A Shot in The Dark: COVID-19 Vaccine Update

The webcast included an overview of:

• Emerging vaccines
• Implementation
• Logistics
• Storage considerations

 

Emerging Vaccines Overview

Charles Dela Cruz, MD, PhD, provides an overview of vaccine basics, explaining that the Pfizer and Moderna vaccines are messenger RNA (mRNA) vaccines, while the Oxford-AstraZeneca vaccine being distributed in the United Kingdom is a viral vector vaccine. The viral vector vaccine is more cost effective because it can be stored at normal refrigerator temperature, although there are still questions about its efficacy. While it is a two-dose vaccine, it is unknown why data showed that its efficacy was higher in those who were given a low dose first, followed by a standard dose at least a month later, instead of two standard doses.

Dr. Dela Cruz addresses questions on allergic reactions and the known effects of the vaccine on pregnant women. According to the Centers for Disease Control and Prevention (CDC), those with a history of immediate allergic reactions to mRNA COVID-19 vaccines or to polysorbate should not be vaccinated. The vaccine should not be withheld from those pregnant women as long as they meet the vaccine criteria. While there has been no large-scale study in the pregnant population, some vaccine trials included pregnant women in the study with no reports of adverse effects on the fetus.

Implementation

What will be needed to implement the COVID-19 vaccine? Who will get it, and when? Ram Koppaka, MD, PhD, FACP, FCCP, from the CDC says there is a wide range of goals and complexities to consider when distributing a new vaccine, especially with some of the unique challenges COVID-19 presents.

Maintaining the balance between preventing morbidity and mortality and preserving societal functioning were both considered in the development of the phased allocation of the COVID-19 vaccine. Sub-prioritizations within these phases needed to be considered because the epidemiology of COVID-19 is constantly evolving, and additional vaccines are being developed.

One of the most important factors in effectively implementing the COVID-19 vaccine is instilling confidence, which starts with healthcare professionals. “A strong healthcare provider recommendation is the single most important factor that predicts successful vaccination,” said Dr. Koppaka.

Healthcare professionals can instill confidence in the vaccine by communicating safety measures and encouraging the use of safety monitoring systems such as the Vaccine Adverse Event Reporting System to report any vaccine side effects.

 

Logistics

Nathaniel Hupert, MP, MPH, FACP, from Cornell Institute for Disease and Disaster Preparedness, focuses more closely on the logistics of efficient distribution of the COVID-19 vaccine. Vaccine distribution requites accurate and timely tracking of the predicted demand, supply, and dispensing.

He reviews supply chain fundamentals, such as:

• Know the needs of the vaccinators and communicate decision-making.
• Construct a lean supply chain organization to eliminate waste and reduce variability.
• Build information infrastructures so information can flow both within and among organizations.
• Establish business processes to track vaccine shipments and information about the vaccine.
• Construct decision support systems that are collaborative and make the process more effective.

Storage Considerations

Where to store the Pfizer and Moderna vaccines, which have different cold chain requirements, also is a challenge. Cherokee Layson-Wolf, PharmD, BCACP, FAPhA, explained that, while both vaccines last six hours once they are ready for administration, the Pfizer vaccine is stored in ultracold freezers and the Moderna vaccine is stored similarly to other vaccinations.

Dr. Layson-Wolf also provided some pharmacy tips to deliver the vaccine efficiently, minimize waste, and keep track of the doses administered. “It’s so important to time the dose preparation with the actual clinic attendance at that time to really minimize waste and ensure we’re using up all the vaccine that we have appropriately.”