Columns for The Lufkin News

Will a Coronavirus Vaccine Be the Answer?

Posted Sep 12, 2020 by Sidney C. Roberts, MD, FACR

The novel coronavirus has changed our lives. Just about everything we do is affected by mask-wearing and social distancing. The economy has been reeling, although you wouldn’t know it by looking at the stock market. There have been more than 6 million cases in the US and closing in on 200,000 deaths so far.[1] Thankfully, scientific knowledge around coronavirus is expanding at an unprecedented pace. Everyone is looking for a silver bullet against coronavirus. Many hope a vaccine will be that bullet.

Development of a coronavirus vaccine is an urgent priority of the federal government. Since its inception in May, Operation Warp Speed – the collaborative effort between the U.S. Department of Health and Human Services (HHS) and pharmaceutical companies to develop and produce hundreds of millions of doses of coronavirus vaccines – has helped identify well over one hundred vaccine candidates and implement dozens of trials. Nine vaccines are in large scale phase 3 trials.[2][3] Projections of when a vaccine will be available have ranged from October[4] (per President Trump in the early days of the vaccine development) to the end of 2020[5] or, more likely, early 2021[6], according to recent comments by Dr. Anthony Fauci, Director of the National Institutes of Health’s National Institute of Allergy and Infectious Disease. Dr. Fauci seriously doubts we will have to rely on an international vaccine (think Russia[7] or China[8]), having openly criticized the Russian President Vladimir Putin-promoted effort as “bogus”.[9]

Obviously, the sooner we have a vaccine, the better. The Centers for Disease Control and Prevention (CDC) is calling on states to have vaccine distribution sites fully operational by November 1, a gargantuan task.[10] That does not mean a vaccine will be delivered on November 1. We need to temper our expectations of what will happen – and how quickly – once a vaccine becomes available.[11]

The goal of any vaccination campaign is “herd” (community) immunity, where a sufficient proportion of a population is immune to make disease spread from person to person unlikely.[12] In general, 60% or more of a community or population needs to have either had a particular infectious disease or be vaccinated against it in order to provide sufficient community immunity. Sounds easy enough.

According to the Centers for Disease Control and Prevention (CDC), only 45.3% of adults got a flu vaccination for the 2018-2019 season, ranging from a low of 33.9% in Nevada to only 56.3% in Rhode Island.[13] Twenty percent of Americans already say they will refuse to get a COVID-19 vaccine[14], and with another 31 percent unsure, reaching herd immunity could be that much more difficult.[15] On a cautiously optimistic note, there is some speculation that the herd immunity level with the COVID-19 coronavirus might be as low as 43%.[16] That shouldn’t make us think twice about getting vaccinated, however, especially when that vaccine will be effectively free[17] and, if all goes as promised, readily available. The more the merrier, when it comes to people getting vaccinated.

I do worry how long it will take to get 300 million doses of a vaccine delivered and administered in our communities. In the 2009 H1N1 pandemic (caused by a more seasonal flu virus than the novel coronavirus), vaccine doses were first distributed to state and local health departments and then further out to mass clinics, employers, schools, hospitals, pharmacies, and doctor’s offices. Even so, only about a quarter of all Americans got vaccinated before the pandemic played out.[18] The coronavirus vaccination effort will have to be larger and faster, and this pandemic is not expected to fizzle like a flu season does. (We already know that optimistic predictions of a summer lull did not happen.) All that is to say, it may be awhile before we reach herd immunity.

There are other logistical uncertainties as well. Will the vaccine require cold storage? (Probably.[19]) Will a single dose be effective? (Probably not.[20]) How will distribution and dosing be prioritized?[21] (Health care workers? Elderly? Racial disparities?) With so many vaccines in development, “the first” vaccine may not be “the best” vaccine for the long run.[22][23] I would still take it… and whatever follows as well, if that is what is recommended by the medical experts.

Politics continues to tussle with Science, most recently in the “breakthrough”[24] announced from the White House regarding convalescent plasma as a COVID-19 treatment. FDA Commissioner Stephen Hahn sheepishly had to backtrack misleading comments made about convalescent plasma therapy[25] while defending against Trump’s accusations that the “deep state” at the FDA was making it hard for drug companies to test coronavirus treatments.[26][27] Thankfully, Politics is funding Science to an incredible extent during this pandemic. I suppose in any dance one partner may step on the other’s toes on occasion. As long as the dance continues, we have hope.

While we wait on a coronavirus vaccine, we should stay current with other vaccinations and definitely get the flu shot this fall.[28] There is some speculation that vaccinations might help “train” or boost our overall immune system.[29] Who knows? And we need to continue to slow the spread of coronavirus by wearing masks (mouth AND nose, please), washing our hands, and social distancing. Remember, this is a community effort.

One final thought. When a coronavirus vaccine does become available – one that is determined to be safe and effective[30] – I would like to see President Trump, Speaker of the House Nancy Pelosi, and other major political and scientific leaders hold a news conference and all get vaccinated together on live television. Lead by bipartisan example! What better way to reassure the public and encourage all of us to follow suit. A vaccine may or may not be a silver bullet, but I am hopeful one (or more) will be a great tool in the fight.































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