So many questions

“We’ve all heard about Operation Warp Speed,” says Arnold Monto, professor of epidemiology and global public health at U-M’s School of Public Health (SPH). “This sounds kind of strange and suggests that there’s undue speed associated with the development of the COVID-19 vaccine. And in fact, that’s not the case.”

The COVID-19 vaccine arrived at U-M on Dec. 14. (Image credit: Joe Hallisy, Michigan Medicine.)

Monto set the record straight and answered some of the most common questions about COVID-19 and the vaccine development during a recent webinar presented by SPH. The title, “Is the end in sight?” captured the mood of a weary country, exhausted by the relentless pandemic. (View the full video presentation below.)

Throughout his seven-decade career, Monto has been involved in pandemic planning and emergency response to influenza and other respiratory virus outbreaks, including the 1968 Hong Kong influenza pandemic, avian influenza, SARS, MERS, and the COVID-19 pandemic. He currently serves as acting chair of the vaccines and related biological products Advisory Committee, which provides advice to the Food and Drug Administration on the authorization and licensure of vaccines to prevent COVID-19.

The presentation below, recorded Dec. 10, features Monto and Emily Martin, associate professor of epidemiology. Martin’s research focuses on respiratory virus epidemiology, hospital epidemiology, infection prevention, and molecular epidemiology. She and Monto co-lead the Michigan influenza Center, one of five centers across the country that collects data for the Centers for Disease Control and Prevention.

An inside look a the vaccine development and approval process

SPH has edited highlights from the video presentation into a short audio podcast. This podcast transcript has been edited for length and clarity.

Arnold Monto: We’ve all heard about Operation Warp Speed. This sounds kind of strange and suggests that there’s undue speed associated with the development. And in fact, that’s not the case. What is happening is that we are putting into a one-year period what typically takes maybe 15-20 years in terms of vaccine development. And how are we doing that? Well, it’s because immunity seems to be related to a specific protein, the spike protein, which allows entry of the virus into the cells. And we are indeed fortunate that this spike protein was identified in earlier work with SARS and MERS-related Coronavirus as the important component of the vaccine so that development could move quickly. And all of the vaccines that are being developed — whatever the platform, whatever the way they have been produced — are related to the spike protein.

We are also telescoping the studies. In other words, we are doing things in parallel, as opposed to doing them in sequence. For example, we would never think of manufacturing and getting vaccines ready to go before they were tested and proven. There has been a lot of attention to this and also a lot of funds given to this effort. So this is one of the major success stories of the response to the pandemic. We are doing exactly what we ordinarily do with vaccine development, but on a shorter timeline.

Martin: The American public is so used to the one-dose strategy in past flu campaigns. This is a two-dose strategy, which is fundamentally different in how we think about things, especially when you have multiple products. Why are two doses important?

Monto: Well, two doses seem to be much more protective than one dose. Some of the studies may show, and they are looking at people who were infected during the clinical trials after the first dose, and we may see whether there is some level of protection. Right now, all of the data are for the two-dose strategy. So it is important for people to get the second dose and for healthcare providers to know what the first dose was so that they give the right second dose.

Martin: A little bit of a different topic now: There’s been a lot of papers, particularly recently on changes in the virus and genetic changes in the virus. Is that going to have any impact on vaccine effectiveness? We’re so used to hearing with influenza, vaccine effectiveness being impacted by changes in the virus.

Michigan Medicine Nurse Elissa Spedoske receives COVID-19 vaccine, December 2020. (Image credit: Joe Hallisy, Michigan Medicine.)

Monto: Well, while the virus is changing somewhat, it’s not changing enough to escape the vaccine. Whether that’s going to last, who knows. The positive is that we have been living with four seasonal coronaviruses, which cause common colds, and those viruses have been just about the same for the 50 years I’ve been involved in studying them. So we can still see the same genes associated with those viruses that have produced antibodies. That’s the good news. The bad news is that we do see re-infection with these viruses. First things first, we can stop the pandemic through use of the current vaccines and unfortunately the herd immunity that’s building up because of bad behavior. Bad behavior may be having good results in terms of getting natural infections producing antibodies in the population, which didn’t happen last spring. And that, combined with the vaccine, is going to result, I would predict, in a decrease in transmission in our populations.

Martin: What are we going to do about the kids and the teens?

Monto: I’m not sure where this emergency use will end in terms of age. Some of the studies have been done down to 12 years of age. They have not been done in younger children. It’s the teens that have been getting infected, and some of them have been getting sick. So I would predict that as we go forward, we may slowly use the vaccines in older children before we go to younger children.

Monto: I’m not going to go into the socio-economic considerations, whether big office buildings will ever be filled the way they have been in the past, whether some of the things that we’ve done have changed. I’ll just tell you my own view, that it is so much more efficient when you and I are down the hall from each other and getting things done than having to communicate the way we’re communicating now. I think we’ll be back to that level probably, if not in the middle of the spring, probably by early summer, because I think we’re going to see seasonality; it’s going to be much more like flu outbreaks, which behave themselves. This one has not behaved itself. I was surprised we had as much transmission over the summer as we did, and it’s probably because we had nobody immune.

Martin: When a vaccine is available for you, are you going to get it?

Monto: I will happily get the vaccine. I think that we should move ahead and get vaccinated when it’s our turn to get vaccinated because I think this is being looked at very carefully. Our local authorities are going to be under tremendous strain handling a pandemic and now also trying to organize the distribution of vaccine. Let’s support them as best we can.