Pandemic Perspective #22   August 22, 2020

What do you think of a COVID-19 vaccine?

Vaccines have been one of the major reasons for the dramatic change in life expectancy among children. Barely two centuries ago one child in four didn’t make it past the first birthday. That number is now about one in 1000. Better nutrition and improved sanitation had much to do with that progress but vaccines deserve most of the credit.

There is a wariness about the COVID-19 vaccine. Like prescription drugs, vaccines sometimes have severe, occasionally fatal, side effects. That will undoubtedly be true for the COVID-19 vaccine by the time the first million or so doses have been administered.

At no time in history has there been such an enormous, frantic effort to produce a vaccine. Among more than 200 candidate vaccines a handful are already in the human testing phase. Even if at least one is approved for use by the end of this year it will likely take most of 2021 to administer it to the globe’s seven billion inhabitants, and that may be an optimistic estimate.

There are several barriers to completion of a successful vaccine program. It may turn out to be like the influenza vaccine, only partially effective and requiring annual administration. Like the influenza virus, coronaviruses undergo frequent mutations, some of which may dictate periodic retooling of the vaccine. A worse scenario is that vaccine recipients, instead of being protected from a subsequent natural infection, may have a paradoxical, worse illness upon such exposure.

Perhaps the most serious challenge to universal coverage is vaccine refusal. Polls indicate that at least a third and perhaps half of adults will refuse to get immunized. Their reasons cover a wide spectrum that includes fear of injury, concern about effectiveness, the cost of the vaccine or even conspiracy theories that range from the plausible to the idiotic.

In all this there is a lesson to be learned from the influenza vaccine. Its ability to prevent illness is nothing to celebrate, ranging from about twenty to fifty percent. That is not the issue. What matters is that even when the vaccine is only partially protective it almost always does modify the disease and – and this is extremely important – it keeps victims from requiring hospitalization. Hospitals breed antibiotic-resistant bacteria that kill tens of thousands of Americans every year. A growing number of bacteria are resistant to all currently available antibiotics.

The next wave of influenza will be in full swing early in 2021 and there is already a consideration that we will see a combination influenza-coronavirus vaccine. I seriously doubt that such a dual vaccine will be available for at least a year. It will require even more testing, although combination vaccines for children have been in use for decades. Contrary to earlier fears, such mixtures are no less potent than individual vaccines and reducing the number of shots is something every parent and child can appreciate.

An intriguing question: how will social distancing, obligatory wearing of masks, closure of usually crowded entities such as schools, theaters, restaurants and other venues influence the spread of influenza? Unless the coming season’s version of the flu virus is unusually contagious there is a strong likelihood that we will see fewer cases of influenza and thus fewer deaths than in most years. That should not deter anyone from getting a flu shot, especially since there is a real risk of acquiring both viruses at the same time – a really scary scenario.

To my knowledge, none of the candidate vaccines consists of live coronavirus particles although a few utilize benign live viruses to transport the coronavirus material into cells for processing and ultimate protection.

The SARS-CoV-2 virus has turned out to be full of surprises from which medical scientists have learned a great deal. I’m certain that the COVID-19 vaccines will provide even more.