When I plug my information into models predicting when I might get the Covid-19 vaccine, I have to scroll almost to the end, past 268 million or so other Americans, until I see my place in line. Health workers and those working and living in care facilities will be the first to receive the vaccines, if states follow the recommendations issued by the Centers for Disease Control and Prevention this past week (most say they will). Next, the vaccine will likely go to those with vulnerable health conditions, as well as to teachers and childcare workers, other essential workers in high-risk settings, those who live in homeless shelters and prisons, and the elderly. After that, once there’s safety data on how well the vaccine works in children, kids will likely be vaccinated, along with any remaining essential workers. And then the shots will go to everyone else—including me.
I feel pretty good about that: I’m reasonably young and healthy, and I can work from home in my nonessential job for the foreseeable future. But there’s also another reason I’m not too worried about coming last: I’m not, actually, coming last. I won’t have to wait for my “turn” to start seeing the benefits of the new vaccines.
Tools like The New York Times’ “Find Your Place in the Vaccine Line” quiz make vaccination sound like an individual enterprise. But giving the vaccine to other people first isn’t just a nice thing to do. People at the end of the line will start to benefit from the process long before they themselves are vaccinated.
This works in a couple of ways. First, the vaccines are very effective at preventing symptoms of Covid-19, which will lead to fewer hospitalizations and deaths. That means if I do get sick or injured—from any cause—I’ll receive care from a less-stressed health system. A health care system that is not overloaded or overwhelmed, and whose providers have already been vaccinated, is good for all of us.
This is how the flu vaccine, for example, works. It allows many of those who would have been hospitalized to recover at home instead, and those who would have been sick at home to experience much milder symptoms. “It basically ratchets down the severity of the disease, which is really, really helpful,” Dr. Andrea Cox, a professor in the infectious diseases division at Johns Hopkins University, told me. “The goal is not to keep anyone from being mildly ill but to keep people from being severely ill.” If everyone experienced very mild Covid-19 symptoms, or none at all, this pandemic wouldn’t be nearly as devastating. It wouldn’t even be a pandemic: It would just be another common cold season.
The Covid-19 vaccine trials were designed to look at how well the vaccines prevented illness, not infection. That means it’s possible after vaccination you could still get the virus and pass it on to others, which is why masks and distancing will continue to play important roles. Very few vaccines produce what’s known as “sterilizing immunity,” making contracting a virus completely impossible. Instead, most vaccines help strengthen your immune response to fight off the virus quickly and more effectively.
But even if the vaccine merely strengthens your immune response, that alone could still lower transmission rates. If you do become infected, you might fight it off more quickly than you would without a vaccine—which means you’re less likely to spread the virus if you get it. And that means that as those earlier “in line” get vaccinated, their vaccination may actually protect people later in line, almost like a defensive ring around the unvaccinated. “If we drive down the population of infective individuals, then those individuals who are not immune are less likely to come in contact with them,” Cox said.
“Basically, the viruses are going to encounter fewer and fewer susceptible people,” Dr. Jen Kates, senior vice president at the Kaiser Family Foundation, told me. “Scientists and researchers believe they will reduce transmission … and there’s a lot of reason to believe they will.” And any limits on transmission would have benefits for everyone, Dr. William Schaffner, a professor of infectious diseases at the Vanderbilt University Medical Center, told me. “Surely the more people we vaccinate, hoping that it actually inhibits transmission, the better off we will be.”
The other thing worth remembering as you compare your spot in line to someone else’s is that it takes more than a good vaccine to stop a pandemic. It’s not as if once someone is vaccinated they can return immediately to normal life. “Even if it were a perfect imaginary vaccine that induces 100 percent sterilizing immunity and everybody gets it and it’s perfectly safe for everybody to take—even then, we wouldn’t be able to say the pandemic is over the day that we start vaccinating people,” Dr. Angela Rasmussen, a virologist and affiliate of the Georgetown Center for Global Health Science and Security, told me. “It is not a small task to roll out hundreds of millions of doses, especially a vaccine that requires a two-dose regimen.”
Those doses need to be manufactured, then stored, shipped, and administered—a mammoth undertaking all on its own. “We’re going to have limited supply in the beginning,” Kates said. “We have to ration out what we have, to have the biggest effect. If we just throw it out there, it wouldn’t have the same effect.” That’s why health care workers are first in line, Kates said. “We need them as a workforce, because our lives are depending on them, and they’re being put at risk.” As soon as health workers and those at high risk are protected, she said, pressure on the health care system will be greatly reduced. “We need to keep them functional, in order to care for everyone else,” Schaffner said.
People in public health departments are working day and night to organize the “gigantic enterprise” of rolling out the vaccine, he added. “They are stretched extremely thin. They are stretched as thin in public health as the hospitals are stretched in clinical care.” And they’re undertaking this effort despite massive shortages in funding. Only $200 million of an estimated $6 to $8 billion needed for vaccine preparedness have been distributed so far.
Equity must be central to this unprecedented vaccination campaign, experts said. Many people of color have been disproportionately affected because of decades of discrimination and neglect, including in the medical system and in the workplace. Because of the U.S. government’s history of medical experimentation upon communities of color, many are also understandably hesitant to step to the front of the vaccination line. “This is a really difficult thing that we are going to try to do. And we’ll need as much help with the leadership in the Black and the Latinx community and other minority communities in our country to help us out,” Schaffner said.
However, experts said, the benefits of successful immunizations will start to be felt immediately. Schaffner particularly wants to prioritize anyone who works in childcare or schools. Not just teachers, but administrators, coaches, janitorial staff, cafeteria workers—everyone who plays a role in childcare and education. “If they could be vaccinated, first of all, you could hear the sigh of relief across the country among parents,” he said. (This parent, for one, sighed audibly as he spoke.) “That would make schools so much safer to open, that the parents could once again earn livings. And that would stimulate the economy and put everything back in a repairing mode. So things would slowly but surely get back to normal.”
Kates agreed. “It’s going to be incredibly life-changing when these vaccines start rolling out,” she said. “It really will.” These changes will begin long before everyone has received their shots. Just as disease isn’t an individual problem, protection against illness is a communal issue. And everyone in the community will benefit from high-risk people going first.