The advent of Covid-19 vaccines is a medical miracle, yet also a tantalizing and dangerous psychological milestone: It’s not the beginning of the end of the pandemic but, more likely, “the end of the beginning,” to borrow a phrase from Winston Churchill.
The first day of distribution of vaccine in the United States illustrated the point. California accepted its initial delivery of 33,150 doses, just as it was beginning to average more than that number of new coronavirus cases every day.
Such realities, though grim, have been easy to overlook. Exuberant headlines about vaccines — Now two! Millions more doses! — have grabbed attention, as have rightfully joyous social media photos of health care workers receiving their inoculations.
“We get so kind of blinded by vaccine euphoria — the light at the end of the tunnel — that we underestimate how long that tunnel is, and how dangerous that tunnel is,” said Peter Sands, executive director of the Swiss-based Global Fund to Fight AIDS, Tuberculosis and Malaria, which has expanded its mission to combat Covid.
For most of the countries the fund invests in, Sands added at a recent health summit hosted by the Milken Institute, “vaccines are not going to be available at scale” until “late ’21 at the earliest, and a lot of lives are going to be lost in that time in between.”
So hand-washing, mask-wearing, social distancing — and, experts warn, a healthy new dose of cognitive dissonance — will continue to be the daily reality for most of us for months to come.
The question is whether Americans will get too caught up in the enthusiasm over what they perceive to be elixirs nearly at hand. Perhaps, they might wonder, can’t they let their guard down, just a little?
William Hallman, a psychologist at Rutgers University and an expert in the study of the perception of risk, noted that the statistical risk of any given activity matters far less than “what you think the risk is.” So “from a risk perception standpoint,” he said, “there is a potential danger that people will now get vaccinated and think they are super-human and nothing can touch them, which is certainly not true.”
Not only do the vaccines not prevent 100% of infections, it’s still unclear whether they prevent infection and transmission of the virus that causes the disease, leaving the unvaccinated vulnerable. Health workers who are vaccinated will most likely follow public health guidance to continue wearing masks in public, but what of the rest of us?
Hallman, who chairs the Department of Human Ecology at Rutgers, said that one of his frustrations, as a psychologist, is that the national messaging about the pandemic has been led most vocally (and perhaps understandably) by physicians and epidemiologists “and their focus is on the germ and what to do about it.” By contrast, he said, there have been “very few social scientists, behavioral scientists in helping the government determine how to change people’s behaviors.”
As a result, he fully expects more public conflicts to play out, sooner or later.
“If I get vaccinated and I decide I don’t need to wear a mask anymore and can go to the grocery store, what’s the proper response from the grocery store manager?”
Hallman said his proposed message to public officials would be brutally clear: “This is what we know, this is how we know it. There are still some things we don’t know. Here’s what’s important. Here’s what we’re going to become a lot more certain about. Here’s what we think you should do now.”
There is also the matter of just how long it’s going to take to distribute enough vaccine for all those who want it. Many potential impediments remain in getting the vaccine from pharmaceutical laboratories and warehouses into the biceps of Americans, starting with the challenges of mass production.
“There’s an old saying: ‘The hardest part of making vaccines is making vaccines,’” said Paul Offit, a professor of pediatrics at Children’s Hospital of Philadelphia and a member of the Food and Drug Administration’s vaccine advisory committee. He noted the storage and shipment requirements for the only vaccines authorized so far are cumbersome, particularly for the vaccine developed by Pfizer and its partner BioNTech. That could make distribution more difficult, even as supply expands. Both require two doses for full effect — itself a logistical and messaging challenge in getting those vaccinated to complete the full course.
“And there will be spurious safety questions,” Offit added. “‘My grandmother got the vaccine and two days later she had a stroke or a heart attack,’ so the virus causes strokes or heart attacks. You’re going to be dealing with all of that. And with all of the misinformation put out there by the anti-vaccine movement, because you can appeal, apparently, to people’s sense of conspiracy, that there are microchips in the vaccine, that the vaccine causes Covid. And no vaccine is 100 percent effective, so some people inoculated will still get Covid.”
Samantha Penta, an assistant professor of emergency preparedness at SUNY Albany, noted that there is also always some segment of the population unable to tolerate vaccines, because of allergies or because they are immuno-compromised. Taken together, such caveats guarantee that “just because a vaccine is out doesn’t mean that a sufficient proportion of the country is protected to mean that the virus is not still spreading.”
So far, any serious side effects of inoculations have been comparatively isolated and easily managed, but the vaccines have yet to be tested on children or those who are pregnant or lactating, for example.
Penta said that “it’s really important for people to keep in mind that while the vaccine is a great step and great progress toward a future in which we don’t have to worry about Covid-19, it’s really hundreds or thousands of little steps that are going to take a long time. Much of the next few months, for a lot of people, are going to look and feel very similar to the last few months.”
Robert Marshall, a cardiologist in Washington, D.C., said health care workers remain exquisitely sensitive about “maintaining vigilance and not letting their guard down at this point,” and that doctors and the public alike should use the vaccine “as motivation to go strong and beat Covid fatigue.”
“As interventional cardiologists,” he warned, “we have to continue to assume every patient is potentially infectious, regardless of whether they have symptoms. This is especially true with heart attack victims, given it is a known consequence of Covid. Many of these patients need an immediate procedure and there is no time for the PCR test and in most cases not even a rapid test to be back in time before rushing off to the cardiac catheterization lab. We therefore don the full protective gear, not only to protect ourselves, but for those we may come in contact with, who may be more vulnerable. We will not change this approach any time soon, and the same case should be made to the public.”
For his part, Offit said he would never have predicted that vaccines could be developed so quickly, “which explains all the emails I got after I said it wouldn’t be ready nearly this soon.”
As a vaccine expert, he said, “I can’t wait to get it.” And as an infectious diseases specialist, he does “round on inpatients, some of whom are in the Covid ward.” As such, he wasn’t a first-tier worker, but imagines he’ll be getting a vaccine next week — just after Christmas.