The Brink: First, can you tell us how you’ve been keeping up with the latest information from local and state public health officials?

Hamer: I’m a member of BU’s Medical Advisory Group that has been guiding the University’s COVID-19 response since March. My background is in global health, infectious diseases, and vaccines, and I’m a faculty member at BU School of Public Health, School of Medicine, and the National Emerging Infectious Diseases Laboratories. Since 2005, I’ve studied vaccines and helped manage the travel medicine clinic at Boston Medical Center. Throughout the pandemic, I’ve provided guidance to the Massachusetts higher education reopening task force, and I chair a group where clinicians and leaders from BU, Harvard University, Tufts University, and Massachusetts Institute of Technology share data and insights on campus coronavirus response efforts.

Platt: I’m a family medicine physician and the director of BU’s Student Health Services. I’m the chair of BU’s Medical Advisory Group and I oversee the clinical management and isolation of individuals who test positive for coronavirus. I also help manage BU’s contact tracing efforts. In coordinating BU’s coronavirus response with the larger community, I’ve been in contact with the local and state departments of public health.

It seems like a lot of vaccine news is happening rapidly now. What’s the latest?

Platt: On Friday, the US Food and Drug Administration (FDA) authorized the emergency use of Pfizer-BioNTech’s COVID-19 vaccine in the United States. By the end of the month, the Massachusetts Department of Public Health (DPH) says it expects the state will receive 180,000 vaccine doses from Pfizer-BioNTech, and 120,000 vaccine doses from Moderna, which is now on the brink of receiving emergency use authorization from the FDA. 

Is there a timetable on how quickly people in Massachusetts will get vaccinated?

Platt: According to Massachusetts DPH, they hope to have 80 percent of state residents vaccinated by June 2021. On Monday, Boston University’s teaching hospital, Boston Medical Center (BMC), received its first shipment of Pfizer-BioNTech vaccines, nearly 2,000 doses in total, and the first doses are expected to be given [to staff there] on Wednesday.

Do you expect the rollout of a vaccine to change how BU’s spring semester looks, as far as health and safety measures are concerned? Or will masks, social distancing, and everything else from the fall remain in place?

Platt: Next semester, people should plan for all the same health and safety protocols that we’ve had this fall semester. Masking, physical distancing, regular surveillance testing. The state says that the third phase of vaccinations for otherwise healthy people who don’t meet the criteria of the first or second vaccination phases will most likely be eligible to get vaccinated as early as April. The timing of when we receive those vaccines is a really important piece, because a lot of our students will leave campus in May. We hope we can vaccinate everyone before they leave campus, which would be within the national overall goal of having the country fully vaccinated by June or July.

Since BMC received its first batch Monday, when would you expect BU to begin to receive vaccines?

Hamer: I don’t think we’ll receive any vaccines for the BU population until next year [2021]. We’re going to have a gradual rollout. It’s going to be a tough winter. People need to keep their masks on and keep distancing. And it’s going to be even longer, until April or May, until vaccines start reaching the general public outside of the higher-risk groups. By then, the national caseload may be dropping because of seasonality and because the effects of the first and second waves of vaccinations are kicking in. But we won’t see a full vaccine effect until May or June at the earliest. By next summer, transmission may not be zero but hopefully it will be a lot better. Maybe…maybe…maybe we could stop wearing masks, if things went really well, sometime next summer.

With a vaccine now becoming available, who are the very first people in line to get it?

Hamer: The initial allocation of vaccines will start with the Pfizer-BioNTech one, which received emergency use authorization from the FDA on Friday. At first, the allocation of vaccines is going to be limited—even within healthcare settings—because they’re not going to have enough supply initially. The recommendation is that all healthcare workers get vaccinated, but vaccines will likely first arrive at larger hospitals, followed by smaller hospitals [getting them]. In the first wave of shipments, there won’t be enough to immunize every clinician. At BMC, the first to get vaccinated will be those healthcare providers who are most likely to have contact with COVID-19 patients—frontline clinicians. 
 
