As the COVID-19 pandemic continues to rage across the globe, the question being posed in scientific journals, on TV talk shows, and over dinner tables all across America is this: When will we have a vaccine? The answer to that billion-dollar question is still up in the air—as of this writing, dozens of vaccines are in human trials, though experts including Dr. Anthony Fauci have said the likeliest approval date is early 2021. So, perhaps an even more important question is this: Once we have a vaccine, will enough people be willing to get it?
In an exclusive survey of almost 3,000 women by Prevention, HealthyWomen, and GCI Health, 57% of respondents said they would get a COVID-19 vaccine as soon as it’s available. Readers are not opposed to vaccines on principle—79% are planning to get the flu shot this year. But there is a sense of distrust over the COVID vaccine, which is being pushed through the development stages in record time: In the survey, 32% of respondents said, “There is not enough long-term data.”
But there is much to find encouraging about these numbers, says Wendy Lund, the CEO of GCI Health. “An average of 64% of women over age 55 plan to get the vaccine, and surprisingly 74% of women between 18 and 24 plan to get it,” she points out. "The younger women are early adopters,” she says. “They also want to get out of the house and get on with all they’re missing, and they know a vaccine is our best hope to emerge from this crisis.”
While there is still much we don’t know about when a vaccine will be approved and how it will be distributed, here’s what we do know:
Yes, we need a COVID-19 vaccine.
Experts generally agree that in order to stop the spread of the virus—and for the country to go back to “normal,” including opening schools, offices, and businesses—we need a vaccine. And though it would be great to have decades to study long-term effects, we can’t afford to wait that long to stop COVID-19, which has already infected more than 5 million Americans and caused over 255,000 deaths. “When you release a vaccine, you don’t know everything—you never know everything,” says Paul Offit, M.D., the director of the Center for Vaccine Research at the Children’s Hospital of Philadelphia. “The question is always, When do you know enough?”
“Let’s say a vaccine been tested on 20,000 people [with 10,000 additional people receiving a placebo] and the efficacy was 75% at preventing moderate to severe disease without any serious side effects, and it’s been shown to be effective for six to eight months and probably longer,” says Dr. Offit. “With 1,000 people dying every day in this country and many more getting sick, would you get that vaccine? I think most people would.”
Dr. Offit also points out that even though different phases in some of the drug trials are being done concurrently instead of over a longer period of years, that is because the government, through Operation Warp Speed, is taking on the financial risk of building manufacturing facilities for vaccines that may not ultimately be approved (typically it’s the pharmaceutical companies that take this financial gamble, which is why they make sure the results of each phase are encouraging before spending tens or hundreds of millions on the next phase). But Dr. Offit points out that the same safety protocols are still in place: “If the Phase III trials that are currently being done show that the vaccine has a safety problem, or it’s less effective than one would hope, then they will throw away those vaccines,” he explains.
Another point to keep in mind is that we are not starting from square one with many of the vaccines and treatments, says Marsha B. Henderson, the former associate commissioner for women’s health at the FDA, who is on the board of directors of HealthyWomen. “We have had other coronaviruses before COVID-19, and there are products that have been identified that could be repurposed and be very helpful.” Henderson says consumers should also find it encouraging that the FDA has already reviewed one much-talked-about treatment and taken it off the emergency use list when it was found to have no evidence of efficacy, and that with new computer modeling, data from drug trials can be crunched much more quickly and efficiently that in the past. “You can do a lot with data from 30,000 people in a trial—they will be reviewing it and cutting it in every possible way,” she says.
Making the decision to line up to get the vaccine still comes down to each person. “People want to make sure that the vaccine has gone through all the bells and whistles that it should go through, and that every other approved vaccine has gone through,” says Beth Battaglino, R.N., the CEO of HealthyWomen. “We’re seeing a lot of conflicting news from different sources, but I am very confident in the research that is going on right now, and once the vaccine is approved and has gone through the appropriate channels, it will save so many lives.” Battaglino urges those who have concerns about vaccine safety to trust in science, not in internet memes. “Go to reliable sources for your information, such as the Centers for Disease Control and Prevention (CDC) and Kaiser Health, rather than reading whatever you find on Google,” she says.
A majority of Americans will need to get it.
