As a medical journalist and fact checker, I’ve been all about the numbers during the COVID-19 pandemic. Unfortunately, the numbers don’t look good. And I’m not just talking about rising cases in the United States. I’m referring to the number of people who say they won’t get the future COVID-19 vaccine.
Recent polls have reported that only 50 percent of Americans are committed to getting a COVID-19 vaccine. And a CBS News poll reported that 70 percent would purposely hold off on getting it or wouldn’t get it at all.
I have severe eosinophilic asthma and an autoimmune disorder. So, to me, those numbers are frightening. Although I know a vaccine won’t get us back to pre-COVID normal, it will be a big step in a better direction. I hope to one day feel safe in public again and even get on a plane to visit my much-missed immunocompromised parents. Having a vaccine is the only way I envision being able to do those things.
But I want to put myself in the shoes of anyone who is vaccine-hesitant. For some people, a completely new vaccine for a novel virus is the frightening thing. So here, I’ve examined some common questions and concerns, done the research, asked the experts, and found some answers. Let’s unpack it.
“The greatest gains in infectious diseases in this century, and the last, has been in the development of vaccine,” says Dr. Nasia Safdar, the medical director of infection control at University of Wisconsin Hospital and Clinics and a professor in the department of medicine at UW’s School of Medicine and Public Health.
Before 1963, nearly all children got the measles by the time they were 15. Many of those who were infected developed encephalitis and long-term complications, and the virus was responsible for tens of thousands of hospitalizations and hundreds of deaths each year. A vaccine became available in 1963. But, as Safdar points out, we don’t have a treatment for measles.
“The fact that we have this highly effective vaccine has meant the difference between kids living with measles and dying of measles — as is still happening in many countries where people don’t have access to the vaccine,” she says. “To see the ravages that these preventable diseases cause, you have to go back several decades in this country, or you have to visit a country where the vaccine is not available. And if that doesn’t convince you, then nothing will.”
In a perfect world, we wouldn’t have a pandemic on our hands. But since we do, we have to think about a perfect world where a novel virus has killed well over 500,000 people globally.
“There are two ways of curbing a pandemic,” says Safdar. “You can either have natural disease in most of the population — such that people recover and become immune — or you can have a vaccine which artificially induces that immunity.”
By this point, you’ve possibly heard about the “herd.” That’s us. We’re all this great big herd. Immunity means you, a person in the herd, cannot transmit. So if you’re immune to a virus, and someone who has the virus sneezes on you, you can’t unwittingly give that virus to Grandma at her birthday party.
Now, herd immunity is the dreamy-dream goal. But again, to achieve that herd immunity for a virus and offer protection to the remainder of folks out there, generally about 70 to 90 percent of a population needs to be immune to infection.
As Dr. Safdar outlined, there are two ways to get there: infection or vaccination.
“The first option is not very appealing,” she says, “because, of course, no one wants people to have to get sick from an illness where the outcomes are very uncertain. And we’re still learning that several months after COVID-19, people are still having trouble getting back to their usual self.”
Well, here’s a tl;dr answer to that question: “All you have to do is look at Sweden,” says Dr. Ashwin Vasan, assistant professor of clinical population and family health and medicine at Columbia’s Mailman School of Public Health and president and CEO of the mental health nonprofit Fountain House.
Sweden’s death toll right now is actually higher than that of the United States.
Now for the longer answer: To achieve herd immunity through infection alone, most of us have to contract the virus. So how’s that going for us? Well, to achieve the roughly 70 percent infection rate required for herd immunity without a vaccine, more than 200 million out of 330 million people in the United States would have to contract the virus. As of my writing this article, 4.4 million people have contracted it.
Not even close.
But the really frightening factor is how many people would likely die in the process. We could double our current death toll (150,000) at the rate of 65,000 new infections per day and we still wouldn’t even be close to 70 percent herd immunity. That’s a lot of deaths to gamble with. And one of those could be me. It could be you. It could be the person you love the most in this whole wide world.
Close to 10 million Americans will have contracted the virus by the year’s end, increasing community spread and possibly driving up the death count… and it won’t be enough.
I’m not a mathematician. My numbers here are basic linear math. But of course a pandemic operates more like a pinball machine, and risk models involve complex equations that could look even worse in terms of the suffering, especially as we see cold and flu season add to the whole mess in the fall.
But the equations all add up to the same thing: If mass infection is our only path to immunity, we have a long way to go, a lot more deaths to grieve, and a healthcare system that will buckle under the weight of it all.
