How vaccines get made and approved in the US
On Dec. 11, Pfizer's COVID-19 vaccine became the first to receive authorization for distribution in the U.S. Members of a special U.S. Food & Drug Administration (FDA) committee that advises the organization on vaccines met the previous day to discuss data from Pfizer and its partner BioNTech. The Pfizer and BioNTech vaccine has demonstrated 95% efficacy in its clinical trial and was praised by FDA scientists upon their review of the trial's detailed scientific results. At the end of the Dec. 10 meeting, the committee voted that the Pfizer vaccine is safe and should be given emergency authorization by the FDA. The agency itself granted this authorization the next day.
One week later, Moderna followed Pfizer: the FDA advisory committee met, discussed data from the clinical trial for Moderna's vaccine (which has demonstrated 94% efficacy), and recommended that the agency authorize distribution of this product. The FDA is expected to again follow its committee's recommendation within days. The nation watched as an initial group of doctors and other hospital staff got Pfizer shots starting on Dec. 14; Moderna's vaccine may be close behind in protecting health care workers and other vulnerable populations.
COVID-19 and its wide-ranging impacts on the lives of nearly everyone on the planet have brought vaccines to the forefront—if enough suitable vaccines can be created, produced, and widely distributed, then life could perhaps resume some semblance of normalcy. People around the world are waiting impatiently for news of vaccine authorization and distribution, looking forward to a better 2021.
However, there is also mistrust surrounding vaccines, and often a lack of understanding about how they are created, how they are tested, and how safe they are. If people don’t trust the vaccine, then people won’t take it, and the pandemic could go on longer.
Some of this lack of trust comes from a lack of information and misinformation. In order to demystify vaccines and the vaccine manufacturing and approval process in the United States, Stacker consulted the FDA, Centers for Disease Control and Prevention (CDC), and other public health sources to better understand and explain vaccines to the general public.
After going through these authoritative health information sources, Stacker identified some key terms to help readers better understand the types of vaccines and how they work, and then listed the many steps involved in the creation, approval, and distribution of new vaccines in the U.S. We then created a list of 30 key terms and steps, showing how intensive and precise the vaccine creation and approval process is, and ultimately that vaccines are safe and effective tools for fighting disease.
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U.S. Food & Drug Administration (FDA)
Center for Biologics Evaluation and Research
The specific area of the FDA that deals with vaccines is the Center for Biologics Evaluation Research (CBER). This center regulates biological products using an array of regulatory measures, such as the Public Health Service Act and the Food Drug and Cosmetic Act.
Stimulating the immune system
Vaccines work by stimulating a reaction from the immune system. They do this by essentially tricking the body into thinking there’s an infection. While the body may occasionally experience minor symptoms of infection after getting a vaccine, the kind of pseudo-infection introduced by the vaccine almost never causes illness.
Whole-pathogen vaccines are the traditional type of vaccine. These vaccines contain entire pathogens that have either been killed or weakened enough that they cannot cause disease. Because they have whole pathogens, they elicit strong immune responses. However, not every disease can be targeted with this type of vaccine.
Unlike a whole pathogen vaccine, a subunit vaccine uses just the antigens to best stimulate the immune system. This vaccine design is safer and easier to produce, but it often requires the addition of adjuvants, components that elicit a stronger immune response, because the antigens are not sufficient on their own for long-term immunity.
Nucleic acid vaccines
Nucleic acid vaccines use genetic material to encode the antigen or antigens needed to produce an immune response from the body. This allows the body’s own cells to produce the antigen(s) using the genetic material. The advantages to this type of vaccine are long-term immune responses, scalability, and vaccine stability. Some of these vaccines are based on mRNA (messenger DNA). Both the Pfizer/BioNTech and Moderna coronavirus vaccines use mRNA.
Some vaccines require more than one dose. There are a few reasons for this. Some vaccines do not provide much immunity in the first dose, and therefore need more. In others, immunity wears off after time, and “booster” doses are needed. In some live vaccines, multiple doses make it more effective. And in the case of the flu vaccine, a new dose is needed every year because the flu virus that causes the disease varies year to year.
Screening for potential danger to animals
Before beginning an Investigational New Drug (IND) application, a vaccine must be screened for potential danger to animals. These take place through animal pharmacology and toxicology studies, taking preclinical data to allow an assessment as to whether the product is safe enough to begin testing in humans.
Investigational New Drug application
Once the screening for potential danger to animals is completed satisfactorily, the vaccine goes through the IND. The IND allows the vaccine sponsor to obtain permission from the FDA to distribute the vaccine across state lines to clinical investigators. At this point, the molecule being used in pharmacological activity changes legally into a new drug.