Also, people who participated in Pfizer’s clinical trial that received the placebo will be among the first to be offered the vaccine.

So, healthcare workers are largely first in line. Is it clear who might be next?

Platt: States are sharing the anticipated numbers of how many vaccines they will receive and administer in this first phase of vaccinations, which in Massachusetts will last approximately from December to February. In addition to healthcare workers who directly care for COVID-19 patients, vaccines will also be distributed to long-term care residents.
 
Hamer: It’s definitely going to be a small group that gets initial access to the vaccine. And every person needs two doses of the vaccine to achieve the highest possible efficacy. Looking at Pfizer’s data, which was released last week, it does indicate that the first dose of the vaccine provides 52 percent protection just a week after getting the shot. It’s a pretty good vaccine, it kicks in fast.

Will Pfizer and the other vaccine makers seeking FDA approval—Moderna, AstraZeneca—be able to scale up vaccine manufacturing fast enough to get everyone vaccinated within the next six months?

Platt: It’s not just about manufacturing, it’s being able to distribute it. Having the vaccine available is one thing, but being able to distribute and administer vaccines is another piece of the puzzle. Massachusetts has publicly suggested they hope 80 percent of the state’s residents will be immunized by the end of June. I think that is an aggressive timeline that will require significant coordination. 
 
Hamer: Each state is developing its own plan for how to receive, distribute, and administer vaccines to its residents. Big states with large rural areas like Montana and Texas will have to figure out how to get the vaccine to everyone. The vaccine has to be stored at -70 degrees Celsius until very shortly before it’s administered.

In the state of Massachusetts, how will the decision-making process about who gets vaccinated first likely go? How will that process be done ethically and equitably?

Platt: BU’s School of Public Health has been engaged with the COVID-19 Health Equity Advisory group helping inform Massachusetts DPH on how to make sure the state’s residents receive equitable access to COVID-19-related resources and services, as well as preventing inequitable and disproportionately negative outcomes in vulnerable populations. It’s really important that the vaccines are distributed in an equitable manner. Committees making decisions about how the vaccine will be distributed in Massachusetts aim to be unbiased, nonjudgmental, and to look at different populations of people to make sure the vaccine is being given in ethically and equitably sound ways.

If someone has already had coronavirus, are they immune? Do they need to be vaccinated?

Hamer: There’s no formal guidance that’s been provided for that yet [from the World Health Organization (WHO) or Centers for Disease Control and Prevention (CDC)]. There’s evidence that there is a small risk of reinfection three or more months after an initial infection. For anyone who is three months post infection, it makes sense for those people to be vaccinated. 

Although the Pfizer vaccine is the only one currently available, Moderna and AstraZeneca are hot on Pfizer’s heels in terms of seeking FDA authorization to distribute their own vaccines. Once there’s more than one vaccine available, how will it be decided who gets access to which vaccine?

Hamer: What worries me the most is how we will define essential workers in phase two of the vaccine rollout. Is someone working at the register at 7-Eleven considered an essential worker? I would say yes, but there are gray zones like that which need to be sorted out. 
 
Ultimately, the determination of who gets which vaccine will come down to availability and allocation. I don’t know if we’ll have that much of a choice—we’ll get immunized with whichever vaccine is shipped to our healthcare providers. One exception to that is the AstraZeneca vaccine uses a live attenuated version of the virus, which can’t be used in anyone who is immunocompromised, so there will be contraindications for its use in some people. Between Moderna and Pfizer-BioNTech, the Pfizer-BioNTech vaccine is more difficult to transport and store. The Moderna vaccine is much more heat-stable and it can be stored at standard freezer temperatures, which makes it easier to distribute, especially in more rural areas. 
 
Platt: Barring a national mandate or state mandate to be vaccinated, people’s trust in the vaccine process is going to play an important role in how quickly we can achieve herd immunity. The real question is, how many people will choose to receive the coronavirus vaccine when it is available to them?

