A recurring sentiment among some in the vaccine-hesitant community is a desire to wait to receive any of the three available COVID-19 vaccines until they have been officially approved by the Food and Drug Administration. And while the FDA has authorized the Pfizer, Moderna, and Johnson & Johnson vaccines ― and is expected to also approve each one in turn ― for many people, the difference between “authorized” and “approved” has been confusing.
To combat COVID-19, the FDA used a measure known as an emergency use authorization (EUA) to speed up the process by which safe and effective vaccines could begin being distributed across the country. Such a measure required only two months of safety and efficacy data from clinical trials in this case, compared with the minimum of six months manufacturers usually have to wait before applying for FDA approval (also known as a Biologics License Application, or BLA).
And while this process has been used by the FDA before ― the measure has existed for decades ― it’s arguably never been followed by the public so closely. That has led to some misunderstandings about what it actually means for a product or procedure to be “FDA approved.”
“The FDA approval process is complex and nuanced. And generally, it is something that the U.S. population does not watch with great intensity. COVID has changed that,” said Dr. Brian Castrucci, an epidemiologist with the de Beaumont Foundation. “Before COVID, most Americans probably didn’t know the difference between a EUA and a full approval, or the difference in the phases of a drug trial.” Here are a few myths circulating about FDA approval and why you shouldn’t let the process stand in the way of getting vaccinated:
Myth: The FDA determines when a vaccine is FDA approved
While the FDA determines if a vaccine qualifies for FDA approval and sets nonbinding guidelines for manufacturers to follow, it’s not entirely up to the organization to decide when. That timeline is first determined by the manufacturers of the products seeking FDA approval.
Manufacturers decide whether and when to submit a request for authorization or approval, an FDA spokesperson said in a statement to HuffPost. Then the review process starts.
In the midst of the pandemic, the vaccine manufacturers chose to first apply for FDA emergency use authorization before applying for FDA approval. While a EUA is not usually a prerequisite before applying for the license, the FDA spokesperson said pharmaceutical companies did the right thing by using a EUA before applying for approval. At the same time, the pandemic is still considered a public health emergency. In this case, authorization simply precedes approval, similar to how the FDA granted a EUA for the COVID-19 antiviral drug remdesivir six months before it gained FDA approval in October.
While it’s true that vaccine development can take a lot longer for some diseases ― we still don’t have an effective vaccine for HIV, for instance ― it can happen much more quickly for other illnesses.
For example, “we understand the vaccine technology very well for influenza,” said Dr. Benjamin Bates, a professor of health communication at Ohio University, “which is how we’re able to develop new vaccines to different strains of influenza annually.” That helps expedite the process.
In the case of the SARS-CoV-2 virus that causes COVID-19, Bates said, we were fortunate because scientists began studying SARS viruses extensively after the SARS and MERS outbreaks of the early 2000s.
“By the time COVID-19 was identified, we had done a lot of the homework over the previous two decades,” he said. That previous knowledge allowed manufacturers to quickly develop laboratory and computer modeling tests for potential vaccines. It also helped them to perform early tests for safety and efficacy in real people to be ready to meet the FDA’s standards for authorization and approval.
Dr. Leana Wen, an emergency physician and public health professor at George Washington University, said that “no shortcuts were taken in the research or authorization process” of any COVID-19 vaccines, and getting them out to Americans more quickly through the emergency use authorization saved countless lives.
“It would have been unethical to prevent a life-saving intervention from reaching people as soon as it was available,” she said. “It would have been unethical to prevent a life-saving intervention from reaching people as soon as it was available.”
– Leana Wen, an emergency physician
The FDA only grants or denies distribution as requested by the manufacturer and in conjunction with each manufacturer’s supporting data. What’s more, manufacturers only apply for authorization or approval for the groups of people their product or procedure have been designed for or tested on at the time.
For example, ultraviolet phototherapy equipment ― such as biliblankets or the blue lights used to treat jaundice ― are only FDA approved for infants and not for older age groups.
In the case of COVID-19 vaccines, clinical trials took place first in adults who were known to be more vulnerable to the disease. A EUA was then requested for those groups once the shots were deemed safe. From there, manufacturers take a “step down,” proceeding with trials among other groups while still reporting the data from the initial problems. This is a standard procedure.
That’s why Pfizer’s emergency authorization was initially only granted for individuals 16 and up before being expanded last week to include individuals in the 12-15 age group. (Pfizer has already said it plans to apply for a EUA for children ages 2-11 as early as this fall.)
“Although the initial population-wide tests were among people most vulnerable to COVID-19, now that we have data from millions of people from all age groups, we know that the risks of these vaccines are minuscule compared to the tremendous benefits they bring,” Bates said.
The FDA spokesperson said that every new age group expansion application is held to the same rigorous standards as previous groups before FDA authorization or approval is granted. “We know that the risks of these vaccines are minuscule compared to the tremendous benefits they bring.”
– Benjamin Bates, a professor of health communication at Ohio University
Myth: If COVID-19 vaccines aren’t (yet) FDA approved, they aren’t safe
While there are essential distinctions between FDA approval and emergency use authorization, those words may be thought of interchangeably in at least one way: both mean the FDA considers the COVID-19 vaccines “safe and effective“ for the groups indicated.
“In this case, both ‘authorized’ and ‘approved’ are flexible terms that basically mean the same thing in terms of quality and the high standards the FDA sets forth,” said Dr. Arnold Monto, a professor of epidemiology and global public health at the University of Michigan. “The FDA did not lessen the standards for anything, including the amount of time that must elapse, before an application for ‘FDA approval’ could be considered.”
The FDA only makes such considerations after “COVID-19 vaccines undergo a rigorous development process that includes tens of thousands of study participants to generate the needed non-clinical, clinical, and manufacturing data needed to support authorization for emergency use,” the FDA spokesperson said.
“The FDA had enough data to demonstrate short-term safety and efficacy during a true public health emergency to grant a EUA,” added Dr. Yvonne Maldonado, chair of the Committee on Infectious Diseases for the American Academy of Pediatrics and a professor of pediatric infectious diseases at Stanford University.
As such, Maldonado said people who trust FDA-approved items (like blood pressure medication) should also count the same organization when they say COVID-19 vaccines are already safe while applications for FDA approval are pending. “These vaccines have been demonstrated to be extremely safe, well-tolerated, and highly effective,” she said.
To that end, the FDA spokesperson also left no room for doubt regarding the safety of the vaccines: “The FDA can assure the public and the medical community that we have conducted a thorough evaluation of the available safety, effectiveness and manufacturing quality information for every vaccine authorized” and that “efforts to speed vaccine development have not sacrificed scientific standards or the integrity of our vaccine evaluation process.”
FDA approval is expected to start within the next couple of months for the COVID-19 vaccines already authorized, but people have no reason to worry and no need to wait to be vaccinated in the meantime.
“With over 120 million people already vaccinated,” Bates said, “this is one of the largest field tests of a vaccine ever conducted, and this vaccine has so far been shown to be as safe and effective as the many medications and vaccines. That has been fully approved.”