F.D.A. Panel Endorses Moderna’s Covid-19 Vaccine


An advisory group’s recommendation will mean millions more Americans can be inoculated, extending protection against Covid beyond major urban areas into rural and suburban regions.

Moderna’s vaccine has the advantage of being distributed more widely because it can be stored at normal freezer temperatures and, unlike the Pfizer-BioNTech vaccine, does not require ultracold storage.
Moderna’s vaccine has the advantage of being distributed more widely because it can be stored at normal freezer temperatures and, unlike the Pfizer-BioNTech vaccine, does not require ultracold storage.Credit...Cody O'Loughlin for The New York Times

The coronavirus vaccine made by Moderna moved closer to authorization on Thursday, a significant step that would expand the reach of the nation’s vaccination campaign to rural areas and many more hospitals.

As the nation buckled from uncontrolled spread of the disease, with 3,611 deaths on Wednesday setting yet another horrific record, a panel of independent experts recommended, by a vote of 20 in favor and one abstention, that the Food and Drug Administration authorize the Moderna vaccine for emergency use. The formal decision, expected on Friday, would clear the way for some 5.9 million doses to be shipped around the country starting this weekend.

Moderna would be the second company allowed to begin inoculating the public, giving millions more Americans access to desperately needed vaccine. The first, made by Pfizer and its German partner BioNTech, received authorization last week.

The Moderna vaccine can be distributed more widely because it can be stored at normal freezer temperatures and, unlike the Pfizer-BioNTech vaccine, does not require ultracold storage. It also comes in much smaller batches, making it easier for hospitals in less populated areas to use quickly.

“Moderna can go to more places,” Dr. Mandy Cohen, North Carolina’s secretary of health and human services, said this week. “We hope to be in all 100 counties with some amount of vaccine — small allocations at first — by the end of next week, assuming Moderna gets approved this week and we get our allocations delivered over the course of next week.”

The two vaccines, and an ambitious rollout by the federal government, states and businesses to deploy them, are the first signs of hope for an end to the pandemic that has killed more than 300,000 Americans, closed schools and businesses and left people afraid to go near friends, neighbors and relatives, especially at the height of the holiday season.

Moderna developed its vaccine in collaboration with scientists from the National Institutes of Health.

A second vaccine couldn’t come soon enough. State health officials complained this week after they learned the second shipment of the Pfizer vaccine would be smaller than the first one, prompting questions about whether the federal government would meet its goal of giving 20 million people an initial dose of the two-shot vaccines from Pfizer and Moderna before the end of the year. The smaller shipment, which appeared to be the result of a scheduling hiccup, ignited tensions between Pfizer and the federal government, who are negotiating over how many vaccine doses Pfizer will sell to the United States in the first half of next year.

The vaccines are in short supply, and the initial batches are being given to people at high risk of infection or serious illness: frontline health care workers and the residents and staff of nursing homes and other long-term care facilities.

On Saturday, an independent panel of experts will decide whether to recommend that the Centers for Disease Control and Prevention allow distribution of the Moderna vaccine. And on Sunday, the same panel, the Advisory Committee on Immunization Practices, will decide which “priority group” should be next in line for the vaccine.

A subcommittee of the group last month proposed that it be essential workers — some 80 million teachers, law enforcement officers, bus drivers, restaurant workers and others whose jobs involve close contact with other people. Each state would then decide which essential workers to prioritize, as there will not be nearly enough vaccine in the short term to cover them all.

The subcommittee said next in line should be people 65 and older, as well as people with conditions that put them at high risk for Covid, like diabetes or obesity. It will be up to the larger group to make a final decision on Sunday, which the C.D.C.’s director, Dr. Robert R. Redfield, will have to approve.

At the meeting on Thursday, the F.D.A.’s expert panel heard from Moderna, agency scientists and the public. In large clinical trials, both vaccines were about 95 percent effective at preventing Covid-19, and Moderna’s vaccine offered persuasive evidence that it could prevent severe cases of the disease, which is crucial for keeping people out of the hospital and reducing deaths.

Dr. Rachel Zhang, a researcher in the F.D.A.’s office of vaccines research and review, said that the agency found the vaccine worked equally well in different groups of volunteers defined by race or ethnicity, gender or age.

She also said that the data from the trial hinted that protection from the vaccine starts to emerge soon after people get the first dose. However, she cautioned that there wasn’t enough data to come to a clear conclusion.

“For maximum protection, both doses should be given,” Dr. Tal Zaks, the chief medical officer at Moderna, said at the meeting.

