Covid-19 Vaccines Are Not The Reset Buttons To Pre-Pandemic Normalcy
Note: This article is only meant to explain why a vaccine alone won’t help us tackle this pandemic. I don’t imply that we shouldn’t invest in vaccines or that vaccines are ineffective. Covid-19 vaccines will help save a lot of lives, but we shouldn’t consider it as the sole ‘saviour’ that’ll help us tackle this pandemic. Please read through the entire article before forming opinions.
We’ve come a long way from 31st December 2019. It has been 9 months since the Wuhan Municipal Health Commission first declared a cluster of cases of pneumonia in the Hubei province. A few days later, a novel coronavirus was identified, and we now call it Covid-19 (aka SARS-CoV-2). The first two big news of 2020 was the bizarre murder of Iranian General Qasem Soleimani by the US government by a drone strike and the Australian Bush fires. In any given normal year before 2020, these two news would have been the talk of the entire year. At least, when I read about the murder of General Soleimani, I really did believe that this was going to be the news of the year.
I was terribly wrong. Almost 100 years after the terrible Spanish Flu that lasted for two years, we are going through a pandemic again. This time, the virus is much deadlier and has more unknowns than the strain of Influenza that caused the Spanish Flu pandemic.
Governments around the world have taken unprecedented actions; strict bans on travels, lockdowns, new methods of Contact tracing, prioritizing the health crisis over the economy, Standard Operating Procedures for various events, etc. It has been 6 months since major countries around the world issued strict lockdowns. However, the global count for daily active cases is increasing day by day. Many countries are seeing a decrease in the daily active cases, while many others are seeing an increase in the daily active cases count. Some countries that successfully flattened the curve are now seeing second waves and some are facing their fourth waves as well.
For the common person, the coronavirus vaccine is the magical surprise that happens in the climax of a movie that can suddenly help us return to pre-pandemic normalcy. Personally, as an academic, this concerns me a lot. If you are in a family WhatsApp group, you will know that any news about some random Covid-19 vaccine excites everyone in that group. People are so desperate that a simple headline about a Covid-19 vaccine passing Phase-1 trials excites us so much.
That is one of the biggest concerns from public health experts. The expectations of a ‘Polio vaccine’ style Covid-19 vaccine is soaring. People believe that once we have a properly tested vaccine, we can immediately throw away our masks, ignore social distancing, stop investing in contact tracing, stop working from home and immediately move towards pre-pandemic normalcy.
Russia has already launched Sputnik-V, the first registered coronavirus vaccine that hasn’t even gone through complete human trials. In the past month, two more vaccines have entered the final stage of human trials which generally last for months. That news brought a lot of the media and politicians to claim these events as ‘historic’ and ‘unprecedented’.
The promise given by politicians is that, we common people must wait for a few more months and once a vaccine is available, we can immediately hit a reset button and have a normally functioning world. Turns out that the promise isn’t that simple to keep. If the pandemic has taught us anything, the public health crisis doesn’t have an on-off switch.
Companies have been claiming that they would be able to launch a good vaccine by the end of this year, without backing themselves with proper data. This blind optimism from politicians and the desperation among common people to move towards pre-pandemic normalcy is very much worrying. As we keep reading more about a new company’s vaccine passing phase-1 trials, the expectations of a ‘saviour vaccine’ is increasing among the public.
To help you understand why the arrival of a vaccine won’t magically bring us back to the pre-pandemic normalcy, we need to understand vaccines.
No, I am not among the group of believers who believe the conspiracy theory that vaccines are bad and that the vaccines are some conspiracy by the rich to control the population, etc. It is sad that in the 21st century, despite the scientific evidence, people are still believing in such conspiracy theories. I am going to present you with facts that are readily available in WHO’s documents and approved claims from National Institute documents of various countries.
Anyways. Let us understand more about vaccines.
In 1955, a very effective vaccine for polio was developed and the US government took swift actions to vaccinate the entire country and eradicate polio there. For their time, it was a very ambitious project. Despite the ready availability of the vaccine, it took 24 years to eradicate polio in the entire country, even though the total number of cases reduced by 80% before 1960.
But I want to focus on one specific incident that happened in the US which is a case study for what might happen if we force the speed of vaccine production; The Cutter incident.
The original polio vaccine is made by weakening three strains of the poliovirus by growing them in monkey kidney cells, which when swallowed by an individual will cause the body to produce the antibodies required to kill the poliovirus, but these weakened poliovirus cells won’t cause the polio disease to that individual.
