Ep. 31: When Will the COVID-19 Vaccine Arrive?
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The COVID-19 vaccine prompts a lot of questions. How effective should we expect it to be? How long will its protection last? Will it be safe? Has Canada secured enough doses, from the right pharmaceutical companies? And perhaps the single biggest issue: When will a vaccine actually arrive for Canadians? In a wide-ranging interview with executive producer Christopher Shulgan, Medcan's Dr. Jason Abrams explains how vaccines work, and provides answers on the race to solve the global pandemic.
LINKS AND HIGHLIGHTS
The Road to the COVID-19 webinar that Dr. Jason Abrams did is on YouTube here.
The New York Times’ coronavirus vaccine tracker is here.
Dr. Jason Abrams bio: Dr. Jason Abrams is the Associate Medical Director and a Senior Medical Consultant at Medcan in Toronto, Ontario. He is a graduate of the Schulich School of Medicine & Dentistry at Western University in Ontario, and he completed a residency in family medicine at McGill University. Over the years, he has completed locums in family medicine and emergency medicine in the Greater Toronto area and has practiced in walk-in clinics in the community. Additionally, he has been an Independent Medical Examiner for Section 44 assessments under the Statutory Accident Benefits Schedule, and a low back expert physician examiner for the Workplace Safety and Insurance Board (WSIB) as part of an initiative to focus treatment and implement safe return to work for employees who have injured their backs. His professional interests include preventive medicine, occupational medicine, and virtual medicine.
Please subscribe and rate us on your favourite podcast platform. Eat Move Think host Shaun Francis is Medcan’s CEO and chair. Follow him on Twitter @shauncfrancis. Connect with him on LinkedIn. And follow him on Instagram @shauncfrancis. Eat Move Think is produced by Ghost Bureau. Executive producer is Chris Shulgan. Senior producer is Russell Gragg.
When Will The Vaccine Actually Arrive? final web transcript
CHRISTOPHER SHULGAN
This is Eat Move Think. I'm executive producer Christopher Shulgan. The pandemic is the topic of a lot of conversations in my household as we stay on top of guidance for mask wearing and social distancing, at school. My kids are perfectly willing to do their part to be safe. They want to protect their grandparents. But it also helps, I think, to know that these are temporary measures. I’ve been telling my kids that it’ll stop once the vaccine is developed. When will that be, they ask—and I actually don’t have a good answer to give them. Thankfully, Medcan has something called the Medical Advisory Services Team, a group of MDs, occupational health experts, who are advising some of Canada’s biggest companies on questions exactly like this one. If you’re an employer seeking guidance, you can learn about how to engage the Medical Advisory Services Team by emailing CorporateSales@medcan.com.
CHRIS
This episode features Dr. Jason Abrams, Medcan’s Associate Medical Director and a key member of the Medical Advisory Services Team to provide guidance on the vaccine, its expected efficacy, when to expect it and how safe it'll be. Dr. Abrams is a graduate of the Schulich School of Medicine at Western University. Here’s my conversation with Dr. Jason Abrams.
CHRIS
Dr. Jason Abrams, thanks so much for being on Eat Move Think. People have this idea that the vaccine is going to be this panacea, that this is the finish line. That life is back to normal, and it's like VE Day, Victory in Europe day for the Second World War. People are celebrating in the streets and all of a sudden we're going to Rolling Stones concerts with 100,000 people and college sports are back in business. And what do you think of that line of thinking?
DR. JASON ABRAMS
I think it's the next phase in the pandemic response. It's going to be great because we can start to get people vaccinated. The only thing I would be cautious about is it's going to take time. And the other thing is, is that we still have to learn more about the response to the vaccine, in terms of how long people are going to be immune for, and how much added protection they'll need for themselves by physically distancing, wearing masks, washing hands, so it might not be time to go back to that Rolling Stone concert yet.
