The new Pfizer vaccine is great news for the world, except perhaps for the coolest part. The coolest part is it must be kept at -70C.
As almost everyone has heard, Pfizer announced this week that its new Covid vaccine has successfully prevented the disease in about 90 per cent of test volunteers.
While it's a press release, and not the actual final study data, experts tell me this is absolutely outstanding, because the flu vaccine typically only protects 40-60 per cent. If true, it will be a huge step toward creating broad immunity and controlling the disease.
"Ninety something is pretty damn good," Associate Professor Helen Petousis-Harris, a vaccinologist at the University of Auckland, told me. "People say the first vaccines out are often not the best. But I thought: why not?"
"I think it's about the best news we could hope for," agreed Dr Keith Jerome, head of the Virology Division at the University of Washington here in Seattle. "One thing to remember is it's going to take a while. It's going be a herculean effort to get these out to everyone in the world. But I'm excited. Cautiously excited."
Both the United States and New Zealand had already signed up for the Pfizer product, which will require two jabs to do the job. New Zealand has contracted for 1.5 million doses, which should protect about 750,000 people. The US has bought enough to cover 50 million people, with options for enough to cover 250 million more of us. Two doses for the first 50 million people cost about US$2 billion, or $40 per patient. Pfizer says they will have enough to protect 25 million people this year worldwide and 650 million in 2021. And other vaccines from several companies are not too far behind.
"It's our first ray of hope," US Senator Patty Murray told me yesterday. "And the new Biden administration will work on it immediately."
There are some considerations and potential problems, of course. The biggest being that the vaccine must be stored long term at -70C. And the second biggest being that no such vaccine design has ever been approved for humans before.
Why so cold? The Pfizer vaccine is what's called an mRNA vaccine, which means it uses the molecule messenger RNA to teach the body how to recognise and defeat Covid. The microscopic RNA strand is delicate, and comes wrapped in a teeny tiny bag of fat to both protect it and allow it to enter human cells once injected to do its job. The problem is that it will quickly degrade if it's not kept very very cold. Seventy-degrees-below-zero cold.
While this might sound nearly impossible, it turns out lots of laboratories, hospitals and universities around the world already have special freezers designed specifically for keeping things that cold.
"They're like a kitchen fridge, but taller, wider and an awful lot colder," Jerome explained. They cost a lot more than a kitchen fridge, too, many thousands of dollars each. But you get value for money: in addition to maintaining the proper temp within a degree or so, they also keep a constant record of the inside temperature. Some models even include WiFi connectivity to raise an alarm if the temperature should rise.
One drawback: they aren't self-defrosting like your home fridge. Defrosting works by actually raising the temperature in the freezer until any ice buildup melts. This might ruin the special contents. So occasionally, Jerome and his staff must quickly transfer the items to another freezer, chip away at the ice, and then return the contents to the cold.
You will be delighted to know that you don't actually need to receive a dose of the vaccine into your arm at -70C. Pfizer spokesmen told me it can survive a short time at room temperature for more comfortable jabs, as well as up to five days at normal 2-8C refrigerator temperature. To ship it, Pfizer has developed a special, highly insulated container that when packed with dry ice can preserve the vaccine for 15 days. Don't have a sub-subzero fridge at your clinic? No problem. Pfizer says you can refill their container with more dry ice to protect the vaccine.
"Once they take it out of the ice, they can give it five days in a normal freezer," said Albert Bourla, chief executive of Pfizer. "So we have worked extensively to develop this distribution network."
New Zealand has been preparing for this. "The Ministry of Health is well advanced with plans to support the Pfizer vaccine with suitable bulk freezers due to arrive before the end of the year and consumables purchases underway," a ministry spokesperson said.
This is particularly good news for the US, where unlike New Zealand, we have utterly failed to control Covid and are now closing in on 240,000 dead with record daily new cases and a record 61,000 of us hospitalised with Covid right now.
Without a vaccine, some officials here have been pushing the radical strategy of intentional infection to achieve "herd immunity", wherein enough people are infected and thus immune to slow or stop the spread of the virus. These herd immunity proponents include Trump's new Covid adviser, Dr Scott Atlas, a radiologist with zero expertise in either virology or epidemiology.
So let's talk about herd immunity, which is the objective of any strategy of reopening and exposing everyone not isolated to the disease. Can you name one lethal disease in history where herd immunity was achieved by intentional self infection? Spoiler alert: there are none.
People tried for centuries to establish herd immunity to measles, which provides a very sturdy lifelong personal immunity after just one infection. People intentionally infected themselves, their families, their co-workers, their church. Nothing worked. As a result, millions were infected annually and 100,000 died every year, including 500-1000 here in the US.
There was no herd immunity for measles until a vaccine was developed in the 1960s and population immunity levels rose to about 90 per cent. The same was true for smallpox. And you can't get herd immunity to rabies either.
If we are willing to infect 40-90 per cent of us with Covid, and see perhaps 1 million Americans die, we might achieve herd immunity after a few waves, as we did against the 1918 flu. And then again, if Covid allows reinfection like dengue, then it might not even work and 1 million would be dead for nothing.
But now the vaccine cavalry is coming. The new plan should be to save as many lives as possible here while we wait for science to ride to our rescue. Like New Zealand has so wisely done since the beginning.
• Dick Brass was vice-president of Microsoft and Oracle for almost two decades. His firm Dictronics developed the first modern dictionary-based spellcheck and he was an editor at the Daily News, NY.