A big part of establishing that trust has to do with the safety information. How confident can we be that these vaccines are safe and effective? Is there a risk that side effects may still emerge after emergency use authorization is granted and Americans start receiving vaccinations?

Platt: Even in the setting of Operation Warp Speed, which involved getting a vaccine to market as quickly as possible, there is still a systematic process where the vaccines are being studied carefully before they can be approved for widespread use. Clinical trials provide us with a systematic way of looking at vaccine safety and efficacy. 
 
Hamer: The long-term side effects are unknown, so we’re going to need to be on the lookout for rare events—if something unexpected happens in one or two people when we are immunizing millions. But the initial safety data looks very promising. Although mRNA vaccines are new, the technology is not. One thing that’s important is that we do monitor people after they’ve been vaccinated—and healthcare providers are trained to report any possible adverse reactions, including concerns that may not immediately be recognized as potentially related to the vaccine. That might help us determine if there are certain groups of people that shouldn’t get the vaccine. That guidance will evolve over time.

What should people know about the potential side effects?

Hamer: Good communication about how the vaccine is working, as well as evolving safety data, will be critical. We need to be educating people that get the Pfizer-BioNTech or Moderna vaccine that they may have a sore arm, and they may get a fever and feel like they have the flu for a day or two after the second dose. Those side effects are good indications that the immune system is being stimulated. People may feel crappy for a few days, but that’s a positive sign that their immune system is working and they are going to be very well protected against getting infected with the coronavirus.

While there are two to three vaccine front-runners, more than 30 other vaccines are still in development. What’s the COVID-19 vaccine market going to look like in a few months—will there be a variety of options?

Hamer: The AstraZeneca vaccine is likely to be available soon, and globally, there are seven or more other vaccines in Phase 3 clinical trials. I’m not sure all of them will go for marketing in the United States. For example, there’s a Chinese vaccine which looks to be 86 percent effective. Then there’s Sputnik, the Russian vaccine, also not likely to be available in the United States.

Speaking about the global aspect and how the virus travels between countries, what needs to happen around the world for the coronavirus pandemic to truly be squashed? Even if everyone in the United States is immunized by next summer, if other countries are still spreading the virus, will the pandemic continue? 

Hamer: There are going to be a lot of issues with getting everyone immunized around the world. India, Brazil, Pakistan, these are examples of countries where heat-tolerant vaccines will be necessary—there may not be reliable chains of cold transport that can get vaccines like the Pfizer or Moderna vaccines into remote locations. Both the Pfizer and Moderna vaccines are also relatively expensive. Cost is going to be an issue. It’s going to require a lot of funding because many poorer countries won’t be able to afford to purchase vaccines themselves. 
 
The vaccine may not need to be distributed in the same blanket fashion as it’s going to be here in the United States, where spread of the virus is rampant. For example, many countries in Africa aren’t seeing as much spread of the virus. Although there is serious under testing in many of those countries, if there were massive surges of coronavirus happening, we’d be hearing about it. Hospitals and ICUs would be filled. That’s not happening.

Why do you think that is?

Hamer: It’s a question for epidemiologists to figure out. Does it have to do with a more temperate climate? With the population’s vitamin D status? Unique genetic characteristics? With the low density of people who are spread out over large geographic areas? Zambia’s coronavirus outbreak has already come and gone. But in South Africa, in crowded townships where conditions foster easy transmission of the virus, people have been hit really hard.

Has BU started working on a plan to receive and roll out vaccinations to the BU community?

Platt: We have several groups working on a variety of aspects of BU’s vaccination plan. These working groups—including a designated Vaccine Preparedness Group convened by President Bob Brown, which I will chair with BU vice provost for research Gloria Waters—are figuring out what it will take for us to give COVID-19 vaccines to our entire community.

We have heard a lot about the vaccine needing freezers. Is BU prepared for cold storage?

