Vials and a medical syringe are displayed in front of the Food and Drug Administration (FDA) US logo. The FDA finds the COVID-19 vaccine.
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Pfizer and BioNTech have already started the application process for full US approval of their Covid-19 vaccine. Rival Moderna is expected to file the same process for its inclusion later this month.
The mRNA vaccines are currently available in the US market under Emergency Use Authorizations (EUAs) issued by the Food and Drug Administration in December. Since then, a total of more than 263 million shots have been administered, according to the Centers for Disease Control and Prevention.
Standard vaccine reviews usually take several months to a year or more to determine if they are safe and effective for the general public. Due to the pandemic that killed nearly 600,000 Americans, the FDA allowed the shots to be used as part of an EEA.
In the event of a public health emergency, the manufacture and approval of vaccines can be optimized through emergency approvals. Former Health Minister Alex Azar declared a public health emergency on January 31, 2020. The health emergency was renewed several times, most recently at the end of April. The FDA allowed the recordings with only two months of safety data to be used under an EUA. This is not the same as a biological license application or a full authorization application that requires data for at least six months.
“The way this works is that in this case, companies have to submit a vaccine, a biologics license application, which is obviously under a little more scrutiny than an EEA,” said Acting FDA Commissioner Dr. Janet Woodcock SiriusXM on April 30. “And there are more standard manufacturing controls that are being looked at and so on,” she added.
Full approval will benefit companies for a number of reasons, said former FDA Commissioner Dr. Robert Califf told CNBC. For one, the companies’ vaccines will be able to stay in the market once the pandemic is over and the US is no longer classified as an “emergency,” he said.
It also creates the conditions for companies to market the footage directly to consumers, he said. Companies cannot advertise their products under an EEA, he said.
“The vaccines must continue to be administered under the supervision of a qualified professional,” added Califf, who acted as agent for the agency under the Obama administration from early 2016. “It’s not like they can send the vaccines to people’s homes.” However, they can advertise on television and promote their products under the watchful eye of the FDA. “
U.S. approval can also have far-reaching implications beyond the companies filing the filings, FDA advisors and health policy experts told CNBC.
It could encourage more companies, universities, and other organizations to require people to get the shots, she said, an already controversial move that has affected millions of students and employees in the United States. It could also build confidence in the vaccines and combat vaccine reluctance. They said.
As quickly as possible
The FDA approval process is expected to take months. There are several decisions along the way, including negotiating with companies about what is on the product label and How Companies can promote the footage, Califf said.
The Chief Medical Officer of the White House, Dr. Anthony Fauci told CNN last month that US regulators would act “as soon as possible” once companies submit their requests for full approval.
“When you get formal approval, you have to have some amount of time to do mostly safety observations, and obviously safety looks really, really good in well over 140 million people who have been vaccinated with at least a single dose.” he said. “I hope you make it quick because … people who hear it’s still an emergency still have a little concern about how far you can go with it.”
It is “very likely” that the vaccine Pfizer-BioNTech and Moderna Covid will already receive full FDA approval The second half of this year said Lawrence Gostin, director of the World Health Organization’s Collaboration Center on National and Global Health Law. The shots, he said, have already been shown to be safe and highly effective in millions of Americans.
“If the FDA doesn’t approve them, it means their safety or effectiveness is of concern,” he said.
On April 1, Pfizer and BioNTech announced that new data from their clinical trial showed that their two-dose vaccine was safe and greater than 91% effective six months after the second dose. The companies announced on May 7 that they had started applying for their biologics license.
Moderna is also nearing the submission of its adult BLA application. The company announced on April 13 that its vaccine was more than 90% effective against the virus six months after the second dose. And on May 6, the company announced in an earnings report that it intends to begin filing for full FDA approval sometime this month.
Browse data
Once the companies submit their application, FDA scientists will carefully review the clinical trial data, including any inconsistencies or safety concerns, said Dr. Paul Offit, voting member of the Agency’s Vaccines and Related Biological Products Advisory Committee.
