Issue 20: The Vaccine On The Horizon
08.02.20 | The monumental feat of developing a Covid vaccine in the lab is, unfortunately, the easy part.
Hello,
This week the national Covid case count drifted slightly lower, stuck in the sixty-thousand-per-day range, as average daily deaths rose their highest levels since May. The stable topline numbers conceal a shifting geography of pandemic — places that had been hotspots have seen their local epidemics cool slightly, while the virus spreads into new communities.
This amounts to a mixed picture: good news that case counts appear to be stabilizing, only they’ve settled at such high levels that we are likely already locked in to several weeks in which more than a thousand people die of Covid every twenty-four hours. Earlier this months models forecast the U.S. would pass 200,000 Covid deaths by November. At the current pace we will reach that threshold by mid-September.
This is, simply put, not a great place for the country to be in as we accelerate towards autumn, when people will spend more time indoors, (some) schools will reopen, and quarantine fatigue—from the financial and psycho-social costs of isolation—will continue to mount.
What’s more, there’s still no coherent national plan to fight the pandemic and no indication that one is coming. Unless you count Operation Warp Speed, the effort to rapidly develop a vaccine against SARS-CoV-2. And the development of a vaccine, which will be a monumental achievement, especially coming within months of the discovery of the virus, will, unfortunately be the easy part.
A vaccine has been touted since the beginning of the pandemic by politicians and in the news media as a silver bullet — the one thing that will bring the pandemic to an end. There’s good reason to believe that an effective vaccine really will be developed and available by 2021. There are several promising candidate vaccines currently entering late-stage trials in humans, promising enough that there are already plans to produce millions of doses of various candidates, to be warehoused on stand-by, to be distributed as soon as the trials show a vaccine is effective and safe. This kind of financially risky bet is unusual, and is a major reason the shortened timeline for a vaccine is possible.
And yet the vaccine on the horizon will not be the end of the story of this pandemic. It won’t suddenly bring about a return to “normal” life. This issue of the newsletter explores some of the reasons why.
[Scientists at the Serum Institute, in India, at work on production of a candidate vaccine for the Coronavirus. Atul Loke for The New York Times.]
// In This Issue:
Link Roundup
A Vaccine Alone Won’t End The Pandemic
// Link Roundup
More on school reopening: A helpful roundup of four principles for safe school reopenings here — 1) Schools can’t reopen safely at all in communities where the test positivity rate is above 5 percent; 2) Reopened schools must avoid high-risk activities like singing, contact sports, or indoor athletics of any kind, avoid high-congestion at lockers and in cafeterias, for example by serving lunch in classrooms; 3) take measures to make medium-risk activities, like learning in a classroom, safer by for example making sure masks are worn, classrooms are well ventilated; 4) generally reduce density of contacts in schools, by staggering arrival and dismissals and reducing the number of close contacts between different teachers and students through “stable cohorts.”
— “Opening Schools Won’t Be Easy, but Here’s How to Do It Safely.” Ezekiel J. Emanuel, Saskia Popescu and James Phillips, The New York Times.How long are people contagious? Among the early missteps health officials made in containing the pandemic was underestimating how widely people with pre-symptomatic or asymptomatic infections could spread the virus. It’s not completely clear when people start being contagious, but we have a good idea of when they stop: even people with long-term Covid stop shedding virus that can infect other people within about nine days after their diagnosis. Why is that? And what’s happening inside the bodies of people with long-term infections? It turns out, SARS-CoV-2 isn’t that unusual in its tendency to lurk in the body in strange places long after an initial infection.
— “The Mystery of Why Some People Keep Testing Positive for Covid-19.” Roxanne Khamisi, Elemental.What exactly is ‘mild’ Covid? We know that Covid infections can leave serious, lingering health consequences even for people who don’t become sick enough to be hospitalized. Why aren’t we developing measures to track these cases? Nisreen A. Alwan, a public health doctor and epidemiologist, suffered a mild bout with the virus and hasn’t fully recovered months later. Alwan writes: “Death is not the only thing to count in this pandemic, we must count lives changed. We still know very little about Covid-19, but we do know that we cannot fight what we do not measure.”
