On Jan. 20, a new resident of the White House will be sworn into office. Every four years, since FDR’s second inauguration in 1937, that date is imbued with pageantry, hope, and the weight of democratic tradition.
This year, Jan. 20 is an augur of a more somber moment in our country’s history. It will mark the first anniversary of the first diagnosed case of COVID-19 in the United States. In that year, we have descended into a strange and unforgiving present. The extent to which our systems of order, function, and fairness have faltered begs the question that this coronavirus may be a dark sigil of the nation’s true pathology. In either case, the arrival of COVID-19 in America found us unprepared to grapple with our diminished capacity for collective action.
With multiple vaccines on the horizon, it is that dissidence that now looms as our biggest hurdle. I am deeply concerned that this collective action frailty will undermine the public use of these vaccines. It is our absolute imperative as Americans to persuade as many people as possible, as soon as possible, to receive a vaccine. Widespread distribution of the successful COVID-19 vaccines is the only way out of our current nightmare.
COVID-19 is the first disease in history to inspire an ‘anti-vaxx’ movement before a vaccine was even developed. While the administration of post trial vaccines has begun in earnest, there are many who might not outright refuse but remain hesitant about committing to inoculation. That is to say, far too many Americans are planning to wait and see what the vaccine’s effects are before taking it themselves. The statistics are bearing out this national skepticism.
A recent Pew Research study revealed that a scant 60 percent of surveyed U.S. adults would likely seek a coronavirus vaccine when one became commercially available. Only 37 percent of U.S. adults would be willing to be among the first Americans vaccinated. These numbers have shown marginal improvement over time, but they are currently insufficient to ease our collective suffering and return us to a semblance of pre-crisis normalcy.
Let’s talk herd immunity: if you’ve been following the data closely this year, you are probably familiar with the virus’s effective reproduction numbers and herd immunity thresholds. In brief, the effective reproduction number describes the number of infections the average infected individual would transmit to a population given the current rate of local immunity, while the herd immunity threshold describes the proportion of the population that would have to be resistant in order to keep the effective reproduction number at or below one.
‘Herd immunity’ — misunderstood at best
Both of these measures are granular over time and space, as changing behaviors, local demographics, and regional contact patterns directly influence a pathogen’s transmission. To reach our national herd immunity threshold, we need to achieve an estimated 60 percent rate of immunity via vaccinations and recovered cases, given early assessments of SARS-CoV2’s infectivity rate.
Still, this herd immunity threshold is an often misunderstood and fickle ally at best. Crossing that line does not mean that we will be immune as society.
Herd immunity, in the most basic sense, means that a newly-infected individual would no longer infect more than one individual on average under normal, pre-epidemic behaviors before they recover. In other words, when the basic reproduction number or “R₀” falls below 1, then that newly infected person will not on average infect anyone else before their infection is no longer contagious. The protection herd immunity offers will be granular and heavily dependent upon consistent compliance and good faith infection control efforts by the populace.
A single state, county, or office building with an insufficient number of vaccinated or recovered individuals could suffer continued outbreaks as the rest of the world moves on without them. Likewise, larger cities and denser social networks will require even greater degrees of resistance to achieve the same ends, as this virus will continue to find and exploit narrow veins of susceptible individuals within society. All of this leaves plenty of room to pass a 60 percent prevalence and see thousands upon thousands of additional deaths.
And thus, hesitancy toward the vaccine threatens to delay a return to normalcy, however we each define it. Amid much disagreement on personal behavior and policy responses throughout the pandemic, this desire to return to normalcy is the one unifying force we can muster.
For those fortunate enough to be spared the front lines of this epidemic, fighting to achieve a high rate of vaccination is the most important battle that we can fight right now.
But what exactly should we be doing?
As a nation, we have suffered a lapse in leadership, coordinated information, and our capacity for meaningful, collective action. We may not have the resources to combat public health education shortfalls, historical skepticism, institutional distrust, our history of medical racism, and more, but we can focus on a more compelling and forward-looking approach.
How to make the case before vaccine skeptics
One severely underutilized talking point in support of individuals’ COVID-19 vaccination decisions is the health costs of our current lifestyles under social distancing versus the perceived risks of a prospective vaccine. Regardless of whether someone thinks COVID is real, has real consequences, or is a real threat to them, no one is healthier this year than they were the year before. It is doubtful that many more of us are happier. Most everyone is more stressed, more isolated, less active, and eating worse.
Markers of internal suffering have increased across the board, from the creeping onset of mental illness, to suicidal ideation and depression, to a general dissociation from our friends and family. The stress alone can shorten your life and the quality thereof. In addition, scores are postponing routine medical care, as the surge of infections has forced hospitals to triage their patients to make the most of their dwindling bed-space. This will bear generational consequences as patients delaying chemotherapy visits and cancer screenings among others will miss crucial windows for intervention.
Observing this, even as a trained epidemiologist, I no longer make this case on the premise of the pathological risks of COVID-19 alone. Instead, I have started emphasizing how a vaccine will return their whole, happy, and healthy pre-crisis life to those still skeptical.
To achieve this, the typical vaccinated individual must only endure a mildly uncomfortable reaction to the vaccine – maybe a short bout of flu-like symptoms – as their body adapts. No one would claim to enjoy a day of these side effects, but consider in contrast how enjoyable the last week, or month, or this entire 2020 year was. Would anyone continue to live this way indefinitely given the choice?
I would not, and I don’t think our friends and family would either. That is a strategy we can work with.
If my word and background mean anything to you, know this: as soon as the vaccine trial enrollment portals opened to the public, I applied myself and encouraged everyone I know and love to do the same.
In a perfect world, I would have preferred to remain in my cozy den, keeping my head down and awaiting word from Tolkien’s Gondor. We do not live in a perfect world, and I fear the risk of prolonging my current lifestyle far more than I do the risks of a novel and unprecedented vaccination.
If we want to reach a meaningful state of herd immunity and halt the unhindered death and malady around us, we need to start promoting the vaccine for what it really represents – normalcy. These vaccines offer us a shot of fresh air, and clearly, we are craving that above all. We can get there, and we can get there soon.
Editor’s note: The opinions expressed here are solely those of Dr. Schlitt and do not reflect any official view of the University of Virginia Biocomplexity Institute
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