Are vaccines the light at the end of the tunnel?

[Arizona Wildcat]

Frozen is not a big issue either for transport,storage or administration of a vaccine in the US.  BIG issues in many less developed countries.

As was said from frozen to injection in minutes as these are so how dose vials.  Will take about length of time to fill the pharma paperwork.  RNA vaccines are not new and the hog wash about changing our DNA is exactly that 

[Shadow9612]

12 hours ago, TeeRick said:

It seems that if Moderna can store their vaccine in a normal freezer at -4 F then the Pfizer vaccine should follow suit.  They are both pretty much the same technology.  If the Pfizer vaccine truly needs -80 F or dry ice then that should be a very negative factor for its widespread success.  I am hoping that one of the protein subunit vaccines is successful.  Tried and true technology and easy to manufacture, store, distribute and store locally.  Also Merck is a bit behind (but not too much) and their VSV vector vaccine has also had success in people (Ebola).

@TeeRick Have you heard anything about another vaccine candidate: DIOS-CoVax2 

 

https://globalnews.ca/news/7303279/hamilton-cambridge-coronavirus-covid-19-vaccine-trials/

 

That article says the vaccine structure allows it to be freeze dried as a powder not requiring cold storage. 

[Ken the cruiser]

8 hours ago, K.T.B. said:

 

IIRC, the shingles vaccine needs to be kept at -5° F.  It's given pretty much ASAP once you request one.

Thanks! Good to hear. I guess they have a way to warm them up rather quickly as I don't remember too much of a wait wait when I got the shingles shot.

[TeeRick]

2 hours ago, Shadow9612 said:

@TeeRick Have you heard anything about another vaccine candidate: DIOS-CoVax2 

 

https://globalnews.ca/news/7303279/hamilton-cambridge-coronavirus-covid-19-vaccine-trials/

 

That article says the vaccine structure allows it to be freeze dried as a powder not requiring cold storage. 

No I have not heard about it.  But it is a DNA vaccine.  I do have experience with this type.  In general DNA vaccines are not very immunogenic in humans.  They have been tried in multiple approaches over many years.  For some reason they work in certain animal species just fine.

[TeeRick]

1 minute ago, Ken the cruiser said:

Thanks! Good to hear. I guess they have a way to warm them up rather quickly as I don't remember too much of a wait wait when I got the shingles shot.

Ken there will be a number of tests conducted about exactly how to go from the freezer to your injection and how long the mRNA vaccine will be stable at room temperature..  Then that will be included in the documentation to pharmacists.

[markeb]

1 hour ago, Ken the cruiser said:

Thanks! Good to hear. I guess they have a way to warm them up rather quickly as I don't remember too much of a wait wait when I got the shingles shot.

 

To add to what Rick said, I wouldn't be surprised if there aren't 2-3 temperature ranges ultimately, but it will depend on the stability data. -70 for storage to meet shelf life and stability, then some temperature range for "ready to use" to avoid constantly having to go into the -70 freezer, and then the final use within X hours or minutes. If the data only supports -70 to prep and use, then I think you're looking at scheduled events at facilities with that type of storage capability. I don't know that you're going into your local pharmacy at that point.

 

Generally speaking, once you go downstream from -70, there's no going back.

[npcl]

On 8/29/2020 at 5:59 AM, TeeRick said:

Yes you are right with your thoughts.  It is not just about finding a freezer.  It is about the entire cold chain from manufacturing, distribution, storage, and local storage.  All aspects must be validated.  A QC and QA world of events and documentation.  Pharmacies need validated freezers most likely that are certified within the storage temperature range.  And then some method of continuous validation.  So for the mRNA vaccines we might be looking at mass vaccination events that are well controlled vs the pharmacy or doctor's office.  We shall see.

Really not that unusual to be distributing frozen product this days.  Fairly common for biologics. Had to do this for one product back in the early 90's. (-70, 6 months shelf life, dropped shipped to Oncologists office with special containers and dry ice to arrive on day of use, little device to indicate if temperature requirements were exceeded during shipment)  A lot more now.  The real question is how many hours it is usable for after it is removed from frozen storage.

