MILWAUKEE — Throughout 2020, scientists raced to develop a vaccine that could protect people from the threat of COVID-19.
They succeeded in developing life-saving shots and in record time. But that wasn't the finish line: As a new year has kicked off, the world is now faced with the unique challenge of getting those shots into people's arms.
Almost one month into Wisconsin's COVID-19 vaccination effort, we look at the Badger State's progress and dig into more critical questions about the vaccines.
How many people have gotten their shots?
In Wisconsin, more than 123,000 people had gotten their COVID-19 vaccinations by Friday, according to a Department of Health Services dashboard.
And as of last week, 5,000 Wisconsinites had also received their follow-up shots, DHS Deputy Secretary Julie Willems Van Dijk said at a media briefing. Vaccinations have been ramping up in Wisconsin since the holidays, and daily doses almost doubled over the course of last week.
Still, fewer than half of the shots listed as “shipped” on the DHS dashboard have so far gotten into arms: As of the dashboard’s latest update on Tuesday, over 266,000 doses had been sent to Wisconsin.
Willems Van Dijk said the gap is because the “shipped” number includes some doses still in transit and others that vaccinators are in the process of giving out. She said vaccinators are asked to plan a week in advance when asking for doses — but to avoid leaving shots on the shelf for longer than that.
Nationally, more than 6.6 million Americans have gotten their first doses, according to data from the Centers for Disease Control and Prevention.
Who is getting vaccinated now?
Currently, Wisconsin is still focusing on its highest-priority “Phase 1a” groups: Health care workers plus long-term care residents and staff.
As the very first vaccines arrived in the state, officials say they focused on getting the doses out to hospitals and health systems. Employees at UW, Advocate Aurora, and SSM hospital systems were some of the first Wisconsinites to get their shots right after they were authorized.
“That’s where we have health care staff who are in direct contact, taking care of patients in very intimate settings who have COVID-19,” Willems Van Dijk said. “We wanted to make sure and get vaccines first to those people who are on the front line, taking care of known infected patients.”
Since these very first doses, though, she said Wisconsin has “thrown the net quite a bit wider.”
Nursing homes across the state have been vaccinating staff and residents. Assisted living facilities begin later this month. And more health care workers not affiliated with a hospital — like those in public health, EMS, or pharmacies — are starting to get their shots.
For example, the city of Milwaukee announced last week that they were starting to get shots to EMS workers, health department employees working at COVID-19 test sites, and others on the front lines of fighting the pandemic.
And who’s next in line?
When more doses are available, the CDC’s Advisory Committee on Immunization Practices has already issued some guidance on who should come next.
“Phase 1b” may include older adults ages 75 and up, as well as “frontline essential workers,” the ACIP recommended in a December vote. Those frontline workers may be first responders, teachers, corrections officers, agriculture workers, or others who have to do their jobs onsite and therefore take on extra risk.
Up next would be “Phase 1c,” which could add adults aged 65 to 75, people with high-risk medical conditions, and other essential workers — a sweeping group that may include those working in transportation, water, food service, construction, finance, media, public safety, and public health, according to the CDC.
It’s up to the states to make final decisions about their priorities, though. In Wisconsin, the State Disaster Medical Advisory Committee has been meeting regularly to hash out the rest of the vaccine queue.
At a meeting on Friday, the SDMAC vaccine subcommittee discussed how to balance Wisconsin’s phases. The debate mainly centered on one central question: Whether to widen the 1b category to make more people eligible for the shots early on, or to keep it more limited and focus on the highest-priority groups.
“Everybody is important. That’s the baseline assumption,” said subcommittee member Rajiv Naik of Gundersen Health. But based on the balance of ethics, feasibility, and science, he said, “We’re trying to see if anyone rises to the top.”
Wisconsinites in congregate living settings, including jails and prisons, and in certain essential industries, like agriculture or public transit, were debated between phase 1b and 1c. The subcommittee's final recommendations are still in the works.
Do the vaccines work on the new COVID-19 variant?
Two mutated strains of the novel coronavirus — one first discovered in the United Kingdom, and another found in South Africa — have raised concerns as they’ve popped up in a growing number of countries.
As of Friday, the CDC had detected 63 cases of the U.K. variant among Americans, mostly in California and Florida.
So far, there’s no evidence that these strains lead to more severe symptoms or a higher risk of dying, according to the CDC. But they do appear to be more contagious, which is a major problem on its own. An essential question now is whether these variants will be able to evade our most effective weapon against the virus: Vaccine-based immunity.
Fortunately, many experts believe the vaccines we’ve developed will still work against these variants. Officials from both Pfizer and Moderna have said there’s little chance the mutations would be enough for the virus to dodge their shots, and the head of Operation Warp Speed said the variants “should be under control” with the vaccines.