A set of polio vaccine doses from Cutter Laboratories had actual living polioviruses instead of weakened versions of the virus. 1,60,000 of those doses were shipped from Cutter Laboratories, which infected 40,000 children with polio, which ultimately leaving 160 children to be completely paralyzed for life. One of the reasons among this human-made epidemic is the public pressure to quickly vaccinate everyone as soon as possible that led to Cutter laboratories to not fully implement the safety checks required before flooding the doses into the market.
The Cutter incident is just one incident, but it led to huge public distrust for vaccines. The Cutter incident is still used as a case study by public health experts to ensure proper manufacturing of vaccines.
We are seeing a much larger global level demand for a Covid-19 vaccine. Even if we have a safe and effective vaccine whose working is much different from how the Salk vaccine works, administering those vaccines on a global scale will take at least a year or two to get done safely (Many public health experts project that it might take years). Many vaccines require multiple shots to be administered to a person which means we must manufacture these vaccines at a much larger scale than required.
Even if the Covid-19 vaccine is much different from the other vaccines, if we mount too much pressure on the manufacturers to develop these vaccines, then we might have multiple ‘cutter incidents’. Remember, the poliovirus isn’t as contagious as Covid-19. So, one ‘cutter incident’ from some lab developing samples for Covid-19 vaccines could cause huge community spreads and outbreaks leading to a much bigger man-made pandemic.
So it is crucial that we don’t mount the public pressure for vaccines on these companies just to fast track the vaccine manufacturing process and quickly vaccinate more people. Due process is crucial to ensure safe manufacturing of vaccines.
Another concern of many scientists is about Vaccine effectiveness and Virus mutations. Viruses like Covid-19 are known to mutate all the time. Most mutations don’t adversely affect people, but such mutations cause worries about administering vaccines. To understand this, we must understand the effectiveness of vaccines.
Not all vaccines are 100% effective. I am not implying that we shouldn’t vaccinate; don’t get me wrong. Vaccines have different levels of effectiveness. For example, the Measles Mumps and Rubella vaccine (popularly known as the MMR vaccine) has 99% effectiveness for Measles and 88% of the people from Mumps. It essentially means that 99% of the people who have taken the MMR vaccine are safe from Measles and only 88% of the people who have taken the MMR vaccine are safe from Mumps. According to a study by Esther Kissling et al (paper available in EU’s CDC website), based on the data collected in Europe, the vaccine effectiveness of Influenza A vaccines averages around just 58% in the year 2017–2018.
A lot of vaccines have such low Vaccine Effectiveness. That doesn’t imply that vaccines don’t work. The point of vaccines is also to achieve herd immunity.
India has eradicated polio. But that doesn’t mean that all kids in India were vaccinated.
Look at it this way. Assume that a vaccine has an effectiveness of 95%. It essentially means that out of every 100 people, 95 of them are assured with protection from a specific disease and it is very likely that the remaining five might not have developed immunity for the virus. So, let’s say only one person in that unprotected group is infected with the virus. It is assured that even if that affected person comes in contact with the 95 protected people, the virus isn’t going to have any effect on those 95 protected people. And the likelihood of the infected person coming in contact with the other four unprotected people and spreading the disease is very very low as well.
This is called herd immunity. So even if we have vaccines that are only 75% effective, we can definitely save a lot of lives and prevent a good portion of the population from being infected with that virus. But this calculation assumes that the entire population is vaccinated. And I just mentioned that we cannot instantly manufacture vaccines for the entire population in a month and that it would take at least a year to do that. So, if this vaccine with 75% vaccine effectiveness is administered only to a portion of the population, then 25% of the vaccinated people and the people who haven’t taken a vaccine are vulnerable to the virus.
We can apply this logic to any potential Covid-19 vaccine. Covid-19 has caused a pandemic and hasn’t sparred a single country. To even think of vaccinating 50% of the global population within 6 to 8 months itself is a logistical nightmare. And a lot of experts are telling that, the vaccines that are in Phase-3 stages now might not have vaccine effectiveness of greater than 65%. Let me quote one of the most influential immunologists, Dr Anthony Fauci who said in a webinar hosted by Brown University, “We don’t know yet what the efficacy might be. We don’t know if it will be 50 percent or 60 percent”. He also said that the possibility of a vaccine with an effectiveness of greater than 90% is very slim.
This means we cannot immediately rush towards normalcy even if a vaccine is administered to a major population; the current mask mandates and social distancing norms will still have to be followed until a much larger population has been vaccinated.
A lot of scientists are projecting the effectiveness of CanSino’s vaccine (China) and Russia’s Sputnik-V at around 50–60% effectiveness. Anna Durbin of Johns Hopkins University recently said about those two vaccines, “It might have 40% efficacy, and that’s better than nothing”.