 

Would expect a hub and spoke system to be used with a hospital acting as the hub in an area and vaccine couriered to each injection location daily based upon an appointment schedule.  Dry ice with special shippers while in transit.

Edited August 30, 2020 by npcl

[cangelmd]

On 8/28/2020 at 10:05 AM, phoenix_dream said:

Interesting.  I am not, nor claim to be, an expert, but I wonder about some of this priority.  Perhaps rather than focusing on people over 65 (and I am one of them, for the record), we should instead be focusing on the people in the workforce to help our economy get back on its feet and stop the deluge of businesses going under.  It's not about not caring about older people (as I said, I am one of them), but purely practical.  Those of us in that age group could continue stricter quarantine practices in the interim for a few months.  I'm also sure I am not alone in thinking I would rather have my 35-50 year old sons protected than be first in line myself. 

 

And does obesity count as having underlying conditions?  I doubt it, and yet obese people are in much, much greater risk of having complications should they get sick.  Medically speaking, a very high portion of the population is technically obese.  ( and please, no one start the fat shaming comments! - we all have loved ones who fit in this category, if not ourselves)

 

I know these are tough decisions, and there is no one right answer.  I also know no matter what plan is released it will be criticized widely.  Hopefully useful vaccines can be produced quickly.

I interpreted some of the older age range priority as being nursing homes and other group living situations. Certainly I think just being over 65 will get a vaccine sooner than a 35 year old whos been working from home all this time, but may be not the very first wave.

I agree about the economic impacts. Definitely people at meat packing plants, migrant workers, truck drivers, grocery stores, teachers, day care workers should get priority that is unrelated to age or health status.

Generalizing what I see at the hospital, relatively healthy persons In their 60s biggest threat are their families- it’s hard to stay away from you close family.

As for the obesity, it’s hard to say and data is coming. My impression is that it isn’t just being overweight by the charts (there are a LOT of us in that category!), it is obesity with some other manifestation of metabolic syndrome - diabetes usually, hypertension, kidney dysfunction. Other impressions, though, is that men do significantly worse, even if they are healthy to start with. Younger people who do badly, are often obese. Also, the traditional risk factors for respiratory viruses like asthma, COPD, lung cancer, don’t seem to be that strong, although I suspect that may be because those people are more careful about protecting themselves.

[TeeRick]

Some random thoughts and questions on vaccine prioritization.  Prioritization - yes I understand why.  But how long will prioritization last?  After a month?  In particular if there is a lot of unused doses of vaccine what will happen?  Will it be shifted regionally? Presumably if it is a two shot vaccine the people prioritized for the first shot will be prioritized for the second shot.  So will the remainder of the population need to wait until the prioritized people get two shots?

[Ken the cruiser]

4 minutes ago, TeeRick said:

Some random thoughts and questions on vaccine prioritization.  Prioritization - yes I understand why.  But how long will prioritization last?  After a month?  In particular if there is a lot of unused doses of vaccine what will happen?  Will it be shifted regionally? Presumably if it is a two shot vaccine the people prioritized for the first shot will be prioritized for the second shot.  So will the remainder of the population need to wait until the prioritized people get two shots?

Good questions. Here's another one. We live in a small town (pop - 50,000 m/l) and don't receive a daily newspaper, but do watch the local area news in the evening. We are in our late 60s, in good health and hang around our farm most of the time lately unless we're running errands. How will we personally get word it's our time to get the vaccine? When we go grocery shopping and the pharmacy inside puts a sign up listing who is eligible for the vaccine?

[TeeRick]

4 minutes ago, Ken the cruiser said:

Good questions. Here's another one. We live in a small town (pop - 50,000 m/l) and don't receive a daily newspaper, but do watch the local area news in the evening. We are in our late 60s, in good health and hang around our farm most of the time lately unless we're running errands. How will we personally get word it's our time to get the vaccine? When we go grocery shopping and the pharmacy inside puts a sign up listing who is eligible for the vaccine?