CHRIS
Let's back up a minute, and can we talk first about what a vaccine is? Probably that underlying information is going to help guide and help listeners or help our listeners understand basically the first principles of this and so that we can then move on to the other topics down the road. So, what is a vaccine? What are some of the kinds of vaccines? Can you basically give us Vaccine 101?
DR. ABRAMS
A vaccine is a mechanism to stimulate an immune response against a virus.
CHRIS
I think the conventional wisdom when it comes to vaccines is that they are essentially dead virus material, dead viral material that is actually injected into you, and that then provokes an immune response that is less serious than you would if you actually got live virus inside you or were infected by the virus. But things are more sophisticated now.
DR. ABRAMS
You know, once upon a time, you would either have to take a dead form of the actual virus or an otherwise inactivated form, attenuated form of the virus, that you would have to inject into somebody to stimulate an immune response. But now scientists are getting more precise. They can take genetic coding for proteins of a specific virus, or they can use another inactivated, less-severe virus to inject into an individual the material required to stimulate an immune response. Or they could take parts of a protein on a virus to stimulate an immune response, so if that virus shows up in the future, a person's immune response is ready to fight it off before it creates an infection. In that sense, you don't actually need to inject the true virus in question into an individual to stimulate the immune response. You can inject essentially what's a sub-unit of it or some of the genetic coding of it to create that same immune response as if you were injecting the actual virus in the first place like they did once upon a time.
CHRIS
It speaks to what a wonderful mechanism the human body is, that we have this—essentially, we have this, like, somewhere in our bodies, we have this catalogue of diseases that we've been exposed to, to provide our body with the tools to fight those off in future. Like, it's actually really cool.
DR. ABRAMS
What's kind of neat about it is that the immune system has a memory, and that memory lasts. So that if the virus shows up many years in the future, the potential is is that that immunity is still there. The one thing about the coronavirus compared to some other viruses we've already studied better is we don't know how long an immune response will take. And that's why sometimes doctors recommend that patients get boosters or updates to vaccines that they've received in the past. For example, the tetanus shot is something that we recommend people get every 10 years to make sure there's lasting memory so people don't get tetanus infection.
CHRIS
I have trouble remembering what I ate for breakfast, but your immune system can remember for at least in the case of tetanus for 10 years, you’re saying.
DR. ABRAMS
Exactly, and then your immunity starts to forget. So we need to re-stimulate the immune system. In some cases, though, all you need is one vaccination and your immune system can remember that virus forever so that it can fight it off in the future if it sees it coming near.
CHRIS
So if we go back to December 2019, we start hearing about this virus in Wuhan, and then very soon after, scientists around the world started trying to create a vaccine to this virus. Can you talk about the historic scale of this effort that is going on to find the vaccine?
DR. ABRAMS
I mean, it's just unprecedented. The first step was isolating the virus itself, so that the scientists could understand what they were dealing with. Once they did that, they could start the design of either new vaccines entirely or modify pre-existing work that they had done to try and come up with a vaccine that would stimulate an immune response in human hosts. We know that there's over 160 candidates that have been approved for testing.
CHRIS
So this is 160 groups are kind of working furiously around the clock to try to come up with the vaccine.
DR. ABRAMS
That's right.
CHRIS
So 160 teams. When do you think—I mean, this is the question on everybody's mind right? You know, when, when when? When do you think the vaccine actually kind of hits market? If you were a betting person, when do you bet that the month is going to be?
DR. ABRAMS
My thoughts are that we will start to see something around the beginning of spring of 2021. So about a year after the virus hit North America in full force and the lockdown started.
CHRIS
For our listeners, can you talk about the different phases? You hear about phase one, phase two and phase three. What are those phases?
DR. ABRAMS
Yeah, so pre-clinical trials will be studies in animals, for example.
CHRIS
Pre-clinical is phase one?
DR. ABRAMS
That's before phase one.
CHRIS
Okay. So pre-phase. Okay.
