Role: Senior Technician of Public Health of the Region
Organization: Public Health
Jaime has been an epidemiologist for 20 years, with time dedicated to vaccinology, communicable diseases and Immunization Programmes. He is working in vaccine groups with the Ministry of Health in Spain and with the ECDC. In addition to this, Jaime is working on COVID-19 throughout 2020, forming working groups in the Ministry of Health and currently in the working group on COVID vaccines in the Ministry of Health. He sits on groups that make the assessments of the upcoming vaccines and determining implementation and purchasing of COVID vaccines at a regional and local level.
Section 1: The Pfizer Vaccine
1.1. What are your thoughts on the Pfizer Vaccine?
We don’t know all the data, but the data we have is very positive. In general, I think it is a really good vaccine and the problem is around the logistics, and we will have to see if it is possible to manage, however I believe it is possible to manage.
I hope that more data will be made available about the temperature requirements to conserve the vaccine, this will make it easier to determine how conserving the vaccine can be made easier.
In general, the studies are very positive. There is a lot of information from the clinical trial as it is really big study. The data is really exciting however, we will have to see what happens during the evaluation process.
The clinical trial had a diverse population sample, across different ages (<18-85) and a diverse ethnic sample too. So I think in general the clinical trail is pretty well done. Of course, there is some data still unavailable.
The criticisms are, that we don’t have the data that informs us if the vaccine is going to protect from dead or severe diseases. But this wasn’t the endpoint; in general vaccines, if they can offer protection from the disease, they offer general protection for the severe disease. So I think that some of the recent criticisms, for me, are not very well founded.
1.1.1. Novel mRNA vaccine
Admittedly, it is a very new process and a very new platform. Occasionally, some people, can be slightly disturbing because they don’t want to take something involving a new process, especially in these situations. On the other hand, I think it wouldn’t have been possible to get a vaccine so fast using the traditional methods. For me, the good points about mRNA vaccines, are bigger than the bad points of them being a new kind of technology.
The point is that as you are evaluating safety in not just one study but many studies, where you are evaluating safety for many more people with these new technologies. Since you have Moderna, you have Pfizer, you have CureVac, there are a lot of different bases using this technology, and you are evaluating safety of all of them. Until till now, there are no safety issues.
So for me, mRNA vaccines are much more on the positive side, but I understand that there are people who can be a little bit frightened about that. I understand that mRNA is really different compared to the dead virus or a particle vaccine, which are more accepted by people. But on the other hand, I think that if you’re correctly explaining these topics, then most people are going to accept mRNA vaccines with little problems.
1.2. How does the Pfizer vaccine distinguish itself from other COVID vaccines?
I think the main point about Pfizer is that they began development a little later than the others, however they are a big company with a real interest in developing a vaccine. That intention has been really clear during the process. For example, one of the main things, one of the positive things is that they had four potential vaccines and they choose one and which was chosen after the first clinical trials. And that’s positive.
When the process began, they started later than others developers but they employed all force to get reach a point where they would have data very early. That’s a very positive example about their process. On the other hand, they ensure that their vaccines are going to be really good with high efficacy. So I think that this their biggest achievement; employing a lot of force to compensate for starting development later and then to be the first developer with a potential vaccine.
1.3. How do payer organisations view the Pfizer vaccine?
Currently, payers are waiting for a vaccine that has a high efficacy and is safe, we are expecting this. Other factors are not as important. At this point we need a vaccine and we need doses of a vaccine. The point is, for example, if Pfizer vaccine had data with 60% efficacy, we would potentially employ the vaccine to a limited number of groups such as the very high risk groups, and other groups would wait for another vaccine.
But with the efficacy data for the Pfizer vaccine or the Moderna vaccine, we are going to produce as many doses as we can. So the approval process, the evaluation process, is going to be very, very critical. And as long as we know that the agencies approve the vaccine and that it’s a good vaccine in terms of efficacy and safety, we are not going to have concerns over the other problems. Later logistical problems can have a role in determining our choice, but at this point logistics concerns don’t have any role in our selection of a virus.