Good general question for everybody - in less populated areas or even in other areas.  I think in your case it is the Alabama Dept of Public Health.  Keep checking their website.  Or perhaps you local county's website?  I am speculating that each state will control prioritization and will have a published set of guidelines.  The state or county might even run vaccination events.

[npcl]

4 hours ago, TeeRick said:

Some random thoughts and questions on vaccine prioritization.  Prioritization - yes I understand why.  But how long will prioritization last?  After a month?  In particular if there is a lot of unused doses of vaccine what will happen?  Will it be shifted regionally? Presumably if it is a two shot vaccine the people prioritized for the first shot will be prioritized for the second shot.  So will the remainder of the population need to wait until the prioritized people get two shots?

Keep in mind that the Government has locked up a lot of the initial supply as a result I would expect prioritization to last atleast through the initial supplies.. Looking at the size of those orders (from both the US and other governments, supply outside of government directed distribution may take a while.

 

I expect that the allocation will be for both shots, so yes the initial supply will be controlled for those to get allocated 2 shots before allocations are made outside of the prioritized groups.

 

It will really come done to speed of manufacturing and how the Clinical trials go.  So far the governments are buying with the assumption that the trials will go well.  Will be interesting to see if one or more fails.

 

You are also seeing some interesting conflicts of interest.  According to one article the Chair of the Committee to approve Vaccines in the UK, is the head of Oxfords Vaccine activities.  The approvals will be interesting to watch, not just in the US.  

Edited August 31, 2020 by npcl

[cangelmd]

6 hours ago, TeeRick said:

Good general question for everybody - in less populated areas or even in other areas.  I think in your case it is the Alabama Dept of Public Health.  Keep checking their website.  Or perhaps you local county's website?  I am speculating that each state will control prioritization and will have a published set of guidelines.  The state or county might even run vaccination events.

I agree, and since I live in Al and have been dealing with ADPH more in the past few months than my entire prior career, lol, I would add check the CDC website as well. Neither place is likely to tell you where you can get the vaccine, but you will find out if you are in a qualifying group at that point. It’s an interesting question, because there is no way ADPH has the resources to administer large numbers of doses, especially in the rural counties. I’m not 100% sure they have the storage resources to distribute doses to hospitals, nursing homes, prisons, etc. Maybe hospitals, pharmacies and MD offices will have a mechanism to get their supplies through their normal distribution channels? ADPH would then be able (if they have the space in the right kind of freezer) to handle their normal clients and some of the general public.

 I’m sure after healthcare workers get vaccinated, there will be plenty of volunteers to handle mass immunization clinics, but someone has to credential the volunteers and set up the clinic.

 I remember mass immunization as a small child, usually at school, but once my parents took me to get a vaccine in the hospital parking lot - it was also my peds office parking. Anyone remember or know how those were organized, over 50 years ago.

[Ken the cruiser]

9 minutes ago, cangelmd said:

I agree, and since I live in Al and have been dealing with ADPH more in the past few months than my entire prior career, lol, I would add check the CDC website as well. Neither place is likely to tell you where you can get the vaccine, but you will find out if you are in a qualifying group at that point. It’s an interesting question, because there is no way ADPH has the resources to administer large numbers of doses, especially in the rural counties. I’m not 100% sure they have the storage resources to distribute doses to hospitals, nursing homes, prisons, etc. Maybe hospitals, pharmacies and MD offices will have a mechanism to get their supplies through their normal distribution channels? ADPH would then be able (if they have the space in the right kind of freezer) to handle their normal clients and some of the general public.

 I’m sure after healthcare workers get vaccinated, there will be plenty of volunteers to handle mass immunization clinics, but someone has to credential the volunteers and set up the clinic.

 I remember mass immunization as a small child, usually at school, but once my parents took me to get a vaccine in the hospital parking lot - it was also my peds office parking. Anyone remember or know how those were organized, over 50 years ago.

