We need a plan B for no vaccine.
OK, this is not going to be short. If that bothers you, just type TLDR right now and move on. You’ll save yourself aggravation.
I’m writing this because of the number of people posting who apparently believe that all we have to do is wait for a coronavirus vaccine and the problem will be solved. All we need is for the American Public to have a little patience, a little discipline, wear their masks and keep up the social distancing and in six months or a year or so, the vaccine will take care of everything. Those people need to be aware of at least three issues:
First, there is no guarantee an effective vaccine will EVER be produced. No one is claiming one CAN’T be produced, simply that it isn’t going to be easy, probably won’t be quick, and it is far from certain it will ever be produced. And even if it can, it may take a long time.
Let’s look at history. The Spanish Flu pandemic 100 years ago was far more deadly than COVID 19 has been (at least as of yet) and it stimulated a search for a vaccine. It was 12 years before the first primitive vaccine came out. But OK, COVID 19 is not influenza, it’s a coronavirus. It’s a little different.
There are at least four coronaviruses that have been with us for a long time, and we’ve never developed vaccines against them. OK, maybe that’s for lack of trying, because all they do in most people is cause the common cold. Nobody dies of them unless they are so riddled with preexisting medical problems that a cold is all it takes. Even so, we’ve known about them for a long time, they are somewhat of economic importance, and a few researchers have looked at what it would take and decided it would be too much effort, technically difficult, for too little possible gain. Not impossible perhaps, but not easy.
The two other more recent additions SARS and MERS, don’t have vaccines either. Both are far more lethal than COVID-19, which makes them less of an epidemic threat since they tend to make those infected deathly ill and well, dead, before they can spread much. The problem with COVID-19 from an epidemiological perspective isn’t that it’s all that deadly really, there are a lot more deadly viruses (like Ebola or rabies) but rather it ISN’T all that deadly allowing rather wide spread.
It’s sort of like Goldilocks and the three Bears. Really benign viruses, like the coronaviruses that cause colds, spread pretty readily but do little damage so nobody has invested a lot of money in producing vaccines for them. MERS and SARS kill people so quickly it’s hard for them to spread and generally die out quickly so nobody has invested a lot in producing vaccines for them either. But it appears, from what little phase 1 research has been done, that if a good coronavirus vaccine is possible it will take at least two shots 2-3 weeks apart.
Secondly, what would likely be the characteristics of a vaccine if it could be developed. It was mentioned above that it was twelve years before a flu vaccine was developed and that vaccine has been continuously improved for the last 100 years. Yet we still have flu. That’s because the influenza vaccine is not terribly effective generally speaking.
On a good year (like this most recent one) the vaccine is about 50% effective against the flu strain going around, and on a bad year (like the one before that) it is about 10% effective.
After 100 years of work that’s still state of the art. And perhaps for that reason we don’t really get maximum benefit out of it even though it is available. Typically, only a little over half of adults and not quite two-thirds of kids get their flu shot which needs to be given annually to be most effective. It certainly isn’t impossible that a coronavirus vaccine could do better, or be developed far quicker but there certainly is nothing in the history of vaccine production to date that suggests that is likely.
Thirdly, it’s the logistics. Edward Jenner, a Scottish family doctor discovered vaccination with cowpox as a preventive for Smallpox in 1796. His work was widely publicized in 1801. Smallpox was not a trivial disease, it was occurring worldwide and had a case-fatality rate of over 30%, comparable to that of MERS. And from an efficacy standpoint, vaccination was highly effective, a single inoculation providing immunity for at least 10 years and more likely twenty. And EVERYONE wanted to get rid of smallpox, there was massive international cooperation, even during the Cold War, so it only took until 1980 - 184 years after development Of the vaccine - for smallpox to be made extinct.
The Salk vaccine was a four shot series to protect against polio that was introduced in 1955. It was largely replaced by the Sabin vaccine a year later - despite the unfortunate habit of the Sabin attenuated virus to occasionally revert to its original (paralyzing) form. But now, 65 years later and despite the Sabin vaccine being capable of being given orally, we STILL haven’t eliminated polio in the world. When you are dealing with a third of a billion people in the US or seven point eight billion worldwide, the logistics to getting the necessary dose(s) to people really matter, even before the days of the antivaxxers making things more difficult. That’s just fact.
Now I’m not saying a good, cheap, effective, and easily administered vaccine against coronavirus is impossible, because few things are really impossible, and I’m not saying it can’t be done in less than a decade because that isn’t impossible either, I’m just saying that there is not one damn time in the historical record that something of this magnitude has been done that quickly and that if it IS done this time it will be a first.
And what that suggests to me is that we can’t just shut down the economy until there is a vaccine, because that could well take a decade and a decade of a collapsing economy is going to cause wars, revolutions, mass famine, etc., and whether you are red, blue, green, or some other color, if you check the historical record that’s what you are going to find. Pandemics are often followed by massive political unrest, economic breakdown, and conflict.
People might just have to get used to the idea of running the economy at levels that keep the ICUs full, letting people catch it and having some of them even die, because the promised arrival of salvation by immunization is not really that likely and the alternative if we don’t keep the economy going will be even worse.