Reality of a vaccine
August 1, 2020 2:05 PM   Subscribe

National leaders talk about when a vaccine will be "available." What does that mean with respect to the timing for widespread vaccination and a return to "normal?"

My office has said that we can work from home through the end of the year. They are likely to extend it if the COVID-19 danger persists.

NYT today: "On Friday, Dr. Anthony S. Fauci, the nation’s top infectious-disease expert, told Congress he was cautiously optimistic that a safe and effective coronavirus vaccine would be available by the end of the year or early 2021, though the federal government’s ability to speedily immunize most Americans was unclear."

What do available and unclear here mean? Available for key healthcare personnel or available for anyone to go get from their doctor? Available the way that the technology for medical-grade PPE is "available" but no production capacity exists?

How do I stay on top of this? All heads up, even a short one before things hit the front page of the NYT, would be helpful.
posted by slidell to Health & Fitness (19 answers total) 7 users marked this as a favorite
I should have specified: I'm in the US (California). Thanks!
posted by slidell at 2:05 PM on August 1, 2020

The COVID threads on the Blue can help you stay on top of this. For one thing, that Fauci story dates back to June 23rd. Regarding vaccine timeline, no one really knows. But this NYT infographic has helped me reset my expectations. Warning, can be very depressing.
posted by lazaruslong at 2:10 PM on August 1, 2020 [3 favorites]

With its well-earned reputation, the Atlantic has all your first rate covid-19 coverage, including vaccine outlook.
posted by j_curiouser at 2:16 PM on August 1, 2020 [3 favorites]

Dozens of COVID-19 vaccines are in development. Here are the ones to follow.

Several efforts are underway to help make that possible, including the U.S. government’s Operation Warp Speed initiative, which has pledged $10 billion and aims to develop and deliver 300 million doses of a safe, effective coronavirus vaccine by January 2021. The World Health Organization is also coordinating global efforts to develop a vaccine, with an eye toward delivering two billion doses by the end of 2021.

So this is a couple of REALLY BIG IFS here, but if at least one of several large-scale vaccine trials actually goes well, and if drug companies are able to produce their vaccines in quantity, then then governments are poised to throw HUGE QUANTITIES OF MONEY to make that happen.

One reason to be a little optimistic is that COVID-19 is similar enough to SARS and MERS that a lot of the basic research has already been done after those previous outbreaks. And while the prediction that a vaccine will be ready by the end of the year is INCREDIBLY optimistic, we haven’t hit any hurdles so far. Fingers crossed.
posted by 1970s Antihero at 2:29 PM on August 1, 2020 [2 favorites]

[Couple comments deleted. Gentle nudge not to get too digressive/chatty in here. Please stick to sources/info on vaccine availability timeline, thanks.]
posted by LobsterMitten (staff) at 2:38 PM on August 1, 2020 [1 favorite]

Further context to the Pfizer study referenced in 1970s Anyihero’s National Geographic link. I’m currently participating in it. Last week they were scheduling shots for phase 3 participants in Charlotte, N.C. in 21 days I’ll go back and get a second round of either placebo or vaccine (it’s double blind so I don’t know what I’m getting). They will do a 1-month visit after the second injection and then also a 6 month visit and there will be blood draws at both. I mention this because I would hazard a guess that some decisions regarding pursuing this vaccine on a larger scale will be made after the 1 month blood draw or possibly the 6 month blood draw.

Past that there are obviously additional issues and considerations regarding production and distribution, but I thought some context to the vaccine development side might also be helpful to you.
posted by raccoon409 at 2:56 PM on August 1, 2020 [13 favorites]

If any of those vaccines in development proves effective, I suspect deployment would be relatively similar to when the H1N1 vaccine became available in early 2010. That is, the first group of people to get it will be the wealthy 1% (the ones who seemed to manage to get tested on demand back in March, when the rest of us symptomatic plebs were told to go home and isolate until we collapsed), then healthcare professionnals, then the general population. The people who are at highest risk of covid and its complications will not be able to afford it.