Thanks! One other place we'll be checking, as we're both retired from the military, is with the nearby AFB clinic as we usually get most of our "cruising" vaccines from them. As far as getting the polio vaccine back in the early 60s when I was 10, we lined up at a local bank where I lived in CA to get our sugar cube. However, the polio vaccine was the only one I remember getting. But, of course, back then you got the mumps, measles, chicken pox and, of course, various flavors of the flu the old fashion way. 🙂

[npcl]

1 hour ago, cangelmd said:

I agree, and since I live in Al and have been dealing with ADPH more in the past few months than my entire prior career, lol, I would add check the CDC website as well. Neither place is likely to tell you where you can get the vaccine, but you will find out if you are in a qualifying group at that point. It’s an interesting question, because there is no way ADPH has the resources to administer large numbers of doses, especially in the rural counties. I’m not 100% sure they have the storage resources to distribute doses to hospitals, nursing homes, prisons, etc. Maybe hospitals, pharmacies and MD offices will have a mechanism to get their supplies through their normal distribution channels? ADPH would then be able (if they have the space in the right kind of freezer) to handle their normal clients and some of the general public.

 I’m sure after healthcare workers get vaccinated, there will be plenty of volunteers to handle mass immunization clinics, but someone has to credential the volunteers and set up the clinic.

 I remember mass immunization as a small child, usually at school, but once my parents took me to get a vaccine in the hospital parking lot - it was also my peds office parking. Anyone remember or know how those were organized, over 50 years ago.

It would have state and county health departments.  The Fed's have played a role in purchasing vaccines and providing them to the states and local agencies. I would expect the state to allocate to the county departments and the local departments to deal with the local logistics.

[npcl]

1 hour ago, Ken the cruiser said:

Thanks! One other place we'll be checking, as we're both retired from the military, is with the nearby AFB clinic as we usually get most of our "cruising" vaccines from them. As far as getting the polio vaccine back in the early 60s when I was 10, we lined up at a local bank where I lived in CA to get our sugar cube. However, the polio vaccine was the only one I remember getting. But, of course, back then you got the mumps, measles, chicken pox and, of course, various flavors of the flu the old fashion way. 🙂

I would suspect as retired military you might have earlier access going through the local AFB since I expect the military will get allocated from the initial purchase.  It will just depend when they will let retirees vs active duty get access.  I assume that you are near Maxwell?

[Ken the cruiser]

12 minutes ago, npcl said:

I would suspect as retired military you might have earlier access going through the local AFB since I expect the military will get allocated from the initial purchase.  It will just depend when they will let retirees vs active duty get access.  I assume that you are near Maxwell?

That would be cool. Yes, Maxwell AFB is the one nearest us.

Edited August 31, 2020 by Ken the cruiser

[markeb]

34 minutes ago, npcl said:

It will just depend when they will let retirees vs active duty get access.

 

🤣🤣🤣🤣

 

AD at Bragg, Hood, Initial Entry Training installations, Norfolk, San Diego, maybe Groton, McDill, etc.

 

Retirees--Walgreens (they dropped CVS from the Tricare Contract a couple of years ago; there's a CVS on every block in the Mid Atlantic, including every Target. Walgreens, not so much.)

Edited August 31, 2020 by markeb

[CHEZMARYLOU]

A friend of ours in his early 70's received the first injection of the trial vaccine for coronavirus in a study through University of Pittsburgh.  It is a 25 month commitment involving a daily journal, frequent trips to the study center and much scrutiny. It's a long commitment but it is a start.  He's very active and still working so a good canidate.  I'm looking forward to updates.

[Ken the cruiser]

58 minutes ago, markeb said:

 

🤣🤣🤣🤣

 

AD at Bragg, Hood, Initial Entry Training installations, Norfolk, San Diego, maybe Groton, McDill, etc.

 

Retirees--Walgreens (they dropped CVS from the Tricare Contract a couple of years ago; there's a CVS on every block in the Mid Atlantic, including every Target. Walgreens, not so much.)

So are you saying at those locations, retirees can't get any vaccine or shingles, pneumonia or flu shot? They have to go a local pharmacy such as Walgreens or a nearby grocery store pharmacy?

