COVID-19 Vaccines - What we know so far
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PROFESSIONAL Pamela Logan, Director of Pharmacy Services, IPU
COVID-19
Vaccines –
What we know
so far: Part 4
What a difference a few months makes. mRNA Vaccines
Early December 2020, we didn’t have any We discussed how mRNA
vaccines work in the
authorised COVID-19 vaccines on the second article in this
series. Comirnaty, by Pfizer/
EU market and now we have three, with BioNTech, and Moderna were
used throughout January
several more on the way. In the fourth and February to vaccinate
residents and staff in nursing
in this series of articles, Pamela Logan, homes around the country
(Cohort 1), with almost
Director of Pharmacy Services at the IPU, all now having received
brings us up to date on COVID-19 vaccines. their second dose (to be
administered within 28 days
of the first dose). The vaccines
were also used to vaccinate
some frontline healthcare
workers in hospitals (Cohort
2) and some GPs. The rollout
of mRNA vaccination to
14 IPUREVIEW MARCH 2021
people aged 70 years and
older (Cohort 3) commenced
through GPs on 15 February.
Studies show that full
immunity is reached seven
days after the second dose of
Comirnaty and 14 days after
the second dose of Moderna;
duration of protection of
mRNA vaccines is still being
determined by ongoing clinical
trials. We also don’t know
yet if vaccination prevents
transmission of the virus but
data from Israel's vaccination
programme published a few
weeks ago suggests that
the Pfizer/BioNTech vaccine
prevents 94% of symptomatic
infections.
The European Medicines
Agency (EMA) started a
rolling review of a third
mRNA vaccine, CureVac,
on 12 February. CureVac is
partnering with both Bayer
and GSK for production. The care, including community Consequently, there were approximately 3 weeks after
CureVac vaccine, CVnCoV, pharmacy teams. not enough results in older the first dose of vaccine
has the added advantage of Whilst it had originally been participants (over 55 years and persists up to 12
remaining stable for at least planned to use the COVID-19 old) to provide a figure for weeks. Studies showed 76%
three months when stored in Vaccine AstraZeneca in how well the vaccine would protection overall against
a fridge and for up to 24 hours people aged 70 years and work in this age group. Whilst symptomatic COVID-19
as ready-to-use vaccine when older, on 3 February the protection is expected, given disease in the first 90 days.
stored at room temperature. National Immunisation that an immune response Modelling showed no evidence
Advisory Committee (NIAC) (i.e. detection of antibodies) of waning of protection in
recommended that mRNA is seen in this age group, the first three months after
Viral Vector vaccines vaccines should be used and based on experience vaccination. Higher efficacy
We discussed how viral for people aged 70 years with other vaccines, NIAC of 82% protection after the
vector vaccines work in the and older where practical concluded that the mRNA second dose was found if the
third article in this series. and timely, as currently, vaccines are associated booster dose was given at 12
The COVID-19 Vaccine there is limited data on with higher reported overall weeks. Consequently, NIAC
AstraZeneca is produced the COVID-19 Vaccine efficacy which makes them has recommended a dose
using a common cold virus AstraZeneca in relation to preferable for use in those interval of 12 weeks for people
that infects chimpanzees older age groups. Combined at highest risk of adverse under 65 years of age.
and is modified to contain results from four clinical outcomes due to COVID-19 However, of those aged 65
the genetic blueprint for trials involving 24,000 people (i.e. 70 years and older). years and older involved in the
SARS-CoV-2. The COVID-19 showed that the COVID-19 There is evidence from the clinical trials, 90% received
Vaccine AstraZeneca has been Vaccine AstraZeneca was safe clinical trials of a greater their vaccine with a dose
used to vaccinate remaining and effective at preventing immune response with a interval of less than 6 weeks.
frontline healthcare workers COVID-19 in people aged 18 longer interval between While longer dosing intervals
in hospitals and GPs and will years and older. However, doses of COVID-19 Vaccine may be associated with
be used in the coming weeks most of the participants AstraZeneca in those under higher antibody levels, the
to vaccinate patient-facing in the clinical trials were 65 years. Evidence shows clinical impact in this cohort
healthcare workers in primary between 18 and 55 years old. that protection starts from is not known at this time. As
“There is evidence from the clinical trials of
a greater immune response with a longer
interval between doses of COVID-19 Vaccine
AstraZeneca in those under 65 years.”
