Pfizer’s new COVID-19 vaccine might get FDA emergency use authorization in a few weeks, and a small group of Americans might begin getting shots in December. Moderna’s vaccine might quickly follow. But even for those who can get vaccinated soon—potentially 20 million people in the U.S., out of a population of more than 320 million—life won’t be able to go back to normal yet.
Even after you’ve been vaccinated, if you’re lucky enough to get a vaccine in the months that follow the initial rollout, you’ll still have to wear masks and practice social distancing. Pfizer’s study showed that its vaccine, made in partnership with the German company BioNTech, has 95% efficacy. But there’s still a risk: Scientists don’t yet have all of the necessary data to know exactly what it’s effective at preventing.
Even if a person gets vaccinated immediately, we still have another month to wait until the full vaccination takes effect. So it’s going to take some time.”
“We don’t have the data yet to know whether these vaccines actually prevent people from getting the virus,” says Lisa Lee, a public health expert specializing in infectious disease epidemiology and public health ethics who previously worked at the Centers for Disease Control and Prevention and now serves as the associate vice president for research and innovation at Virginia Tech. “We only know that they prevent people from getting really sick from the virus. These data have been released very early because they’re so promising. But we still have a lot of analysis to do and a lot of work to do to make sure that we understand what the vaccines are preventing.”
If it’s proven that the Pfizer vaccine or other vaccines fully prevent infection, we could begin to stop wearing masks and taking other prevention measures. But if the vaccines only prevent severe disease, things are different. That will obviously save many lives. But it risks the possibility of spreading the virus further. “If we vaccinate people and they don’t think they’re going to get sick, and they don’t know they’re sick, they could still pass it on to vulnerable people,” says Lee.
That’s especially a problem because the vaccines will initially be available in only limited quantities. Manufacturing began early—long before it was clear that the vaccines might work—so some doses will be ready when the FDA gives the green light. But there won’t be enough to cover the whole population. U.S. officials have said that they expect to have enough doses of vaccine from Pfizer and Moderna, which is also likely to be considered for emergency use authorization, to inoculate around 20 million people in December. (Both vaccines require two doses; Pfizer is aiming to make around 50 million doses by the end of the year, with half of those going to the U.S.; to serve the entire U.S., we’d need around 600 million doses.) In early 2021, there may be enough doses of vaccine for around 25 to 30 million people a month. Doses will go first to healthcare workers and frontline providers. Most Americans won’t have access to the vaccine until later in 2021.
“It’s great news that we have two candidate vaccines that are showing in early studies to have 95% efficacy,” says Lee. But “that’s the start of a long journey, probably realistically a journey of 6 to 12 months, in terms of getting the vaccine made, stored, distributed, allocated, and then into the population itself. It’s going to take time to manufacture and get enough vaccine. Each of these are two-dose vaccines, between three and four weeks apart. So even if a person gets vaccinated immediately, we still have another month to wait until the full vaccination takes effect. So it’s going to take some time.”
We’re going to have to continue to be concerned about both our own health and, importantly, the health of the people we love and interact with.”
Lee suggests that the first doses may not actually roll out until January (rather than December, as promised), as manufacturing plants package the doses, the CDC handles allocation, and the logistics are planned for transporting and storing the vaccines, which have to be kept at cold temperatures to work. If the first group of people gets vaccinated in January, they’ll have to wait three or four weeks before their next dose. By February or March, the first small group should be vaccinated. Then they’ll still have to take precautions, and so will those that follow, until more data is analyzed and further studies are completed.
There’s a very real risk that people will begin to feel confident when they have the vaccine and stop wearing masks and distancing, even before it’s clear that that’s safe. “Pandemic fatigue is a real thing, and I think it’s very hard for all of us to keep this up,” says Lee. “I would say that in any infectious disease situation, in any contagious situation, there are two things people worry about. One is their own infection and illness. And the other is whether and how they infect other people with the bug that will cause illness. With either of these vaccines, we know they will help protect the individual. We don’t know yet if it will protect our spreading it to others. We’re going to have to continue to be concerned about both our own health and, importantly, the health of the people we love and interact with. Because if we stop doing the public health mitigation behaviors, the distancing and the masking, while we might be fine, we could potentially hurt somebody else.”
One of the founders of BioNTech recently said that he expected that vaccine would reduce transmission between people—but perhaps not completely. “I’m very confident that transmission between people will be reduced by such a highly effective vaccine—maybe not 90% but maybe 50%—but we should not forget that even that could result in a dramatic reduction of the pandemic spread,” he told the BBC. Life might not be back to normal, he said, until next winter. Another challenge will be reaching critical thresholds of vaccination; if enough people are vaccinated globally, we can reach herd immunity. But large percentages of Americans have said that they’re hesitant about taking the vaccine.
“If everybody takes the vaccine, then nobody can get really sick, and it doesn’t really matter if we have the virus and can infect each other because we’ll all be protected,” says Lee. “But until that happens, or until we find out that the vaccine actually prevents infection itself, we’re kind of stuck with these public health mitigation strategies, I would say, at least for the next year, if not longer.”