Why the Vaccine isn’t a COVID Panacea, but How the Vaccine-plus Could Be

I am pro-vaccine. I support science and scientists and public health experts. But now that the Pfizer/BioNTech, two-dose Covid vaccine has been approved and the push is on to create, “an Operation Warp Speed for vaccine communication,” I find myself at odds with the prevailing narrative — or at least at odds with the ramped up marketing trying to convince the public that a vaccine can end the pandemic.

It can’t. And it won’t.

The science behind the two front-runner vaccines — Pfizer and Moderna — is undeniably elegant. In trials each has been shown to nearly eliminate the risk of developing serious illness, which is unprecedented. To go from vaccine design to distribution in less than a year is remarkable. And there are dozens more vaccines in various stages of development.

This is something to celebrate, a genuine triumph of science, scientific cooperation and, of course, speedy, generous government funding.

But these vaccines are not panaceas and cannot on their own end the pandemic. Vaccines are not a silver bullet. But they can be a critical part of a silver bullet strategy that includes three other well-known, low-tech, low-or-no-cost, readily available, time-tested, well-proven public health “technologies”: masks, social distancing and hygiene.

The success — or failure — of any campaign to sell Covid vaccines to a skittish and skeptical public will depend entirely on whether the messaging is perceived as upfront and honest.

Learning curve

Nearly a year into the Covid pandemic and we are still on a vertigo-inducing learning curve with a killer. First we thought Sars-Cov-2 was a lung disease. Then we found out it can attack all sorts of body parts, including the heart. Then we learned it could leave lasting damage, even in patients that exhibited few symptoms. Then came the “long haulers,” patients who never recover — for whom Covid morphs into a chronic illness. Very likely it is auto-immune disease where the body’s defense system is hijacked and trained to attack rather than protect.

We learned that Covid is primarily spread through air droplets, although virus particles can survive on surfaces for an unsettlingly long time, so it may also be spread by unlucky touch. In the spring health officials instructed the public against wearing masks and downplayed the risk of airborne spread in an effort to save scarce PPE supplies for healthcare workers. Now the message is that everyone needs to wear a mask all the time, except at home — but even there, too, if anyone in a household is sick.

We learned that poor ventilation and dirty air filters make it easier for Covid to spread. We learned that asymptomatic carriers — people who are infected but don’t show signs of illness — can spread virus and that a single such carrier can become as “super-spreader” in a crowd, leading to cascades of transmission.

We learned just how essential low-paid, hourly workers in healthcare, retail, manufacturing, transportation and logistics are. We learned that an unchecked, microscopic virus can bring down local, regional, national and global economies.

We learned just how awful this disease can be, with the death tally in the US now rivaling that from WWII. Families have been devastated and communities hollowed out.

Is it any wonder we look to a vaccine as a savior that will end this nightmare and restore our lives?

Caveats

The Pfizer and Moderna vaccines provide genuine hope that it is really possible to get ahead of this Covid train-of-death. But there are still many hurdles and a handful of “unknown unknowns” to navigate:

