Insight: What The Pfizer vaccine means for a return to normal life in Scotland
There were celebrations across Scotland and around the world, with one of the most optimistic reactions coming soon after the news broke as Professor Sir John Bell, Regius Professor of Medicine at Oxford University and part of the UK vaccine taskforce, declared that life will begin “returning to normal” by spring 2021.
While this view is not shared by many others in the field, few dispute the significance of the Pfizer breakthrough.
“It’s a massive step forward,” says Dr Christine Tait-Burkard of the Roslin Institute at Edinburgh University, whose doctoral research was in the field of Coronaviruses.
“But it’s quite optimistic [to say] that everything’s going to be back to normal by next spring. I don’t think it will be.”
Dr Tait-Burkhard says it will not be possible to vaccinate enough of the elderly population or at-risk patients for society to go “back to normal” that soon.
We do not yet know how effective the Pfizer vaccine will be in older people, as vaccines tend to be less effective in the elderly, as well as in those who are immunocompromised.
Light at the end of the tunnel
It is nonetheless a very positive step forward, and First Minister Nicola Sturgeon welcomed the news as “light at the end of the tunnel”.
“It is very positive on all levels. We knew this type of vaccine was coming, and we knew there were positive results coming through in the small animal studies but to see it coming so rapidly in humans and reinforcing what we believed was going to be the outcome is very positive,” says Yvonne Perrie, Professor in Drug Delivery at Strathclyde University.
It is “hard to tell” if the Pfizer vaccine will allow a return to normal by spring, she says.
“It's basically dependent on their supply chain, and how many we can get here. But we have to remember we’ve got this vaccine, and the Oxford vaccine coming through as well as others, and that increases the potential access.”
“I think March might be a bit of a struggle but things are definitely improving,” she adds.
Storage and delivery
The Pfizer vaccine presents significant logistical challenges, not least that it needs to be stored and transported at minus 80 degrees Celsius.
The First Minister announced this week that Scotland has bought around 20 large freezers for storage of the vaccine, which will be placed in “strategic locations” around Scotland.
Dr Tait-Burkhard is not overly concerned about the logistics of vaccine delivery.
“What we can do in order to keep something at such a low temperature is use dry ice, and as long as the dry ice is there - supplies have decreased over the actual lockdown period but they've gone back up - then if it is kept in well-insulated containers it can be used to ship medical supplies, drugs and vaccines, as well as scientific materials, around the globe,” she says.
“We ourselves use it regularly for shipping our precious material. And that also means it’s a good way of transporting the vaccine to a vaccination clinic - for example in rural Scotland it can easily be transported and can be kept on dry ice for days if the supply is large enough.”
Dr Tait-Burkard also points out that aviation authorities have been planning the potential delivery of vaccines for months.
“The decrease in leisure air traffic is really advantageous there, because there's almost no obstacle to transport planes flying,” she says.
“We’ve already seen a lot of passenger airlines converting some of their planes into transport for PPE, and this is likely going to be the case again for the vaccine transport around the globe.”
Once it gets to Scotland, the vaccine will most likely be delivered locally. Health Secretary Jeane Freeman has said the rollout will be led by health boards, and that it won’t follow the same model as the winter flu vaccine programme, which has been plagued by delays and stock shortages.
Supply and demand
While the flu vaccine was taken out of GPs hands and set up at popup sites administered by Health and Social Care Partnerships, this may mean a return to existing infrastructure for a Covid-19 vaccine, including local pharmacies.
The more effective a vaccine is, the fewer people need to be vaccinated, and Dr Tait-Burkhard estimates that at 90 per cent efficacy around 55 to 65 per cent of the population will need to receive it, roughly between 2.5 and 3.5 million people in Scotland. The UK Government said it had secured 40 million doses of the Pfizer vaccine, enough for 20 million people, as each person will require two doses, three weeks apart.
Ms Freeman said the vaccine would be allocated within the UK based on population, leaving Scotland with enough for about 1.6 million people in 2021, and around 400,000 people before the end of 2020, if the vaccine is approved by then.
Dr Tait-Burkard says around 1.5 billion doses of vaccine are produced every year for the seasonal flu. This year between two and 2.5 billion doses were made, in anticipation of higher demand due to Covid-19.
But she estimates the pandemic will require 6.4 to 6.9 billion doses of Covid-19 vaccine.
“That is a big number to produce, especially when we're looking at two doses per person,” she says.
“When we look at the numbers, Moderna will be able to produce about half a billion in a year, Pfizer probably about one and a half billion, and the Oxford AstraZeneca vaccine about one billion.
“That still only adds up to three billion doses which is probably less than half of what we need. So we need more vaccine to come through. There’s Johnson and Johnson as well who are quite far in advance, and others who are not so far off as well.”
Return to normal?
Dr Tait-Burkard foresees a Covid-19 vaccine coming into its own around this time next year, reducing the difficulties of winter 2021.
