As health officials hang hopes on vaccines to get us out of this pandemic, we introduce you to a young local nurse who is helping to run clinical trials for COVID-19 vaccines here in the Bay Area. Listen to the latest edition from our @WORK series.
A significant milestone was reached on February first when the number of people in the United States who have gotten at least one shot of a COVID-19 vaccine surpassed the total number of Americans who have been infected with the virus. While the rollout has been far from smooth, the fact that we have several effective vaccines is something to be grateful for. What does it take to get to the point that a vaccine is ready to be used? We found out when we met a local nurse who has been working on the clinical trials of a COVID-19 vaccine.
Elba Avila’s office is on the ground floor of the former Masonic Temple near the corner of Market and Van Ness — a few blocks from San Francisco's City Hall. It's a majestic building with an ornate doorway and statues and columns around the outside. But inside, her office looks much more like an everyday clinic.
Elba is a nurse on a COVID-19 vaccine clinical trial. During COVID-19, while most of us have been hunkering down, Elba has been working hardto help get us a vaccine.
“I've been working six days a week for the past couple months,” Elba tells us. “Sometimes we go in at 7am, and we don't come out until 7pm.”
I first spoke with her on a Sunday in November. Weekends would normally be a time for her to be with her family, but COVID-19 has changed things.
“I haven't seen my family in months,” she says, “because both of my parents are about 78 years old, and my dad has chronic kidney disease.”
Elba's family moved to the Bay Area from Mexico when she was 15. Since then large weekend gatherings had been the norm.
“I have a really large family, there's eight of us. So even just by getting together with my immediate family is like already a party like way beyond the CDC guidelines,” she says with a laugh.
The research unit that Elba works in is part of a San Francisco Public Health program called BridgeHIV, that normally studies things like pills and vaccines to prevent HIV infections.
When the COVID-19 pandemic hit, their expertise allowed them to quickly take on COVID-19 vaccine trials. That's when Elba was hired. Both personally and professionally, the job has been a great fit.
“As a queer woman of color, one of my goals, career wise was actually working in a place that work with a very diverse community,” Elba says. “So for me, being able to work in a clinic that is super queer friendly, that really embraces people of color, people with different identities was kind of my dream job.”
So what exactly is her job? Elba explains that testing a vaccine, once it has reached human trials, is a long and involved process. And as a clinician, she works directly with the participants throughout.
“With vaccines, you have several goals, right? The first thing you want to know is if a vaccine works.”
In other words, does it prevent someone from getting COVID-19? Early data indicates that their vaccine does.
“So now our job is to find out for how long, how long are those antibodies going to protect you,” she says.
And will people need additional injections in the months and years ahead to stay protected?
The vaccine they are studying is made by AstraZeneca and Oxford University. You may have heard about the vaccine in the news for some unfortunate reasons.
A Bloomberg Television host introduced a piece like this: “Development questions mounting over AstraZeneca and Oxford's vaccine candidate after they acknowledged a manufacturing error that affected trial results.”
But the vaccine has been making news for some very good reasons as well: Unlike the first two vaccines approved for use in the United States, this one doesn't need to be frozen. That makes it a lot easier and cheaper to distribute and store.
“So being able to reach communities that are very rural,” Elba highlights, “or countries that don't have the ability to keep vaccines that are very, very low temperature will give us the ability to reach a greater audience.”
When this study launched the response from the community was tremendous. Hundreds of potential volunteers from around the Bay Area stepped forward.
“There's people who work in restaurants, there's lawyers, there's scientists, there's nurses, doctors,” she says fondly, “and everyone has been so, so nice.”
The initial safety trials were conducted in the UK. This is a much larger trial, with 30,000 volunteers. It’s taking place in 44 states across the U.S., with additional sites in Colombia, Peru, Chile, and Argentina. Elba’s San Francisco site has been enrolling 250 of these participants.
Elba points out, “this is probably the biggest amount of recruits in a short amount of time that we have done.”
Screening people into the study is done in several steps.
“That starts with an info session, about what you can expect, the type of commitment, what are goals in the trial, and some of the risks that might, you know, that might come with joining the trial and just have them an opportunity to ask questions,” she explains. “A lot of my job is just counseling - is this the right thing for you?”
And if somebody wants to move forward, then Elba and other clinicians dig into their medical history.
She says, “safety is our number one concern. So if you have any uncontrolled or severe chronic diseases, we have to make sure that we're able to keep that in mind.”
If there are no red flags in the medical history, then prospective participants are invitedinto the clinic for an in-person medical exam.
“And if everything goes well we will order the injection, so either the placebo or the vaccine.”
This is a randomized, double-blind placebo-control study — the gold standard in trial design. Neither the researchers nor the participants know who's getting the actual vaccine This means the folks running the study can’t knowingly or accidentally influence the results.
“And then we give the injection, and then we follow up for the next two years. So we'll see them again in 29 days. And then two months, three months, six months, one year, two years.”
Elba is proud of the work that she’s doing and has been heartened by all of the Bay Area residents who have volunteered to take part.
“It's been a really great pleasure to be able to help drive this greater cause of creating a vaccine, but also be able to meet so many people who are willing to donate their time, and their body for the greater benefit of society, for you and I, for so many other people,” she says, again with a smile, “and maybe generations to come, we don't know.”
And in the short term, the hope is that this easier-to-store vaccine will make its way to the harder-to-reach communities across the globe.