• Spread: Vaccine trial data show that both vaccines are outstanding at preventing serious illness, but less is known about how well they prevent infection. Until an robust immune response has been built up, a vaccinated person could still be vulnerable to Covid infection. The shot in the arm goes into a muscle — the vaccine works inside the body to develop immunity. But the virus, which is airborne, enters through the nose, where it can stay and multiply for quite a while, and spread through sneezes and droplets. To err on the side of caution, people who have just been vaccinated should be considered the same as asymptomatic carriers — which they potentially could be — and should continue to wear masks to protect both themselves and others.
• Side Effects: According to trial data, side effects are common but comparatively mild: soreness, fatigue, low fever. Yet on the very first day of the public vaccination campaign in England, two health care workers, both with histories of allergies, promptly went into anaphylactic shock after receiving the vaccine. As a result a warning was added, advising people with histories of food and drug allergies to wait to get the vaccine. This sort of after-the-fact messaging is reminiscent of the don’t-wear-a-mask/wear-a-mask fiasco. It undermines the public’s trust and provides fodder for anti-vaxxers. For a vaccine marketing campaign to succeed, it is essential to be in front of any potential issue and and also never to downplay the seriousness of concerns. As someone who is very allergic to penicillin, the way this was handled adds uncertainty: Should I take the shot? Do I trust that anyone really knows the answer? What does this mean for people with asthma, a condition that disproportionately affects people of color?
• The Elderly: The most common side effects have been described as similar to those caused by the Shingles vaccine, which also requires two shots. My mother only had the first shot because her reaction — soreness and fatigue — created more problems. She was in good health for someone in her early 90s, but she was in her early 90s. The side effects made her too tired to eat, which made her weak, and the soreness made it difficult to move. She needed help to get through a rough couple of days. Are staffs at assisted living facilities and nursing homes prepared to provide the extra, post-vaccine care that may be required? How about families with seniors in the household? What about those who are older and living alone? An effective campaign must include advice on how to prepare for the vaccine (e.g, make sure there is plenty cooked food in the fridge, Tylenol in the medicine cabinet, and a cozy place to curl up and rest for a few days). Should people within a household stagger the scheduling of shots so they can better take care of one another?
• Logistics: The Pfizer vaccine has to be kept at extreme cold temperatures — colder than that of the Arctic. Much has been made the meticulous and costly plans to package and ship vaccine across the country. But it is the last, preparing the vaccine for a shot, where it could all fall apart. It is a delicate process. Many hospitals have the expertise, but drug stores that are expected to play a big role in administering the Covid vaccine generally do not. What are the safeguards to assure that a vaccine has been thawed and prepared properly? Do pharmacists have the training and resources to address adverse reactions such as anaphylactic shock?
• Protection: There are no data on how long either the Pfizer or Moderna vaccines provide protection. It could be forever. But if it turns out that immunity fades after a matter of months, then we are vulnerable to new waves of illness. There is already evidence that Covid survivors can be infected a second time with the virus. We will have to wait and see whether this is an issue with those who were vaccinated.
• Safety Nets: According to several surveys Americans report that they are less likely to line up for a Covid vaccine than their European counterparts. Much of this has been chalked up to the success of anti-vaxxer propaganda, but also — especially in BIPOC communities — a legitimate, deep distrust of both the medical establishment and the government. There may be yet another angle to consider: When the two health care workers in the UK suffered severe reactions to the vaccine, they only had to worry about recovering, not the cost of recovery. Although the vaccine itself is free in the US (paid for with taxpayer funds), the cost of any medical attention required to treat a side effect would fall to the patient. This underscores once again the frayed, fragile and systemically unequal state of the American healthcare system.
• Privacy: The federal government is requiring states to provide information on everyone who receives a vaccine. This includes names, addresses and ethnicity, causing some to raise concerns that the information could be weaponized against immigrants, discouraging many from getting the shot.

Silver bullet strategy

It will take several months — well into 2021 — before there is enough vaccine to vaccinate enough people in the US to begin to make a noticeable dent in the pandemic. This slow roll out provides an opportunity to get the messaging right. That means positioning the vaccine in context, as part of a four-prong “silver bullet” strategy: the vaccine plus masks, social distancing and hygiene. Soap and water work.

The pandemic will end when the virus has nowhere to go — when there are no more would-be victims to infect. A pandemic is only as strong as its opportunities for transmission. Virus-infused droplets have been shown to travel 20 feet or more under the right circumstances and also, depending on size, remain suspended in air for a long time. But viral particles that are unable to penetrate a mask cannot make the mask-wearer sick. The virus hits the equivalent of a brick wall.

We have seen evidence all over the world of how mask-wearing has helped cities — even entire nations — get back to more-or-less normal life. With the US death tally now closing in on 300,000 — far higher than in any other country — the politicization of mask-wearing has resulted in hundreds of thousands of avoidable deaths. This is killing on a scale that qualifies as a crime against humanity.

Yet the powerful combination of cheap, well-known public health practices and cutting-edge vaccines not only have the potential to break the back of the pandemic, but could also help quickly contain — and perhaps prevent — the next one.

This new generation of vaccine, which is based on snippets of messenger RNA (mRNA), will likely soon be used to protect livestock, poultry and possibly wildlife from various diseases (exactly how a vaccine is delivered in the wild is tricky, but there is precedence with a rabies vaccine).

Since most human pathogens, including Covid, are zoonotic — meaning they infect multiple species, including ours—keeping animals healthy is good for us, too. It is possible that in the future viruses with the potential to spark pandemics could be short-circuited by animal vaccines and never get into the human population.

The Pfizer / BionGen and Moderna vaccines, along with all others in the pipeline, are great news. But if they are marketed as The Answer to Covid and not Part of the Solution, they will not live up to the hype. And this godawful pandemic will continue to grind on.