Several months ago, as an infectious-diseases specialist and a career-long vaccine enthusiast, I recommended caution in seeking early vaccination against the SARS-CoV-2 virus. I write now, with much more information at hand, to reverse that stance. I suggest that all but the very few who might have contraindications (primarily severe allergies that are anaphylactic in nature) get vaccinated with the currently approved COVID-19 vaccines as soon as they are available.
As Dr. Anthony Fauci did in his evaluation of the protection afforded by masks, I make this switch in recommendation without the slightest embarrassment or regret. My concern four months ago involved the politicization surrounding vaccine development, and the possibility that the earliest vaccines might be developed in countries that have a mixed reputation for biologic product safety and efficacy. I am now convinced that the two vaccines currently approved have been rigorously and honestly evaluated for both these attributes, and have met the appropriate levels of performance.
Vaccine Effectiveness and Hopes
While it may turn out that efficacy is in the 80% range rather than the currently demonstrated 90 to 95%, that would still produce effective immunization. The possible overstatement of efficacy might occur because we are not in the moral or biologic position to do the most-definitive efficacy studies, which depend on artificial challenge after vaccination. In that type of efficacy study, volunteers are vaccinated and then purposely exposed to an infectious dose of the agent under investigation. The infection rate in people who receive these vaccines is then compared to that in exposed patients who were not vaccinated or received a placebo. Since SARS-CoV-2 can cause serious disease and death, this method could not be used. We have had to rely on smaller numbers of individuals who were infected naturally. Ironically, the number of comparable vaccine and placebo recipients was achieved as quickly as it was because of the highly contagious nature of this virus and because many people did not follow mitigating procedures.
Under current circumstances, with infection and mortality still increasing at tragic rates, we must encourage as many people to be immunized as we can, in the shortest possible time. This is a matter of life and death.
I personally hope that I get a vaccine before COVID gets me.
Future COVID19 Vaccines
It may turn out that vaccines that are even more effective will be developed in the future, but we are facing increased cases and deaths right now, and if and when new vaccines are released, we will be able to get those too. It may also turn out that annual vaccinations are needed, as is true with influenza vaccines. So be it. We must deal with the present.
A final comment: even at the amazing 90% efficacy level, one out of 10 vaccine recipients will not become immunized. That’s why it so important that we do all we can to prevent infection, not only before but after receiving a vaccine. This means that it may be a while before we can relax mitigating restrictions and give up wearing masks.
My previous questions about vaccines have been sufficiently answered. Now I want to see the vaccines succeed beyond all our wildest expectations.
