By all accounts, the approval process for the vaccines is moving faster than it ever has before. However, the FDA has yet to disclose a timeline for when its work will be complete and data is still being reviewed.
On Wednesday, President Joe Biden told CNN’s Don Lemon during a CNN Townhall that he expects Covid-19 vaccines could get full approval “quickly.”
“They’re not promising me any specific date, but my expectation, talking to the group of scientists we put together… plus others in the field, is that sometime, maybe in the beginning of the school year, at the end of August, beginning September, October, they’ll get a final approval,” Biden said.
Earlier Wednesday, the National Institutes of Health Director Dr. Francis Collins told CNN’s Jim Acosta that full approval could come in the “next couple of months.”
Vaccine maker Pfizer appears to be furthest along in the process.
The acting commissioner of the FDA, Dr. Janet Woodcock, has said the FDA intends to complete the review in advance of its January deadline.
Because the FDA has already reviewed the manufacturing materials and has been reviewing clinical data all along, Tice said, “We don’t expect it to go the full six-month priority review clock.”
“We are still in the process of completing our rolling submission, which we announced on June 1st. It is not complete at this time,” Ray Jordan, a spokesperson for Moderna said. “It’s not the case that the FDA has our final submission and that we are waiting to hear from them.”
Moderna expects it may have its materials complete this fall. The time frame for approval would then be subject to the FDA regulatory review process, Moderna said.
Where the process is now
Historically, getting a vaccine licensed by the fall would be fast, especially with as much as the FDA has to review.
At this point, what takes time is that the agency has to go through absolutely everything, it cannot skip a page, and there is a lot of everything.
The Covid-19 vaccines received authorization based on interim data that showed the vaccines were safe and effective for only about three months. “Although, when something’s 95% effective, you can assume it’s probably going to be highly effective for awhile,” said Offit.
For full approval, the FDA has at least six months of efficacy data to review. “People are saying ‘why is it taking so long?’ Well, the FDA wants to make sure that it has a protective duration, long term effect,” Tice said. “It’s not that the agency, I think, has any concerns about the vaccine per se, they just per licensure requirements, you have to have this additional data.”
“The FDA does not cut corners on making sure of the quality, the purity, the potency of your products.”
Offit believes the data review should go pretty quickly, since the FDA has been getting data all along. What often takes time is that the FDA has to also validate the process that makes the vaccine for it to be licensed. Every step has to be validated.
“Whether it’s the computers that are being used or cleaning out the vats, or whatever it is, it’s a lot of boxes to tick to ensure that there’s consistency in each lot to the next,” Offit said.
That means an interdisciplinary team of FDA experts is pouring through millions of documents, running their own analysis, getting any clarification that it needs from the vaccine companies, and giving the manufacturing process a thorough inspection.
And it’s not just one FDA person that does the review, Baylor said. There’s a secondary and tertiary review. So a clinician would review the material and then a supervisor would need to review it and then it goes up to the division director.
“We have some reviewers who are reviewing long into the night, really, this is not a 9 to 5 review,” Baylor said. “The public is not aware, but yes people are giving up their vacations, working on weekends, Saturdays and Sundays. You’re working into the night.”
“The FDA is not sitting down twiddling their thumbs,” Baylor said.
Calls to move faster
While historically, the process has moved quickly, for some it’s not fast enough.
“I have been frustrated because I know it should have been approved by now,” Topol said. “Janet Woodcock made a statement that this was ‘among the highest priorities.’ No, it has to be the number one priority.”
Why full approval matters
Yet, as vaccination rates have dropped dramatically in the US, some have pointed to approval as one sure way to speed up the process.
“If it was approved with the full approval from FDA — which we all anticipate may be coming pretty soon…Maybe in the next couple of months — then the legal ability to mandate becomes a lot stronger,” Collins, the NIH director, said.