Unfortunately, most government and public-health officials are not preparing the public and businesses for the likely scenario following when a vaccine for coronavirus is available. The belief this past spring was that by now, things would be getting back close to normal. That hasn’t happened. Now, people expect that a coronavirus vaccine will be the silver bullet cure, the light at the end of the tunnel, that will bring the pandemic to a decisive end. As Dr. Anthony Fauci, head of the National Institute of Allergy and Infectious Diseases, recently said that just because a vaccine is available doesn’t mean things will go back to normal. He said many of the public health measures we’ve adopted lately, like wearing masks, social distancing and restricted size gatherings, will still need to stay in use once people start receiving a vaccine. Unfortunately, that is not only the likely scenario for when the vaccine is being deployed but even beyond for several reasons.
Herd Immunity – The first issue is whether we can soon reach herd immunity. The purpose of a vaccine is not only to reduce a person’s risk of getting ill from Covid-19, but more importantly, to get us to herd immunity. Herd immunity is achieved when a high enough percentage of a population becomes immune to an infection, whether through vaccination or previous infections, such that person-to-person spread is unlikely. Herd immunity provides indirect protection – or herd immunity – to those who are not immune to the disease, so everyone, not just those immune, are protected. Once herd immunity reaches a certain threshold, the disease gradually disappears.
Dr. Fauci said he would “settle” for a coronavirus vaccine that’s 70% to 75% effective taken by two-thirds of Americans, as that would bring the United States to herd immunity levels.
Different vaccines offer different levels of protection, their effectiveness. If 100 people are inoculated with a vaccine that is 60% effective and then exposed to the virus, on average, 60 of them will not get ill, but 40 will. Flu vaccines have only achieved an effectiveness of 20% to 60%. The 2017-2018 flu vaccine was only 38% effective.
A recent study using computer modeling found that if 75% of the population gets vaccinated, the vaccine has to have an effectiveness of at least 80% to extinguish an ongoing epidemic. If only 60% of the population gets vaccinated, the thresholds are even higher, 100% to stop an ongoing epidemic.
The U.S. Food and Drug Administration (FDA) sets licensing standards for vaccines. The FDA said it would license a vaccine that is at least 50% effective. If only a 50% effective vaccine is approved, it will only prevent disease in half of those people who are vaccinated and won’t get us to herd immunity. Even after a vaccine with low effectiveness is available, the coronavirus will still be around, infecting and killing people. The numbers will just be lower.
Dr. Fauci says it is “unlikely” that the U.S. will achieve sufficient levels of immunity to quell the outbreak, as it appears too many people will refuse to get the shot when it’s available because of a “general anti-science, anti-authority, anti-vaccine feeling. . . I don’t really see us eradicating it.”
Dr. Fauci also said he worries about how vaccine science is being communicated to the public. “I never liked the ‘warp speed’ terminology,” he said. “It suggests, incorrectly, that you’re rushing things. Whenever people hear things are being rushed, they worry about safety. They think you’re prematurely putting something out there that isn’t entirely safe.”
If a vaccine is licensed or even given an emergency use designation by the FDA before this November’s election, that could add fuel to the propaganda that the vaccine was a political decision, not a scientific, medical one.
The most recent Kaiser Family Foundation Health Tracking Poll found that more than 6 in 10 adults (62%) are worried the FDA will rush to approve a vaccine due to political pressure.
A September Economist/YouGov poll found that over slightly more than one-third of U.S. adults (36%) will get a coronavirus vaccine. Nearly one-third said they wouldn’t get a vaccine. The remaining 32% answered they were “not sure.” Some of those are sure to eventually fall into the “not” category.
A September 2-6 Morning Consult poll was more promising. One-half of adults (51%) said they would get the vaccine; 23% said they wouldn’t, and one-quarter (25%) didn’t know or had no opinion.
A third-quarter 2020 poll by Civic Science found that 7 in 10 adults (70%) indicated they would get a coronavirus vaccine within one year.
If 70% of the population does get the vaccine, the vaccine would need to have very high effectiveness to achieve herd immunity.
But just because a vaccine is available doesn’t mean things will go right back to normal. Dr. Fauci said many of the public health measures we’ve adopted lately, like wearing masks, social distancing and reduced capacities of gatherings, might even have to continue after widespread vaccinations if herd immunity is not reached (which appears to be the more likely scenario).
