A few nights ago, a relative sent a message about her friends’ worries about the COVID-19 vaccine. The message suggested to colleagues that they do not deserve to receive the vaccine, because epidemiologists say that even vaccinated people can transmit the virus.
In other words, the thought went, if a vaccine does not guarantee total immunity for you and everyone around you, what’s the point?
This relative and their friends were all essential young workers who were given priority for vaccination. But the answer to their skepticism was simple: get the vaccine as soon as possible.
Here’s why.
The best tool for controlling the new coronavirus is our own immune system. The basic problem is that our immune system needs to see the virus that causes COVID-19 to learn how to protect us. Vaccines solve this problem by letting our immune system see what the virus looks like before we become infected so that it can learn how to fight the virus. Recall photos – both vaccines authorized in the US require one – work like exercise, helping the immune system to further improve its ability to fight the virus.
Through an unprecedented global effort and the use of state-of-the-art technologies, we have developed a vaccine against COVID-19 faster than previous generations would have ever dreamed of. The need to quickly reduce mortality with this new tool has meant that we need to act before we know exactly how much it would help reduce transmission, as opposed to disease.
Clinical studies have shown quite clearly that the current vaccine harvest from Pfizer, Moderna and others around the world is safe and effective against severe COVID-19 disease. But some questions remained unanswered immediately after their launch. How long would the protection last? Will the vaccine prevent transmission, as opposed to just helping to prevent people from getting sick or dying? Will the virus evolve like the flu and cause repeated epidemics?
Because of these unknowns, the messaging around the vaccine was cautious. Scientists and public health officials are willing to make statements about the effectiveness of a new pharmaceutical product without any evidence to support it. This is especially true because misrepresentations, no matter how well-intentioned, can undermine confidence during a pandemic that has seen the response to public health guidance too far politicized.
Example: attitudes related to masking.
But there is a downside to this prudent messaging. Lack of certainty or strong empirical evidence is often interpreted as meaning that we have evidence that something is not True. This phenomenon is exacerbated only by the voices of the anti-vax community and other public health skeptics. It is possible that people will only hear that we cannot say that the vaccine does not prevent transmission and not that this is only because we are waiting for the evidence to come or that most experts would be shocked if it did not have at least an effect on infection prevention.
Likewise, prudent public health advice that is meant to prevent unintended tragedy, such as admonishing to continue the social distance and take precautions even if vaccinated, often ends up increasing skepticism about vaccination.
The result is that too often people do not see at all why they should be vaccinated.
They are not vaccine skeptics or anti-vaxxers who normally oppose vaccination. Instead, they are worried, worried people, worried that they might refuse the protection vaccine to someone at high risk or take a new medical product for a small benefit to themselves and others.
It is essential to get the message out to such people both about how we believe the vaccine might work based on its basic biology and about the emerging evidence that tells us quickly about the vaccine’s effectiveness and safety.
This message is as follows: Based on the performance of similar vaccines, the fact that asymptomatic individuals may be less likely to transmit coronavirus and a rapidly growing body of evidence from studies and campaigns, we are confident that vaccination against COVID-19 reduces the chances of transmission of the virus. Transmission protection may be considerably lower than protection against severe disease, but at this point it would be beyond shock if there were no impact.
Evidence indicates natural immunity that lasts for many months, although reinfection is possible (especially after a mild illness). The vaccine is likely to provide a similar length of protection, although this is less clear. Most importantly, even if the protection is not permanent, either because of declining immunity or new variants of the virus that are evolving to get rid of growing human immunity, subsequent infections are likely to be less severe for those whose immune systems have had a chance to find out a little about the virus.
Critically, even if the effects of vaccines on COVID-19 transmission are imperfect and temporary, vaccination will continue to lead to massive decreases in the number of cases if – and only if – there is widespread absorption of vaccines in the general population. This is the safest way to return to a place where we can all attend parties, dinners and simple office conversations that we want so much.
So, when you have the opportunity to be vaccinated, take it. It will make our whole life better.