The Schoolhouse Rock of Vaccines: From Concept to Clinic

Much like the classic "Schoolhouse Rock" episode, "I'm Just a Bill," we're here to explore how a vaccine goes from a brilliant idea to a lifesaving shot. In this discussion on Peds RAP, Sol and Dr. Paul Offit kicked things off with a playful nod to "I'm Just a Bill," reminding us of the catchy tune that taught us about legislative processes. But this time around, it's all about vaccines!

Step-by-Step: The Vaccine Approval Process

Here is a quick rundown of the stages of a journey to a vaccine:

• Preclinical Studies: Testing in animal models to see if the vaccine concept works.
• Phase 1 Trials: Involves fewer than a hundred people to check if the vaccine induces the desired immune response.
• Phase 2 Trials: Expands to a few hundred people to ensure there are no common severe side effects.
• Phase 3 Trials: Involves tens of thousands of people to confirm the vaccine's efficacy and safety on a larger scale.

During these phases, the company also works on stabilizing the vaccine, figuring out the best dosage, and ensuring it remains effective over time.

In addition, vaccines undergo multiple studies targeting different age groups. Each approval phase, starting with older children and moving to younger ones, requires FDA review and CDC recommendations.

• The FDA's Vaccine Advisory Committee evaluates the safety and efficacy of vaccines.
• The CDC's Advisory Committee on Immunization Practices (ACIP) makes recommendations based on FDA findings.

The FDA and CDC's Vaccine Advisory Committees operate independently of pharmaceutical companies and government associations. Members of these committees scrutinize data skeptically to ensure unbiased decisions. Vaccine approval relies on a majority vote (51%) from committees comprising 13-14 members. The FDA also produces separate reviews to highlight any discrepancies in company-provided data.

The vaccine review process is rigorous and transparent. Primary care clinicians are encouraged to communicate to their patients that committee members meticulously review extensive data, always considering whether they would recommend the vaccine to their families.

The Timeline

On average, this process takes about 20 years (did you know that the process for the rotavirus vaccine, RotaTeq, took a whopping 26 years?!). So, when people hear about the rapid development of the COVID-19 vaccine, it's understandable that they might feel uneasy.

The COVID-19 vaccine development was a unique case, propelled by the Operation Warp Speed initiative, where the government assumed the financial risk. This program allowed simultaneous development and manufacturing phases, significantly shortening the timeline without cutting corners. In our discussion, Dr. Offit emphasized that safety protocols were strictly followed despite the expedited process.

Vaccine Safety Monitoring Systems

Two primary systems monitor vaccine safety: the Vaccine Adverse Event Reporting System (VAERS) and the Vaccine Safety Data Link (VSD). VAERS is a passive system where anyone can report adverse events, leading to a noisy dataset that generates hypotheses. The VSD, however, provides more reliable data by linking electronic health records from large health organizations, allowing for comprehensive and real-time monitoring.

Addressing Myths and Financial Incentives

Vaccine researchers do not pursue financial gain but are driven by scientific curiosity and the desire to prevent diseases. The financial rewards for inventors are minimal, with most profits going to institutions like hospitals. Vaccines are not significant profit drivers for pharmaceutical companies compared to other medications.

Want to learn more? Tune in to Peds RAP for the entire conversation on the vaccine approval process with Dr. Paul Offit!