Ask the Pharmacist

Q) Am I correct in assuming that once we get a vaccine, life can pretty much go back to being normal?

A) Unfortunately, no one can answer that question with certainty at this point in time, but the consensus from epidemiologists (not to be confused with populist presidents whose opinions seem to differ somewhat…) is that even with the successful development of a vaccine, we are likely still years away from being done with the wearing of masks in public spaces, social distancing and all of the other unwelcome “new norms” in our lives.

In fact, one paper published by experts suggested “normalcy” could return by 2024 or 2025, if at least one of the current vaccine candidates proves successful. This prediction was made with the knowledge that at least one vaccine was in phase 3 testing (the final testing before a drug can be approved for use in the general public) and another 32 candidates were in some stage of testing in people worldwide.

Another infectious diseases expert, Barry Bloom from Harvard, has stated that the idea that a vaccine will end the pandemic just isn’t very realistic. Now, once again, these dire forecasts are all still just pure speculation but for many of us who are tiring of the restrictions placed upon our lives, this possible timetable is distressing to say the least. That doesn’t mean they’re not correct however and there are a number of reasons why.

The first reason is that in order for a vaccine to protect the population, there has to be a minimum percentage of the population who will take it. Without achieving this number, community spread will continue and seek out the most vulnerable among us. This whole concept is known as herd immunity and it occurs when enough of the population has become immune to a virus (either from having contracted it earlier or from being vaccinated) that the chances that someone who is not immune comes in contact with the virus are very low.

In general, people who are not immune are people who cannot take the vaccine such as an infant or someone whose immune system is impaired or do not respond very well to a vaccine such as our most elderly who exhibit diminished protection from just about every existing vaccine we have thus far developed.

Typically, somewhere between 70 to 90% of the population must become immune in order to achieve herd immunity and we are well short of that mark here in Canada (experts believe that in the U.S., a so-called COVID-19 hotspot, somewhere between 3 to 5% of the population currently is immune in most areas and it would be reasonable to assume we are far below those numbers here in Canada).

As such, for us to achieve herd immunity with such low numbers of infections, we are going to have to rely upon the vaccination route barring a massive second wave that would be catastrophic to our population and health care system. The problem with this route, once again assuming we get a viable vaccine, is that as Bloom says “Vaccines don’t prevent anything. Vaccination does.”

Any new vaccine will be rolled out slowly and as such there initially may well be only a few million doses available. Just how Canada plans to distribute these initial doses is yet unclear but the U.S. has a protocol whereby the vaccine will be administered in 4 phases and it is likely Canada will come up with a similar plan.

In the U.S., the 1st phase of vaccines will be reserved for health care workers and first responders with the next batch going to people with health conditions that put them at the highest risk of dying from COVID-19 and seniors living in group homes. This phase will make up about 15% of their population.

The 2nd through 4th phases will be rolled out later as supplies allow. For those interested, the 2nd phase will be comprised of essential workers at high risk of exposure (e.g. teachers), people with health conditions that put them at moderate risk, people living in congested quarters (e.g. prisoners, residents of shelters) and seniors who weren’t covered in phase 1.

Phase 3 will be the largest group, about 40% of the population, and will include children and other essential workers with the last phase making up the rest. Beyond this slow roll out, another major challenge is vaccine hesitancy. This is a general term used to describe people who are afraid of getting a vaccine(s) and therefore refuse it and it is increasingly becoming such a massive problem that the WHO has deemed it one of the top threats to global health.

Recent surveys by Gallup have found that 35% of Americans don’t plan on getting a COVID-19 vaccine ever and, of the other 2/3’s who will, 71% have indicated they would prefer to wait at least 9 months after its introduction before receiving it to make sure that it is “safe”.

While “anti-vaxxers” can be perplexing, I can see the logic in waiting a while to be fully aware of the downsides of this strategy. Both of these mindsets will obviously delay, or even prevent us, from reaching our “herd” targets and extend the various restrictions we currently face.

Another challenge revolves around just how well the vaccine will actually work. Both the FDA and the WHO believe that, in order to be approved, a vaccine should be at least 50% more effective than using a placebo. This means that the approved vaccine may not stop transmission well, or even at all, but may instead benefit us by helping us to fight the infection off better when we do contract it.

Lowering mortality and hospitalization rates is still a major benefit but unless the vaccine also helps stop the spread of COVID-19, health authorities will have little recourse but to continue with restrictions.

Lastly, there is the challenge of re-introduction. We live in a highly mobile society where visitors come to Canada daily and mingle among us, as we do in their countries as well. Even though the pandemic has greatly reduced this, airports and border crossings are far from deserted. While we may get our numbers up sufficiently, eventually we will need the rest of the world to follow suit as well. Otherwise, business travellers or family members from some of the third world countries in particular could well inadvertently spread the virus at meetings, family gatherings and similar social settings to our vulnerable people who cannot get vaccinated.

There is an effort underway called COVAX in which many of the wealthier countries (but regrettably not the U.S.) are helping to eventually fund vaccinations for poorer countries. This is a great initiative and an all too rare example of global cooperation and compassion but there is no guarantee this effort will succeed in helping those countries achieve “herd immunity”. As such, we may well face the challenge of continually having this infection “sneak” back across our borders and shutting them down permanently is a non starter from an economic point of view.

The long and short of this is … don’t get too discouraged with this information. We are making significant progress and will likely have a vaccine and maybe effective treatments by the spring of 2021. Just temper your expectations on what life will be like immediately after. All experts continue to believe this will be a long-term effort regardless. For more information about this or any other health related questions, contact your pharmacist.