So even if we have a vaccine, the likelihood of it having an effectiveness of greater than 60% is low. Even if we administer it to a portion of the population (we cannot vaccinate the entire population within a year), there are still going to be outbreaks around the world and pre-pandemic normalcy will still be a far-reaching goal for us. Administering less effective vaccines could also lead to the vaccinated people assuming that they are immune to the virus, when in fact there is a good likelihood that even the vaccinated people might contact Covid-19 and become vectors for further transmission.
The other problem with vaccines with less effectiveness is that there is a mild chance of these viruses mutating quickly and some scientists are worried that less effective vaccines could apply “evolutionary pressure” to these viruses which can mutate so that these viruses can evade antibodies that are produced by the body as a response to these vaccines. Ian Jones of Reading University expressed his concerns saying, “Less than complete protection could provide a selection pressure that drives the virus to evade what antibody there is, creating strains that then evade all vaccine responses. In that sense, a poor vaccine is worse than no vaccine.”
We do not know how effective Sputnik-V is and these are the two reasons why scientists are reluctant to approve it to the general public without running larger-scale tests.
Let’s get to the other issue; with how the news media has projected the development of vaccines from various countries. Every time a vaccine has passed a phase of clinical trials, the news media projects it as some form of major victory that has brought us drastically closer to getting back to normalcy. Especially in the past month, we’ve been listening too much chatter about two vaccines moving towards phase-3 trials.
Let me quote Mike Ryan, executive director of the WHO’s emergencies health program, who said recently, “Phase three doesn’t mean [we’re] nearly there. Phase three means this is the first time this vaccine has been put into the general population into otherwise healthy individuals to see if the vaccine will protect them against natural infection.”
The quote from Mike Ryan makes perfect sense. The media has been projecting Phase-3 trials as the definitive step of the vaccine testing process. A lot of people are also under the impression that Phase-3 trials are easy to pass. That is not the case. Until Phase-2, we only test the vaccine ‘under lab conditions’. Phase-3 trials are the first time the vaccine is given to a more diverse and large population and we must always remember that the real world is a lot of times much different from lab conditions.
It is extremely hard for a vaccine to get positive results in Phase-3 trials and a lot of vaccines have been dropped in Phase-3 trials. And due to the rushed development of Covid-19 vaccines, it is in Phase-3 do we understand the complications and potential side effects of vaccines and it is very likely that the vaccines that have entered Phase-3 could face lots of barriers.
If you look at the full interviews of the people working on these vaccines, you can tell that even those people have such doubts but that they remain optimistic (an amazing trait found in most scientists). These doubts expressed by these scientists are never properly projected by the news media.
We cannot rush Phase-3 trials because it is far more dangerous to administer untested medicine than waiting for a safer vaccine.
There are other issues too, but I’ve covered the major concerns that the academic in me has. Vaccines are great and we must invest more on the development of safe and effective vaccines. But vaccines are not the silver bullets. Even if we have a vaccine, it might take years to properly manufacture and administer it to the entire population. It would take a year or more to vaccinate at least 75% of the population which could lead to better herd immunity.
It is important that we invest in vaccines; it is also equally important that we stay with mask mandates, social distancing rules, staggered lockdowns and re-openings, work from home norms and wait until it is safe to reopen schools and colleges. As I mentioned before, the likelihood of the current slate of potential vaccines having low vaccine effectiveness is high and hence, retaining the social distancing norms, lockdowns and mask mandates are crucial even after approval of safe vaccines in order to ensure lower amount of cases. And I want to repeat, having an effective vaccine doesn’t mean that we can easily administer it to a global population immediately. Manufacturing vaccines take time and to vaccinate at least 50% of the population would at least take a year or maybe even more.
This pandemic is even more deadlier than Spanish Flu and even with the recent advancements in medicine and with a potential vaccine in the near future, it will still take a year or more for us to move towards a world where we can safely have a normal school life, house full theaters, stadiums and malls and to throw away our mask mandates.
I hate to quash your hopes that a vaccine could be the reset button. I wish I am wrong about everything I mentioned in the previous two paragraphs about how long it will take to go back, but based on currently available data, I cannot sugar coat science just to make it feel good about the realities of this pandemic. We must treat this in a much more serious manner and accept that vaccines are not going to be the silver bullet that is going to give us the Hollywood style rom-com happy ending that we expect. Vaccines can only speed up the process of returning to normalcy.
So, brace for impact. We will slowly return to normalcy, but it is going to be a staggered return. We still have a long way to go to return to normalcy where we can safely go out in crowds and have a normal life that we expect.