Vaccination will “make a dent” in early to mid next year, she says, and then we may see larger scale vaccination by autumn.
“It's definitely going to make a difference for our next winter wave, we just sadly cannot breathe freely yet for this winter.”
This view was echoed by Professor Eleanor Riley, Professor of Immunology and Infectious Disease at Edinburgh University who said when the news from Pfizer broke: “With the best will in the world, this vaccine – or any other vaccine currently in trials – isn’t going to change things for the majority of us this winter.”
She added: “We all need to accept that the current public health measures are going to remain in place at least until the end of the winter, possibly longer. But if this vaccine lives up to this early promise, and other vaccines work equally well, we may be able to look forward to a much better summer and autumn in 2021.”
Work is being done to improve treatments for Covid-19, and to improve access to testing. This week it was announced that up to 65,000 students living in halls would be allowed to travel home for Christmas following the rollout of a mass-testing programme, with students allowed to travel if they return two negative tests.
Vaccines and treatment
For Professor Perrie the best solution is vaccination.
“I think where we are it's very important to focus on the vaccine. The WHO has a great quote saying that two things have changed global health, clean water and vaccination,” she says.
“I think a vaccine is much better for global control of health than treatment. If we can just avoid it in the first place then the impact on health is much better.”
While some diseases in animals have been completely wiped out, this is rare in human illnesses.
The WHO has declared just two diseases officially eradicated: rinderpest, which decimated cattle herds and was officially eradicated in 2011, and smallpox, which was gone by 1980.
“Whether we can achieve this with Covid is a different thing, because we haven't achieved it with flu,” points out Professor Perrie.
New vaccines are released every year to keep up with rapidly evolving flu viruses.
A similar situation may develop with Covid-19, but Professor Perrie is confident that it will be possible to adapt the vaccines currently being developed.
“The fact that it's a new platform, a new design of vaccine, and it's so easy to make in many respects, it will be easy to tweak it. For example if a different vaccine is required the same technology can then be used and rapidly adopted,” she says.
Many vaccines in development
The Pfizer vaccine, known as BNT162b2, is one of hundreds of Covid-19 vaccines currently being developed.
It is a messenger RNA (mRNA) vaccine, which uses the virus’s genetic code rather than any part of the virus itself, and as such has the potential to be quicker to produce on a large scale.
The UK Government has bought access to six vaccine candidates, representing 340 million doses, and has spread its interest across a selection of different types of vaccine, which will all work in slightly different ways and may be more appropriate for different sections of the population.
A promising candidate is that from Oxford University and AstraZeneca, which like the Pfizer vaccine is in phase three clinical trials.
Head of Oxford’s vaccine trial team Professor Andrew Pollard said there is a “small chance” of it being ready by Christmas.
Called ChAdOx1 nCoV-19, it uses adenovirus, a weakened version of a cold virus which causes infection in chimps.
Johnson and Johnson is developing a single dose adenoviral vaccine which is also in phase three.
Some way behind these three is a vaccine being developed by pharmaceutical companies Sanofi and GlaxoSmithKline, which is in phase two of trials and expected to be ready by the middle of next year.
It uses an adjuvant that boosts the immune system to help it fight off a virus, which is particularly promising for older people, as immune systems weaken in older age.
The only vaccine to be manufactured in Scotland is being developed by French company Valneva at its Livingston site.
It is an inactivated whole virus vaccine, which is due to enter phase one clinical trials before the end of the year.
Factors still unknown
It is not yet known how long the Pfizer vaccine will be effective for - the trial data which has been so widely celebrated shows only 90 per cent efficacy seven days after the second dose.
“We may have to vaccinate people every year to keep the immunity up, that’s something we don't know yet,” says Dr Tait-Burkard.
“We don't know how long immunity is going to stick around but initial data from people’s antibody levels suggests that it might be as little as six to 12 months. With vaccines having boosters in them, adjuvants that stimulate our immune system, they might stick around for longer and allow us at least a year if not longer protection.”
This is one benefit of there being several vaccines in development, Dr Tait-Burkard says.
Another is that some may still fail during the trial process, and having many attempts increases the chance of success.
Professor Perrie is optimistic about the outlook for other vaccines in the pipeline.
“There are hundreds of vaccines in development, and a lot of them are using a very similar platform to this [the Pfizer vaccine], the same ideas and technology,” she says.
“The fact that one works means I would be surprised if the other ones don’t work, because they’re using similar strategies. So we can expect more positive news coming through, I would say, with all the other platforms.”
While a “return to normal” may be too optimistic, she expects to see changes in our way of life around March and April, as the more vulnerable people who are vaccinated the more restrictions will ease for the rest.
“It might be that we only manage to cover NHS frontline staff to begin with. But if we can do them and care homes, what a difference that would make to people’s lives,” she says.
“Both for the people in the care home and their families. That would be a fantastic start, just to be able to see family again in those scenarios.
“While we may not be able to get back to the pub the way we used to, if a person in a care home can see family again that would be fantastic.”
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