ImageDr. Rachel Zhang, an F.D.A. researcher, discussed the vaccine’s efficacy across race, ethnicity, gender and age during the virtual panel hearing.
Dr. Rachel Zhang, an F.D.A. researcher, discussed the vaccine’s efficacy across race, ethnicity, gender and age during the virtual panel hearing.Credit...via YouTube

The panel grappled with questions about the potential for allergic reactions after a few cases occurred among people who received the first doses of the Pfizer-BioNTech vaccine. The Pfizer-BioNTech shots have been linked to three cases of a severe and potentially life-threatening reaction, anaphylaxis — two in Britain, and one in the United States, in a health care worker in Alaska. A second person at the same Alaska hospital also had a serious allergic reaction, though not anaphylaxis. All have recovered or are recovering.

With distribution of a coronavirus vaccine beginning in the U.S., here are answers to some questions you may be wondering about:

    • If I live in the U.S., when can I get the vaccine? While the exact order of vaccine recipients may vary by state, most will likely put medical workers and residents of long-term care facilities first. If you want to understand how this decision is getting made, this article will help.
    • When can I return to normal life after being vaccinated? Life will return to normal only when society as a whole gains enough protection against the coronavirus. Once countries authorize a vaccine, they’ll only be able to vaccinate a few percent of their citizens at most in the first couple months. The unvaccinated majority will still remain vulnerable to getting infected. A growing number of coronavirus vaccines are showing robust protection against becoming sick. But it’s also possible for people to spread the virus without even knowing they’re infected because they experience only mild symptoms or none at all. Scientists don’t yet know if the vaccines also block the transmission of the coronavirus. So for the time being, even vaccinated people will need to wear masks, avoid indoor crowds, and so on. Once enough people get vaccinated, it will become very difficult for the coronavirus to find vulnerable people to infect. Depending on how quickly we as a society achieve that goal, life might start approaching something like normal by the fall 2021.
    • If I’ve been vaccinated, do I still need to wear a mask? Yes, but not forever. Here’s why. The coronavirus vaccines are injected deep into the muscles and stimulate the immune system to produce antibodies. This appears to be enough protection to keep the vaccinated person from getting ill. But what’s not clear is whether it’s possible for the virus to bloom in the nose — and be sneezed or breathed out to infect others — even as antibodies elsewhere in the body have mobilized to prevent the vaccinated person from getting sick. The vaccine clinical trials were designed to determine whether vaccinated people are protected from illness — not to find out whether they could still spread the coronavirus. Based on studies of flu vaccine and even patients infected with Covid-19, researchers have reason to be hopeful that vaccinated people won’t spread the virus, but more research is needed. In the meantime, everyone — even vaccinated people — will need to think of themselves as possible silent spreaders and keep wearing a mask. Read more here.
    • Will it hurt? What are the side effects? The Pfizer and BioNTech vaccine is delivered as a shot in the arm, like other typical vaccines. The injection into your arm won’t feel different than any other vaccine, but the rate of short-lived side effects does appear higher than a flu shot. Tens of thousands of people have already received the vaccines, and none of them have reported any serious health problems. The side effects, which can resemble the symptoms of Covid-19, last about a day and appear more likely after the second dose. Early reports from vaccine trials suggest some people might need to take a day off from work because they feel lousy after receiving the second dose. In the Pfizer study, about half developed fatigue. Other side effects occurred in at least 25 to 33 percent of patients, sometimes more, including headaches, chills and muscle pain. While these experiences aren’t pleasant, they are a good sign that your own immune system is mounting a potent response to the vaccine that will provide long-lasting immunity.
    • Will mRNA vaccines change my genes? No. The vaccines from Moderna and Pfizer use a genetic molecule to prime the immune system. That molecule, known as mRNA, is eventually destroyed by the body. The mRNA is packaged in an oily bubble that can fuse to a cell, allowing the molecule to slip in. The cell uses the mRNA to make proteins from the coronavirus, which can stimulate the immune system. At any moment, each of our cells may contain hundreds of thousands of mRNA molecules, which they produce in order to make proteins of their own. Once those proteins are made, our cells then shred the mRNA with special enzymes. The mRNA molecules our cells make can only survive a matter of minutes. The mRNA in vaccines is engineered to withstand the cell's enzymes a bit longer, so that the cells can make extra virus proteins and prompt a stronger immune response. But the mRNA can only last for a few days at most before they are destroyed.

Neither Moderna nor Pfizer-BioNTech reported serious problems with allergic reactions during their clinical studies, but when drugs or vaccines move out of trials and into broader distribution, rare side effects can emerge.

The two vaccines are similar, but not identical. Both consist of genetic material, mRNA, encased in a bubble of lipids. The exact composition is not the same, so it is not clear that an allergic reaction to one means the same thing would occur with the other. But the possibility is a concern. Anaphylactic reactions to vaccines in the United States have been rare, with fewer than one in a million cases a year. At the meeting on Thursday, Dr. Doran L. Fink of the F.D.A. said that the agency and the C.D.C. were investigating the reactions.