As the saying goes, vaccines don’t stop disease, vaccinations do. So it’s not enough to have an FDA-approved vaccine: In order to stop the spread of COVID-19, a large enough percentage of Americans need to be vaccinated so that the virus can’t find new hosts to infect, a concept known as herd immunity. There is a complex formula for this based on the efficacy of the vaccine and the number of people each infected person typically passes the virus to. For COVID-19, that number is between 2 and 3. To put it in perspective, that’s more contagious than a seasonal flu (1.3) but far less contagious than measles (12 to 18).
“If the vaccine is 75% effective at preventing shedding [when an infected person releases the virus into the environment, infecting others], then you would need to vaccinate about two thirds of the population to stop the spread,” explains Dr. Offit. And though a segment of the population has already been exposed and developed antibodies, Dr. Offit explains those numbers won’t likely come into play when vaccines are distributed. “So many people have had mild cases or were asymptomatic and were never tested, so I think it would be too difficult to screen people that way.” It is also unclear how long immunity lasts for those who have been infected.
Who will get the COVID-19 vaccine first?
So let’s jump to the (hopefully near) future, when a vaccine has gone through all the testing protocols, and has been found to be safe and effective. Once it is approved, there will be a priority list of who receives it first. The CDC’s Advisory Committee on Immunization Practices (ACIP) is working with the National Academy of Medicine to develop that strategy right now, says Dr. Offit. “We can assume it will go to frontline medical personnel first,” he says. The first wave of immunizations will likely also include essential workers such as those in mass transit and nursing homes, as well as the elderly and other high-risk populations. “That first group will include about 120 million people, and since the vaccine will likely require two doses [given one month apart], we will need about 240 million doses,” he says. But even after the vaccine is approved and produced, there will be a major challenge rolling it out, Dr. Offit says. “At least as of today, the government hasn't made it clear exactly how they're planning to do that.”
One thing Henderson and other public health experts are adamant about, however, is that no one should have to pay for the COVID-19 vaccine once it’s approved. “The public has already paid for the vaccine—our taxes have supported the development of these vaccines, and we have poured out billions into the manufacturing as taxpayers. There should be no reason why any U.S. taxpayer should have to pay for that vaccine,” Henderson says. The administration has so far only stated that the vaccine will be provided free to those who “are vulnerable and can't afford it”—for others, it will be up to insurance companies whether they will require a copay.
There will be a diverse group of trial participants—except for one demographic.
Because Black, Latino, and Native American communities have been dying from COVID-19 at higher rates than the general population, Dr. Offit points out that it’s crucial that the clinical trials include as diverse a group of subjects as possible. “We need to make sure that groups who are most at risk are adequately represented in these trials,” he says. “So then we can say, look, this vaccine works—if you’re African American, or over 65, or you have co-morbidities, the vaccine is this percentage effective.”
In the Prevention/HealthyWomen/GCI survey, only 34% of Black women said they would get the vaccine right away, Lund points out, which speaks to a sense of distrust over whether enough safety precautions are in place. Dr. James Hildreth, an immunologist and the president of the historically Black medical school Meharry Medical College in Nashville, recently told reporter Soledad O'Brien that he has volunteered to take part in vaccine trials so he can encourage other African Americans to get the vaccine without fear.
However, in what will surely be disappointing news to parents, Dr. Offit points out that there is one group that is not currently being included in vaccine trials: children. “The initial studies are all being done on people who are over 18,” he says, pointing out that studies on children will likely not come along for a few months or years after the adult studies.
But there is a vaccine you should get right now.
All the experts we spoke to are confident that once the COVID-19 vaccine is approved and Americans see front-line workers (and trusted experts such as Dr. Fauci) get vaccinated without any significant side effects, doubts will fade away and enough people will become vaccinated to create herd immunity. But while we wait for the COVID-19 vaccine, there is another vaccine that everyone should get, says infectious diseases expert Morgan Katz, M.D., an assistant professor of medicine at Johns Hopkins Medicine. “We absolutely need everyone to get vaccinated for the flu,” she says. “This is the only protection we have now from what is preparing to be very hard winter and fall, and we need to use the tools that we already have.”
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Marisa Cohen is an editor in the Hearst Lifestyle Group’s Health Newsroom, who has covered health, nutrition, parenting and culture for dozens of magazines and websites over the past two decades.