It’s a lot of data, added Offit, also a doctor at the Philadelphia Children’s Hospital. He had previously said that when Merck presented its data from its rotavirus vaccine study of 70,000 people, the pages generated could have exceeded the height of the Sears Tower – a 1,450-foot skyscraper in Chicago now known as the Willis Tower.
“The FDA will go through every single one of these files,” he said. “And then they create their own 100-120 page document that they submit to our FDA advisory committee for review. You want to make sure that the company has displayed all of this data fairly and accurately.”
Dr. Archana Chatterjee, another voting member of the agency’s Advisory Committee on Vaccines and Related Biological Products, said she did not expect any rare adverse events that might show up in the data to be a major problem for the vaccines.
The FDA and CDC urged states to temporarily stop using another approved Johnson & Johnson vaccine in April after six women developed a bleeding disorder. States resumed use of the vaccine 10 days later after a CDC advisory panel concluded that the blood clots were very rare and the benefits of the shot outweighed the risks.
Chatterjee told CNBC that it is common to experience rare adverse events after clinical trials. “It is sometimes found that using and giving vaccines to millions of people can experience very rare vaccine-related adverse events that even tens of thousands of people did not experience during clinical trials,” she added.
However, Offit said he could not imagine any adverse events from a vaccine that did not occur within six weeks of a dose. “About 200 million doses have been given out, so if there’s a rare side effect, you know,” he said.
Mandates
Dorit Reiss, a professor of law at UC Hastings College of Law, said there will likely be more vaccine mandates once the vaccines are fully approved. Employers and schools already have very few legal restrictions on people being vaccinated, she said.
“Traditionally, employers and universities have the right to commission vaccines,” she said.
Reiss said the vaccines’ emergency approvals made some groups nervous about ordering the shots, adding that it raised some questions. The FDA had never before granted an EEA for a vaccine to the whole population, and the standards for an EEA were viewed by some as lower than for full approval, she said.
“I think we’ll see more vaccine mandates once we get approval,” she said.
Still, the post-approval surge in vaccine mandates may not be as widespread as it is thought, Reiss added.
“There will still be many places that will hesitate,” she said. “And we know some states are considering banning employer mandates or banning companies from asking for vaccines as evidence, which creates their own problems.”
The groups commissioning the vaccines must consider people with disabilities or those who are against vaccinations for religious reasons, Reiss said.
“There is a law on Americans with Disabilities, which applies to both employers and universities, and has a medical reason not to be vaccinated,” she said. “The other thing is for employers, under the Civil Rights Act of 1964, if an employee has a serious religious objection to a workplace rule, the employer must include it unless it is an undue burden.”
Winning approval
Once the vaccines are approved, companies are likely to market their vaccines aggressively and potentially change prices, said Gostin, who is also a law professor at Georgetown Law.
Both Pfizer and Moderna expect their Covid vaccines to generate billions in sales this year. As part of the pandemic, Pfizer billed the US about $ 19.50 per dose. Moderna previously billed the US about $ 15 per dose. Companies have announced that they will raise the price of their vaccines once the pandemic subsides.
“We’re already seeing this with other vaccines like HPV and shingles,” added Gostin. “But the vaccine wouldn’t just be bought by the consumer. Rather, it would be paid for by the consumer or through health insurance and then given by a doctor or a nurse.”
The approval could also build confidence in the vaccine and combat vaccine reluctance, health experts say.
In the past few weeks, the pace of vaccination in the United States has slowed as Americans eager to get the shots have already done so.
The FDA approval could convince more “sensible people” or about 70% of the population that the shots are safe and effective, Offit said. The remaining 30% are unlikely to be persuaded and will have to be forced through other means such as employee perks, he said.
People think there is a difference in data quality between approval under emergency approval, but really there isn’t, he said. “The only real difference is the length of follow-up for effectiveness,” he said.
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