You are using an outdated browser.
Please upgrade your browser
and improve your visit to our site.
Skip Navigation

Transcript: The Vaccine Pipeline

A transcript of Episode 22 of The Politics of Everything, How Pandemics End

Laura Marsh: This week I did something I never imagined doing: I logged on to The New York Times, entered my age, my job, the county I live in, and some information about my health, and the website gave me a number. It told me roughly how long I might have to wait to get the coronavirus vaccine. There’s a long line of people who need to get the vaccine, but, for the first time since the beginning of the pandemic, it looks like the end could be in sight.

I’m Laura Marsh. I’m the literary editor of The New Republic.

Alex Pareene: And I’m Alex Pareene. I’m a staff writer at the magazine.

Laura: Today we talk to a range of experts about how pandemics end, and how long it will take to distribute the vaccine.

Alex: And when life will get back to something like normal.

Laura: So, Alex, do you know where you are in line for the vaccine?

Alex: I did the New York Times thing just sort of idly, and it confirmed that I’m toward the back. I don’t actually remember the number.

Laura: Two-hundred-ninety million?

Alex: Yeah, it was like, “You’re going to be waiting a while.” It is interesting—you mentioned you entered what your job is, and by certain definitions, including in New York, journalists are essential workers. I don’t particularly think I need to jump the line to, for example, do this podcast, but we’ll see if I might get the opportunity.

Laura: Right. I did not check that box in the quiz.

Alex: Thankfully, the quiz was not legally binding.

Laura: No, but it’s interesting, because it’s one way of thinking about what could happen next. And I have no road map at all for understanding what the next year is going to be like. When is the first time I’m going to get on the subway? When is the first time I’m going to go back into the office? I would love for someone to just be able to tell me, “This is the date when you should expect to be able to cross these benchmarks. This is when you might feel normal.”

So our first guest is Dr. Nicholas Christakis. He’s a physician and sociologist at Yale University and the author of a book about the long-term effects of the Covid-19 pandemic. Nicholas, thanks for coming on the show.

Nicholas: Thank you so much for having me, Laura and Alex.

Laura: I guess our first question is a big one: How long do you think it will take the U.S. to reach a turning point in the fight against Covid?

Nicholas: I think there will be two landmark turning points. One will occur sometime at the beginning of 2022, about a year from now. And the next one will occur sometime at the beginning of 2024, hence about three years from now. And to explain why those landmarks occur as they do, I’d have to go on a bit of a digression. I don’t know whether you want me to go on that digression to talk about herd immunity.

Alex: Please.

Laura: Yeah, I think that’s good. So when we’re heading out on this digression, can you define herd immunity? I think it’s a term we’ve all heard a lot in the last year, but exactly what is it?

Nicholas: Yeah, with that technical knowledge out of the way, then we can look at these important landmarks that you asked me about. So pathogens like SARS-CoV-2, the virus that causes Covid-19, have a number of intrinsic properties—for example, how deadly they are—and other properties as well. One of those properties is how infectious they are—that is to say, what is the ability of the pathogen, of the germ, to spread from one person to another and cause new cases for every existing case? And for coronavirus—for this coronavirus—every case can cause three new cases. That’s actually pretty infectious. That’s a serious disease, and just to benchmark you, the seasonal flu recreates itself plus another half a case, whereas SARS-CoV-2 creates three new cases. Well, you can take this number and then use a formula to compute something known as the herd immunity threshold. It’s the percentage of people that need to be immune in a population such that even though not everyone is immune, you can’t get epidemics anymore. So probably the natural herd immunity threshold for SARS-CoV-2 is about 50 percent. If we get to 50 percent of people being infected, then we’ve reached this milestone. That’s the background about what herd immunity is: It’s the ability of a population to be immune to a condition, even when not everyone is immune. And it’s a minimum percentage of people that have to be immune as individuals such that the epidemic force of the pathogen has been stopped.

Laura: So the question I have is: The 2022 benchmark—is that the herd immunity?