DR. ABRAMS
Then phase one and phase two are smaller studies that will look at things like what is the safety profile of a vaccine in a human being? What is the efficacy on a small scale of a vaccine? What's the proper dose of the vaccine? Do we need one or two shots of the vaccine, and at what timing relative to each other? Once that's established, you need to start large-scale studies. And that's typically what the phase three study is, which is a large-scale and long-term term study. In fact, in most cases, phase three trials can go on for four or five or more years. But we know that it will not take that long for approval of a coronavirus vaccine due to the urgent need.
CHRIS
Essentially, phase three is kind of a dress rehearsal for the mass rollout, and they're looking for kind of final problems. It's a dress rehearsal.
DR. ABRAMS
It's fine tuning, but also scientific principles state that there needs to be reliability when we call a vaccine or any other treatment safe, efficient, and that it does what we advertise it should.
CHRIS
I almost hate to ask this question because it plays into the anti-vaccination movement, but I do wonder, you know, when you talk about many phase three trials last four or five years, and this one is lasting months, I wonder about shortcuts and I wonder about is this going to be as safe as we want it to be relative to the number of people who are going to be, you know, inoculated with this. I mean, do you have any concerns about that?
DR. ABRAMS
Well, I think the reality is, is that it will be possible for us to describe any short-term issues with safety and side effects, but we really won't know the long-term effects because it will take post-marketing surveillance to really understand those. Even in a vaccine that's been studied for four or five years, can we say what it will do to somebody in twenty-five years? These are real concerns, but I think we have to go with the best information available to us at the current time, which is that the vaccine is effective at immunizing a person against the virus. And I think they want to study liver function and kidney function and heart function in patients who take these vaccines. And sometimes data only becomes available to us after it's introduced to market in terms of the long-term effects.
CHRIS
We've talked about when. So now let's talk about who gets it when it finally does arrive. Let's say it's coming from China, let's say it's coming from somewhere else. First shipping containers land in Vancouver or some port somewhere. Who gets those first shipments relative to the rest of the population? So for example, back in the days of H1N1, there was a controversy regarding the Toronto Maple Leafs getting an early shipment of H1N1 vaccine relative to the wider population. And that was very controversial. Are we going to see the Maple Leafs first in line for this one, or how do you envision the rollout happening?
DR. ABRAMS
Well, I think we're going to have other stars who will end up getting the vaccine first, which is frontline workers. You know, for example, health care workers will probably be immunized first as they are with every flu vaccine every flu season. The reason for this is because they're some of the most susceptible to acquiring the virus. And also they need to stay healthy so that they can continue to treat the people who are infected with the virus. The next people who will be in line for vaccination early on will be the people most susceptible to severe complications. So we're talking about the people who are elderly, the people who have medical conditions that make their immune system weakened, or people who are taking medications like chemotherapy or steroid treatments, that will weaken their immune system to help them generate immune response if they're exposed to the virus. These are people who until a vaccine comes will probably be very limited in what they can do in our communities due to fear of acquiring the infection. And so they will be chosen first to get the first doses of vaccine that are available once they come to market.
CHRIS
You know, we're talking about people who are 70 and above, 75 and above, who may have health concerns, who are really now sort of trapped in their homes as a result of fear of coronavirus and actually legitimate infections concerns. So this, essentially, the arrival of the vaccine liberates them from their homes.
DR. ABRAMS
I think for many people, it will be the case. You know, many grocery stores, for example, have set up an the early morning hour where people above the age of 65 can go do their grocery shopping and not intermingle with the 35 year olds who are going into work every day and going to the bars after work.
CHRIS
So number one, frontline health care workers, number two, you know, seniors and other immuno-compromised individuals. Who’s number three?
DR. ABRAMS
Well, then I think we start to offer it to the general population. And there might be a strategy, let's say, to reinforce it within our school systems to keep our schools open. So there might be somewhere along the lines where our school systems get it. There might be where drug stores and grocery stores, there will be campaigns for the populations of people who work there to get it. So common places that people need to go in the community to keep the communities and the economies open might be targeted in order to increase the uptake of the vaccine within those people.
