On Monday, Dec. 14, 2020, the state collectively watched with bated breath as history unfolded before our eyes. After nearly a dozen long, arduous, pandemic-ridden months, the first doses of a COVID-19 vaccine were administered to a handful of frontline health care workers at the Arkansas Department of Health (ADH). Poetic symmetry readily apparent, it was almost nine months to the day after the state announced its first presumptive case, on March 11, and exactly 11 days prior to Christmas Day.
Such relief could not have found the state, and the country, in a more dire time of need. As predicted, the fall and winter months brought on another wave of transmission and infection, spiraling toward caseloads that risked a “significant and possibly uncontrollable rise in cases,” the state’s Health Secretary, Dr. Jose Romero, said in November. As of December, Arkansas had logged a total of more than 200,000 cases and more than 3,000 deaths related to COVID-19 complications. Broken down for comparative purposes, we’d confirmed around 65,000 cases per one million residents, almost 15,000 higher than the national average.
Romero, who also serves as the chairperson of the Centers for Disease Control and Prevention’s (CDC) Advisory Committee on Immunization Practices, went on to compare the billowing cases and routine record-breaking days to a boulder rolling down a hill, adding that “there will come a time when we can not stop it.”
We are yet to know whether this ominous warning will turn true, but this much is certain: For the first time since its arrival in our state, we now have the best ammunition to fight this coronavirus in our hands. But, will we make it to the finish line in time? According to our health experts, most of that responsibility falls on us.
“We all want to return to normal as soon as possible, but it will not be immediate,” State Epidemiologist, Dr. Jennifer Dillaha, tells AY About You. “We know it will take time to assess the impact of the vaccines, therefore, social distancing and masking will still be needed for quite some time. COVID-19 can continue to spread even as doses are being administered in the state. So we’ll still have to take the same precautions, like face coverings and social distancing, as we work through this process.”
Elsewhere, at the hospital level, which has borne the full brunt of this pandemic and where caseloads are creating overwhelming levels of critical care needs, the distress is disconcerting.
“Our concern is that many people have become dull to the pandemic and are dismissive of public health officials’ calls of alarm about the increasing COVID-19 positivity and hospitalization rates. This is dangerous and irresponsible behavior,” says J. Larry Shackelford, president and CEO of Washington Regional Medical Center in Fayetteville. “We must continue to wear a mask in line with CDC recommendations, watch our distance and wash our hands as diligently as we did this spring. As we move into winter, we must also watch gathering in large groups and must restrict gatherings to 10 or fewer whenever possible.”
Even though the end of this current pandemic appears more clear than it ever has, many questions remain for a lot of Arkansans, and even public health experts.
That first dose of injected immunization delivered at ADH in December was the Pfizer-BioNTech COVID-19 vaccine, one of multiple options that could reach wide-scale use in the United States, but the first to receive authorization. According to Dillaha, the next-likeliest vaccine to arrive in Arkansas would be Moderna’s. Other candidates at various stages of clinical trials/approval include AstraZeneca and Johnson & Johnson (Janssen).
But given the emergency nature of this pandemic, the general public is unlikely to gain access to any of these vaccines for months, as the doses are being produced and delivered to all 50 states (and worldwide) in real-time. Since the demand will outweigh the supply for an extended time, the vaccination plan entails treating health care workers and residents of nursing homes first, who data show are among the most susceptible to COVID-19 complications.
“It will likely stretch into the beginning of 2021 before those groups are complete,” Dillaha says. “As we receive additional vaccine supply, and potentially as additional COVID-19 vaccines are authorized, we will expand into other groups, including essential workers and persons at risk for severe disease. This timeline may vary based on the amount of vaccine that is ultimately available, but we do expect the process will take some time.”
In November, Romero estimated that it might be midway through this year before the vaccine will become available to the general public.
Just as the news related to these vaccines has generated a healthy dosage of hope, so too has it created a substantial level of concern. In addition to the increased contention surrounding vaccines in general, these were created at a rate in which we have never seen. “Operation Warp Speed” is how the federal government referred to this process, which has some worried that quality may not have been heeded as much as quickness; most vaccines take years to develop, test and approve, not months. Health experts are working to calm those fears.
“Even though these vaccines have been developed with an accelerated timeline, the process for ensuring safety and efficacy has not been compromised,” Dillaha assures. “Both the Pfizer and Moderna vaccines have undergone robust safety reviews, including three phases of clinical trials where thousands of people were administered the two-dose regimen. That data [is] reviewed by the FDA using their established criteria for safety and efficacy before authorization [is] granted.”
