As NC health workers anticipate the COVID vaccine, Duke researchers look ahead to the next hurdles

The success of two COVID-19 vaccines on the horizon certainly offers hope in what has been a very dark year.

But several potential obstacles remain in the process before we can even think about letting down our guard and putting aside our masks.

Researchers from Duke University this week examined some of the challenges we face in getting the vaccine distributed globally, the inequities between rich and poorer countries scrambling for limited doses, and how to combat people who may be hesitant to take the vaccine.

Thomas Denny, chief operating officer, Duke Human Vaccine Institute

Thomas Denny, chief operating officer of the Duke Human Vaccine Institute, said it is a remarkable achievement to be where we are today, but there will be challenges in distributing billions of doses.

“We need to be thinking about the long-term efficacy of these vaccines. We know that the data is suggesting good efficacy in the short-term, but how does that hold up six months, nine months 12 months. Is this something we’re going to have to keep doing as we go forward until maybe we get another vaccine developed that gives us longer lasting coverage?”

Dr. Gavin Yamey with the Duke Global Health Institute notes that the pandemic cannot be eradicated if the medicine only goes to those countries that can afford it.

“An outbreak anywhere can become an outbreak everywhere. So we’re really not going to bring this pandemic under control until we’ve controlled viral transmission everywhere. It can’t just be in the rich world,” he cautioned.

Yamey said that over 80 percent of the initial doses of the Pfizer and Moderna vaccines have already be purchased by wealthier nations, leaving poorer nations behind.

“That is an enormous concern.”

Yamey is hopeful the COVAX facility led by the World Health Organization, the Gavi vaccine alliance, and the Coalition for Epidemic Preparedness Innovations (CEPI) will guarantee fair and equitable access for every country in the world.

Dr. Gavin Yamey, professor of the practice, global health and public policy

According to Yamey, if all goes according to plan, COVAX could secure enough vaccine to vaccinate one billion people by the end of next year —  about 20% of the population in each low income and lower-to-middle income country.

Key to the success of course will be getting a sufficient number of people to take the vaccine once it is readily available.

“One of the most powerful indicators of whether a community will take up a vaccine is whether the health providers in that community take it themselves,” explained Professor Yamey.

Denny with the Duke Human Vaccine Institute believes each community will need to have so-called vaccine ambassadors.

“Former Presidents Bush, Clinton and Obama have agreed to be filmed taking the vaccine early on. That’s a wonderful start, but it has to go down into every local level where community leaders, church leaders, other people that have status in a community say, ‘This is safe, this is good, we must do it.’”

Denny calls 2021 a transition year.

“As we begin to get more people vaccinated, and I think it will take us at least into the second quarter, that slowly we begin to come out of the social distancing, maybe less masking. But I do think the majority of 2021 we’re still behaving like we’re behaving right now,” explained Denny.

According to Denny, there is a massive amount of work underway in the Operation Warp Speed labs to understand the neutralizing antibody levels of the approved vaccines, just how robust the response is and how long it lasts.

Research must also determine when children can safely receive a vaccine. The current trials have been mostly done in adults or older children.

Dr. Yamey agrees that we will all be wearing masks and distancing ourselves in public for the foreseeable future.

“Science is our way out of this, but I would have loved to have been starting from a point where Taiwan is or New Zealand or Australia or Vietnam,” said Yamey noting that those countries have done better in limiting community spread.

On Thursday, a week after Thanksgiving, the U.S. saw more than 3,100 daily deaths from the virus.

Coronavirus cases have also spiked in North Carolina in the past week with a record 5,637 new  cases reported Thursday and more than 2,100 people hospitalized.

State officials hope North Carolina’s health care workers may begin receiving the Pfizer vaccine by mid-December.

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