CHRIS
That's interesting. So, like, there may be other classifications of workers who are doing things to keep the economy rolling: grocery store workers, teachers, for example, who are helping with childcare so that other people can go to work. That's interesting. And then I guess, after everyone, there's the Toronto Maple Leafs.
DR. ABRAMS
Yeah, and then the Toronto Maple Leafs. I think one of the interesting things is is that what is the policy going to be for children and toddlers and infants? We don't know about whether the vaccines will be indicated for those age groups. So that's one thing that relates to the school system, and is also very important for the full reopening of the economy is kids to be vaccinated to reduce the risk of outbreaks in schools, so parents can go to work without having to worry about childcare issues.
CHRIS
Is the vaccine a shot? Is it something you get by syringe? Are you getting it in a puffer? Are you getting it in a pill? How exactly are you getting it?
DR. ABRAMS
Right now, reports of the vaccines that are closest to market are done by injection. And this would either be done into the muscle or just into the space underneath the skin. And there might be one dose or there might be two or three doses of the vaccine to stimulate the immune response that's necessary to protect against the virus.
CHRIS
Can you tell our listeners your thoughts on how we're actually going to get it? Are we getting an appointment at a doctor's office? Or is it the kind of thing where we're going to a pharmacy or where there are kiosks at malls or, you know, how exactly are we getting this vaccine?
DR. ABRAMS
I think public health organizations are going to try to stimulate as many mechanisms as possible for people to get the vaccine. You'll be able to get it at your doctor's office, you'll be able to get it at your pharmacy, you'll probably be able to get it at the Eaton Centre if you want to. You will probably be able to get it if you're going to the Raptors or Leafs game. There will be kiosks probably in different parts of our community with public health nurses, for example, who will be willing to give the vaccine to people who want to take it. I think we have to use as many measures as possible to try and increase the uptake of the vaccine once it's introduced to market and available to the Canadian public.
CHRIS
A couple of weeks ago in a webinar, Dr. Scott Gledhill of Medcan talked about immunity passports. And he talked about immunity passports are these things that people who have already had the virus and who have had confirmed cases of the virus, it's a concept that they would be able to, for example, have some sort of a card or something that says, "Yes, I've had the virus. I'm immune to the virus. And, you know, I'm safe to do this, I don't have to wear a mask necessarily or all of these other things. I can travel with freedom." He thought that immunity passports didn't make sense because to do the bureaucracy required to roll out immunity passports, by the time you do that the vaccine will have already arrived. However, once the vaccine arrives, does something like that become rational and smart, where you have documents that show people who have been inoculated already and who perhaps can maybe, for example, you know, we talked about sports, we talked about the Maple Leafs and the Raptors, maybe they're allowed to go to sports games, maybe they're allowed into karaoke bars. You know, we're talking about superspreader events at karaoke bars. Maybe you have to show the fact that you've been vaccinated in order to go to your favourite karaoke bar. Do you envision something like this, or is that kind of a Black Mirror scenario where actually, you know, that's a little sci-fi?
DR. ABRAMS
No, I can see this being realistic. I think before we introduce a concept of using an immunity passport to allow people to go places, we have to understand better what the immune response from a vaccine means. So how long it lasts for, how effective it is. But I could foresee that little yellow card in Ontario that people carry that show their vaccination history, for example, when they travel, might be very necessary to travel in the coming months and years, or to go to certain places within our community. Once we establish what the immunity from a vaccine response will be, which, by the way, we hope a vaccine will actually stimulate a greater immunoresponse in even from somebody who's had the infection previously, then we can start to create the concept of what the immunity passport means and what the impact of that is for an individual.
CHRIS
Okay, let's unpack what you just said a little bit, because I think you said something super interesting, which is, so you're hoping that the immune response stimulated by the vaccine will be larger than a case of infection. Can you tell me a little bit more about that?