It’s common for viruses to mutate as they spread and make copies of themselves. Most of these changes are small, basically amounting to minor “typos” in the virus’s genetic code.
The two new variants are more concerning because they’ve accumulated a bunch of these small changes. And one mutation, detected in the U.K. and South Africa strains, affects the coronavirus’s spike protein — which the virus uses to get into human cells, and which is the target for COVID-19 vaccines.
Still, the vaccines are designed to attack multiple parts of the spike protein, so the spike would have to change a lot for the virus to slip away, infectious disease expert Anthony Fauci tells Axios. Pfizer released preliminary research on Friday showing that their vaccine appeared to protect against a version of the virus with the mutated spike, and more research is ongoing.
“It was a very reassuring finding that at least this mutation, which was one of the ones people are most concerned about, does not seem to be a problem,” Pfizer’s chief scientific officer told the Associated Press.
Even if we do have to make some changes to the shots, the “plug-and-play” mRNA technology used by the Pfizer/BioNTech and Moderna vaccines makes them easy to edit, Fauci told Axios. BioNTech’s CEO said if necessary, they would be able to produce an updated version of their shots within six weeks.
For now, then, the central concern is that these strains are causing infections to speed up — sparking deadly surges even as vaccines offer a glimmer of hope for the pandemic’s end.
As Zeynep Tufekci writes in The Atlantic: “We are in a race against time, and the virus appears to be gaining an unfortunate ability to sprint just as we get closer to the finish line.”
Will other vaccines be added to the mix?
So far, the FDA has only authorized the Pfizer and Moderna shots for distribution in the U.S. But other vaccine candidates may be on the way in the coming months.
The AstraZeneca vaccine could be authorized sometime in April if all goes well with the company’s late-stage U.S. trial, according to Moncef Slaoui, chief adviser for Operation Warp Speed.
AstraZeneca’s shot sends coronavirus DNA into the body inside a weakened version of a common cold virus — sparking the immune system into action. It’s a bit sturdier than the mRNA vaccines and doesn’t need to be frozen, which would be a big benefit for shipping doses out.
The vaccines were found to be up to 90% effective in international clinical trials, depending on dosage, but some questions remain about the study’s methods. While versions of AstraZeneca’s shot have been authorized in the U.K., India, Mexico, and Argentina, scientists are still finishing up late-stage trials in the U.S. — including at UW Health — which they say will clear up earlier confusion.
Johnson & Johnson could also seek authorization for its vaccine as soon as February, the company announced recently.
The Johnson & Johnson shot uses a similar method to AstraZeneca’s, sending in coronavirus DNA inside a non-infectious cold virus. But Johnson & Johnson’s version only requires one dose, which could be another huge benefit in getting immunity numbers up.
The company hasn’t released efficacy data yet but predicts it will wrap up Phase 3 trials by the end of the month.
Dozens of other candidates are also in various stages of development. DHS officials say expanding the number of vaccines in action will be essential to meeting more of the demand for shots.
“To really get a higher throughput of people through these phases, we’re going to need new vaccines,” Willems Van Dijk said. “We’re going to need additional vaccines.”
Are we seeing negative reactions to the vaccines?
Out of the millions who have gotten their COVID-19 vaccines so far, the vast majority have seen no major issues. Some side effects — like fatigue or minor flu-like symptoms — are pretty common after the shot, but they’re a sign that the immune system is doing its job.
In some very rare cases, people have experienced allergic reactions after getting the vaccine. The CDC reported Wednesday that 29 people had developed anaphylaxis after the shot, most of whom had a history of allergies. Still, CDC experts said the known benefits of the vaccine outweigh the known risks.
“Of course, we all would hope that any vaccine would have zero adverse events,” CDC official Nancy Messonnier said. But even with the reactions we’ve seen so far, she said, “it’s a very safe vaccine.”
Scientists at the CDC — and all over the world — are still monitoring any reports of possible reactions to the vaccine, and keeping an eye on any unexpected effects will be of the utmost importance as distribution continues.
But experts also warn against jumping to cause-and-effect conclusions in isolated instances.
Last week, health officials in Florida said they were looking into the death of a doctor weeks after he received a COVID-19 vaccine. Pfizer said it was also “actively investigating,” but did not believe the death was related to the vaccine.
Cases like these should be taken seriously — but they should also be considered carefully. When we’re getting vaccines out to huge numbers of people, it makes sense that we will see some vaccinated people face health issues. After all, people face health issues all the time, pandemic aside.
“It is important to note that serious adverse events, including deaths that are unrelated to the vaccine, are unfortunately likely to occur at a similar rate as they would in the general population," Pfizer said in a statement to CNN.
In other words: We will see some “bumps in the road,” as immunology expert Patsy Stinchfield said at a Poynter webinar last month.
“There will be people who will get vaccinated and shortly thereafter die, or get a disease, or cancer,” Stinchfield says. “There's always a backdrop of life.”