— “What Exactly Is Mild Covid-19?” Nisreen A. Alwan. The BMJ Opinion.Most of us are wearing masks: There’s been a lot of hand-wringing about the partisan divide around masks. And while a vocal minority have either shirked mask-wearing or embraced it on purely ideological grounds, most Americans are diligently masking up in public, according to new polling from HuffPost/YouGov. There is a partisan gap — Democrats are likelier than Republicans to say they always wear a mask in public — but the gap is bigger in perception than in reality. Democrats vastly underestimate the share of Republicans who support mask wearing. Interestingly, Republicans are far more likely than Democrats to say President Trump supports mask wearing.
— “Wearing A Mask Is More Popular — And A Little Less Partisan — Than You Might Expect.” Ariel Edwards-Levy, The Huffington Post.How to win public trust: There’s an interesting line of literature I’ve been following, on lessons public health professionals are learning from the fight against Ebola in 2014. Not about treatment or pharmaceutical interventions, but in winning public trust for disease prevention. Charlie Warzel at the Times interviewed several experts, who noted that the key to winning the trust of people in West Africa who resisted outbreak control advice was recognizing that they “weren’t selfish or anti-science. They were scared and felt stripped of dignity by officials who didn’t respect them or understand their traditions. What they needed was for someone to listen to them and to feel like they had some agency.” When it comes to physical distancing, economic shutdowns, masks, and even vaccination, paying attention to people’s sense of agency is crucial here in the U.S. as well.
— “How to Actually Talk to Anti-Maskers.” Charlie Warzel, The New York Times.It’s somebody else’s job until “our people” fall ill: There’s a raft of reporting out in the past week painting a picture of a White House that failed to act seriously against the pandemic until it started directly affecting people perceived as Trump voters. In the Washington Post Ashley Parker and Philip Rucker write: “In the past couple of weeks, senior advisers began presenting Trump with maps and data showing spikes in coronavirus cases among ‘our people’ in Republican states, a senior administration official said. … This new approach seemed to resonate, as he hewed closely to pre-scripted remarks in a trio of coronavirus briefings last week.” This resonates with Katherine Eban’s reporting for Vanity Fair — a public health official who consults with the White House’s coronavirus task force described a sentiment among administration officials that “because the virus had hit blue states hardest, a national plan was unnecessary and would not make sense politically. ‘The political folks believed that because it was going to be relegated to Democratic states, that they could blame those governors, and that would be an effective political strategy,’ said the expert.”
— “One Question Still Dogs Trump: Why Not Try Harder To Solve The Coronavirus Crisis?” Ashley Parker and Philip Rucker, The Washington Post.
— “How Jared Kushner’s Secret Testing Plan ‘Went Poof Into Thin Air’.” Katherine Eban, Vanity Fair.Afrofuturism and the post-Covid world: The way out of the pandemic isn’t only a technological story, but a cultural one. This fantastic essay considers how Afrofuturism might hold the keys to envisioning a more just, equitable future. C. Brandon Ogbunu, a computational biologist and an assistant professor at Yale University writes: “Why do we care about what the Afrofuturist has to say? And why would we suspect that their answers would differ from that of an average futurist? It is because the Black experience is defined by a historical struggle for existence, the right to live, to be considered a person, to be afforded basic rights, in pursuit of (political, social, economic) equality. Because of this, the Afrofuturist can see the parts of the present and future that reside in the status quo’s blind spots.”
— “How Afrofuturism Can Help the World Mend.” C. Brandon Ogbunu, Wired.
// A Vaccine Alone Won’t End The Pandemic
Usually, vaccines take years to develop. For some viruses, like HIV, a vaccine has eluded scientists for decades. Luckily, thanks in part to the uncommon machinery it uses to protect itself against mutation, and in part thanks to broader scientific innovations in recent years SARS-CoV-2 is a relatively stable virus that has been yielding under a scientific moonshot to develop a vaccine. There are now six different vaccine candidates in late-stage trials around the world. At least one of them is likely to have proven effective and safe by the end of this year.
