Vaccines have changed the world, saving hundreds of millions of lives. They are also, to date, our best hope for stopping the Covid-19 pandemic. Our other solutions to stop the disease are isolation, which is detrimental to our economy and society, or the strengthening of ‘herd immunity’ due to natural infection, which would mean more than a million deaths in the United States and 10 million or more deaths worldwide. However, pushing Covid-19 faces three main obstacles.
First, will it work? Preliminary studies show that several types of vaccines currently being developed elicit a strong immune response. This is good news, but it does not mean that the vaccine will protect people from infection or disease. We do not know if the immune response is protective, and if so, what that protection will be. (Protection from 0% to 60% from flu vaccines to 95% or higher for some other vaccines.) Even if a vaccine protects against disease, it may not prevent people from becoming infected and spreading the virus to others.
We also do not know whether all people will be protected by the new vaccine, especially the elderly, who are at a significantly higher risk of Covid-19 and who may be less likely to have a strong immune response. We also don’t know how long any protection will last. We don’t even know how natural Covid-19 infection protects; for many vaccines, immunity against natural infection is the limit of their effectiveness.
We don’t know if all people will be protected by the new vaccine.
However, we have good reason to be optimistic that some vaccines will provide a certain level of protection and that this will be demonstrated by 2020. The end. Some vaccine candidates may be dirty, while others may lose their effectiveness in just a few months. – something like that will definitely take many months. Different vaccines may be more or less effective, and some vaccines may not work as well for some groups. And most vaccines never confirm that; many promising candidates today may fail. We just don’t know. That is what studies are for.
Second, will it be safe? What can happen to new vaccines? A lot. Several vaccine candidates use a harmless virus as a “vector” to deliver the antigen. This technology is promising, but we have little experience in using it. And we have never used DNA or RNA vaccines – the technology used to develop several Covid-19 vaccines – in humans.
We now know that a small percentage of children infected with Covid-19 can cause a life-threatening inflammatory condition because their immune systems respond to the coronavirus. The vaccine can, in rare cases, cause a similar immune storm, causing serious illness, especially in children, due to the vaccine itself or from subsequent exposure to the virus. There is no particular reason to believe that Covid-19 vaccines will cause this type of excess, but this is a risk and should be investigated both before and after approval.
Vaccination against polio is cautious. Shortly after the invention of the vaccine, one manufacturer infected a batch of the vaccine and many children were paralyzed. In 1976, when an outbreak of H1N1 flu in Fort Dix, NJ, sparked concern about the pandemic, President Gerald Ford prompted vaccinations for tens of millions of Americans. But the feared pandemic never materialized, and the vaccine paralyzed more than 500 people, causing some to have lifelong problems.
Despite these rare and deplorable episodes, vaccines are still extremely safe: billions of doses are given to people around the world every year with very few problems. Despite vaccination side effects, it may go unnoticed until hundreds of thousands or millions of people have been vaccinated, so there can be no brief indication of safety. Humility in order.
Third, can we get it for people? Even if we can develop an effective vaccine that provides the primary safety record, would we be able to get it for humans? Vaccine production is not easy. Failure or contamination can occur even in experienced pharmaceutical companies – and not all companies producing new vaccines are experienced.
And even if an effective, apparently safe vaccine is produced in large quantities, it will be difficult to distribute it quickly and correctly, store and ship it at the right temperature, educate doctors and inform communities, and monitor uptake and potential adverse effects. . The protection provided by even a very effective vaccine is as good as our supply systems. The measles vaccine is more than 90 percent effective, but the World Health Organization reports that more than 140,000 children worldwide died of the disease last year, most of them in low-vaccination communities.
Especially in this election season, the process of evaluating vaccines must be scientifically rigorous and open.
The biggest challenge to getting enough people with Covid-19 will not be scientific, technical or logistical; this will result from mistrust. Especially in this election season, the process of evaluating vaccines must be scientifically rigorous and open. Public confidence can be destroyed by high profit margins of vaccine manufacturers, a lack of transparency about production costs and prices, despite the fact that many vaccines benefit greatly from publicly funded research. Open meetings of the main advisory committees of the Food and Drug Administration and the Centers for Disease Control and Prevention will be required.
We must communicate with American society in a way that was not done during this pandemic. We do not have enough tests, so we need to set priorities. There are not enough protective equipment for healthcare workers, so we should produce safe reusable95 masks. And when we get vaccines, we won’t have enough of them for everyone. Different vaccines may be available at different times, and some are likely to work better than others. Governments will need to prioritize between different groups, taking into account factors such as the risk of severe Covid-19 disease, protection of key functions, and equity. For example, staff working in prisons, nursing homes and hospitals, blacks and Spaniards are more prone to the effects of the virus and have health problems that make them particularly vulnerable.
In addition, vaccines will not provide perfect protection and are unlikely to eradicate a pandemic. In our connected world, a truly global vaccination campaign will be essential to America’s long-term health and economic recovery.
Even in the U.S., unless the vaccine is particularly effective and acceptable, cases and groups will continue, necessitating rapid, effective public health responses. Our society will still have to adapt to limit the spread of the virus – it will reduce close contact indoors, hold on to hand clicks, wear masks and improve ventilation. And unless the vaccine is surprisingly strong or we find very effective treatments, my 91-year-old mom will soon return to her beloved choir practices.
Deploying the Covid-19 vaccine is the most important thing we can do to restore order and normalcy in our world. We cannot afford to make mistakes.
—Dr. Frieden was director of the CDC from 2009 to 2017. He is President and CEO of Resolve to Save Lives (an initiative of the public health organization Vital Strategies) and a senior associate on the Foreign Relations Council.
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