Ex-CDC chief: Vaccines amaze, but we're not out of the woods; questions and a cruel winter remain, so caution is still needed

This is excerpted from The Wall Street Journal. The full version is here.

By Dr. Tom Frieden

Vaccines that have been developed with amazing speed now offer us the prospect of an end to the Covid-19 pandemic. Most public-health specialists, myself included, didn’t expect vaccines to be so effective or to be ready this quickly. Suddenly, we are much closer than anyone thought possible just a few months ago to bidding good riddance to this pandemic.

But we shouldn’t get ahead of ourselves. Rolling out vaccination is likely to take many months, and the process will be complicated, confusing and almost certainly controversial. Navigating these perils is the key to emerging from our ongoing crisis. . . . 

Dr. Thomas Frieden

We aren’t out of the woods. There are key questions that we can’t yet answer, and each could undermine the success of vaccination. We don’t know, for instance, how long immunity will last. Studies of infection with the different coronaviruses that cause Covid-19, SARS and MERS offer conflicting information. Although some antibody levels appear to decline over time, it isn’t clear how much this matters, since antibody levels don’t necessarily correlate with immunity. For some vaccines, it has taken years of careful study to figure out how long they provide protection.

We may also discover rare but serious adverse effects of vaccination. With millions getting vaccinated, some people will inevitably get sick afterward. The challenge will be to determine whether these illnesses are coincidental or related to the vaccine. . . . 

Another key question is whether companies can quickly manufacture enough vaccine. During the H1N1 outbreak, drug firms promised large quantities of vaccine swiftly but experienced production problems and couldn’t deliver on time. . . . Because safety is so crucial, any potential problem with vaccine production can result in unexpected and unavoidable delays. Even in the best-case scenario, it will be many months before we have enough vaccine to drive risk down far enough to get life back to some version of normal. . . . 

Covid-19 is the first disease to have an antivaccine movement before it had a vaccine. So-called “antivax” sentiment has grown in recent years, leading to outbreaks of measles and other previously controlled infections. Doctors and community leaders tell me that they have already heard people say things like, “I’m not going to take that Trump vaccine.” Every responsible person must avoid making disease-control measures such as vaccines partisan or ideological—in contrast to the way the current administration has handled masks.

In general, the U.S. does a poor job of providing vaccines to adults, and the Covid-19 campaign is going to be particularly difficult. All three of the vaccines that have shown promising results require two doses several weeks apart, which more than doubles the logistical challenge. (Johnson & Johnson's vaccine may be single-dose, but we won’t know whether it works for at least a few more months.) We’ll need sophisticated education and follow-up to reduce the number of people who skip the second shot.

We may be able to help reduce resistance to vaccination by explaining that minor but unpleasant reactions such as arm soreness, malaise and fever likely signal a vaccine “take” and successful protection. Every effective vaccination program requires two-way communication—listening to community concerns and addressing them with messages and messengers that work for different groups. . . . 

We are still in for a cruel winter. If all goes well, vaccination could tame the pandemic in the U.S. by the middle of 2021. Until then, and possibly for many months after, we will still need to double down on protection protocols. That includes what I call the “Three Ws”: wear a mask, watch your distance from others and wash your hands when they may be contaminated.

As vaccine uptake proceeds, we will be able to loosen physical-distancing restrictions and more fully reopen businesses. When the virus is spreading rapidly, we will still have to close infection-prone environments—notably bars and restaurants—even as we work to protect schools and health-care facilities. But most healthy, young and middle-aged Americans won’t get the vaccines for many months. It is more important than ever to get through that interval with minimal loss of life and maximum economic and educational recovery.

Tom Frieden was the director of the Centers for Disease Control and Prevention from 2009 to 2017. He is the president and CEO of Resolve to Save Lives, an initiative of the public-health organization Vital Strategies.