Uncertainty lingers around COVID-19 vaccine safety, development and distribution

Although a COVID-19 vaccine may be approved by the end of 2020, North Carolina likely won't have enough doses available for widespread distribution until later in 2021. 

Elizabeth Tilson, North Carolina's state health director and chief medical officer, said while there may be a small number of vaccine doses available by the end of 2020, those doses will be reserved for people such as health care workers, who are at the highest risk for exposure.


“I think there is a chance that we might have a small supply before the end of this year,” Tilson said, “but I want to be mindful of really setting an expectation that I do not expect there to be widespread supply, or really cover most of North Carolina, until well into 2021.”

North Carolina recently released a COVID-19 vaccination plan. According to the plan, the state's response will occur in four phases — planning, implementation, adjustment and transition — which are based on increasing availability of COVID-19 vaccine doses. 

Distribution will likely be done by private distributors contracted by the federal government.

Tilson said in the beginning, distribution is expected to be limited by a smaller supply of the vaccine, but as time goes on, distribution can become more widespread.

"In the beginning, we anticipate it won't be in broad distribution, it won't be in broad community based vaccination clinics, it'll be through our health departments and through our health system,” she said.

Additionally, the vaccine trials currently underway have not enrolled certain groups of participants, such as children and pregnant women, so those groups of people will not be able to receive the vaccine until it has been proven to be safe for them.

Depending on who develops the vaccine, there are concerns it will require ultra-cold storage, meaning many hospitals and pharmacies will be unable to store them long-term. Vaccine candidates like those under development by companies Pfizer and BioNTech will need to be stored at a temperature far below zero for long-term storage. 

For hospitals and pharmacies lacking ultra-cold storage equipment, dry ice containers could remedy the issue, Tilson said. The vaccines would be shipped in these containers, which, according to Pfizer and BioNTech, could safely store vaccine doses for up to 15 days. This would eliminate the need for permanent ultra-cold storage in the beginning of the distribution phase.

David Wohl, a professor of medicine at the UNC School of Medicine's division of infectious diseases, said he believes that the main issues facing COVID-19 vaccine distribution will not be related to the distribution or storage of the vaccine itself. Instead, he believes it will stem from whether or not people will trust the vaccine once it is released. 

During the presidential debates, President Donald Trump repeatedly said a vaccine will be ready for distribution by the end of 2020.

However, vaccine experts like Wohl and Tilson said the timeline proposed by Trump might not be realistic, and that vaccine distribution will likely take much longer than he is saying.

According to a study from the Pew Research Center, just 51 percent of people across all major political and demographic groups said they would get a COVID-19 vaccine if it was approved in September — compared to 72 percent in May. Wohl said this is likely the result of the politicization of the vaccine development process. 

Between Democrats and Republicans, the latter said they would be less likely to get the vaccine if it was available today. 

“I think that reflects a lot of concern about the messaging,” Wohl said. “The very blatant messaging from the administration that a vaccine is hoped for and will be there by Nov. 3. And the politicization of a vaccine as an achievement of the administration, really, I think, has concerned people that to achieve that, corners will be cut.”

Both Wohl and Tilson said they understand the concerns of people who are concerned about an unconventional type of vaccine, as well as the political entanglement with the vaccine development process. But they said the process is still science-based, and that even if people do not trust what politicians are saying about the vaccine, they should trust the science.

“I do think we have to let science do its work, trust the scientists, keep politics out of it and that way we can evaluate whether or not a vaccine is safe and effective enough for all of us to take," Wohl said. 

Wohl said while he is unsure of the possibility of a COVID-19 vaccine being approved by the end of 2020, there is still reason to be hopeful because of how many promising vaccine candidates there are to study.

There are currently four vaccine candidates in the United States that are in the final phase of clinical trials before they can be approved by the Food and Drug Administration for distribution. 

"I think it's encouraging that there's a number of candidates that are being studied here in the United States," Wohl said. 

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