That we’re this close to a vaccine barely half a year after having discovered the virus is a monumental accomplishment. It might not be one we can repeat against future emerging infectious disease pandemics. And it’s fraught with potential failures that might derail the process. But assuming at least one vaccine makes it credibly through the approval process, there are still three major barriers to ending the pandemic: distributing doses to the public, convincing people to get vaccinated, and maintaining public health measures to control new clusters of infection.
As science reporter Sarah Zhang wrote in this excellent long-read, a successful vaccine will be only the beginning of the end of the pandemic. There’s simply too much SARS-CoV-2 circulating in the world right now for us to talk realistically about eradicating it. A successful vaccine will almost certainly not be 100 percent effective. If we’re lucky, vaccination will drive down the total number of active infections, or reduce the severity of the average case, lightening the burden on the hospital system. That’s been essentially the state of play with flu vaccination for decades.
But we can’t talk meaningfully about the widespread effectiveness unless people can get access to a vaccine in the first place. The CDC is the only agency in the government to have experience in setting up an emergency nationwide vaccination program — it built and deployed one for the H1N1 flu pandemic in 2009. But that infrastructure has atrophied, and there’s general confusion coming from the White House now about the degree to which the CDC will even be involved in distributing a Covid vaccine — the administration is considering tapping the Department of Defense to lead the effort instead.
Assuming that hurdle can be cleared, there’s the question of getting people to accept the vaccine. There’s broad distrust of the Covid vaccine process right now, according to polling, distrust that goes beyond the more general skepticism around vaccination that has been a volatile element in our politics in recent years. It’s easy to imagine a scenario in which a disorganized vaccine distribution process fails to convincingly slow the spread of the disease, further undermining public trust, in a vicious cycle.
Finally, even once a vaccine begins to be administered, we’ll still need to be wearing masks and avoiding handshakes for some time to come. And we’ll still need to administer tests widely, do contact tracing, and isolate people who’ve been infected and the people they’ve been in contact with — in this respect, Covid will become no different from Measles, or Tuberculosis, or any other of the serious infectious diseases that still smolder in the human population.
As former head of the CDC Tom Frieden put it recently, one of the most important things to do in the run-up to the release of a vaccine is to temper expectations, and give everyone time to come to grips with the fact that life won’t actually return to normal very quickly even once a vaccine is definitively found to be effective. Frieden writes:
We must level with the American public in a way that hasn’t been done during this pandemic. We don’t have enough tests, so we need to prioritize. We don’t have enough protective equipment for health-care workers, so we should produce safely reusable N95 masks. And when vaccines do arrive, we won’t have enough for everyone. Different vaccines may become available at different times, and some will probably work better than others. Governments will need to set priorities among different groups, considering such factors as the risk of severe Covid-19 disease, protection of essential functions and fairness. Workers in jails, nursing homes and hospitals, for instance, and Black and Hispanic people are more likely to be exposed to the virus and to have underlying health conditions that make them particularly vulnerable.
Moreover, vaccines won’t provide perfect protection and probably won’t completely end the pandemic. In our interconnected world, a truly global vaccination campaign will be essential to America’s long-term health and economic recovery.
Even within the U.S., unless the vaccine is extraordinarily effective and accepted, cases and clusters will continue, necessitating quick, effective public-health responses. Our society will still have to adapt to limit the virus’s spread—reducing close contact indoors, holding off on handshakes, wearing masks and improving ventilation.
It’s difficult to imagine what the world would look like in a post-vaccine future in which Covid still circulates fairly widely, maybe in seasonal waves. Even if medical advances tame the disease to the extent that it takes as many lives as seasonal flu, we’re still in a world in which there are tens of thousands of additional deaths every year in the U.S. alone. But even that toll doesn’t take into account the long-term symptoms and disabilities that Covid inflicts that flu generally does not.
In other words, buy or make some backup masks. We’ll be wearing them for a while.
That’s our shot for this week - see you next weekend in the inbox!