DR. ABRAMS
Yeah. So there are some reports coming out now of people becoming reinfected a second time with COVID. And the concern is that means that maybe somebody who's had a COVID infection doesn't develop long-lasting immunity to the virus. We know that there are certain circumstances in which the immunity may not last a significant period of time after the infection is clear. When it comes to the vaccine, there are things that you can do to generate an even greater immune response. So for example, there are molecules called adjuvants that are almost tagged onto or attached to the immunogenic material of a vaccine to stimulate an even greater immune response, whether that be a more fulsome response, or even a longer-lasting response burned into the memory of a person's immune system.
CHRIS
So it might actually be rational for people who have been infected by the coronavirus to get the vaccine in addition just to stimulate that greater response.
DR. ABRAMS
Now I can't say today that that will be the case, but that's definitely a possibility that's out there.
CHRIS
Initially, Canada was criticized as being slow to secure a storehouse of vaccines. Can you tell us about that process?
DR. ABRAMS
Yeah. Well, I can't tell you too much about the process of what the government went through in negotiations to secure those orders of vaccines. But I can tell you this, it's great that they're looking to different companies, because as of today, we don't know which vaccines will be the most successful, and which will actually make it to market out of phase two or phase three trials. So good on the government for taking the opportunity to arrange deals with multiple companies so that whomever reaches the finish line first, at least the Canadian government will already have secured a supply. I think that it may take multiple vaccines coming to market to have a successful rollout strategy, due to supply or even issues related to efficacy as it relates to genetic mutations of virus as it continues to spread throughout the world.
CHRIS
Canada has ordered approximately 88 million doses of the vaccine at last report. Our population, I think, is about 37 million. Why the huge discrepancy between Canada's population and number of vaccines ordered?
DR. ABRAMS
So there's two things that I can think of there. One is that potentially they're ordering more doses of the vaccine than number of people in the country, because you might need more than one dose to become immune to the virus. So it accounts for the need for multiple dosing potentially in the future. The other issue that it might address is Canada's ability to take part in a world strategy by offering vaccination to underdeveloped countries, for example. I think many of the first world countries may consider this opportunity to help out some of their cousins in the world.
CHRIS
Is there a hedging of bets happening as well?
DR. ABRAMS
Absolutely. It's not a given that all of these companies will successfully bring their vaccine candidates to market. So the government needs to take the opportunity to strike deals with multiple companies, in case several of them don't actually make it to market, or make it to market much later than some of the other candidates that are out there currently. Normally, I call them competitors, but the nice thing is is that everybody's working together to bring a vaccine to market and to introduce it to the public. So that collaborative effort will be necessary amongst countries, amongst groups that are creating the vaccines, and also necessary for the dissemination of the vaccine.
CHRIS
With respect to efficacy, one percentage that has been talked about is 70 percent. That we can reasonably expect a successful vaccine to be 70 percent effective. I presume what that means is that of 100 people who take the vaccine, 30 will still be susceptible to infection after taking the vaccine. If I take those 30 people and I give them another dose of the vaccine, does that 70 percent effectiveness still apply to that 30 people? So then 21 of those people on the second dose would then become immune?
DR. ABRAMS
Theoretically, that seems to make a lot of sense. I think in practice it gets altered a little bit, because there may be reasons why those 30 percent are non-responders. They may be genetically pre-programmed, or they may have medical conditions that inhibit the appropriate immune response, so no matter how many times you give them the vaccine, they will not become immune to the coronavirus. As a result, the concept of herd immunity allows for everybody who is a responder to the vaccine to get vaccinated to protect those in their community who are non-responders.
CHRIS
We haven't talked about what types of vaccines we've ordered. You told me something interesting about Moderna, that Moderna actually is based on MRNA. Can you talk about the different vaccines that are out there and how they apply to the coronavirus vaccine?
