Why A Covid Vaccine Will NOT Lead to a Return to Normal

First, there has been considerable socioeconomic and political fallout from the pandemic and the failure of governments to protect their citizens, both physically and financially, that will forever change how people interact and earn a living. Many businesses have gone under and will never return. It’s been estimated that 50% of all U.S. restaurants and museums will never come back. Many businesses are realizing they function just as effectively with their employees working from home, so why return to office building and continue paying rent and utilities?

But from a purely medical perspective, the idea that a vaccine will suddenly or even slowly allow us to gather in large crowds without masks may be pie in the sky, and here’s why:

1.      For things to truly go “back to normal,” which I believe, for most people, means being able to gather in large groups, indoors, without masks, without obsessive handwashing, without anxiety that anyone in the room might be another super spreader, AND being able to send their kids back to daily, 100%, in-person school, there would have to be enough immunity in the population for the virus to die out and disappear completely. Experts use the term “Herd Immunity” to refer to this condition.

2.      We have fully achieved herd immunity with Smallpox, which is now considered extinct, through a combination of an incredibly effective vaccine and an incredibly effective worldwide collaboration to distribute and administer the vaccine. We’ve come close to eradicating Polio. The reason we have not is due to several factors, including governmental policy failures in several countries, but also because Polio immunity is much more complex than Smallpox immunity and creating effective vaccines has been much more difficult. Similarly, with mumps, measles, rubella, diphtheria and many other deadly scourges of past centuries, we’ve come close, but because of anti-vax hysteria (people refusing the vaccines for their children out of the irrational and scientifically debunked fear that the vaccine was more dangerous than the disease), outbreaks continue to crop up.

3.      To reach herd immunity, we need 60-80% of the population to be immune. Herd immunity means that enough people have acquired immunity that the virus can no longer take hold in the community, even though some people may still be susceptible.

4.      Problem #1: we still don’t know how effective the Covid-19 vaccine will be. If it’s 70% effective (meaning 70% of those who get it will develop immunity) and 80% of the population receive it, the result will be 56% of the population develops immunity (70% x 80% = 56%)—probably too low to reach herd immunity.

a.      The FDA has said it will accept any vaccine that proves to be safe and at least 50% effective. Yet no manufacturer has yet completed their studies and published any data on their vaccine’s effectiveness, so this is still a big unknown.

b.      50% effectiveness won’t get us close. Even if 100% of Americans get a vaccine that’s only 50% effective, we’d end up with only 50% of the population acquiring immunity

5.      Problem #2: In the U.S., over 20% of the population has vaccine hysteria and has said they will refuse any vaccine, period, end of story. Another 30% is still on the fence. According to CIDRAP, roughly 51% of Americans said they’d get the vaccine. And in the most recent studies of people's willingness to take the vaccine, researchers found that only 51% of people would take the vaccine if it's only 50% effective, and only 61% if the vaccine was 90% effective. Both of these rates are too low to create herd immunity. So, if we do nothing to change this (as we’ve done so far), that leaves only 40-50% of the population that would get vaccinated. So, even if the vaccine is 100% effective (and no vaccine is), we will end up with only 50-60% of the population acquiring immunity, which is far too low to reach herd immunity. This could change, easily, with an effective and vigorous public health outreach campaign (e.g., TV, billboards, social media, etc, promoting how the road to normalcy is developing herd immunity, and the quickest way to herd immunity is for everyone to get vaccinated), combined with strong public health policies (e.g., no one is allowed into school or the workplace without proof of having been vaccinated).

6.      Problem #3: We don’t yet know if the covid-19 vaccine will produce full or partial immunity. Coronaviruses, in general, and covid-19, specifically, tend to produce partial, short-term immunity in those who have been infected. Consequently, people can, and have, caught Covid-19 twice. And the second bout can actually cause worse symptoms than the first one. Vaccines tend to produce more robust immune responses than actual infections, due in part to dosing and the use of adjuvants. Even so, the covid-19 vaccine might still only produce partial or short-term immunity and/or require regular boosters. If this is the case, it would be much hard to reach herd immunity, as people would have to remember to go in for their regular boosters.

7.      Problem #4: Coronaviruses are RNA viruses (they contain no DNA), which tend to mutate and evolve at a much higher rate than DNA viruses (like pox viruses). Consequently, we may be faced with new strains and even new species of deadly coronaviruses each year, requiring completely new vaccines each year, as is the case with influenza. Many of the vaccines currently under testing for covid-19 are designed to recognize the spike protein common to all coronaviruses, which, theoretically, would protect us against all new coronaviruses, but it remains to be seen if this will in fact be true. It is entirely possible that covid-19, or some other coronavirus, will evolve the ability to evade the vaccine.

8.      Problem #5: Vaccines often have varying degrees of efficacy in different age and health cohorts. For example, the covid vaccine might be 80% effective for healthy 20 to 50-year-olds, but only 40-50% effective for infants and toddlers or for those over the age of 80.

9.      Problem #6: Even if one of the vaccines completes its clinical trial by the end of the year, it could take another 6-12 months before enough can be produced and distributed to the general public. So, even if it turns out to be 90% effective, and even if 70-90% of the population agree to take it, masks and distancing will not be going away soon. Some experts are saying we should brace for another 2-3 years of masks and social distancing.