End of pandemic hard to forecast

Panel members differ on criteria, time frame

For the past year, people have pinned their hopes on vaccines to end the COVID-19 pandemic.

Each month since June, USA TODAY has asked a panel of more than a dozen experts in medicine, virology, immunology and logistics to estimate on an imagined clock when a COVID-19 vaccine would be available to most Americans.

This month, with three authorized vaccines and seemingly enough supply coming, they say it’s only 45 minutes from high noon, when shots will be widely accessible. The momentum follows a sputtering start to the vaccine rollout that stalled the clock at the start of the year. February’s time was 10:45 a.m.

But the closer we get to the longawaited goal, the less it seems as if it will mark the end of the pandemic that has disrupted lives and loves for a full year.

So we asked our panelists: When can we declare victory?

Their definitions of an endpoint differed, from a level of outbreak no worse than the flu to no new cases at all.

To Pamela Bjorkman it’s the smallpox scenario – a wiping out of the virus. A structural biologist at the California Institute of Technology, she sees victory as coming when everyone in the world is vaccinated and there are no more cases.

Others see it more as bringing COVID-19 in line with other diseases humans have learned to coexist with.

For Dr. Monica Gandhi, an infectious disease expert at the University of California-San Francisco, the pandemic will be over when deaths from COVID-19 fall to levels typically seen with the seasonal flu.

“There are more than 30,000 deaths a year of influenza in the United

States, so bringing COVID-19 mortality down to less than 100 deaths a day would be equivalent to rendering it similar to influenza-related mortality,” she said.

We’re nowhere near that. About 1,900 Americans a day are dying from COVID-19.

It may not be possible to say things have really shifted until next winter, when COVID-19, and all coronaviruses, tend to peak.

“We can declare victory over this pandemic in the U.S. if the virus causes only a negligible bump in cases next winter,” said Dr. Paul Offit, a pediatrician and head of the Vaccine Education Center at Children’s Hospital of Philadelphia.

To get there, Peter Pitts, president and co-founder of the Center for Medicine in the Public Interest, wants Americans to think of being vaccinated as a patriotic duty. To win the war against the virus, the country must get to a national vaccination rate of at least 65% and likely closer to 85%.

“I see herd immunity happening at some point between Memorial Day and the Fourth of July,” Pitts said. “All the more reason to come together as a nation, and roll up our sleeves so we can celebrate with barbecues and fireworks.”

Reaching herd immunity will require kids to be vaccinated, too, noted Vivian Riefberg, professor of practice at the Darden School of Business at the University of Virginia. At this point, with studies still underway, adolescents might be eligible for vaccination sometime in the spring or early summer, and younger children this fall or even later.

The pandemic’s unofficial end could also come when we’re still having flareups of COVID-19 but they’re small enough to handle, said Prakash Nagarkatti, an immunologist and vice president for research at the University of South Carolina in Columbia.

“There will be small fires in the form of sporadic cases of COVID-19 even after administering the vaccine to the majority of the population, but it will be easier to put out such fires,” he said.

There’s also the ravaging of the economy to keep in mind, notes Arti Rai, a health law expert at Duke University Law School.

“One very important indication will be data on job growth,” she said. “Once we reach, or surpass, pre-pandemic levels, we should be able to breathe a sigh of relief.”

We also need manufacturing and distribution readiness to deal with smaller outbreaks, said Prashant Yadav, a medical supply chain expert at the Center for Global Development.

“Having sufficient vaccines and therapeutic supply to meet demand and also a sufficient stockpile of reserves of vaccines and therapeutics” is crucial, he said.

As the country reopens, vigilance will be necessary said Dr. William Schaffner, an infectious disease expert at the Vanderbilt University School of Medicine in Nashville, Tennessee.

“As we gradually open schools, restaurants, sporting events, we will need to be alert to whether these activities result in superspreader events. If not, that will be very reassuring,” he said.

All of this presumes the Biden administration delivers on its promise that there will be enough vaccines to vaccinate every American adult by May.

Overall, the panelists agree that 500 million doses (200 million each of Pfizer and Moderna, 100 million from Johnson & Johnson) will be ready in time. On Wednesday, the Biden administration announced the purchase of 100 million more doses of the Johnson & Johnson vaccine.

If the administration can’t meet its goal, it won’t be for lack of trying, Rai said. She cited the administration’s “creative” use of the tools at its disposal to push the technology transfer necessary to scale up production.

Getting everyone vaccinated may take longer. And convincing those who aren’t certain they want the vaccine is another hurdle.

“I remain concerned that getting from 50%-60% coverage among adults (those who want the vaccine) to 80%90% (what we need to control the pandemic) will be very challenging,” said Daniel Salmon, director of the Institute for Vaccine Safety at Johns Hopkins Bloomberg School of Public Health.

Scientists and researchers in the biopharma industry have made incredible progress in delivering the scientific solutions needed to end the pandemic, said Dr. Michelle McMurry-Heath, president and CEO of the Biotechnology Innovation Organization, a trade group.

Health and patient safety coverage at USA TODAY is made possible in part by a grant from the Masimo Foundation for Ethics, Innovation and Competition in Healthcare. The Masimo Foundation does not provide editorial input.

“I see herd immunity happening at some point between Memorial Day and the Fourth of July.” Peter Pitts President and co-founder of the Center for Medicine in the Public Interest