Another issue is that when a safe and effective vaccine is licensed, only a few million doses of the new vaccine would be available at first. Some of the potential vaccines require two shots to get a full immune response, further complicating the timeframe and logistics of getting everyone who wants it fully vaccinated. It could take up to a year to vaccinate everyone in the U.S. willing to get the vaccine. If a vaccine is approved by early 2021, it could well take until the end of 2021 or early 2022 to manufacture enough vaccine and get everyone willing vaccinated.
Unless a vaccine is nearly 100% effective (extremely unlikely, at least for the initial vaccines), many vaccinated people can still catch the virus. If the vaccine is 60% effective, 40% of the people who get it will not be immune and can still get ill from Covid-19. What a vaccine does is reduce the odds of getting sick, not eliminate it. But even the 60% who won’t get sick could still spread the virus.
The vaccine will prevent some people from getting ill from the coronavirus if they catch it. But it will not necessarily protect against them infecting other people with the coronavirus. Vaccinated people may still get mild or asymptomatic infections, and thus shed the virus and possibly spread it to others. People who are vaccinated will still need to social distance and wear masks. That’s going to be a hard message to have people understand and follow, as they will assume a vaccine gives them immunity so they can’t get or spread the virus. Currently, it is difficult enough to convince people who have no symptoms, the pre-symptomatic or asymptomatic, that they need to wear masks to stop the spread. Dr. Fauci said, “It’s now clear that about 40%-45% of infections are asymptomatic.” He noted that asymptomatic carriers could account for up to 50% of virus transmissions.
Length of Immunity – There’s another significant uncertainty that will affect how effective wide vaccination will be. We don’t know how long immunity will last and how soon people can be reinfected and get ill from Covid-19. We won’t know that until sometime in the future when the people vaccinated in the Phase 3 trials for the licensed vaccines are monitored long-term for their continuing immunity. If the immunity is not long-lasting, people vaccinated early could lose their immunity while the vaccination of the population is still underway, eliminating any possibility of significantly reducing infections, let alone reaching herd immunity unless booster shots are given.
High At-risk Population – The majority of the adult population, 60% according to the CDC, are at high risk of getting severe illness or death from Covid-19. In addition to everyone over age 65, between 3 in 10 to nearly half of younger age groups are at high risk due to underlying health conditions.
For the high-risk adults, unless a vaccine is highly effective, they will continue to be reluctant to visit public places, especially the higher risks places that include indoor restaurants, entertainment and cultural venues, and most of all, those with fixed seating and long length-of-stays such as theaters and sports facilities. More than one-third (37%) of the highly sought-after young adult cohort for entertainment and cultural venues, those age 18-34, fall in the high-risk category.
The most recent September 10-12 Harris poll found that nearly one-half of adults (49%) currently “fear I could die as a result of contracting coronavirus.”
Long Haulers – The public is becoming aware that even mild cases of Covid-19 that don’t require hospitalization can have serious long-term health consequences. This growing group of what are being are called “long haulers” is raising the risk perception of getting Covid-19, even for the 40% of the adult population who are not at high risk.
Complacency – One barrier to getting back to normal, or at least close to it with a drastically reduced number of infections, even assuming an effective vaccine, is pandemic fatigue and complacency. This is already proving to be an issue with younger adults and their partying and other gatherings without social distancing and masks.
It looks like getting back to a normal with no more mask-wearing, social distancing, limited capacities at public places and the need to work from home isn’t in the near future. Based upon the unlikely scenario of getting to herd immunity based on a highly effective vaccine that enough people get that gives them long enough immunity and gets us to herd immunity, we’re going to have to wait until the pandemic runs its course over several years, or a vaccine or cure for the disease that is good enough arrives. For the next few years, for probably at least until sometime into 2022 at the earliest, masks will have to be worn as part of human clothing, many people will be experiencing hardships and many businesses will need to continue operating under challenging conditions. Until then, infections should decline, but the coronavirus will still be with us, disrupting life as we once knew it.
I hope I’m wrong and that something new comes along soon that can stop the coronavirus dead in its tracks. But right now, we should psychologically prepare ourselves for a long road ahead.
Additional reading: There Won’t be a Clear End to the Pandemic – The Atlantic
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