As COVID-19 immunization speeds up across the U.S., vaccine makers hope the country will reach mass immunization by the summer and be the first country of its size to meet that goal.
In a panel at the virtual J.P. Morgan Healthcare Conference on Wednesday, Moderna CEO Stephane Bancel said that if the Moderna and Pfizer vaccines' distribution continues to go smoothly, 400 million vaccines will have reached 70% of the U.S. population by the end of the second quarter of 2021. While smaller countries like Israel may reach herd immunity earlier, the timeline would still put the U.S. ahead of some of its peers.
"I think Europe will be much later," Bancel said. "I would not be surprised if it takes Europe through the end of the year to get good immunization across the country."
The federal government's central focus is on getting vaccines into people's arms, according to Dr. Moncef Slaoui, chief advisor to Operation Warp Speed. Ultimately, he believes the COVID-19 virus is here to stay, and how the country has responded to the crisis can act as a playbook for dealing with the next global pandemic.
"They will come again, there will be more pandemics, I don't know when they will come, but we need to be even faster for the next one than we have been for this one," Slaoui said during a panel discussion.
He said he expects the Johnson & Johnson one-shot vaccine to be "coming to fruition" as soon as the end of January and the AstraZeneca vaccine to receive federal emergency use authorization by March. He did not provide a timeline for approval for the Novavax vaccine.
The federal government has paid $1 billion to order at least 100 million doses of the Johnson & Johnson vaccine; Operation Warp Speed paid $1.2 billion to AstraZeneca to secure up to 300 million vaccines; and the government invested $1.6 billion to secure 100 million doses of the Novavax vaccine.
The U.S. has invested at least $1.5 billion in the Moderna vaccine and $4 billion in Pfizer. While 40 million Moderna and Pfizer-BioNTech vaccines have been distributed, only 9 million people have received their first shot, Slaoui said, pointing to the low number as proof that "there is a need to accelerate the immunization."
"Where things need to improve is the capacity of the healthcare system," Slaoui said.
Pfizer Biopharmaceuticals Group President Angela Hwang said the company has so far shipped out 30 million doses of its vaccine to about 10,000 different locations. The company has partnered with logistics companies like UPS and DHL to deliver the vaccine and invested in temperature monitoring and tracking systems for the shipments. While a couple of boxes had separate excursions, Hwang said Pfizer has verified that all the vaccines inside are still intact and that distribution "has gone remarkably well."
"All the doses have gotten to where they need to get to exactly on time with almost negligible variance, almost no product returns," she said.
Moderna is relying on McKesson Corp. to distribute its vaccines. According to McKesson CEO Brian Tyler, secure McKesson vehicles pick up the vaccines directly from Moderna and, in 24 hours or less, arrive at healthcare sites that are pre-approved by local and state officials.
Because the initial doses of the vaccines were rolled out in the middle of the holidays and being distributed primarily to busy front-line workers, "maybe teething pains [in administering] should have been expected. I think we're starting to see that get better and better," Tyler said.
To accelerate the pace of immunizations, Slaoui stressed a need for more vaccines—even if they have efficacy rates lower than 95%—and a one-shot immunization. Realistically, he said that after May, "a very large percentage of people vaccinated with the first dose will not get their second dose."
"Fifty percent [efficacy] is so much better than having no vaccine," Slaoui said. "It would allow the appropriate immunization throughout the population and save millions of lives."
If Moderna and Pfizer were tested as a one-dose in their current iterations, Slaoui said they would still likely have "a very high efficacy." But he noted that once people hear a shot is 95% in stopping the virus, anything less seems like a compromise. All vaccine candidates have included clinical trials that include at least double-digit representation of Black, Hispanic and other underserved populations and Operation Warp Speed is currently reviewing companies that could help underscore the importance of vaccination to the broader population, particularly to these minority groups that have been disproportionately impacted by the disease.
Karen Lynch, executive vice president of CVS Health and incoming CEO of Aetna, said that engaging local stakeholders will be vital in communicating the importance of immunization, as well as of other best practices like hand washing and wearing a face mask. She said community pharmacists at CVS Health and elsewhere could also work to educate their members on the importance of vaccination.
The company operates 10,000 retail stores across the U.S. CVS Health has all the tools it needs to start vaccinating up to 1 million people per day, she said.
"We're very hopeful that the federal program will open up soon, and then that will open up more of a direct distribution into pharmacies across the country," Lynch said. "Then I think that will open up the ability for individuals to go to their community-based pharmacies so we can have more people vaccinated."
More vaccines will also help the world deal with the virus as it mutates. Bancel said Moderna has tracked COVID-19 mutations since January. The company is not concerned with mutations in the short-term but is concerned with the long-term implications of the virus changing.
"As we see the virus mutating, now in six months, nine months, two years, as the virus drifts from origin sequence that came out a year ago, are you going to need to have a new vaccine?" Bancel asked.
Last week, Pfizer released data that proved the company's vaccination was effective against the mutations that have been reported, Hwang said. Going forward, she said the company remains bullish about its vaccine's ability to respond to the various transformations of the virus since its messenger RNA composition can be easily altered once a new virus variant is sequenced. She estimated that Pfizer could develop a new vaccine in as little as six weeks.
In addition to tracking mutations of the virus, she said following patients for another two years will be necessary for understanding the virus's transmissibility and the durability of the vaccines. She stressed the need for regulatory agencies to quickly approve new coronavirus treatments and effectively communicate the individual and social responsibilities around vaccination.
"We see this as a durable business," Hwang said. "It's a business and piece of research we're going to continue to have to do for a long time."