IPUREVIEW MARCH 2021 15such, it cannot be concluded, Order of vaccination using the mRNA vaccines Cohort 2), mass vaccinations
based on clinical data, that (Cohort 3) and all patient- will be rolled out to the
vaccine efficacy increases We know that all of your facing healthcare workers general population, in priority
within the time interval customers are anxious to in primary care, including order, through community
in this cohort. Conversely, know when they will receive community pharmacy pharmacies, GPs and mass
a shorter dosing interval, their vaccination. Once all teams, have been vaccinated vaccinations centres. Last
within the recommended people aged 70 years and older with the COVID-19 Vaccine month, the Department of
range, allows for earlier have been vaccinated by GPs AstraZeneca (remainder of Health announced the setting
completion of the schedule to
optimise protection offered
by the vaccine for those aged
Table 1: Mass Vaccination Centres
65 years and older. These
recommendations are based County Location
on current data and are
subject to ongoing review.
For people aged 65-69 years, Carlow The Barrow Centre, Institute of Technology, Carlow
NIAC recommends that the
dose interval for the COVID-19 Cavan Kilmore Hotel, Dublin Road, Cavan
Vaccine AstraZeneca should Clare West County Hotel, Limerick Road, Ennis
be 6 weeks.
NIAC has updated Cork • Páirc Uí Chaoimh in Cork City
its advice on the use • City Hall, Anglesea Street, Cork City
of COVID-19 Vaccine • MTU Campus Melbourn Building, Bishopstown
AstraZeneca in pregnancy • Bantry Primary Care Centre
which is now in line with the • Mallow GAA Club, Carrigoon
recommendations for mRNA
vaccines. When COVID-19 Donegal Letterkenny Institute of Technology, Port Road, Letterkenny
Vaccine AstraZeneca is being
Dublin • Aviva Stadium, Ballsbridge
administered in pregnancy,
• Citywest Convention Centre, Saggart
the two dose schedule should
• Helix Theatre, Dublin City University, Santry
be given 12 weeks apart if
• TU Dublin Campus, Grangegorman
possible. However, as the two
dose schedule should be given Galway Galway Racecourse, Ballybrit, Galway
between 14 and 33 completed
weeks of gestation, a shorter Kerry • Killarney Sports & Leisure Centre, Bypass Road, Killarney
interval can be used, 4-12 • Kerry Sports Academy North Campus, Dromtacker, Tralee
weeks apart. Women who are
Kildare Punchestown Racecourse, Naas
less than 14 weeks or more
than 33 weeks of gestation Kilkenny Cillin Hill Conference Centre, Dublin Road, Leggettsrath
should not receive COVID-19
vaccines. Laois Midlands Park Hotel, Jessop Street, Portlaoise
The Janssen (Johnson &
Leitrim Carrick-on-Shannon Primary Care Centre
Johnson) vaccine, COVID-19
Vaccine Janssen, is also a Limerick Radisson Hotel, Ennis Road, Limerick
viral vector vaccine produced
using a human recombinant Longford Longford Slashers GAA Club, Longford Town
replication-incompetent
adenovirus serotype 26 (Ad26) Louth Fairways Hotel Dublin Road, Haggardstown, Dundalk
vector encoding a full-length Mayo Breaffy House Resort, Breaffy, Castlebar
and stabilised SARS-CoV-2
spike protein. In studies, Meath Simmonstown Gaels GAA Club, Navan
a single dose of COVID-19
Vaccine Janssen showed that Monaghan Hillgrove Hotel, Old Armagh Road, Latlorcan
the vaccine is 66% effective Offaly Faithful Field GAA Centre in Kilcormac, Tullamore
at preventing moderate
to severe disease and 85% Roscommon Abbey Hotel, Galway Road, Roscommon
protective against the most
serious symptoms as of day Sligo Sligo IT Sports Arena, Ash Lane, Bellanode, Sligo
28. Furthermore, a single
Tipperary • Abbeycourt Hotel, Nenagh
dose in primates provided
• Clonmel Park Hotel, Poppyfields, Clonmel
complete protection against
SARS-CoV-2 replication in Waterford WIT Arena, WIT Sports Campus, Carriagnore, Waterford
the lung and near complete
protection in the nose. On 16 Westmeath • International Arena Athlone IT, Dublin Road, Athlone
February, the EMA announced • Bloomfield House Hotel Mullingar
it had received an application
Wexford Riverside Hotel, The Promenade, Enniscorthy
for COVID-19 Vaccine Janssen
and said it hoped to issue an Wicklow • Arklow Bay Hotel, Sea Road, Ferrybank, Arklow
opinion in the middle of March. • Charlesland Golf Club, Greystones
16 IPUREVIEW MARCH 2021up of 37 mass vaccination Figure 1: The new coronavirus variant
clinics around the country,
with at least one centre in
each county – see Table 1.
