#9: The current SARS-COV-2 vaccination plan is a bridge too far
By starting the vaccination campaign while the pandemic is still growing and raging uncontrolled, we are trying to disprove McKeown's hypothesis in real-time.
Because of the world losing the war against SARS-COV-2, our only way out was inventing technology from the future to match this virus from the future. It seems mRNA is that. For the first time in this pandemic, we have a formidable weapon. But even if everything turns out just as we hope, it is merely the beginning of our fight-back. We might have found a way to speed up the creation of a vaccine, but due to many practical obstacles, there is no way to speed up the global vaccination campaign needed for herd immunity. That will mark the true end of the pandemic; this is the end of the beginning.
The unrealistic euphoria of a miracle that will solve all our problems by spring or summer 2021 that's being propagated by politicians, pharmaceutical companies, scientists, and financial analyst is a childish irrational exuberance. I know that the responsible 50% of the population is getting tired and just want it all to be over soon, but wishing it is not enough. The gigantic work needs to be done, and the outcome is still unknown. Due to global connectivity, we will not be safe until everyone is safe. Billions of doses need to be manufactured, distributed and administered all around the world. And until now, in this pandemic, nothing went according to a plan. To act as if the war has already been won is sabotaging our end goal. Why do they think people will continue with NPIs? How will they convince the other, irrational half of the population to receive the injection, not once but twice?
The truth is, officials gave up on the goal to defeat SARS-COV-2 and are just satisfied to cohabit under its rule? In my first COVID-19 post, I outlined four possible outcomes. The first that it will burn out or mutate away to obscurity looks less and less plausible. Most also gave up on outcome B). Almost nobody believes anymore that we will ever manage to eradicate SARS-COV-2. If we need +90% for herd immunity, it's safe to say it won't happen. Even if it does, we won't develop lifelong immunity. SARS-COV-2 will become an endemic human pathogen, something like the seasonal flu that will be managed with vaccines. Those will have to be regularly updated, like the annual flu jab, to keep up with viral antigenic drift. There will be occurrences of SARS-COV-2 mutations, but we will update the vaccines and administer them again after one, two, or three years, as we do with the flu every year. Deaths and severe cases will fall, although some acceptable deaths among the at-risk population will continue, and for others, life will go on.
Nevertheless, to me, this sounds like surrender because it's impossible to control SARS-COV-2. Everybody forgets that it is not nearly as seasonal as the flu. First, it never vanishes during the summer, only decreases. If the prevalence in a specific population is low, SARS-COV-2 will surely subside in warmer months because of different conditions (more outdoor, open windows, etc.). BUT second, due to its high endurance and transmissibility, if the prevalence in the population was high at the beginning of the summer, it will attack and infect different groups of people through different channels of transmission. And third, the incubation period and the duration of illness and contagiousness are much shorter for the flu (a couple of days and up to a week) than for SARS-COV-2 that can persist in humans for weeks and even re-emerge or re-infect after its elimination.
Because of all that, it will be impossible to predict and get ready for the arriving wave, so we will not be able to front-run it. The asymptomatic transmission will decrease, but without SARS-COV-2 eradicated, outbreaks will happen in different corners of the world for a whole year without a predictable pattern. Instead of vaccination campaigns for at-risk groups before the seasonal flu appearance, we would have to have an all-around VACCINATION CAMPAIGN FOR EVERYBODY FOREVER. That's an enormous extra cost and burden for our health-care systems. Not to mention that a lot of younger people won't come back for a second dose, even much less for an updated vaccine. Also, long-term consequences of COVID-19 are much worse and diverse than of the flu, destroying many people's quality of life.
By starting the vaccination campaign while the pandemic is still growing and raging uncontrolled, we are trying to disprove McKeown's hypothesis in real-time. Thomas McKeown claimed in the 1950s, among other controversial things, that modern medical interventions and successful vaccines played only a small part in the historical decline in the mortality of major infectious killers of the 19th century. That they came AFTER public-health mitigation measures already suppressed the spread, and the natural evolution of the diseases decreased its lethality (through mutations or large enough herd immunity). Vaccines are one of humanity's greatest achievements but were by now mostly used in the late stages of epidemics, as the final blow to the disease that shuts the door for any reemergence.