Platt: Here at BU, we’ve already taken inventory of all ultracold freezers on our campuses, and we’ve also arranged for offsite cold storage so that we can keep the vaccines properly stored. I feel confident that cold storage won’t be an issue. Once the vaccines come out of cold storage in preparation for administration, the vaccines can be kept on dry ice for a period of days.

How many vaccines will BU receive, and when?

Platt: That is a question we’ll be able to answer more definitively over the next few months. We’d like to receive enough vaccines to immunize our entire population. My hope is that BU will be recognized, as it has been in the past, as a closed point of dispensing vaccines to a population, meaning that we are able to receive vaccines from the CDC or Massachusetts DPH for the purpose of immunizing our community. It remains to be seen, but the hope is that everyone at BU—students, faculty, staff—will be able to get the coronavirus vaccine through the University.
 
We don’t know the number of vaccines we’ll be allocated yet, but we do know that Pfizer-BioNTech is shipping vaccines in either 5,000 or 975 doses at a time. We don’t know yet whether we’ll receive one big batch of doses, or we’ll receive small amounts of doses meted out as they become available, which we would use to hold immunization clinics to work our way down BU’s prioritized lists for who should be vaccinated next.
 
The good news is that as far as administering the vaccines themselves, we already have a plan in place for that. We do massive-scale vaccine clinics every year, administering an average of 16,000 immunizations in a typical year.

Does BU have a plan for who will be vaccinated first within our community?

Platt: It’s premature to talk about specific groups, but we’ll be working with the city and state to align our priorities with their guidelines. Healthcare providers will be at the top of our list—as well as our isolation nurses who go into the rooms of BU students isolated with COVID-19 infections.
 
Hamer: I think the first people should be anyone with direct patient-facing duties. BU will need to stratify prioritization for all groups of people on campus except for physicians and other clinical personnel who will get vaccinated through BMC.

Will vaccinated people receive a special designation indicating they’ve received a COVID-19 immunization?

Platt: We do have plans underway for badging, similar to the testing compliance badging, to indicate the receipt of a vaccine. There are also physical cards that are part of the CDC’s vaccine kit that a person receives after their first dose—it has information indicating when you need to receive your second dose.
 
Hamer: There are official CDC vaccine certificates already in use for other immunizations (such as yellow fever) that have allowed people to travel, internationally for example, that indicate they’ve received certain vaccines. A process like that for COVID-19 is in development. They have to be done in such a way that they can’t be falsified. In the future, to travel, it might be necessary to have documentation certifying that you’ve received COVID-19 immunization. 

After a member of the BU community is vaccinated, will they need to continue following BU’s COVID-19 health protocols and keep getting tested regularly?

Platt: It’s likely that certain measures will need to continue until we can confirm for sure that the vaccines are working as intended—and that the virus is no longer active in our community, in the Greater Boston community, and regionally. There are still many unanswered questions that our Vaccine Preparedness Group and other working groups will need to address in accordance with emerging guidance from local, state, and federal public health officials.

Will the COVID-19 vaccines provide lasting immunity or will everyone need to keep getting revaccinated each year, like the flu shot?

Hamer: We need more data on how often people who have been vaccinated eventually get infected with COVID-19. And, can they still shed the virus even if they have no symptoms? If they come into contact with someone who is sick, can they then shed the virus and give it to others, even if they never get symptoms themselves? We’re going to have to keep our guard up to see how protective these vaccines are against transmission. There’s some hope that people who have had COVID-19 experience long-lasting immunity to the virus, but will that translate to vaccines? Both Pfizer-BioNTech and Moderna vaccines induce very high levels of antibodies, so based on that, I suspect protection could last up to a few years. We’ll need to do follow-up to monitor the length of immunity. If you look at the immune response to SARS-CoV-1, people had antibodies for over a year. Ultimately, we’ll probably need to give booster shots at some intervals. Whether that’s once every two or five years, we don’t know yet.