Vaccines nearing, but normalcy will take time

Return to regular life will depend on many factors.

For many Americans chafing to return to normalcy, recent reports that at least two experimental COVID-19 vaccines are highly effective come as welcome news in the midst of a frightening surge of infections and deaths. The first shots may be given in mid- to late December, but that doesn’t mean you can hug your friends, stop washing your hands or throw away your mask anytime soon.

The return to many of our old familiar ways will take time, and how much time remains unclear.

The answers await more research into the vaccines, how they can be distributed and how many people are willing to get them.

“A vaccine won’t be available immediately for everybody,” says Arthur Reingold, a professor of epidemiology at the School of Public Health at the University of California, Berkeley. He also chairs California’s COVID-19 Scientific Safety Review Workgroup, which will evaluate the safety and efficacy of COVID-19 vaccines.

“It probably will take four to six months,” he says. “What that says to me is that people will have to keep wearing masks at least until spring. We won’t be in a magically different situation by February or March. I don’t see how that can possibly happen.”

Equally important are the unknowns about the vaccines themselves. Scientists still don’t know how long vaccine-induced protection will last, for example, or whether inoculations can block actual infection or only prevent the onset of disease. If the latter turns out to be the case, meaning the vaccines keep us from getting sick but not infected, we still could be infectious to others. Until we know, don’t toss those masks into the trash.

“The bottom line is that although an effective vaccine will certainly diminish greatly the relative risk of transmission, we still should not completely abandon basic public health measures, including the wearing of masks,” Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, said in an email.

In a recent JAMA report, he and his colleagues stressed the need for continued vigilance, saying such precautions as mask-wearing would be “essential” during any initial vaccine rollout.

Robert T. Schooley, an infectious diseases specialist at the University of California, San Diego, points out that, although vaccines will provide another level of protection, the virus will not disappear and will be around for many years.

“But until we know more about how long protection lasts and the extent to which people are protected,” he says, “it’s important to continue to use all the tools we have to keep the virus in check, and that means masks, social distancing and ventilation.”

These safeguards will ensure against transmission if the vaccines fail to prevent infection, says William Schaffner, professor of preventive medicine at Vanderbilt University. He urges people to be patient.

“The average person wants answers yesterday,” he says. “But try to keep in mind that we are still moving at rocket speed.”

Some experts say they hope for a level of protection by next summer that will allow us to resume certain activities. “I’m not sure about mass gatherings, such as baseball games, but it is plausible,” Reingold says. “Time will tell.”

Andrew Badley, an immunovirologist who chairs Mayo Clinic’s COVID-19 task force, says the return of any normal activities depends on numerous factors, including how many people get vaccinated.

“The only possibility that life will return to normal by summer is if the majority of the population receives the vaccines by then and the early efficacy data is borne out in ongoing studies,” he says. He adds, however: “I think it is unlikely we will be able to vaccinate the majority of the population by then.”

Schaffner expects a “substantial improvement” by summer, although probably not a complete return to our former lives. But he adds: “Next Thanksgiving could well be back to near-normal.”

The two leading vaccine candidates were developed by Moderna Therapeutics, which reported 94.5% efficacy, and Pfizer partnering with the German company BioNTech, which demonstrated a 95% success rate, including 94% among those 65 and older.

Both vaccines involve a new and promising technique based on messenger RNA, or messenger ribonucleic acid (mRNA), that uses a synthetic form of RNA to trick human cells into making the virus’s distinctive “spike” protein, prompting the immune system to generate antibodies in response.

Preliminary findings about their efficacy were based on the number of people who became ill, not on whether the vaccines prevented infection.

“Although [preventing infection] might be the ultimate effect, we do not know that at this point,” says Fauci, the nation’s most recognized expert on the pandemic. “The primary endpoint [in these studies] was the prevention of symptomatic infection. So it is conceivable that the vaccine would protect you against clinical disease but not necessarily protect you against infection.”

Schooley expects that further research will study participants’ blood to see whether their antibodies are a response to the vaccine or to a natural infection with the virus or both.

The vaccines generate antibodies to a single viral protein — the “spike” — while natural infection produces antibodies to multiple viral proteins.

“If you find somebody with antibodies to the spike protein alone, it means they came from the vaccine,” he explains. “If they have that, plus other viral antibodies, they may have been vaccinated — but they also have been infected,” he says. “That will tell us whether the vaccine, in addition to reducing disease, also reduces infection. Also, we still don’t know the durability yet,” referring to how long protection will last “or the level of protection of different subgroups of people at risk,” such as the elderly or those with underlying medical conditions.

Vaccinations will probably come in waves, with initial inoculations expected before the end of the year, with front-line health-care workers and emergency responders receiving the first doses, followed by the most vulnerable, including the elderly, especially those in nursing homes, and people with underlying medical conditions, and then younger, healthier people. Participants in the trials who received a placebo may also be offered the vaccine early. Those who have been sickened and recovered from COVID-19 probably will also receive vaccinations, since it’s still unclear how long natural immunity will last — although they probably will come at the end of the line, experts say.

Two shots are required, each one month apart. Because it is still unclear how long protection will last, public health officials don’t know whether boosters will be necessary and, if so, how frequently.