Edited August 31, 2020 by Ken the cruiser

[markeb]

12 minutes ago, Ken the cruiser said:

So are you saying at those locations, retirees can't get any vaccine or shingles, pneumonia or flu shot? They have to go a local pharmacy such as Walgreens or a nearby grocery store pharmacy?

Not necessarily. But Walgreens had flu last year probably months before Belvoir or any of its satellites. Didn’t try Walter Reed; it was too easy at Walgreens. And you have to check who’s in network in TRICARE East. 
 

But they’ll do readiness processing with vaccines before releasing to to us ORFs and our families. Who knows. If it’s limited, it’ll probably go to readiness first. That’s what I’d recommend...

[Ken the cruiser]

37 minutes ago, markeb said:

Not necessarily. But Walgreens had flu last year probably months before Belvoir or any of its satellites. Didn’t try Walter Reed; it was too easy at Walgreens. And you have to check who’s in network in TRICARE East. 
 

But they’ll do readiness processing with vaccines before releasing to to us ORFs and our families. Who knows. If it’s limited, it’ll probably go to readiness first. That’s what I’d recommend...

I have to admit we usually go to the Publix Pharmacy every year to get a flu shot, and go to the base only when we need a more exotic vaccine, depending on where we're cruising too. We probably won't be able to get the COVID vaccine at the base, but it won't hurt to ask when they start becoming available.

 

In any event we'll definitely be checking the various state and county health department websites once we hear one has been approved.

[npcl]

1 hour ago, markeb said:

Not necessarily. But Walgreens had flu last year probably months before Belvoir or any of its satellites. Didn’t try Walter Reed; it was too easy at Walgreens. And you have to check who’s in network in TRICARE East. 
 

But they’ll do readiness processing with vaccines before releasing to to us ORFs and our families. Who knows. If it’s limited, it’ll probably go to readiness first. That’s what I’d recommend...

The difference in this case is government controlled initial distribution vs the normal commercial distribution.

 

It will be an interesting case study.

 

 

[markeb]

5 minutes ago, npcl said:

The difference in this case is government controlled initial distribution vs the normal commercial distribution.

 

It will be an interesting case study.

 

 

 

Yes, it will.

 

There's been the initial prioritization discussion, but I don't know how that will impact the different customers, such as the Military Healthcare System and the VA Healthcare System. There are agreements with BARDA for access to products in general, but we'll see how that plays out. And the MHS would generally favor readiness for any initial distribution they receive (as probably would Canadian Armed Forces, the UK MOD, etc.). And that all still assumes equivalence of the different candidates across populations...

 

Will there be a distribution to state, county, and city health departments? "Fencing" to Medicare recipients? School and/or college students and potentially first responders through health departments? Distribution directly to hospitals/clinics/etc. for health care providers? What about contracted health care providers versus employees? Contractors are usually responsible for any preventive medicine requirements for their contract employees, not the facility they're working in. Getting way inside baseball here, but those are unfortunately all very real potential conversations on who actually gets the distribution that impacts who gets the vaccine on initial distribution.

 

Note that nothing in this post includes delivery of vaccine to support leisure travel in the initial distribution if the recipient isn't otherwise in a priority population...

[cangelmd]

3 hours ago, npcl said:

It would have state and county health departments.  The Fed's have played a role in purchasing vaccines and providing them to the states and local agencies. I would expect the state to allocate to the county departments and the local departments to deal with the local logistics.

Some of the county health debts in AL have very rudimentary facilities and low staffing. I’m sure they all can give vaccines, but don’t know what their storage abilities are. 
Actually, given all the marks against us - deep poverty, sheer bloody minded stubbornness, low education levels, very Hands off electorate - the state has done really well against Covid. The governor has provided leadership that I didn’t expect. Some of the national metrics make us look bad, but those tend to be the ones that include a measure of contact tracing, which I think has been only in SNFs and maybe some in prisons.

University of AL not withstanding, the mask ordinance has been successful, and we done better than our Eastern and Southern neighbors.