First, the good news. Only a year ago, SARS-CoV-2 emerged on the world stage, slowly growing into the pandemic we know today. A year later, multiple vaccines against this new virus are on the verge of being distributed to millions of people around the world. The timeline is astounding. It’s a testament to science first and foremost. Earlier this year I was skeptical of the prognostications of having a vaccine within a few months—mainly because of the gaps in our knowledge about SARS-CoV-2 and the immune response to it, and the reliance on novel mRNA technologies for some of the candidates. I was wrong, and I couldn’t have been happier.
But as my Yale colleagues Jason Schwartz and David Paltiel, new CDC Director Designate Rochelle Walensky, and Harvard Medical student Amy Zheng have warned in a new paper and op-ed in USA Today: Vaccines don’t save lives; vaccinations save lives. The point here is that in clinical trials vaccines are evaluated in controlled settings, which are never reencountered in the real world. With vaccines, context is king (or queen).
What my colleagues point out is worth discussing here, because it’s about how we must face the next few months together. The main take-home message to all of us? Keep stocked up on masks, keep up the social distancing, and refrain from indoor gatherings. Why do we need to do this still, if a vaccine is being handed out across the country? It’s because in the context of a raging pandemic—lots of transmission in the community—even a vaccine that looks spectacular in clinical trials will have trouble competing with the force of infection that an uncontrolled epidemic of a highly infectious pathogen presents.
This will be easier said than done. Not only may the arrival of vaccines in and of themselves discourage mask wearing and other public health measures; most of these vaccines have shown efficacy in preventing severe disease rather than in preventing transmission of the virus. As we roll out vaccination in the elderly, we are likely to see the first effects of the vaccine in a decrease in death rates. We keep telling people this is not like the flu. However, as the fatality rate drops, Covid-19 is going to look a whole lot less dangerous to many people, potentially further discouraging basic public health protections. We still haven’t invested in helping ordinary Americans to take up, adhere to, and maintain these kinds of individual behaviors. We haven’t made it easy for them.
What my colleagues also point out is that while we have had an Operation Warp Speed for vaccine research and development, we need one now (actually, we needed it yesterday) for vaccination. Vaccination campaigns are run by the states—and they’ve been warning for months that they simply do not have the resources to do this successfully. The failure of Congress and the Trump administration to provide these needed resources even now that vaccines are on the verge of FDA authorization is kneecapping states just when we have an opportunity to start to put this pandemic behind us. Furthermore, the companies that make the vaccines we are going to rely on simply aren’t equipped to meet global demand, which means the United States may not be able to meet ambitious goals for vaccine rollout as other countries demand access to these products as well. At the same time, more and more Americans are saying they won’t take a vaccine: In May, according to the Pew Research Center, 27 percent of Americans said they would either “probably” or “definitely” not get a Covid-19 vaccine when it becomes available. By November, that percentage was up to 39 percent. My colleagues warn in their paper that going slow or low—that is, having a sluggish vaccination rollout or too many people opting out—can water down the real-world effectiveness of a promising vaccine.
All of this is sobering stuff. The arrival of vaccines against Covid-19 is a spectacular achievement and the investment of the Trump administration in this process was one of the only bright spots in their response to the pandemic. But they didn’t follow through. All of this downstream work now—keeping public health measures in place to give the vaccines a leg up in containing the pandemic, ensuring fast rollout to a broad swath of Americans—is up to the new Biden administration and a Congress that may or may not want to cooperate (if you’re reading this in Georgia, I am talking to you, voters!).
And it’s up to us, too. Twenty twenty has been the worst. To hear that we’re going to have to keep at it, with the masks and the social distancing, is depressing. I know. But there is light at the end of the tunnel. Vaccines are the vehicles—at least in part—that will get us through the darkness. But the urgency of the journey means keeping the pedal to the metal now. The more we can stick it out and do our part, the greater chance of success for this massive vaccination campaign. And though we are all relieved that Donald Trump will be in the rearview mirror in 2021, we cannot demobilize, stop organizing. We need to ensure that the Congress steps up with a pandemic relief package to underwrite the direct needs for getting this vaccine out to the millions who need it, while helping all of us to hold on for a few more months with the social and economic aid we require. We are so close. We cannot give up now.