Nicholas: Yes. Exactly. So how are we going to get there? Right now, we have these vaccines invented, which is miraculous, like 10 months after the germ leapt to us—unprecedented in human history. But it’s going to take time for us to manufacture millions of doses of this vaccine, distribute those doses (which won’t be easy—many of the vaccines need to be kept in serious cold temperatures, in specialized freezers, for example), and then persuade people to take the vaccine. And there’s a lot of people who are afraid to take the vaccine or have some legitimate concerns, let’s say, about the safety of the vaccine.

So we have our work cut out for us to persuade the American public. But anyway, that’s going to take time. We’ll be at the end of 2021, maybe the beginning of 2022, before we finally have vaccinated, let’s say, 50 percent of the American public. Meanwhile, the virus is spreading. Right now, probably only about 13 percent of Americans have been infected, and we’re rapidly adding about half a percent or 1 percent of Americans every couple of weeks. By a year from now, we’re going to reach herd immunity naturally if we don’t reach it artificially because of the vaccine. So from my desk, either way, 2022 or the beginning of 2022 is a milestone in the history of this global pandemic. That’s when I feel will be the end of the immediate pandemic period.

Laura: So does that mean even with herd immunity, those 50 percent of people who aren’t vaccinated, they can still get the virus, it’s just much less likely?

Nicholas: That’s right. The point is, when you reach herd immunity, you haven’t eradicated the virus. The virus is still around. In fact, the virus will be with us forever, but its epidemic force will have been sapped.

Laura: So you threw out another number, the date 2024. What turning point do you envision happening three years from now?

Nicholas: Right—having left the initial biological and epidemiological impact of the pandemic behind us, we still have to recover socially, economically, psychologically, even clinically. Because of the pathetically bad job we have done as a nation in confronting this epidemic, at least half a million Americans are likely to die before the epidemic is over. But in addition to all the people that die, roughly five times as many will be disabled. So if half a million Americans die, about 2.5 million Americans will have some form of long-term disability: pulmonary fibrosis, renal insufficiency, neurological deficits, maybe some cardiac problems. After the force of the epidemic has hit us, we will have a clinical recovery, we will have to cope with the disability. So that time period between 2022 and, say, 2024, which I call the intermediate period, is the time in which, if you look at historical epidemics, it takes the population to recover economically, socially, psychologically, and clinically. And then we’ll get to the next milestone, when the post-pandemic period will begin.

Alex: We don’t know for certain yet how long immunity lasts, right? Could the Covid-19 vaccine become like a flu shot, where you get it regularly?

Nicholas: It’s possible. If I had to guess, I think immunity will be sustained. The reasons that you need your flu shot repeatedly have to do with the ability of influenza to mutate through recombination in a very particular way, which is generally not what we see with a coronavirus. And looking at certain other biological evidence regarding coronavirus species in animals and so on, I think there will be some significant and sustained immunity. Over a few decades, I think this coronavirus is going to wind up being just another cold virus in our species, where you will be exposed to it as a child—we know that children are relatively unaffected by this virus—and after exposure as a child, you’ll develop some kind of immunity. Then, if you’re re-exposed as an adult, you just have a common cold, and it’s not lethal. And now, since the virus is circulating, children will just get it naturally when they’re young, and that’ll be how our species comes to a detente in the end with SARS-CoV-2.

Laura: One thing I want to ask you about is this immediate period. So next year, it’s so hard for me to imagine how that’s going to unfold. Obviously, we were plunged into the pandemic. No one—well, people like you maybe saw it coming, but ordinary people, like me and Alex, didn’t know that the coronavirus pandemic was coming. There wasn’t much time to adjust, and something I’ve been thinking about a lot is how we emerge from this pandemic, because it’s going to happen slowly. There isn’t going to be a week where everyone goes back to work suddenly. As a sociologist, how do you envision the next year? What kinds of changes do you think we’ll see in the way that people start moving around again?