The only way around this is if the US government and Pharma decide to reverse a century of profit motive and give it out for free. Unlikely, particularly if the Republican oligarchs retain control of the executive and Congress remains split. Other countries with a more functional healthcare system might do better.

In fact, the last time we managed a mass vaccination campaign in the US was the Salk vaccine in the 1950s -- vaccine depots in school gyms and the like. Salk was asked about the patent, and famously said "The patent belongs to the people. It would be like trying to patent the sun."

The last global mass vaccination campaign was the WHO vaccinating against smallpox, which remains the only disease we humans have managed to eradicate. That effort took two hundred years and some dubious ethics esp at the end.

All of which is to say, end 2020 may be scientifically reasonable to ID an effective vaccine, but returning to some semblance of a pre-covid society probably not till mid 2021 at the earliest.
posted by basalganglia at 3:24 PM on August 1, 2020 [4 favorites]

On Point's What It Takes To Develop A COVID-19 Vaccine with Magna Chakrabarti is well worth a listen if you want a more nuanced context for the vaccines (plural) they're creating, the role the federal government is playing and so on.
posted by Violet Blue at 3:33 PM on August 1, 2020

There's also strong potential for multiple competing vaccines, given how many are in development and how low the bar for 'success' is. Keep in mind that the most effective one identified of the current batch might come in around 60%, more similar to some (bad) years' seasonal flu vaccine than to the great effectiveness of eg smallpox vaccine mentioned above (>95%).

One interesting corollary to herd immunity via vaccination is that the less effective the vaccine, the larger the proportion of the population that needs to get it before herd immunity can take effect.

A 90% effective vaccine is pretty good at protecting some few percent of the population. A 55% vaccine does very little for personal or public health until 90%* of the population gets it.

*numbers made up for illustrative purposes. The real values depend on the natural rates of spread, factors of the disease, if people are otherwise acting to prevent transmission, how many, etc.
posted by SaltySalticid at 3:42 PM on August 1, 2020 [4 favorites]

There appear to be technical and ethical issues related to distribution, e.g. from the most recent US/COVID FPP:

> Lancet editor Richard Horton has harsh words for Trump, hope for science (WaPo, Jul. 29, 2020) ("We have to have a global response and need to protect those most at risk. We know who those people are. They’re older. People with chronic diseases. They’re from black and minority ethnic populations, and workers in the health system. They’re the people who need to get the vaccine. Not me.")

> Johns Hopkins Experts Address COVID-19 Vaccine Challenges, Realistic Timelines (CBS 13, Jul. 30, 2020) (“Most likely, older adults will be prioritized. Health care workers will clearly be prioritized on the front line. The question then becomes what about essential workers? What about keeping the economy going?” [...] "A reasonable timeline for wide distribution of vaccines is likely the end of 2021, according to Dr. Bar-Zeev. “Even after we have a vaccine that works and even after we demonstrate its safety and efficacy and even after we’ve produced enough doses to go around, at least for the first round, we still need to get it delivered and that’s going to be a big challenge,” Dr. Bar-Zeev said.")

> Fauci optimistic COVID-19 vaccine will be widely available (AP, Jul. 31, 2020) ("“I believe, ultimately, over a period of time in 2021, that Americans will be able to get it,” Fauci said, referring to the vaccine. There will be a priority list for who gets early vaccinations. “I don’t think we will have everybody getting it immediately,” Fauci explained.")

You could Ctrl+F for "vaccine" on the thread, because the issue does tend to get discussed when it is in the news.
posted by katra at 3:50 PM on August 1, 2020 [1 favorite]

Thanks. This is all really helpful. I'm realizing that I might've framed this a bit too narrowly because I'm really trying to figure out how long we should be making contingency plans for. When will we be expected to go back to real life? If my mom came out to help with the kids but will have to leave once it's safe to go back to the office, can she sign a six-month lease? Should we stop saving a daycare spot for a child who will start kindergarten in Aug/Sept 2021? For my purposes I don't care whether the return to "normal" comes via a vaccine or some kind of testing and tracing routine. I am really appreciating everything that people have commented so far. Thanks!
posted by slidell at 4:10 PM on August 1, 2020 [2 favorites]

I wrote a longer comment with analogy to the H1N1 vaccine and previous mass vaccination campaigns, but katra's comment summarizes a lot of the potential problems -- even if one of the many vaccine candidates proves effective, implementation will be uneven due to the fragmentation of the US healthcare system. That's what Fauci means when he says "unclear."

