still be some time before the general public can receive one of these vaccines. In this waiting period it will be prudent to keep a keen eye on which vaccine seems to be the most effective with the least side effects. Certainly during this waiting period a great deal more information will come out such as which age groups seem to benefit most from each vaccine. As a consumer, we should ask which vaccine we are offered and why. In effect while we wait we get to continue to evaluate which vaccine seems best suited to us. When we get to the front of the line we should be prepared to ask our doctor which vaccine is recommended for us and why.

MUSC Health has earned a "High-Performing Hospital" designation in geriatrics from U.S. News & World Report for 2018-2019