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Now Is When We Choose How Effective the Covid Vaccines Will Be

If we let cases continue to surge, we’ll be stuck in this pandemic for much longer.

The manager of Perches Funeral Home pushes the casket of Humberto Rosales, a care provider who died of Covid-19 complications.
The manager of Perches Funeral Home pushes the casket of Humberto Rosales, a care provider who died of Covid-19 complications.

Imagine if the United States had quickly employed proven public health advice, updated regularly as new science came in, throughout the entire pandemic. Far fewer people would be dead or suffering long-term health issues. And in a few months’ time, a coordinated vaccine rollout could have halted the pandemic in its tracks and returned us to life as normal. The vaccines wouldn’t even need to be super effective to help stop the pandemic, as long as we were doing everything in our power proven to stop the virus’s transmission. But now, with cases spreading uncontrollably across the country, it’s going to take more than approving vaccines—even highly effective ones—to save us.

If we’d maintained the level of cases we had in September, researchers say, vaccines that were only 50 percent effective would have brought us to a better situation than what we’re facing now. Instead, at our current pace, authors of a new paper on the topic told The New York Times’ David Leonhardt on Tuesday, 10 million more Americans may become infected as the vaccines are rolled out in the next few months, with 160,000 people possibly dying—even as highly effective vaccines become available. As cases skyrocket, it’s harder for vaccines to make a dent at the rate they’re likely to be rolled out. The vaccines are very effective at preventing Covid-19 symptoms and, hopefully, death, but it’s unclear whether or how much they prevent transmission. Either way, the vaccines would be better at halting the emergency if the people who are vaccinated are much less likely to have significant exposure to the virus.

In addition, political interference in the scientific process has significantly eroded public trust in federal agencies and the vaccines they support. Fewer than two in three Americans say they would get a vaccine if it were available today—more than those surveyed a few months ago but possibly still not enough to establish herd immunity in the population.

The new vaccines are unambiguously good news, and they will make things better. But in some ways, we have already set them up to fail—or at least, we haven’t created the conditions for maximum success. The more this virus rages out of control, the harder it will be to rein it in with any measures, including vaccines.

The Trump administration has largely pegged its hopes on pharmaceuticals—on the rapid development of brand-new vaccines, and on treatments ranging from monoclonal antibodies and convalescent plasma to hydroxychloroquine and bleach—“medical therapies which, by and large, have ranged from unproven and promising to outright ridiculous,” Dr. Jeremy Faust, an emergency physician at Brigham and Women’s Hospital and instructor at Harvard Medical School, told me. This strategy allowed the virus to spread largely unabated while relying upon the questionable judgment of pharmaceutical companies striving to make a profit. It also overlooked the proven methods we already know will help curb the pandemic: testing and treating everyone who is sick, supporting those who need to isolate or quarantine, offering income and food assistance, providing guidance on masks and other protective measures like avoiding crowded indoor areas, and getting resources where they’re needed.

“The mistake was this notion that the therapeutic du jour was going to turn the tide on this crisis,” Faust said. “The notion of therapeutics being a panacea, literally, has distracted the administration, and therefore the American people, from the intervention that works the best in the short term, which is the nonpharmacologic interventions. These are things we all know we have to do but don’t want to do”—wearing masks, physical distancing, staying home, washing our hands. Although many of these measures depend upon individual actions, the failures come from the top. The White House didn’t want to tell people “something they didn’t want to hear, which was that they have to alter their behavior for longer than we all want to,” Faust said. The biggest mistake of the pandemic wasn’t putting our hopes in a vaccine, he said; it was refusing to change our behavior in the meantime. “People across the political spectrum should have been rallying around masks and social distancing in the way that a few on the fringe continue to rally around ideas like hydroxychloroquine.”

The administration’s narrow focus on vaccines and medications has sometimes made it seem as though nothing else can be done to stop the virus. After all, there hasn’t been an Operation Warp Speed—as the government termed the vaccine effort—for masks and protective gear or for testing, Dr. Bijay Acharya, a hospitalist in Baltimore, pointed out. “It’s so traumatic to see that everyone is going through this, and all we were talking about is billions of dollars being promised to nonexistent therapeutics,” he told me. There has been “a very limited effort to ramp up or speed up actual things that we need to take care of these patients.”

Investing in nonpharmaceutical measures would have gone a long way in curbing the pandemic and saving lives, Acharya said—and it would still help now, and in the coming weeks and months. But with the first press releases of the new vaccines’ strong trial results, something tragic happened: “Everyone stopped talking about deaths and the rising positivity rates all across the country,” as the vaccine news “completely overshadowed” a major surge in cases. Even with highly effective vaccines, there is much that needs to happen before and after the vaccines are rolled out, Acharya said. “I worry about having this magic vial, that people will say, ‘Oh, yeah, we have the cure here,’” and stop taking the pandemic seriously before it has actually subsided.

Allowing the virus to spread this year without a serious national intervention plan was an unmitigated disaster. But letting up on distancing and other basic measures now, when the end is in sight, could be an even greater tragedy. “I’m a little worried that we’re going to be fumbling the ball on the one-yard line here—that people think the vaccine is out, so we’re all safe,” Faust said. The message shouldn’t be “OK, the vaccines are here now, and let’s all relax,” he said. It should be: “Vaccines are here now; all the more reason to double down on keeping as many people alive as possible until they’re fully vaccinated.”

“I think about the two sort of famous Americans who were the last two people to die in the Vietnam War,” said Faust. “How did their families feel knowing that they essentially died during our retreat from what people think was an unnecessary war? Who’s going to be the last person to die of the coronavirus before the vaccine would have saved them?” There is still time to save that person—time to prevent other families from having to grieve searing and senseless losses.

Now is not the time for pandemic senioritis. On the contrary, the impending vaccines are a strong incentive for taking swift and comprehensive measures now, before the winter surge gets worse. If cases are low as the vaccines start rolling out to high-risk individuals in January, February, and March, there’s a better chance for the vaccines to work as intended.

That’s a message National Institute of Allergy and Infectious Diseases head Anthony Fauci emphasized at an event on Thursday with Columbia University. “We’re going to be distributing doses within the next few weeks,” he said. “And I believe good emphasis on public health measures, together with the gradual incremental distribution of vaccines, will put us in a position where we can actually truly crush this outbreak. The only way we’re going to do it is if we do that all together, as people adhere to public health measures, and as many people as possible get vaccinated.”

There’s positive news here, though: Americans have shown they are willing to shoulder these burdens if they know there’s a good reason for them, especially if it’s for a set amount of time. Compliance with stay-at-home orders was quite good for the first month or so of the pandemic. And unlike in April and May, as people (and politicians) grew restless under precautionary measures, the end is now in sight.

Politicians and leaders should be using the vaccines as the spoonful of sugar to sweeten the bitter pill of precautionary measures this winter, rather than as a justification for not implementing them. Stay-at-home orders, mask ordinances, quarantine and isolation support, indoor dining closures, and other actions are more crucial than ever to help us all cross the finish line. There’s always time to flatten the curve, if we have the right information and support to do it. There’s light at the end of the tunnel. Let’s not snuff out that light, killing thousands more people and prolonging the ordeal for everyone.