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 Public Health in Practice 1 (2020) 100061

Contents lists available at ScienceDirect

Public Health in Practice

journal homepage: www.journals.elsevier.com/public-health-in-practice

Letter to the Editor

Pfizer: The miracle vaccine for COVID-19?

A R T I C L E I N F O

Keywords
Vaccination
COVID-19
Coronavirus
Public health
Health policy
Health care

The recent news of Pfizer and BioNTech’s COVID-19 vaccine gave the reduced efficacy if not stored at precise temperatures [6] – vaccinated
world a sense of light at the end of a tunnel [12]. Although over 40 subjects may become emboldened to discard their precautions and take
vaccine candidates now exist [3], Pfizer and BioNTech’s vaccine gener- greater risks, shedding their social responsibility in curtailing respiratory
ated the most excitement as it was the first to reveal promising efficacy transmission, presenting an increased risk for those with inadequate
data [2]. According to interim results published on November 9, 2020, immunity. As the full research findings about the vaccine are not yet
the vaccine appeared 90% effective [2]. However, the confidence rose publicly available, we have only press releases from Pfizer to look to for
further with new data, published on November 18, 2020, revealing their our information at this time – which state that there are no significant
vaccine now appears to be 95% effective [1]. In response, stock markets risks to the vaccine.
rallied and hope spread worldwide, as the prospect of a return to
normality became a tantalising possibility. Yet, are such thoughts pre- 3. Issues with the data of the vaccine trial
mature? Is it naïve to think that an effective vaccine is the solution to the
pandemic? Despite the optimism surrounding a vaccine, many challenges Phase III trials of the vaccine involving 43,538 participants produced
exist, from guaranteeing its safety and efficacy, to mass production and 170 confirmed cases of COVID-19 in the first 28 days, with the vaccine
distribution, to challenges with public messaging, particularly with rising found to be 95% effective in preventing COVID-19 (162 cases observed in
vaccine hesitancy in high-income nations [4]. the control group versus eight in the vaccinated group) [1]. Whilst this is
a significant breakthrough, it remains a relatively small sample and a
1. What the vaccine promises short time horizon. Furthermore, although Pfizer reported no significant
safety concerns to date, the medium- and long-term safety of the vaccine
Although distancing, masks, and lockdowns have slowed the spread remain unknown. Public concerns about the longer-term safety of the
of COVID-19, a vaccine can protect individuals and create lasting change. vaccine remain valid, considering that it may take months or years for
The COVID-19 vaccine will enable individuals to develop immunity to these effects to become evident. The vaccine’s efficacy may still change
the SARS-CoV 2 pathogen [5] and if taken up by a large proportion of the following further studies, or its effectiveness may wane over time. The
population, it may provide a degree of herd immunity. This will reduce duration that the vaccine provides immunity is unknown, thus compli-
the spread of COVID-19, protecting vulnerable populations, preventing cating decision-makers’ abilities to gauge vaccine dosing, timing, budg-
the healthcare system from becoming overwhelmed and enabling focus eting, and possibly increasing the risk of an inequitable distribution. The
and funding to return to managing ongoing chronic diseases. Also, the most recent data suggests that the vaccine effectively protects the elderly
reduced risk of developing COVID-19 will enable individuals to return to – a particularly vulnerable and high-priority group – with 94% efficacy in
a degree of normality, allowing economic activity to increase and pre- people aged over 65 years old [1]. It also appears unlikely that a single
venting further economic damage. dose will provide lifelong immunity, with data suggesting that immunity
lasts only 12–18 months [7].
2. Risks of the vaccine However, critical to the eradication of the disease is the mass vacci-
nation of a large percentage of the population, which will require quel-
As safety and efficacy data continues being released about this new ling public concerns regarding this vaccine. First, there are fears that the
mRNA vaccine, there is limited information about the known risks of the vaccine is being granted expedited approval and that this will compro-
vaccine. Understandably, with the duration of the clinical trials as they mise quality and safety standards. Second, there is distrust of Pfizer, a
are, long-term side effects and whether the vaccine will provide lasting private pharmaceutical company, its intentions, and whether they will
immunity are unknown. Also, the vaccine is not 100% effective and has place the interests and needs of the public above their desire for

https://doi.org/10.1016/j.puhip.2020.100061
Received 23 November 2020; Accepted 26 November 2020
Available online 6 December 2020
2666-5352/© 2020 The Authors. Published by Elsevier Ltd on behalf of The Royal Society for Public Health. This is an open access article under the CC BY-NC-ND
license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
Letter to the Editor Public Health in Practice 1 (2020) 100061

commercial gain, especially regarding product safety and quality. Third, suffering, destabilised economies and altered civilisations. Yet, now more
anti-vaccination movements have increased the spread of misinforma- than ever, humanity has the scientific knowhow to attempt to challenge
tion and undermined public trust in established authorities [8]. These these great scourges. This pandemic has shed a painful spotlight on the
issues have all been amplified by mass communication, which has political, sociocultural and commercial determinants of health. Pfizer
enabled a vocal minority to receive a disproportionately large following and BioNTech’s vaccine cannot deliver an immediate return to the
to disseminate conspiracy theories and fake news. Overcoming these normality of the pre-COVID world. Nor does it claim it will. However, it is
attitudes will require empathy and listening to these people’s concerns, a step. It is a significant step in defining a new normal in a world where
as well as consistent and effective public health messaging [9]. COVID-19 has left its mark.