“We anticipate that there may be additional reports which we will rapidly investigate,” Dr. Fink said, adding that robust surveillance systems were in place to detect these rare cases.

He said there was not enough information to tell if an ingredient in the vaccines had caused the allergic reactions.

Moderna is developing eight other vaccines that use mRNA. The company has tested them in animals and in 1,700 people, and has not had cases of anaphylaxis or other severe allergic reactions linked to the vaccine, Dr. Jacqueline Miller of Moderna said. One anaphylaxis case occurred two months after vaccination, in a person with a soy allergy. Anaphylactic reactions to vaccines generally occur within minutes or even seconds after the shots are administered.

Other side effects — fever, chills, fatigue, headache, muscle and joint pain — are much more common after getting the Moderna vaccine, especially after the second shot. Although the reported side effects are not dangerous they can be unpleasant, lasting one to three days. Doctors say the symptoms are comparable to those experienced by many people after getting Shingrix, the vaccine to prevent shingles. People should be prepared to feel under the weather for a day or two after each shot, they said, and may need to take a day off work.

Moderna’s study found that 91.6 percent of recipients had sore arms, 68.5 percent had fatigue, 63 percent headaches, 59.6 percent had muscle pain, 44.8 percent had joint pain and 43.4 percent had chills. Some participants also had swollen lymph nodes in the armpit on the side where they received the injection.

Company scientists emphasized on Thursday that the vaccine does not alter a person’s genes or interact with DNA, and that the mRNA is quickly broken down and does not linger long in the body.

Both the Moderna and Pfizer-BioNTech studies reported a small number of cases of a temporary facial paralysis called Bell’s palsy. Moderna found three cases in the vaccine group and one in the placebo group, and Pfizer had four cases, all in the vaccine group. F.D.A. reviewers did not think the disorder was related to the vaccine. On Thursday, Moderna said the company would monitor for the condition.

Shipping of the vaccine will be managed by the Trump administration’s Operation Warp Speed, but each state will decide where its doses go. Tennessee, for example, plans to disperse most of its anticipated allocation of 115,000 initial doses next week among all 195 of its local health departments, which will inoculate first responders, and to every hospital in the state that did not receive a Pfizer shipment this week.

In Kentucky, Gov. Andy Beshear told reporters that he expected close to 80,000 doses of the Moderna vaccine in the state’s initial shipment, adding, “We’re going to ensure we have some allocation for every acute care hospital across the commonwealth.”

And in Massachusetts, Gov. Charlie Baker said Tuesday that 110,000 of the state’s expected 120,000 Moderna doses would go to smaller hospitals and outpatient clinics, including community health centers.

Some states will be handing over part of their Moderna allocation to CVS and Walgreens, which have contracts with the federal government to immunize residents and staff in nursing homes starting next week.

Dr. Jasmine Marcelin, an infectious disease physician at the University of Nebraska Medical Center, was one of several clinicians who called into the F.D.A. panel’s meeting. She mentioned the disproportionate effect of the pandemic on people of color, and urged her colleagues to listen to their concerns and include trusted professionals from their communities. “The health care profession has previously betrayed these communities through centuries of structural racism,” she said.

Iletta Norris, a certified medical assistant at the Medical University of South Carolina, said she planned to get vaccinated — but would like to wait six months. “I just want to see a little more research done,” Ms. Norris said.

Living at home with her parents and siblings, Ms. Norris said she and her family were a little nervous about how well side effects had been documented, and would feel more comfortable receiving the shots later.

But once Ms. Norris is vaccinated, she said, “I will be a spokesperson. I will let everyone know about my positive experience.”

Moderna has requested authorization to vaccinate adults, based on its clinical trial in 30,000 people 18 and older. Pfizer included some younger volunteers in its study, and was authorized for use in people 16 and older.

But neither vaccine was tested in pregnant or breastfeeding women. Many vaccines and drugs are studied in other groups before their safety is assessed in pregnant women. But researchers did not observe any harmful effects of the Moderna vaccine in 13 women who became pregnant during the trial.

An estimated 330,000 health care workers are expected to be pregnant or breastfeeding as the vaccines are rolled out. With no evidence of harm, and given the high risk of Covid-19 in these women, the F.D.A. did not exclude pregnant or breastfeeding women from its authorization. An advisory group to the C.D.C. recommended last week that women who are either pregnant or breastfeeding, or in the planning stages, consult with their doctors before choosing to take the Pfizer vaccine. The committee is expected to make a similar recommendation for the Moderna vaccine this weekend.

Apoorva Mandavilli and Katie Thomas contributed to this article.