Moncef Slaoui, the outgoing head of the federal Covid-19 vaccine program, warned Wednesday to remain vigilant about Covid-19 far into the future. “I’m optimistic we will get this virus under control,” the Operation Warp Speed director said on a panel at the annual J.P. Morgan Healthcare Conference. “But we cannot forget. We forgot with Ebola. We forgot with Zika.” While the general public may still be holding out hope that this will all just go away, the pharmaceutical industry is preparing for the Covid-19 line of business to be recurring and long-lasting.
“Our thesis as a company is Sars-CoV-2 is not going away, we are going to deal with this virus we think forever,” said Moderna CEO Stephane Bancel. The key moving forward, he said, is to stay on top of the variants and mutations and “to very quickly find a regulatory pathway to evolve our product so that we can keep protecting people.” There are still many unknowns surrounding the duration of the vaccine’s protection and how frequently people will need to receive boosters.
“We’re bullish about what our vaccine is going to be able to do to respond to the various mutations and variants,” said Angela Hwang, group president of biopharmaceuticals at Pfizer, which is partnered with BioNTech. Though she acknowledged at some point there might be a need for a new vaccine all together.
But part of the beauty of mRNA, the technology behind the Pfizer and Moderna vaccines, is that it would be relatively easy to produce a new vaccine within a matter of weeks, instead of the usual several years. It is critical to continue long-term studies of patients in trials to understand the durability of the vaccine response, said Hwang. “We see this as a durable business,” said Hwang. “It’s a business and piece of research that we’re going to have to continue to do for a long time.”
There will be more pandemics. It’s impossible to predict when.
While manufacturers have upped their capacity, the actual rollout into people’s arms has gone less smoothly. With 29.3 million vaccines distributed, only 10.3 million have been administered, according to the CDC. Bancel expressed confidence that if Pfizer and Moderna are able to hit their Operation Warp Speed contract goals of a combined 400 million vaccines delivered by the end of the second quarter that the United States “will be one of the first countries of size to get sufficient protection.” On the other hand, “I would not be surprised if it takes Europe until the end of the year,” he said.
While Pfizer and Moderna were the first vaccines to get authorization in the United States, but there are several other vaccines coming down the pike, including Johnson & Johnson, AstraZeneca and Novavax. One of the big unanswered questions is whether they’ll be as effective. The flu vaccine has around 40 to 60% efficacy depending on the year, but Pfizer and Moderna greatly exceeded expectations, with efficacy rates around 95%. What if these other vaccines have lower rates?
The 95% benchmark, Slaoui said, makes people hone in on the individual benefit versus the population benefit. “The scientific answer is a 70 or 80% vaccine can be highly effective in inducing herd immunity,” he added. Another issue with most of the Covid-19 vaccines is that they require a two-dose regimen taken three weeks apart.
“In real life, a very large percentage of people immunized with the first dose will not get their second dose,” said Slaoui. And while the performance of one dose versus two dose vaccinations still is being studied, he said he is confident that one dose will “likely also demonstrate very high efficacy.”
The most important thing from a public health standpoint is getting any vaccine with more than 50 percent efficacy available as quickly as possible. “There will be more pandemics. It’s impossible to predict when,” said Slaoui. “We need to be even faster and better equipped for the next one than we have been for this one.”