4. Issues with administering the vaccine

References
Notwithstanding safety concerns, mass-production and delivery of
the vaccine remains a difficult task. First, storage and transportation of [1] Pfizer and BioNTech Conclude Phase 3 Study of COVID-19 Vaccine Candidate,
the vaccine requires a 70  C environment to maintain its efficacy [6]. Meeting All Primary Efficacy Endpoints | Pfizer [Internet]. [cited 2020 Nov 18].
Available from: https://www.pfizer.com/news/press-release/press-release-detail/p
This will be especially challenging as the equipment required to achieve fizer-and-biontech-conclude-phase-3-study-covid-19-vaccine.
such cold temperatures is not readily available in typical medical settings [2] Pfizer Pfizer, BioNTech Announce Vaccine Candidate against COVID-19 Achieved
(as no common commercial vaccine needs storage at such extreme tem- Success in First Interim Analysis from Phase 3 Study, Pfizer, 2020.
[3] W.H. Organization, Draft Landscape of COVID-19 Candidate Vaccines, 2020.
peratures) [6]. Second, administration of the vaccine will be challenging [4] A. de Figueiredo, C. Simas, E. Karafillakis, P. Paterson, H.J. Larson, Mapping global
considering that recipients require a booster 21 days later [10], and trends in vaccine confidence and investigating barriers to vaccine uptake: a large-
tracking these people down and administering the vaccine within a scale retrospective temporal modelling study, Lancet 396 (10255) (2020 Sep 26)
898–908 [cited 2020 Nov 19].
specific timeframe (to maximise its effectiveness), will require additional [5] B. Pulendran, R. Ahmed, Immunological mechanisms of vaccination, Nat. Immunol.
coordination and effort. Third, distribution will require identifying and 12 (2011) 509–517. NIH Public Access.
agreeing upon strategic priority groups who will be offered the vaccine [6] BBC. Covid Vaccine: How Will We Keep it Cold Enough? - BBC News.
[7] Y. Young-Xu, R. Van Aalst, S.M. Mahmud, K.J. Rothman, J.T. Snider, D. Westreich,
first. It appears likely that amongst the priority populations, frontline et al., Relative vaccine effectiveness of high-dose versus standard-dose influenza
healthcare workers and the elderly would first receive the vaccine [11]. vaccines among veterans health administration patients, J. Infect. Dis. 217 (11)
(2018 Jun) 1718–1727.
[8] The biggest pandemic risk? Viral misinformation. [cited 2020 Nov 19].
5. Future challenges for the vaccine
[9] H.J. Larson, Stuck: How Vaccine Rumors Start - and Why They Don’t Go Away,
2020.
Since it first emerged in humans, SARS-CoV-2 has mutated and has [10] The Economist. Suddenly, Hope - the Promise of the New Covid-19 Vaccine Is
Immense | Leaders | the Economist.
been able to cross between human and animal populations [12,13]. For
[11] Guardian T. Covid Vaccine Could Be Ready for Rollout Next Month, Says Hancock |
example, 12 Danish people developed COVID-19 from a specific World news | The Guardian.
mink-associated variant strain of the virus [13]. If the SARS CoV-2 virus [12] K. Kupferschmidt, The pandemic virus is slowly mutating. But is it getting more
continues to replicate and transmit, new strains could develop which may dangerous? Science (80-) (2020).
[13] WHO. Mink-Strain of COVID-19 Virus in Denmark, 2020 Nov.
become resistant to a vaccine. If SARS-CoV-2 cannot be eradicated with
an effective vaccine, this will lead to the disease becoming endemic
A.A. Badiani*
within the human population, like influenza and AIDS remain – this
University College London, Gower St, Bloomsbury, London, WC1E 6BT, UK
could be due to an ineffective vaccine product, poor production, distri-
bution or population vaccine uptake. J.A. Patel, K. Ziolkowski, F.B.H. Nielsen
London School of Hygiene and Tropical Medicine, Keppel Street, Bloomsbury,
6. Conclusion London, WC1E 7HT, UK

*
This is not the first pandemic in the history of humankind. Nor will it Corresponding author.
be the last. Previously, pandemics have caused untold death and E-mail address: [email protected] (A.A. Badiani).