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Aug. 23, 2021, 11:15 a.m. EDT

Will vaccine skeptics accept the safety of the COVID shot now that the FDA has granted full approval?

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By Jennifer Girotto

About 30% of unvaccinated American adults  say they’re waiting for the COVID-19 vaccines currently authorized for emergency use to be officially approved by the U.S. Food and Drug Administration. The FDA   granted that approval  for those age 16 and older for the Pfizer-BioNTech vaccine on Monday. What had to happen for the FDA to advance from  emergency use authorization , or EUA, to full approval?

I’m a pharmacist who trains other pharmacists, health-care providers and students on why, when and how to administer vaccines. Emergency-use authorization, while streamlining the regulatory process so the vaccine is more quickly available to the public, still follows a  rigorous process  that the FDA requires to ensure vaccine safety and effectiveness. The difference is that more time has passed and more data is available for review when a company applies for full approval.

EUA and full approval share similar first steps

For both emergency authorization and full approval for COVID-19 vaccines, the FDA first requires  initial safety studies  on a small number of people. Here, researchers document potential adverse events, or side effects, that the vaccine may cause. Researchers also determine the safest and most effective dose of the vaccine.

Doctors question the optics and the scientific rationale behind the plan for COVID-19 booster shots in the U.S.

Once the vaccine is determined to be safe and an optimal dose identified, researchers will create larger studies to ascertain how well it works in a controlled setting where some people are given the vaccine while others are given a placebo.

It is important to note that the number of people who participated in the initial COVID-19 safety studies was similar to that in the safety studies of other commonly used vaccines, including vaccines for  tetanus, diphtheria, whooping cough and meningitis . Over 43,000 adults participated in the early phases of the Pfizer /zigman2/quotes/202877789/composite PFE +0.56% BioNTech /zigman2/quotes/214419716/composite BNTX +0.11%   clinical trial , over 30,400 in Moderna ’s /zigman2/quotes/205619834/composite MRNA -0.92%  and over 44,000 in Johnson and Johnson’s /zigman2/quotes/201724570/composite JNJ -0.98% . Half the participants in each study were given a vaccine, while the other half were given a placebo.

Where EUA and full approval differ

From this point on, emergency-use authorization and full FDA approval for COVID-19 vaccines follow different clinical study requirements.

For the  emergency-use authorization , the FDA requires at least half of the participants of the original studies to be followed for at least two months post-vaccination. This is because the vast majority of vaccine-related side effects  occur right after vaccination .

Full FDA approval, on the other hand, requires participants in the original studies to be  followed for at least six months . Reviewers look at data from the same study participants but collected over a longer period. All adverse events are examined.

The manufacturer must also provide more detailed manufacturing plans and processes, as well as a higher level of oversight and inspections. All of this adds significantly more time to the review process.

Both  Pfizer  and  Moderna  began their rolling submission for approval in the FDA’s  “Fast Track” process , designed to speed up review. This allows the companies to submit portions of their approval application to the FDA for review as they’re completed.

Full FDA approval will initially apply to only the same age groups that were tested in the original emergency use authorization. This means that the vaccine has been approved first for people ages 16 and up for Pfizer, and will likely be approved for those 18 and up for Moderna. Rolling submission will allow approval of the vaccine for younger groups as more data becomes available.

Different timelines, same rigorous requirements

Full FDA approval is a milestone that may help build confidence among the vaccine hesitant about the safety of the vaccines. But the true test of the vaccine came when it first gained emergency-use authorization. Then, researchers identified the majority of its potential side effects and proved its ability to protect against severe disease.

<STRONG>Jennifer Girotto is currently an associate clinical professor of pharmacy practice at the University of Connecticut. Her focus areas of practice are on immunizations and pediatric infectious diseases.</STRONG><STRONG>Dr. Girotto does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment</STRONG>

This commentary was originally published by The Conversation—What does full FDA approval of a vaccine do if it’s already authorized for emergency use?

People in the U.S. who received Moderna’s or Pfizer’s COVID-19 vaccine will be eligible for a booster dose in September

Debate over mask mandates in schools continues as COVID-19 vaccination rates increase among teens

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