Nicholas: I don’t think that’s going to happen in the next year. I think in the next year we’re going to still live in the kind of way we’ve been living. We’re nowhere near herd immunity, the vaccine is going to have a certain rollout, I think we’re going to be wearing masks, I think we’re going to be physical distancing. I think a lot of people are going to be working from home. And just to be clear, we actually don’t know if this vaccine prevents death. We just know that it prevents illness. And initially in the Pfizer trial, we didn’t even know if it prevented serious illness. And we also don’t know if this is not enough. All these people listening—“Oh my God, the vaccine is here, hallelujah”—and it’s great, it’s great that we have the vaccine, but you’ve got to think more clearly about this. We don’t know if the vaccine stops you from spreading it.

Alex: Yeah, I was just going to ask, because what we’re testing is to see if it prevents serious symptoms, but we don’t know if it prevents infection, and then you are still a contagious person.

Nicholas: Yes, exactly. Now we know in the AstraZeneca trial, they very smartly tested the family members of people who were randomized to get the vaccine or not. Actually, I’m not totally up to date on the details of these trials, but my understanding is that the AstraZeneca vaccine may reduce infectiousness. So it’s possible we would vaccinate all these people, which is great, but it might not actually stop or have the same impact on the pandemic. So there’s lots we don’t know. And finally, if that’s not enough, we don’t know how safe this vaccine is. We know it’s safe in a population of 40,000, or in the Moderna trial it’s about 30,000—about the same in the two trials—but we don’t really know how truly safe it is until we roll it out and start giving it to millions of people. I just want to say, I do not want to be taken as a cynic or a pessimist. I think it’s miraculous and amazing that we have developed this vaccine, and we can talk about what that means in the history of epidemics. But I also want listeners to understand that it’s not an instantaneous panacea, for all the reasons we’ve been discussing.

Laura: So we talked about the next year, and I’m thinking about the next few years. You say that we should expect to see people’s behaviors change in a lasting way. Are there other examples that you can think of from previous pandemics or plagues where the way people act has actually changed significantly?

Nicholas: One of the key examples I like to give is spittoons. At the turn of the prior century, around 1900, there were tuberculosis outbreaks in this country. And public spitting was rightly seen as very unsanitary. And then the so-called Spanish Flu struck in 1918. And at the time, not only was public spitting not uncommon, but every restaurant had a little brass bucket in it called a spittoon that you could spit in—just really gross, accumulating big buckets of spit over the course of a day. People got rid of these because we don’t want people spitting in our restaurants. And after the epidemic was over, the spittoons didn’t come back. None of us have ever been to a restaurant where we’re like, “Where is the spittoon? I want my spittoon back.”

Laura: Is there something in the twenty-first century that resembles a spittoon, but we’re so used to it that we don’t see it as disgustingly unhygienic?

Nicholas: Well, I don’t think handshaking is as disgusting as public spitting, but I do think there’s a possibility that handshaking may go the way of spittoons. You know, there are different ways of greeting each other in different cultures. In Europe and the United States, we shake hands, sometimes we hug strangers when we first meet them—it’s uncommon, but certainly we shake hands. But in many other parts of the world, people bow, they clasp their hands together, and they don’t have physical contact.

Laura: Right. As a socially awkward English person, I’d prefer to stand about six feet away from the person and just wave to greet them. No warmth, no physical contact.

Nicholas: Exactly. The future is going to favor you hugely, Laura. But the point is, I don’t think it’s likely that we’ll abandon handshaking in Western countries, but I think it will be much less common. And it won’t be seen as weird if people don’t want to shake your hand 10 years from now, a little bit like smoking on airlines. So the spittoon and the handshaking are interesting examples. And many people are talking about how working from home will be persistent in business, travel will be less common, people aren’t going to fly across the country for a trivial meeting. But there could be other larger-scale and more subtle effects. Let me give you an example: It is still the case in our country that most couples are heterosexual. Of course, we have homosexual couples, we have single-family heads of households, single parents. And in most heterosexual couples, it’s still the case on average that men make more money than women. Let’s consider what happens in a situation in which we have a radical shock to our economy. Tens of millions of people are out of work, and the schools are closed. So couples sit around the kitchen table, and they’re thinking, “What should we do?” Kids are stuck at home. People are losing their jobs. And they make the very rational decision that the man should stay in the workforce, because he was earning more money, and the woman should stay at home with the children. Every couple can make their own decisions about what they’re going to do with their own lives, that’s their own business. But if millions of couples make the same decision, we may find, after the pandemic, that women’s labor market participation has been set back 20 years.