When the locations of the
mass vaccination centres
were announced, some people
expressed concern that
they were not particularly
convenient, especially for
those without a car. You
can reassure your patients
that they can get their
vaccine from your pharmacy
when it is time for their
particular priority group to be
vaccinated.
It is anticipated that the
first three cohorts will be
vaccinated by the end of
Q1, meaning that the next
number of cohorts will be
vaccinated in Q2 and the
remaining vaccinated in Q3.
The Government’s aim is to
have all people 18 years and
over vaccinated by the end of
September. The timescales,
however, may move as more
Source: Associated Press reporting
and more vaccines become
available. Ireland is expected
In February, the UK (WHO) recommends which manufactured and tested
to receive 1.1 million doses
announced that a mutation of strains of flu virus should be within a few months. Booster
by end of March, more than
concern had been detected in covered in flu vaccines for the vaccines are being prepared
4 million in Q2 and a further
cases of coronavirus in Bristol northern hemisphere; they do for new variants that have
4 million in Q3. From Q2, we
and Liverpool. The mutation, the same each September for emerged and some companies
should be able to administer
known as E484K, is already the southern hemisphere. We are looking for a vaccine
250,000 vaccines per week.
present in both the variants may need to do the same for that will work against any
that originated in South Africa COVID-19 vaccines, though variant. Pfizer and Moderna
New variants of and Brazil. Researchers at perhaps not to the same say their vaccines appear
the University of Edinburgh extent. Sequence variations in to work against UK variant
coronavirus recently identified another SARS-CoV-2 strain appear to and South African variant
Much media attention is coronavirus variant B.1.525, be eight- to tenfold lower than (though slightly less so in the
being given to new variants which has been detected in for influenza A. This might latter). Britain has launched
of coronavirus that are being the UK, US, Denmark, Nigeria mean that today’s vaccines a trial to assess the immune
discovered, almost on a weekly and Australia. The variant might protect against SARS- response generated if doses of
basis. Viruses mutate all the has similarities to B.1.1.7 and CoV-2 strains in the future, but Pfizer/BioNTech and Oxford/
time. Sometimes they spread contains the E484K mutation we do not yet have sufficient AstraZeneca are combined in
without altering the virus’s to the spike protein. evidence to say that new a two-shot schedule. Oxford/
behaviour. Very occasionally, Vaccines produce antibodies introductions of genetic drift AstraZeneca is starting a trial
they trigger dramatic changes. against many regions in the might produce a variant virus to combine its vaccine with
SARS-CoV-2 is an RNA virus spike protein, so it is unlikely requiring a different vaccine the Sputnik V vaccine (both
and mutations arise naturally that a single change would strain. adenoviral vector vaccines)
as the virus replicates. While make the current COVID-19 Luckily, the modern to see if protection against
most countries are currently vaccines less effective. technologies for vaccine COVID-19 can be improved.
seeing a decline in overall If someone received a production, especially for Oxford/AstraZeneca is also
infections as a response COVID-19 vaccine for an older mRNA and viral vector working on a modified vaccine
to non-pharmaceutical generation of the virus, they vaccines, can facilitate to combat the South African
interventions, the introduction would likely have protection rapid development and variant.
and increased spread of against this one. Influenza manufacture of second
new SARS-CoV-2 variants vaccines are changed each generation COVID-19 vaccines The next article in the series will
first identified in the UK year to accommodate the against new variants or look at Novavax (protein subunit)
(B.1.1.7), South Africa (B.1.351) evolution of the influenza mixtures of variants. This and Valneva (inactivated whole
and Brazil (P.1) have raised virus. Each February, the is already underway, with virus) vaccines.
concerns. World Health Organisation new vaccines expected to be
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