If you are looking for when things will be back to precovid society in the US, mid 2021 is an optimistic maybe. Sooner than that would be nothing short of a miracle.
posted by basalganglia at 4:19 PM on August 1, 2020 [2 favorites]

#1. At least a couple of the primary vaccine candidates in the U.S., they are moving forward to manufacture something like 100 million dosages of them, even as final steps of testing move forward. That is to say, they are preparing vaccine dosages in the 100s of millions before the final testing and approval to distribute them is even complete. One example.

The idea is, if the vaccine passes the final round of testing, then the 100 million dosages will be available pretty much as soon as that approval is given. Also this ramps up the manufacturing capacity so that further 10s to 100s of millions of dosages could be produced in pretty quick order. So everything pans out, this accelerates the availability of vaccines by a large margin.

Keep in mind that the development of vaccines is usually measured (literally) in decades. So even getting out a vaccine by, say, 2 years would be amazing by usual standards. But they are apparently shooting for early 2021 *if* all goes well.

And if all *does not* go well and the vaccine fails its final round of tests, they are prepared just dump that 100 million dosages. So that is a financial risk the federal government is taking.

But even if they do have to dump them--ie, don't get the vaccine dosages as quickly as in the best-case scenario--the manufacturing etc is still in place and has had its shakedown cruise. So it's still a considerable leg up, and they should be able to produce vaccine dosages in the 100s of millions range quite quickly, as soon as final testing and approval is complete.

#2. Manufacture isn't distribution. Even if we had 350 million vaccine dosages available in the U.S. right this second, there is some question about how long it would take before the average person could actually get their hands on one. Weeks to a couple of months at best, probably.

#3. People are worried about "when the vaccine will be available to me" or--thinking about more altruistically--"when will it be available to to high-risk populations".

In reality, most of us probably ought to be thinking about letting other people go to the front of the line. Doubly so if you happen to be in a high-risk group.

Fact is, the final line of testing before public release is somewhere in the 10s of thousands of subjects. So that is simply not enough people to be able to test every combination of possible health condition, risk factor, age group, etc. That takes many millions of subjects, not just 10s of thousands. And . . . the trial subjects are certain to be weighted heavily in favor of younger, healthier people. I believe in the final stage of testing, most companies are making a definite attempt to include a wider ranges of ages, risk factors, etc. But still you're looking at dozens to hundreds to maybe low 1000s in the test group for any given condition.

And as you combine conditions (ie, someone with kidney disease AND diabetes AND in their 60s AND an ex-smoker or whatever) the number in your test pool inevitably shrinks even more.

So rich people are probably going to be able to get their hands on the vaccine very early on. Fine--let'em. They can be the next round of de facto testers. And it makes sense to distribute early on to health care professionals, nursing home staff, maybe police, EMTs, firefighters, etc because the benefit clearly outweighs the risk there. Then maybe you move to healthy people in the 20-40 age range where the vaccine has the clearest safety record--and also many high-risk-for-spreading populations like college students, military. Maybe schoolchildren next. Maybe there is an outbreak somewhere so they rush a bunch of vaccines to that geographical area and do mass inoculations. And so on.

Point is not that I can exactly predict who will be able to get the vaccine earliest and in what order, but rather that it will most certainly roll out in stages over time and it's very likely that you (or your particular co-workers or whatever) are not necessarily going to be in the earliest rounds of groups receiving it.

And, that's fine.

(And someone who is in one or more high-risk categories may want to think hard about whether they want to rush to the front of the line to get the vaccination. Maybe, instead, let a few tens of millions more early adopters find out any rare side effects and such first. This isn't some kind of anti-vaxxer BS but simply an acknowledgement of historical reality about vaccine development (CDC) and that someone with some already-existing health problems may weigh the risk-benefit a little differently from others, until further information about the safety of a particular vaccine has been gathered from a much larger population.)