Alex: Do you think that in the West mask-wearing will become commonplace for flu season or just in general?

Nicholas: If I had to guess, no, I think people will be so relieved to get rid of masks in two or three years that I think they’ll stop. But I think the threshold for reusing them will be low. So if you read in the newspaper, flu season is forecast to be bad, now you will have had the experience of wearing a mask for two years, and so you’ll say, “OK, I’ll wear a mask for a month. It’s not a big deal. It’s right here in my drawer.” The culture around it will change, I think.

Laura: Well, this is where I’m curious about the historical precedent, because I was so surprised to find out that in the Spanish flu of the early twentieth century, people were wearing masks. Do you have any sense of how that practice was lost? Why didn’t we keep doing it then?

Nicholas: Well, there were huge debates about mask-wearing in 1918, very similar to the debates we’re having now. However, the pro-mask groups sort of won out, in part because they were able to frame mask-wearing as a patriotic duty. I actually think that one of the things that upsets me so much about the framing of this pandemic, the political framing, is that acts would, should have been seen as really apolitical, like you wear a mask because it’s a physical barrier for droplets, it’s not a sign of your virtue. It’s not like, Oh, I wear a mask, that means I’m a good person. I’m concerned about my community, nor is it a sign of your freedom? Like I refuse to wear a mask because, you know, I don’t want the government telling you what to do. This is a silly framing of a mask. It’s just a tool to reduce infection. And I think what we should have done is we should have framed mask-wearing as a kind of least noxious thing we could do to cope with the pandemic. Like, we should have said, “Look, if you wear masks, if you physical distance, if you avoid big gatherings, you can keep your schools open. You can save lives.” And in the 1918 pandemic, that was the framing that we needed to keep our troops fit for battle for the First World War—that mask-wearing reduced infection, was also something people could do on the home front. You know, “Our young men were dying on the front, all we’re asking from you is to have a victory garden and to wear a mask, so step up and be patriotic.”

Laura: So let’s hope by 2024, let’s say, that we’ve emerged from this, and we’re able to try and put some of the worst of coronavirus behind us. Do we need to worry that something like this is going to happen again in the next five or 10 years? It might not be Covid, it might be a completely new virus, but should we be worrying that the world could stop again because of another pandemic?

Nicholas: Yes. So Tony Fauci was writing about respiratory pandemics when I was in elementary school, a paper that looked at the history of respiratory pandemics for the last 300 years. And in this paper, he and others have shown that respiratory pandemics come every 10 to 20 years. Most listeners won’t remember these pandemics often because they’re not very deadly; it’s only every 50 or 100 years that we get a really serious one like the one we’re facing right now. This pandemic will be the second-worst pandemic we faced in 100 years, worse than the 1957 influenza pandemic, which was the previous second-place record holder, but not as bad as the 1918 pandemic. But the point is that this is stochastic—that is to say, it’s random. On average, pandemics come every 10 to 20 years, but that’s not a rule. One could come every year for a while. And on average, you get a serious one every 50 or 100 years, but that’s not a rule. You could get another serious one in five or 10 years just by chance. So absolutely we should be prepared. But, see, the problem was we were prepared. There was a playbook for managing a pandemic that was given to the Trump administration by the Obama administration, which I think inherited it from the Bush administration. We just didn’t act. We did not act as a nation. We have goofed at every step. We goofed on testing. We goofed on public messaging. We goofed on PPE. We goofed on contact tracing. We have not as a nation risen to the challenge. So I hope that the next time we as a nation face this, perhaps because of the unpleasant memories of what we’ve just experienced, we’ll do better.

Alex: I also hope we do better next time. It seems like in many respects it would be hard to do worse. On that note, thank you so much for taking the time to talk to us today, Nicholas.

Nicholas: Thank you both so much for having me.