“It isn’t a responsible strategy anywhere,” Vasan says of natural herd immunity. “But it’s particularly irresponsible in a society like ours with vast structural inequalities and disparities in health and social welfare, which will result in the burden of that herd immunity strategy falling on people who are already at the margins of society. That’s not a moral or an ethical, let alone effective, response.”
The first thing to realize is that a vaccine won’t do anything if people don’t go out and get it. If a fire breaks out and you’ve got access to a fire extinguisher, isn’t it a no-brainer to take aim? And if it’s a big fire, the more people you have trying to put it out, the better.
With SARS-CoV-2, we don’t yet have all the answers on immunity — and when I say “we,” I really mean the smart scientists and experts out there doing all the research. They don’t know whether contracting the coronavirus makes us immune to reinfection. And because we don’t have an official ready-to-administer vaccine yet, we don’t know the level of immunity one will provide. A vaccine may give us partial or short-term immunity or make the virus less severe if contracted.
“It’s more likely that this is going to be like a flu vaccine that we refresh every year, that gets better every year, or that adapts to circulating strains every year, and that we’re constantly tweaking,” Vasan explains. “If we had to guess, that’s the prevailing wisdom right now, but we’re not sure.”
Life won’t morph back into some sort of pre-corona unicorn once we have a vaccine, either. The virus doesn’t just poof itself away. We’ll need to continue with certain social-distancing and mask-wearing measures for a while, Vasan says, especially if only 50 percent of Americans get the vaccine. “If that number doesn’t move, then we’re not going to get to where we need to go,” he explains.
But if most people grab for that fire extinguisher….
Some people worry about vaccine risk, but serious side effects from vaccines, although not zero, are extremely rare. The U.S. Department of Health and Human Services website says, “For example, if 1 million doses of a vaccine are given, 1 to 2 people may have a severe allergic reaction.”
Large-scale studies are in place to determine risk on a new vaccine well before it enters your arm (or however else it’s administered).
“The vast majority of vaccine-related complications happen in the relatively immediate aftermath of administering the vaccine,” Vasan explains. “The vast majority of complications and adverse events and reactions will be captured within a clinical trial. The likelihood that something comes to market, approved by the FDA, that is patently unsafe is probably unlikely.”
Yes! We shouldn’t just be sitting on our hands and waiting for a vaccine as some sort of golden ticket. There is another way of getting on top of a pandemic and saving lives. “The roadmap is to suppressing transmission of the virus,” Vasan says. “And that has very little to do with the vaccine — at least to start.”
Vasan says one answer is a nationalized, federally led public health response strategy to the pandemic like we’ve seen work in some countries.
“It is massive investments in testing,” he explains. “It is massive investments in contact tracing. It’s investments in the ability for people to quarantine and the support that they need economically and socially to get relief from the effects of quarantine. It is massive investments in personal protective equipment and executive orders that mandate masking and social distancing…”
That’s a great wish list. But unfortunately, many of those things Vasan mentions are not in place nationwide. For example, one of the most effective (and the simplest!) things we can do to stop community spread, according to science, is wear a mask.
Scientific models show that if 80 percent of people wore masks, we could dramatically slow transmission, save lives, and even potentially eliminate the virus. Yet the United States doesn’t even have a national mask mandate. The governors of 17 states still haven’t made it the law to cover your face. And, sadly, not enough people are willing to do it of their own accord. Less than half (44 percent) of Americans say they always wear a mask outside the home, and there’s a strong anti-masking movement out there.
So we aren’t likely to quash the pandemic anytime soon via a unified national public health strategy from our government leaders — or, I might add, simply out of kindness and respect for other people.
“Calling it ‘Operation Warp Speed’ is probably not good messaging, because people think you’re making sacrifices in safety in order to get something to the market quickly,” Vasan says of the Trump administration’s name and vision for an available vaccine ready to go by early 2021.
Right now the world has more than 100 projects dedicated to finding a COVID-19 vaccine, with close to 30 of them being tested in humans in some capacity. So yes, there’s a race for a vaccine — but let’s dive into what that really entails.
“Vaccines have to go through this very well-laid-out, very vigorous plan for assessing two things,” Safdar says. “One is safety and the other is efficacy, and both of those things have to be very strong for the vaccine to be out in the population.”
A Phase III trial to test if a vaccine is effective involves thousands of people. And before a vaccine even reaches that stage, it’s been tested on volunteers in a Phase I safety trial and a Phase II expanded trial.
In the United States, the FDA is responsible for regulating vaccines and requires drug developers to adhere to a strict process. You may have heard that the FDA has given “fast-track” designation to some vaccines in the works.
“The accelerated time frame for a vaccine doesn’t mean that any of these steps have been short-circuited or skipped altogether,” Safdar explains. “Rather than having it in [the FDA’s] usual flow of putting things in a queue and reviewing them when they come to that spot in the queue, they’re fast-tracking them, meaning that they’re pushing them to the top of the queue.”