As payers, we will work to make the logistical process possible since the company has made the vaccine possible..
1.4. How does the Pfizer vaccine fit into your country’s (Spain) vaccine strategy?
The most important vaccine is going to be the COVID vaccine in 2021. So we’ll make the logistical arrangements to be able to administer the vaccine as soon as possible. We know that it will not be easy, since the temperature of the vaccine is very low at minus 70-80C. But we know that the vaccine is going to be manufactured.
So the goal is to make the logistical system to distribute the vaccine at least every three days to the centers and then we’ll arrange employment through that.
It will depend very much on the region. There are some regions where we have a logistics system that can distribute vaccines to every single distribution point up to once a day, or at least twice a week. In these regions, I think, we are not going to have many problems, since we are able to distribute from a central point to all the health centers. The vaccine can be stored in the fridge for five days, so, taking three days for the administration of the vaccine is not an issue.
Other centers in other regions where they are not able to administer or distribute vaccines to all the health centers are arranging immunization points, but it is not possible to get the vaccine in the Pfizer boxes at all health centers. So vaccine administration will depend a little bit of the logistical challenges in specific regions.
One of the things that we are trying to develop is a communication strategy, which we currently don’t have yet. One of the main aims of this communication strategy is to help the wider population understand that the vaccine development process has not skipped any steps, and that every step has been followed and everything has been done in a safe way. That’s been important as many people believe that since the vaccine development has been so fast something wrong must have been done. It is important to communicate this. Besides that, we are going to develop a communication strategy to inform which people are going to be preauthorized for the vaccine. And that, of course, the core theme is administering to those within an interval of three weeks..
Section 2: Alternative Vaccines
2.1. What are the other leading vaccine candidates?
Well, of course the other one in everyone’s head is Moderna, and the third one could be the Oxford vaccine that has also been in the media. The point is, especially because one of the things about the Pfizer vaccine, was that at the beginning, no one knew about it. It was only a few people who were really interested in the vaccination field who were really expecting it.
Most people didn’t have previous news about the Pfizer vaccine and that’s not been the same with Moderna or with the Oxford vaccine which has been in the media during the whole process. And of course, those vaccines and the Novavax vaccine get attention. But the two ones that we are expecting is Moderna and Oxford.
2.2. How do they compare to the Pfizer vaccine?
Well, Moderna is a logistic point really, because, at the it’s the same technology as Pfizer. So Moderna it just logistical issues. And the other vaccines, for example, the Oxford vaccine, it is a bio-vector and since the good news that we have had about the process of the clinical trails, it was in the vector viral vaccines it was also Moderna and Johnson at some point.
And there are some papers about the race of the viral vector vaccines. It’s true that there are some worries about it. A good point is, especially when we have data on efficacy and safety, is on the point of logistics, vector vaccines logistically than the mRNA vaccine.
So there are some really good points and on the other side, we need more data about the safety of this vaccine and of course the efficacy that we don’t have yet.
2.3. What impact will competition between vaccine manufacturers have on vaccine deployment?
At this point it is not going to influence anything. When we’re speaking about vaccine prices, for the COVID-19 vaccine the price is not a really good indication. Maybe in two years things can change, but at this point we are going to look at safety data, at the efficacy data and at the logistical points. The most important thing is efficacy and safety, but it’s just that if the companies are able to give us enough doses.
We know that we are going to have the doses of Pfizer. Pfizer is with a Germany company. Moderna has partnered with Lonza and even with a Spanish company. So I think that it’s going to be easier to get doses when the manufacturing process is in Europe, but we expect to have doses not just from those companies.
2.4. How promising are the Chinese and Russian vaccines?
Well, we don’t know enough data, of course they have published some papers. So I don’t think we are going to buy Chinese vaccines for this specifically. And the Russian vaccine, I think that if the process in the clinical trials is similar as in the Western countries such as in the United States or the European countries, maybe we can improve our trust of the vaccine. I’m sure that it’s a good vaccine and there is no problem.