Laura: Dr. Nicholas Christakis’s new book is Apollo’s Arrow: The Profound and Enduring Impact of Coronavirus on the Way We Live.

Alex: After a short break, we’ll be joined by Rebecca Coyle from the American Immunization Registry Association and author and frequent New Republic contributor Melody Schreiber.

The distribution of a Covid-19 vaccine might be the single greatest public health challenge in our nation’s history. Joining us to talk about the policy decisions surrounding vaccine distribution is New Republic contributor Melody Schreiber, whose latest piece is titled “So You Won’t Get an Early Covid-19 Vaccine. That’s OK,” and Rebecca Coyle, executive director of the American Immunization Registry Association.

Rebecca, tell me a little bit about your organization and what it has been doing around the Covid-19 vaccine preparation.

Rebecca: AIRA was birthed back in 1999 out of a need to pull folks together to solve problems more nationally than locally. While immunization information systems—or registries, as they’re often called—are really tools for state and local health departments, there is a need for them to act and respond consistently across the U.S.

Laura: When you are not responding to a global pandemic, what does AIRA usually do?

Rebecca: If you think back in time, most often as a child, you were given a yellow card, a piece of paper. It was noted on that piece of paper what vaccine you received, the date you received it, and then when you probably need to come back for your next dose. There’s a way for immunization registries to capture all of that and provide a consolidated record—so it’s sort of taking that yellow card and digitizing it in a way that’s meaningful and can follow somebody, regardless of what provider they’re accessing.

Laura: For the average person out there who’s thinking about when they might get the vaccine or wondering and worrying about what the challenges might be, if you just had to tell them very simply what your organization hopes to do to make that easier, what would you say?

Rebecca: My organization is working with all the states that operate a system. So right now, we are working with them to develop the data specifications or the data file that needs to be extracted on a daily basis and sent up to the federal government so that they can look broadly across the U.S. to see how many vaccines are out there, how many doses of Vaccine A, how many doses of Vaccine B have been administered, for planning purposes. And then also verification that doses that have been shipped are actually being administered.

Alex: I actually want to back up a little bit here because I think this is sort of interesting. You’re talking about how your organization works with all of these state and local governments that operate their own immunization information systems or registries of people who have been vaccinated. Is the American system of a sort of patchwork of vaccine registries unique? Do other countries track this more universally?

Rebecca: That’s a great question. And I think this is one of those where, you know, we have a federated approach to everything in this country. That’s sort of how we were built. And that’s why we have this patchwork approach. There are other countries that have a single system for their country—recognizing that oftentimes some of these countries are the size of one of our states. There are also other countries—Canada is a great example—where they also have a more federated approach. So there’s a combination of things out there. At the core, it’s important to recognize that all states but one (which is New Hampshire) operate a system. And then, in addition to the state, there are also large cities like New York City and Philadelphia that operate a system.

Laura: One question I have is, there are all these different systems, some of them sound like they probably work really well, but it’s unclear how they fit together. What’s the danger that people might fall through the cracks; where are the weaknesses there?

Rebecca: So I think some of the concerns might be for somebody that may have moved, particularly if they’ve received the first dose in one state and moved between the first dose and second dose, there’s concern that that first dose won’t necessarily be known by the new state. There are some technology solutions that will allow state systems to figure out, you know, what did that person receive for their first vaccine dose.

Laura: So the rollout of the vaccine is interesting because I know that, certainly during these last several months, I have been focused on there being a vaccine and thinking that will be kind of the light at the end of the tunnel, but the rollout is uneven. You know, it depends on how people adopt it, and it depends on what states do. Melody, you’ve written about the order in which individuals may actually get this vaccine.

Melody: So the order will be determined by the CDC, by a committee of experts from across the country, and the order’s going to be: first, health workers, and including people who work in care facilities. And then, the people who live in the care facilities, that just makes sense. It’s where the prevalence of death is highest. So, after that first phase, the committee will meet again to continue making recommendations on the next phase.

Laura: So they haven’t actually come up with a full order of:  It’s group A, and group B, then group C and group D.

