Vaccines have changed the world, saving millions of lives. They are by far our best hope for stopping the Kovid-19 epidemic. Our other choices to prevent disease are staying separate, affecting our economy and society, or creating “herd immunity” through natural infections, which means more than one million deaths in America and 10 million or more deaths are worldwide. But the push for the Kovid-19 vaccine faces three major hurdles.
First, will it work? Preliminary studies indicate that many types of vaccines now in development produce a strong immune response. This is good news, but it does not mean that the vaccine will protect people from infection or disease. We do not know if the immune response is protective or not, and if this is how widespread this protection will be. (Protection for influenza vaccines ranges from 0% to 60% and for some other vaccines is 95% or higher.) Even though a vaccine protects against disease, it can help people become infected and spread the virus to others. Can not stop spreading.
Nor do we know if all people will be protected by a new vaccine – especially older ones, which are clearly at higher risk from Kovid-19 and may be less likely to have a stronger immune response. We do not even know how long a security will last. We also do not know how protective the natural Kovid-19 infection is; For many vaccines, the extent of immunity from natural infections is the extent of their potential efficacy.
We do not know if all people will be protected by a new vaccine.
Nevertheless, we have reason to be sufficiently optimistic that some vaccines will provide some level of protection, and that this will be demonstrated before the end of 2020. Some vaccine candidates may pair, and others may lose their efficacy within a few months. Certainly, it would take several months to find out. Different vaccines may be more or less effective, and some vaccines may work less well for some groups. And most vaccines never make it to approval; Many of today’s promising candidates may fail. We just don’t know. This is the study.
Second, will it be safe? What can go wrong with new vaccines? very. Many candidates use a harmless virus as a “vector” to deliver vaccine antigens. This technique is promising, but we have limited experience of using it. And we have never used DNA or RNA vaccines – the technology has been used in the development of many Kovid-19 vaccines – in humans.
We now know that a small proportion of children who contract Kovid-19 have potentially lethal inflammatory conditions because their immune system reacts to coronovirus. A vaccine can, in rare instances, cause a similar immune storm that causes severe disease, especially in children, either from the vaccine or from subsequent exposure to the virus. There is no specific reason to believe that Kovid-19 vaccines would cause this type of redundancy, but it is a risk and should be studied both before and after approval.
Polio vaccination provides a cautionary tale. Soon after the vaccine was invented, a manufacturer contaminated a batch of the vaccine, and many children were paralyzed. In 1976, when an outbreak of H1N1 influenza occurred in Fort Dix, NJ, raising concerns about an epidemic, President Gerald Ford led an effort to vaccinate tens of Americans. But the dreaded epidemic never occurred, and the vaccine paralyzed more than 500 people, some of whom had lifelong problems.
Despite these rare and unfortunate episodes, vaccines are still safely safe: billions of doses are given each year to people worldwide with very few problems. Yet adverse events from vaccination may not be evident until hundreds or millions of people have been vaccinated, so there may be no shortcut on safety. Humility is in order.
Third, can we make it reach people? Even if we could develop an effective vaccine with an initial safety record, would we be able to pass it on to people? Vaccine manufacturing is not simple. Can fail or become contaminated, even with experienced pharmaceutical companies — and not all companies making new vaccines are experienced.
And even if an effective, apparently safe vaccine is produced in large quantities, it is necessary to quickly and equitably at the right temperature, to educate physicians and inform communities and monitor potential harmful effects. It will be difficult to distribute from and deliver. . Even the protection provided by a highly effective vaccine is only as good as our delivery system. The measles vaccine is more than 90% effective, but the World Health Organization reports that more than 140,000 children died of the disease worldwide last year – most of them in communities with low vaccination rates.
Especially in this election season, the process of vaccine evaluation should be scientifically rigorous and open.
The biggest challenge to get a Kovid-19 vaccine in a weapon of enough people will not be scientific, technical or logical; It will come from lack of trust. Especially in this election season, the process of vaccine evaluation should be scientifically rigorous and open. Public confidence can be eroded by large profit margins for vaccine manufacturers, a lack of transparency about the cost of production and prices that fails to take into account the fact that many vaccines greatly benefit from publicly funded research Occur. Open meetings of the major advisory committees of the Food and Drug Administration and the Centers for Disease Control and Prevention will be unavoidable.
We should level with the American public in a way that has not been done during this epidemic. We do not have enough tests, so we need to prioritize. We do not have enough protective equipment for health care workers, so we should safely produce reusable 9595 masks. And when vaccines arrive, we won’t be enough for everyone. Different vaccines may be available at different times, and some will probably work better than others. Governments will need to set priorities among different groups, given such factors as the risk of severe Kovid-19 disease, the safety and impartiality of essential actions. For example, those working in prisons, nursing homes and hospitals, and Black and Hispanic people are more likely to be exposed to the virus and have underlying health conditions that make them particularly vulnerable.
In addition, vaccines will not provide true protection and will probably not completely eliminate the epidemic. In our interconnected world, a truly global vaccination campaign will be necessary for America’s long-term health and economic recovery.
Even within the US, cases and groups will have to continue until the vaccine is exceptionally effective and approved, requiring quick, effective public-health responses. Our society will still have to adapt to limit the spread of the virus – reducing close contact, holding onto handshakes, wearing masks, and improving ventilation. And unless the vaccine is surprisingly powerful or we discover very effective treatments, my 91-year-old mother will not be returning to her beloved singing practices anytime soon.
The deployment of the Kovid-19 vaccine is the most important thing we can do to restore some order and normalcy to our world. We cannot get it wrong.
-Dr. Freeden was the director of the CDC from 2009 to 2017. He is the President and CEO of Save to Lives (Vital Strategies, an initiative of the Public-Health Organization) and a senior fellow of the Council on Foreign Relations.
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