DR. ABRAMS
Yeah, so some of the newer technologies that don't require you to actually take full viral particles and inject them into people to stimulate an immune response are being utilized for development of coronavirus vaccines. The first two vaccines that the Canadian government signed up for, made by Moderna and Pfizer are mRNA vaccines. So mRNA vaccines are based on mRNA particles, which are genes that code for proteins of the virus. And what they do is they take these particles that can basically deliver them to cells once injected in human hosts, where the human cell translates that genetic material into a viral protein. So not the whole virus, but just a part of the virus. For example, in the case of many, it's the spike protein that everybody's heard about with this coronavirus that will then be presented to the host human's immune system to build an immune response. The great news about this is that it doesn't require you to inject the full coronavirus into the human host to stimulate an immune response. It was faster to isolate than trying to isolate the whole virus and deliver it to humans for building an immune response. And it has a potentially safer profile. The issue is, is that there has never been a successful mRNA vaccine yet that has come to market for human beings. This may be a huge breakthrough in science, not just for coronavirus but for future viruses that we try to develop vaccines for.
CHRIS
So some of them are mRNA vaccines. What are some of the other types of vaccines being developed to fight the coronavirus?
DR. ABRAMS
So we've heard about early approval or limited-use approval of a couple of vaccines that are called viral vector vaccines. And this is what's being used by Johnson & Johnson, one of the newest companies that the Canadian government signed an agreement with. A viral vector vaccine takes material from the coronavirus inside another virus,in these cases called the adenovirus, which is a virus that causes basically the common cold, and it injects it into a human. Through that mechanism, the adenovirus can deliver the material of the coronavirus to stimulate the human host's response, to build immunity against the coronavirus. And the best part is, is it doesn't make them sick from coronavirus, and it shouldn't make them significantly sick from the adenovirus either, because that adenovirus carrier is rendered inert before it's injected into the human host.
CHRIS
That's fascinating. It's actually very fascinating stuff, like the immune response, the body's immune response.
DR. ABRAMS
Basically, it's like going on Google Maps and asking all the ways that you can get from Toronto to Miami if you were to take a car ride down there. And then you see which way is the most efficient to get there.
CHRIS
And at this point, we don't know. But one of them—the idea is that you eventually get there.
DR. ABRAMS
Well, the hope is that multiple will reach the finish line, if we're lucky. But there's funding to so many different vaccine potentials, because we need at least one.
CHRIS
Do you have any sense on how long the vaccine will be effective?
DR. ABRAMS
I think the answer's still TBD. But the reality is is that it may not be effective forever. We might see a situation where people need to be vaccinated against coronavirus on, for example, an annual basis much like the flu vaccine, because people's immunity against the coronavirus from a vaccine may only last a year.
CHRIS
You might see public health drives similar to the flu. You know, get your coronavirus shot. You know, it's coronavirus season. Get your coronavirus shot.
DR. ABRAMS
If we're lucky, we may see a two-for-one vaccine in the future. So you only need to get injected once and you get immunity against two viruses.
CHRIS
Dr. Jason Abrams, thank you so much for this. You know, we have this hazy idea of the vaccine as the finish line. And what we've done today is demystify that finish line, and also provide some reality to it. So thank you for that. I really appreciate your time today.
DR. ABRAMS
Thank you for taking the time to speak with me. It was a real pleasure to have a real conversation about where we're headed.
CHRIS
Thanks very much.
DR. ABRAMS
Thank you.
CHRIS
That's a wrap for this episode of Eat Move Think. Dr. Jason Abrams also has conducted a webinar on the road to the COVID-19 vaccine. As with all of Medcan's webinars, that's posted on YouTube at youtube.com/medcanlivewell. Check out the podcast website for highlights and full episode transcripts at Eatmovethinkpodcast.com. Eat Move Think is produced by Ghost Bureau. Senior Producer is Russell Gragg. Remember to rate and subscribe to Eat Move Think on your favourite podcast platform. Follow host Shaun Francis on Twitter and Instagram @shauncfrancis— that's Shaun with a 'U'—and Medcan @medcanlivewell. We'll be back soon with a new episode examining the latest in health and wellness.