Melody: What I have in front of me is the National Academies of Science, Engineering, and Medicine, and they have recommendations of where they’ll likely go.

Laura: So these are recommendations, but it’s not as if the government has said: We’ve committed to laying everything out in this exact order. Is that correct?

Melody: That’s correct. And part of that is because we’re still getting the data on the vaccine. If we discover that the vaccine just doesn’t work as well among the elderly, the recommendations are going to be: Put this vaccine toward the elderly, and put this vaccine toward people who work in schools. So as that data comes out, then they’ll have a better idea of where it’s going.

Alex: What the CDC has come up with and is going to send to the states is recommendations, and the states will ultimately determine how they will distribute it and what the order will be. And so, for example, that could mean it could be different in different parts of the country, right?

Because there was a story that might’ve just been a sort of overblown Twitter reaction to a headline, but might’ve had some more basis to it, I’m actually not sure, about essential workers in New York that could include employees of financial firms, right? Because, I mean, under New York’s rules, Laura and I are essential workers because we’re in the media. It’s true! Because we were allowed to go to work, to do reporting during lockdown.

Laura: Such a shame that this is audio, because if you could see my face.… As much as I love this podcast, it definitely doesn’t feel like it should put us first in line for a vaccine.

Alex: Right.

Melody: In my heart you’re essential.

Alex: But we don’t know yet whether or not New York State will determine that us podcasting journalists will get to be higher up on the list than preschool teachers or something, right?

Melody: So, the CDC will make the recommendations. It’s always going to be up to the states to follow those recommendations and to interpret them. So you say health workers. Does that mean health workers in clinics? Does it mean health workers who go and visit people’s homes? Quite a bit of it is going to depend on how many of each category you have in each state and how many doses you get. The vaccine is being allocated based on population, not on need per se, but on the number of people and how many doses they have. So in Alaska, for instance, if they have enough to cover all of their health care staff and all of the people living in care facilities who go next, the states will be determining that—and then, yeah, how you define essential worker is going to be a huge debate.

Laura: If you’re an ordinary person, it’s natural to sort of wonder, well, when would I get this, right? You can even go on the New York Times website, and they’ve made a kind of little interactive feature, and it will sort of tell you, you know, you’re in line behind 90 million people. So what does that really mean?

Melody: Well, from the first shot that goes into the arm of a health worker, I’m going to start being protected. You know, these health workers are keeping hospitals going. They’re caring for people who are getting sick. They need to absolutely be protected first.

Alex: Right. It’s like I’m waiting in line overnight for the “I want my grandma to stay alive and for me to not get Covid” store, I want it to open at 8 a.m., and there’s 90 million people in front of me, but each person who gets in there makes the likelihood of me getting what I want from the store more likely.

Melody: They’re going to have a circle around me that protects me because they’re suddenly a lot more protected. And so that’s going to protect me long before I get a shot. And honestly, I’m not just waiting in line for a vaccination. I’m waiting in line, like you said, for my parents to be protected, for people I know who have preexisting conditions. Honestly, looking at my risk factors, if I were to get sick, it would probably be pretty mild. So I don’t worry about my getting sick. I worry about other people getting sick and those people who are at high risk, they need to be way ahead of me. And I’m totally fine with that.

Alex: We’ve been talking about the order in which the government is deciding people will receive the vaccine. We have been also talking about it as if people will then go take it when it’s their turn on the list. Rebecca, you know about the vaccine registries. Do people have privacy concerns about, effectively, the government making a list of what people have what vaccines?

Rebecca: That is a great question. I think it is absolutely one of the concerns that we know people have about their data, and making sure that only the right people have access to that. I think that’s been one of the fundamental principles across immunization information systems or registries. We know that there are a couple of states that still have an opt-in requirement, meaning that in order for the information to go into the registry, somebody has to sign explicit consent to go into the system. Most of our systems operate on an opt-out basis, meaning that if your information is in there and you don’t want it there, you can request to have it removed. And having worked in a state and actually switching from an opt-in to an opt-out platform, the reason why we did that is we found that for most parents that had to opt in at birth, we were getting about 90 percent of parents saying, “Yes, we want our kids included in this registry.” And over the course of the first year of life, we are actually finding that virtually all children are going in. At the core, I think, privacy is a huge concern. That’s why we want to make sure that only the people that are authenticated, that should have access to these systems, do, in fact, have access to these systems. It’s why this data doesn’t get broadly shared across the board. It’s very controlled and very regulated.