She goes on to say it is important to convey and understand that, once a COVID-19 vaccine is approved, this means the safety evaluation was conducted just as rigorously as any other vaccine.
The record-breaking vaccine development has also spelled plenty of praise for these unprecedented scientific advancements, for just as the coronavirus, SARS-CoV-2, is a novel one, so too is the technology behind the vaccines.
The Moderna and Pfizer versions utilize a revolutionary mRNA technology, which does not involve an injection of the actual virus into our bodies.
According to literature from the CDC, “To trigger an immune response, many vaccines put a weakened or inactivated germ into our bodies. Not mRNA vaccines. Instead, they teach our cells how to make a protein — or even just a piece of a protein — that triggers an immune response inside our bodies. That immune response, which produces antibodies, is what protects us from getting infected if the real virus enters our bodies.”
At the vaccine’s direction, our cells create a “spike protein,” the same type that is found on the surface of SARS-CoV-2. The affected cells then display this protein on their surfaces, and the body’s immune system recognizes that they do not belong, making antibodies to fight off these harmless, coronavirus-mimicking proteins — the same antibodies our immune systems will then use when we are exposed to the actual virus.
Health experts are hopeful that this new technology may lead to additional advancements, where one vaccine could provide protection against multiple diseases simultaneously.
These mRNA vaccines are the first-ever approved for use in the United States, although the technology has been studied since at least 2011, mostly for cancer research. At this time, two doses, weeks apart, must be administered for immunity. Each has shown a greater than 90 percent effectiveness at preventing severe COVID-19 disease. In comparison, a typical flu vaccination averages around 40-60 percent effectiveness.
The other vaccine candidates, like AstraZeneca, for example, use DNA technology in adenoviruses. Essentially, they work similarly with the spike proteins, making the adenoviruses appear to our bodies as the novel coronavirus, creating an immune response. Trials are still ensuing, but these appear to have an effectiveness of 60-90 percent, depending on the dosage. Given the more durable nature of DNA as compared to the fragile RNA, AstraZeneca’s does not have to be stored frozen (like Pfizer’s and Moderna’s), and can last for around six months refrigerated.
However, a complete understanding of what lies ahead is still a moving target. According to Dillaha, we do not know if the vaccines will prevent people from spreading the virus, even if they do not fall ill to the disease; we do not know how long any of the vaccines will provide immunity; and we do not know if an annual COVID-19 vaccination will become as recommended as a flu shot. However, Dillaha does expect the disease to remain for the “foreseeable future,” and anticipates that vaccination will become routine to some degree. Experts also recommend that even those who have already contracted COVID-19 previously get vaccinated, as there is still no conclusion on how long natural immunity lasts.
The data is still out on how much of the population needs to be immunized before our lives return to what most would describe as “normal.”
“We don’t yet know what overall vaccination rate will be necessary to end the pandemic, but we do know that getting as many people vaccinated as possible will help us get there,” Dillaha explains. “Some experts are estimating that approximately 70 percent of the population will need to be vaccinated, but that is just an approximation.”
Dr. Mark Thomas, Vice President and Medical Director of Population Health at Washington Regional, echoes the epidemiologist’s sentiments.
“Traditionally, herd immunity has been thought to be present when the number of people who have had the disease, in addition to those successfully immunized totals almost 70 percent of the population,” Thomas says. “However, we are encouraged by the initial results of the vaccine trials showing a very promising response rate to the vaccine (above 90 percent, which is much better than the flu vaccine, for instance), and we know that those most likely to be infected in the community (young people with multiple contacts) may already have a high percentage of post-infection immunity. For these reasons, some scientists think herd immunity might be possible as we approach 50 percent of the population.”
Dillaha also opines that, over time, we may come to find that each of the vaccines approaching availability may inhabit different, specialized uses.
“For example, one vaccine might protect older adults [better] than others,” she says. “We will rely on the Advisory Committee on Immunization Practices to evaluate the accumulating data on vaccine effectiveness to make recommendations on whether one vaccine may be preferred over another in certain situations.”
The suspense is building for Arkansans and people across the globe. If the projections are true, the general public will have endured this pandemic for more than one year before a vaccine becomes available to them — sometime in the late spring or early summer, most likely. But just as our patience grows thinner, the need for it grows exponentially larger. The end is near; we can make it there together.
EDITOR’S NOTE: This article will appear in the upcoming January 2020 issue of AY About You Magazine.