Right now, COVID-19 is set to become a leading cause of death in the United States for 2020. So it’s the health crisis that is the biggest priority, and a vaccine is one of the biggest priorities for pounding down the pandemic.
Vaccine risk, rare but not zero, isn’t the only risk in the equation. Here’s the full set of risks to consider: “On the one hand,” Vasan says, “you’ve got the potential risks of a vaccine, which I think by the time it comes to market will be relatively minimized. On the other hand, you have this very real and documented risk of getting coronavirus.”
You could die from the virus, he adds, endure long-term complications, or transmit it to someone more vulnerable than you — if you don’t fall into the high risk category yourself.
The Centers for Disease Control and Prevention (CDC) lists broad categories of people with heightened risk for severe complications. But the reality is more complicated.
“Even young people are suffering pretty dire consequences,” Safdar explains. “Without the ability to predict severe illness, death, and long-term complications, there’s only one solution. Most people in a population need to be vaccinated to protect themselves and each other.”
Another consideration is that vaccine hesitancy is a very real threat to the world. “WHO has identified that as one of the greatest public health threats of the next era — the next 10 years and beyond,” Vasan says. But if you do the research, get beyond the fear, and get the vaccine, others you know may follow. If you spread fear, however, the opposite can happen.
During a pandemic — not to mention one in a presidential election year — disinformation can spread much like a virus. And we’re all responsible for stopping that spread. A big key here is that we can’t assume memes or cousin Tommy’s social media posts are truth. Consider whether you can click on a link in a post and be taken to a reputable, unbiased source.
When I teach media literacy to university students, I encourage them to use this chart in choosing a news source. It categorizes news organizations on their reliability and impartial reporting.
Additionally, if you want to investigate a post or claim, plug it into a fact-checking site. For example, there’s a viral image going around that states “Four kids who took the coronavirus vaccine died immediately.” You can simply search “vaccine” on PolitiFact, which is run by the Poynter institute, and quickly learn that the claim is false.
“Find one or two trusted sites where science is leading the way,” Safdar suggests, “whether that’s your local department of public health, whether that’s the CDC website or the NIH website, those are the places to go to for vaccine information.”
When you’re in doubt or worried about disinformation from the higher reaches of government, always focus on the science. “Trust the scientists who are reviewing these studies, talking about these studies, and publicizing these studies,” Vasan says. “We’re guided by the right data. We’re not guided by power and political gains and by votes.”
We don’t know the specifics of who will be the first to get the vaccine when one is available. Experts like Vasan are suggesting roll-out plans that protect the most vulnerable first along with front-line workers.
“We already know that this virus is having a disproportional impact on the poor, on communities of color, and on vulnerable groups with preexisting conditions, and otherwise elderly, and the like,” Vasan says. “So we need to be talking about a national vaccine distribution strategy that prioritizes those groups, which will create immunity, or at least short-term immunity in the highest-risk categories. And then we can work in successive stages to make sure that it’s distributed more widely.”
Depending on your circumstances, you may not have access to the vaccine right away. “If it becomes available to you,” Safdar says, “that’s an opportunity you should avail yourself of.” Make a plan to rally friends or family members (who have it available to them as well) to go with you — while practicing social distancing, of course.
And although we don’t know the specifics on a COVID-19 vaccine yet, keep in mind that you won’t have an immediate level of immunity. “Vaccines have timing issues in the sense that it does take a couple of weeks for the antibodies to build up,” Safdar explains.
I get it. The COVID-19 pandemic is terrifying. Less than 3 months into a year of barely finished resolutions, many of us entered lockdown. Some of us are still sheltering in place by choice. Now we’re staring down this race for a vaccine, and that seems scary too — until you look at the data behind vaccines and understand how they’re developed, tested, and vetted. Then it becomes less frightening.
With my compromised immune system, I can’t risk getting this virus. All I have to look forward to is a day, hopefully, when it’s a little safer to go out in public. And the hard part is knowing that so much of what will make it safer for me is out of my hands. For example, in my state, many people are still refusing to wear masks. Gah!
No question — as soon as I can, I will get the vaccine. But I have zero control over what everyone else will do. If you’re hesitant to get a vaccine when one is available, I plead for you to read the science and to remember this closing note from Dr. Safdar: “The vaccine serves a greater social good as well as an individual good.”
Jennifer Chesak is a Nashville-based freelance book editor and writing instructor. She earned her master of science in journalism from Northwestern’s Medill and is working on her first fiction novel, set in her native state of North Dakota.