Since our goal is not eradication, but prevention of severe cases and deaths, and therefore decrease in hospitalizations, we are focused on vaccinating the most vulnerable at-risk populations, but not on breaking transmission chains. Thus we are leaving the younger, most often to be asymptomatic superspreaders, for later. Vaccination campaigns aimed at the damage of an epidemic start from the old (flu), while successful global eradication campaigns start from birth (most of the rest) and last for decades.
Besides, usual children's vaccinations are mandatory; nobody asks them whether they want the injection or not. Is there a plan on how we will convince the adult population to voluntarily come for a vaccine if many of them still don't want to wear a mask? And if they reluctantly take the vaccine, they'll care even less whether they still spread the virus or not. Therefore, any good vaccines bring will likely be negated with the collective abandoning of social distancing and other NPIs by those vaccinated.
The best chances for success have countries that already control the pandemic. The rest of us have too much virus floating around. Nobody knows what will happen when we prevent the damage of COVID-19 while letting SARS-COV-2 roam and live in our noses. If we pressure but don't kill the virus, we will provoke it to evade our antibodies. Whether it succeeds will depend on how much time and opportunities we provide.
And those at present abound. We are now vaccinating hasty in the middle of the wave, with millions of active cases, but without enough doses to cover any whole segment of the society, therefore unable to establish safe no-COVID zones. Also, yearly flu vaccination campaigns begin before the epidemic wave, so there is enough time for people to wait out any disease they have and then come back healthy for the injection, and still have enough time to develop immunity. At present, nobody is checking whether those vaccinated are in an incubation period or are asymptomatic, so some of them become ill before forming immunity.
The COVID-19 vaccination campaign is a monumental health-care endeavor, but at this moment looks like the most disorganized, most incompetent, almost amateurish, and incredibly irresponsible global vaccination campaign in human history. What have we done to the WHO, CDC, NHS, European public-health agencies? They all look like ruined institutions compared to the past. Without coordination on regional, country, or county levels, we are collectively acting in sheer panic, vaccinating little-here, little-there. Some are vaccinating politicians first, some LTC residents, some health-care workers, and some working-age people. Some are prolonging time-interval between doses, some splitting the doses, some mixing the vaccines, and some letting pharmacists in shopping-malls to vaccinate (even though CDC clearly warns that ALL persons need to be observed for 15 minutes after vaccination and that ALL sites must have immediately available appropriate medical treatment for an anaphylactic reaction).
No matter how effective it is, the vaccine can't do everything on its own. That's why I believe we could be stuck with an outcome C). The Chinese realized that on January 23, 2020. If we continue this way, SARS-COV-2 will never be put under control, no matter how much we wish and pretend it will.
Therefore, I don't believe this current vaccination campaign will stop the pandemic unless accompanied by serious efforts to reduce the number of infected individuals. And that means at least a month of harsh Chinese-style lockdown in combination with a zero-tolerance elimination strategy prepared for implementation from the moment we open up. Of course, nobody will choose to do this, but then we shouldn't be surprised next fall and winter.
No matter what happens, humans will adapt and continue to live as normally as possible. We will try to forget about it, work around it, but SARS-COV-2 will influence our lives and hold us back on a permanently lower level. If this is shaping to be our future, let's not pretend we won. We must be grateful for vaccines. But if this is all we plan to do, we will be signing an honorable-surrender cohabitating-treaty with the virus.
With a magic bullet, without worrying about possible consequences, we hope to avoid unpleasant but necessary public-health measures and jump-start the natural dynamics of the disease. If officials continue like this, they will botch the vaccination campaign and destroy our best chance of ever controlling SARS-COV-2. That light at the end of the tunnel might become a bridge too far.