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Pfizer and Moderna COVID-19 Vaccines 'Breathtakingly Effective,' Says UCSF's Dr. Robert Wachter

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Pedestrians wearing face masks walk past the headquarters of biotechnology company Moderna in Cambridge, Massachusetts on November 16, 2020.  (MATTHEW HEALEY/AFP via Getty Images)

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For the past several weeks, advances with COVID-19 vaccines have offered hope in what has felt like an endless slog through this pandemic.

On Nov. 20, Pfizer applied for emergency use authorization for its COVID-19 vaccine from the Food and Drug Administration. On Monday, Moderna announced it would also be applying for authorization for its vaccine, which reportedly has a 94.1% efficacy rate. If approved, doses could start rolling out before the end of the year.

But with the possibility of a vaccine in the near future coming into clearer focus, questions are being raised how these vaccine doses might be distributed. In California, state officials have made it clear that health care workers will be the first to receive the vaccine. But since the initial rollout will likely be limited, officials will have to decide which health care workers will get the vaccine first.

What does that mean, then, for the rest of us?

KQED Forum host Michael Krasny spoke with Dr. Robert Wachter, chair of the UCSF Department of Medicine, about the vaccine rollout and when the general public should realistically expect a dose.

This interview has been edited for length and clarity. Hear the full interview

Michael Krasny: There's good news on the horizon with respect to vaccines. And I'm interested in finding out your thoughts about the timing, first of all, but also the distribution of vaccines at this point.

Robert Wachter: Let's start with the big picture: A month ago, we didn't know for sure that we would get a vaccine that worked. I mean, we've been working on an HIV vaccine for 30 years. We don't have one. So November, really, will go down in history as a remarkable month in the history of science, that now we have three vaccines that we know work — two of them remarkably effective, the AstraZeneca [vaccine] a little bit less so. But the news on the Pfizer and the Moderna vaccine are breathtaking, really beyond anything any of us had anticipated.

But even more impressively, the Moderna news that came out this morning in their trial: There were 30 severe cases, 30 patients that were quite sick that had to go to the hospital or to the ICU or had very low oxygen. All of them — all 30 — were people that got the placebo. Zero of them were in people that got the vaccine. So these are breathtakingly effective.

And I think those of us in the health care business are giddy about this. But now we start the work of trying to get them manufactured, distributed and sorting out who gets it first, because there will not be enough vaccine to go around until probably the middle part of next year. So we have some complicated decisions and logistics to work out in the next month or two.

There's still a big uncertainty about how long the vaccine can last. And the vaccine is mainly targeting symptoms to a great degree. Does it really help us understand or avert infections, particularly in asymptomatic people?

Here are the things we know: We know that the vaccine prevents infection 95% of the time — so 19 out of 20 cases are prevented. We know, just as importantly, that it also prevents severe cases. We now know that it is incredibly effective in preventing people from getting very sick and almost certainly from dying.

What we don't know for sure is how long it will last. And we care about that, but if it turns out you need to get a booster in a year or two, that's not the worst thing in the universe. And we don't know for 100% sure that it prevents you from getting infected — meaning you're carrying the virus in your your mouth and nose and potentially giving it to someone else. That's going to be important because that may ultimately determine whether we have to still take some precautions, like wearing masks.

But overall, the news that we now have a vaccine that is incredibly safe, has some moderate side effects that will last for a day and will bring the number of infections — and severe infections — down to close to zero is unbelievably good news.

And when we get the vaccine in maybe 70% of people in the United States is when we will reach herd immunity in the right way. You don't want to reach it by people getting sick and dying. You want to reach it through a vaccine. And if you do the math in terms of distribution and manufacturing, we should be able to get there probably by the end of the summer.

A sign on the entrance to a pharmacy reads 'COVID-19 Vaccine Not Yet Available' on Nov. 23, 2020 in Burbank, California. (Robyn Beck/AFP via Getty Images)

We've got three phases likely with distribution. Can you outline it for us?

The first phase is complicated. It's often divided into phase 1A, 1B and 1C. And I don't think we know the order yet.

There have been recommendations made by a prestigious national group, the National Academy of Medicine, in October, that had the first group be health care workers — people with direct exposure to patients. The next group being people over 65 or with preexisting conditions.

But then, what really matters is what advisory group to the Centers for Disease Control and Prevention says. And it looks like the order is tilting toward the first group being health care workers, the second group likely being essential workers and then the third group of phase one being people over 65, and people with preexisting conditions.

The exception there is probably going to be people over 65 who live in nursing homes and other congregate settings, which have had a remarkably high mortality rate. But the devil's in the details. We don't know the order yet, and the numbers get a little daunting.

We really want is all of those groups to go to get their vaccine as quickly as possible. But when you do the math, the number of health care workers in the United States is about 20 million. The number of essential workers is close to 90 million. The number of people over 65 is 50 million. And the number of people with preexisting conditions: 150 million.

When you add up those groups, you get to 200 million or so people. The amount of vaccine we will have by the end of December is probably about enough for 20 million people.

So the amount of vaccine that's available is going to force some tough prioritization decisions. We shouldn't go too crazy over this because eventually there will be enough vaccine for everybody, and when you look at the time that it takes to manufacture it and the speed with which they're ramping up, we're probably going to get through all of those groups by early spring.

But, you know, we're talking about when you look at the number of cases, hospitalizations and deaths, it does make a difference whether you got your shot and if your shots were in December and January or March and April. And that's what we're going to be debating for the next week or two.

There's also some debate about how much race should be considered — how much income and health care access and those kinds of things.

One of the things that's been exposed by COVID-19 — although it has been well-known in every part of health care — is that there are major disparities in the people and the risk of people for the disease and how they do.

And it's become quite clear, including in San Francisco — which has had the best experience with COVID-19 of any major city in the country — you see rates of COVID-19 in the Mission District and in other more diverse areas being far higher than in less diverse and more affluent areas. And so there certainly is a case to be made that people who are the most vulnerable and most at risk get their vaccines early.

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My guess is there will not be a race category of prioritization, which will create its own challenges, but rather the CDC committee will look very carefully at the at the essential worker category and who's in nursing homes and who has preexisting conditions and try to be sure that those groups are being prioritized. And by doing that, to be sure that diverse populations and poor people are getting their vaccines early.

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