San Diego Union-Tribune (Sunday)
EXPERTS: VACCINE WILL BE A TOOL, NOT A CURE
Local researchers see breakthrough soon, but urge continued safety
A COVID-19 vaccine once seemed a distant dream. Now, it’s a matter of when, not if, one is available.
For Charlotte Thomas, that’s welcome news.
Each time the critical care nurse practitioner enters a COVID-19 patient’s room at Scripps Mercy Hospital Chula Vista, she dons a black helmet with a broad, clear face shield. She calls it her “Star-lord” mask, because it resembles the high-tech mask worn by the “Guardians of the Galaxy” superhero.
“We’ve all been really looking forward to the day where we can come to the hospital with that extra suit of armor and feel really confident that we are going to be able to care for these patients and not get sick and not take it home,” Thomas said. That urgent desire for a sense of safety and a return to normalcy has fueled an unprecedented search for a vaccine against the worst pandemic humanity has faced in a century.
CEOS of Pfizer and Moderna, two of the vaccine developers furthest along in that search, have said they could request emergency-use authorization for their COVID-19 vaccines by late November and December, respectively, depending on results from trials that have enrolled tens of thousands of volunteers (including San Diegans).
On Wednesday, Health and Human Services secretary Alex Azar said there could be enough doses of a COVID-19 vaccine for those most vulnerable to the disease by the end of 2020, with enough vaccine for all Americans by early April.
Many experts say that is overly optimistic. But regardless of the exact timeline, public officials are already planning how to distribute the first doses of a vaccine and assure the public that it has been thoroughly vetted. It’s unclear how effectively and quickly a vaccine would quell a pandemic that has killed more than 223,000 Americans. Some vaccines have totally or nearly eradicated diseases — think smallpox and polio. But don’t expect a COVID-19 vaccine to be a panacea, says Dr. Davey Smith, UC San Diego’s director of infectious diseases and global public health.
“If you have a vaccine, that’s just another tool in your toolbox,” Smith said.
That toolbox includes strategies public health officials have stressed throughout the pandemic. Testing. Contact tracing. Social distancing. And wearing a mask, which researchers estimate could save nearly 130,000 lives by the end of February.
When combined with these measures, a vaccine could substantially slow the spread of COVID-19, reducing your chances of getting infected or developing serious illness. That’s the approach Vista educator Rick Worthington plans to take. He’s a wellness teacher at Vista High School, which reopened this past week, and says he would take the vaccine if it’s available.
“I would still take precautions. I would still wear a mask. I would err on the side of caution,” Worthington said.
What’s unclear is how many people will do the same.
Expect people to react to the prospect of a COVID-19 vaccine in radically different ways, says On Amir, a researcher at UCSD’S Rady School of Management who studies how we make decisions and weigh risks.
“We have to acknowledge that there are different groups of people out there, both with respect to adherence and with respect to vaccination,” Amir said.
He thinks people’s behavior will likely fall into a few categories. In one, those tired of following public health precautions might trust that a vaccine will be the ultimate fix and throw caution to the wind.
That may already be happening, as the number of community outbreaks in San Diego County has trended upward, and the county’s latest COVID-19 case rate nearly pushed it into the state’s most-restrictive reopening tier. Infectious disease experts like UCSD’S Smith worry about these developments, as driving up transmission of the virus could cancel out a vaccine’s protective effects. But the sense that a vaccine is on the horizon could also have the opposite effect, Amir says, citing what researchers call the “goal gradient effect.” The idea: The closer you are (or think you are) to completing a task, the more motivated you are to stick it through for the reward. In this case, that reward would be some semblance of a return to normalcy.
How people react, he says, will depend on whether public officials frame the rollout of a vaccine as an instant triumph or a series of steps.
For instance, making clear a vaccine would be rolled out in phases.
In early October, the National Academies of Sciences, Engineering and Medicine released a four-phase guideline for distributing the first doses of a COVID-19 vaccine when one becomes available.
At the front of the line would be front-line health care workers, first responders and those who provide cleaning and transportation services for health care facilities — about 5 percent of the population.
Without these people, the health care system breaks down. And routinely working in high-risk settings has taken its toll. One study found that front-line health care workers in the U.S. and U.K. had about 12 times the risk of getting COVID-19 as the general population.
That would place Mark Selapack, a paramedic with American Medical Response in San Diego, among the first to get a vaccine. In February, Selapack became one of the first health care providers in the region to handle COVID-19 cases among evacuees quarantined at Marine Corps Air Station Miramar. Since then, he’s handled coronavirus surges at skilled nursing facilities and stabilized and transported countless patients.
“As a front-line worker, I feel obligated to get the vaccine because we are helping some of the most vulnerable people,” Selapack said. “If I can do my part, I will get the vaccine.” The next-highest priority group, about 10 percent of the public, includes those with multiple medical conditions strongly associated with severe disease, such as cancer or serious heart conditions. About 90 percent of COVID-19 patients who end up in the hospital have at least one underlying condition.
Also in this group are adults 65 and older living in nursing homes, homeless shelters and other group living settings. That’s because about 80 percent of COVID-19 deaths have been among people 65 and up, and close quarters make it hard to follow social-distancing guidelines.
From there, vaccine access would gradually broaden to all older adults, teachers, other essential workers and, eventually, the entire population.
That’s the idea, anyway. The National Academies report, totaling more than 200 pages, won’t matter if no one is willing to take a vaccine.
A recent poll by STAT and The Harris Poll found that 58 percent of Americans said they would get a vaccine once it was available, down from 69 percent in August, in part due to a sense that the push for a vaccine has become polluted by politics.
There are efforts under way to allay those fears. On Monday, California Gov. Gavin Newsom announced a scientific panel that would independently review any authorized vaccine. That panel includes Dr. Rodney Hood, president and founder of the Multicultural Health Foundation, a consortium of health providers serving San Diego County’s most diverse neighborhoods. It’s unclear if these efforts will boost the percentage of people willing to get a vaccine. That percentage matters, as it will determine whether we reach what epidemiologists call herd immunity — the point where a disease outbreak slows because enough people in a community are protected, leaving the virus with nowhere to go.
The Centers for Disease Control and Prevention estimates between 55 percent and 82 percent of the public would need to be protected against the virus, either by getting a vaccine or recovering from the disease, to reach herd immunity.
That percentage range is so broad because it depends on two unknown factors: How well the vaccine works (and for how long), and how widely the coronavirus is spreading at the time vaccination begins.
We can’t control the first factor, but we can control the second, says UCSD psychologist and mindfulness expert Karen Dobkins. And that’s one key thing to keep in mind during these uncertain times.
“I don’t have control over when the vaccine’s going be ready, I just don’t. I do have control about whether I want to put a mask on or not,” Dobkins said. “If people could get a little better at discriminating between those areas of risk where they do and don’t have control, there’d be less anxiety.”
jonathan.wosen@ sduniontribune.com paul.sisson@sduniontribune.com deborah.brennan@sduniontribune.com