What you're going to see as a vaccine rolls out is the gradual dropping of COVID-19 transmission rates. And a gradual, very gradual re-opening of things and return to "normal". But--to directly address your question--it is almost certain to play out over several months at quickest and possibly as long as a year or two.
posted by flug at 4:24 PM on August 1, 2020 [10 favorites]

Skeptical Raptor has been blogging about this for a while. They're not as optimistic as others. Personally, my thinking is more in line with them. There are other things to think about besides the vaccine such as pharmaceutical grade glass.
posted by kathrynm at 5:53 PM on August 1, 2020

the current batch might come in around 60%, more similar to some (bad) years' seasonal flu vaccine

Actually, that would be a very good year indeed for flu vaccines, not a bad one. They are routinely significantly less effective than 60%. See these data from the CDC. The last time the flu vaccine was as effective as 60% was a decade ago; in recent years it's been between 19-48%. If the general consensus is that flu vaccines are still worthwhile at effectiveness rates like those, then 60% is nothing to sneeze at.
posted by nirblegee at 8:13 PM on August 1, 2020 [3 favorites]

Everyone is focused on vaccine development, but there's another viable way back to some normalcy -- antibody treatments. The FDA is approving various blood plasma treatments, and there are monoclonal antibody therapies on the way as well. So if vaccines don't pan out as optimistically as expected, various kinds of antibody treatments could get us to a short term fix until vaccines are widely available. But... Just because it's medically possible doesn't mean it will be economically viable.
posted by mhh5 at 12:44 AM on August 2, 2020 [1 favorite]

When will we be expected to go back to real life?

Well, that's one of the big problems. We may not go back to 2019. IMHO, the national message should have been, "this is hard to do, it won't be done in six weeks, and we will probably have an unfolding plan over several years."

Vaccine durability - how long it lasts - could be short.

The levels of protection could come in at less than ideal (sterilizing immunity).

The phase three trials might reveal an intolerable side-effect.

The experts think it's unlikely, but SARS-CoV-2 could mutate to be more transmissible, create worse outcomes.

"We got this." Was not the right attitude to project. By March 2020, this should've been the clear message:

"this is a brand new virus, we know nothing about it, we don't know how to treat it, we don't know how to prevent transmission. it's near worst-case for an epidemic and definitely the worst health and economic crisis in 100 years. We're lucky the mortality rate is *only* 10x seasonal influenza. This will be a long hard effort. We have amazing experts who will do everything possible to advance the science and medicine as quickly as possible. For a long time, they will be largely improvising an approach. At this rate, we should all expect to know someone who suffered from covid-19 by years's end. We are all in this together."

Laurie Garrett and Vincent Racaniello made early predictions on how this would go if specified actions weren't taken. They've been largely right.

Synthesizing all the information I know right now, my layperson's view...

When will you be able to go 3 months without thinking about covid-19? Roughly never. At minimum, we will all need to keep our personal vaccine boosters on schedule. And at an estimated 20% vaccine-refusers, we will not hit the magic herd immunity number, and COVID-19 will be endemic in the US for the foreseeable future.
posted by j_curiouser at 11:45 AM on August 2, 2020

Convalescent plasma is hit or miss. Essentially, "shit. I dunno. maybe let's borrow someone else's antibodies?" Also, with covid-19, if you you don't use it early enough, it introduces much worse clotting problems than any positive immune effects it may have (follow Daniel Griffin's guest appearances on TWIV).

How do you get plasma to patients early? Detect it early. Free, ubiquitous, timely, accurate testing. Thorough contact tracing.

With a federal response actively in opposition, that clinical approach is much less likely to have large scale results.
posted by j_curiouser at 12:03 PM on August 2, 2020

Today, a syndicated article from afp - a legit news agency. Expect 'lengthy' coronavirus pandemic.
posted by j_curiouser at 12:43 PM on August 2, 2020

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