Alex: I guess maybe even just speaking personally, how worried are you in this information environment that conspiratorial thinking about these lists is going to hamper delivery of the vaccine?

Rebecca: I would like to think that it won’t hamper that. However, I do think there are some unique considerations with this particular rollout that haven’t existed before. And to say that I’m not concerned about them, I think, is not accurate. So we know that in this vaccine rollout, as I mentioned, there are some new data exchange components that haven’t existed before—that being immunization information systems; our states are supposed to send their identifiable information up to CDC. And I think that is something that we have really questioned. At the core, is there a reason for that? How is that data going to be utilized? There’s nothing that the federal government is going to be able to do that the states can’t do themselves. I think that’s the key piece. States have been doing this for a long time, but what we haven’t been doing is sending data to the federal government for them to deduplicate, consolidate, and monitor and maintain—that just hasn’t happened. And I do think that presents some risk from a privacy perspective, but then also from a data-flow perspective.

Laura: I want to go back to something Melody mentioned, which is that there is not just one vaccine, there are a couple of different vaccines. They all have to be stored at different temperatures. So they require different supply chains in order to reach people Does that make things more complicated or is that something we’re used to seeing with vaccines?

Rebecca: So the good news is, from a vaccine perspective, this is just another vaccine. We already have the systems in place for a variety of different combinations. For the most part, as of now, the vaccines are really two-dose vaccines. That’s very comparable to most of the vaccines that we have out there. In fact, it’s more rare to have a vaccine that only requires one dose. So there some added complications, but I don’t think it’s going to be as challenging as everyone might think it is.

Laura: Melody, with there being several different vaccines for Covid, how do you think that will affect the way the public thinks about getting the vaccine? For instance, should someone be concerned if they get the Pfizer vaccine instead of the Moderna one? Is there any difference between them? How much do we know about it?

Melody: So far, with what we know, I don’t think we can really say what the differences between Pfizer and Moderna are. As more of the data is released, they’ll have a better idea. I think knowing which one you got will be important for knowing when you follow up in the second dose that you get, making sure you go to the right place. The other issue that I’m following quite closely is, if there’s a vaccine that’s not as effective but easier to administer, there are questions about equity. In rural areas, across the world—if a vaccine is more effective but harder to administer, who gets it, and how do we make those decisions? I think that there are a lot of equity questions in general with the vaccine rollouts that really need to take front and center.

Laura: Right. Because if they’re the one that needs to be kept in super-cold storage, it seems like you’re more likely to get that if you live near a hospital that has really high-tech, expensive facilities, versus if you live further away from that kind of facility and you might end up getting the one that doesn’t need such special training.

Alex: That gets to something we talked about in our meeting about this episode, which is that there’s a ton of things we can be doing, and I say “we” meaning both the federal government, meaning state government, meaning city government, and then meaning the individual, too. There’s a ton of things that we could be doing that are often not being done that could be making things a lot easier right now. To what degree is the fact that soon there will be vaccine … do you think that is causing politicians to say, “Well, I don’t need to do any of that hard stuff like closing things back down, I don’t have to do that because the vaccine is right around the corner”?

Melody: Yeah. I do think that’s the temptation among politicians, but also among everyday people. The end is in sight, but we just have to hold on because it’s going to get way worse before it gets better. I mean, the light is at the end of the tunnel, we’re just still not there yet. We’re still in the middle of the tunnel. Every day that we have the opportunity to take precautionary measures and curb the spread, we still have in our power the ability to make a difference before a vaccine ever arrives.

Alex: Well, Melody, Rebecca, thank you so much for taking the time to talk to us today.

Melody: Thank you for having me.

Rebecca: This has really been fun and very different from my normal day, so I appreciate that.