Covid-19 vaccination: Reaching a place where the virus doesn't control us

Immunologists say the development has been awesome in its speed and effectiveness. But masks, social distancing and Zoom are not going away anytime soon.

Laurie Allen
Dr. Susan Koletar, director of the Division of Infectious Diseases, Ohio State University Wexner Medical Center

After enduring more than a year in the grip of a deadly, unpredictable virus that brought misery and chaos, Columbus’ public health leaders can sense a shift to the positive as vaccines roll out from lab to large-scale immunization.

Despite stalls and shifts in supply and distribution, the effort to vaccinate some 300 million Americans in the next several months is moving forward, giving healthcare leaders a sense of optimism.

“I am in awe of all the progress that’s been made,” says Dr. Susan Koletar, director of the Division of Infectious Diseases at Ohio State University Wexner Medical Center.

“I continue to be hopeful, and I think we need to keep focusing on the positives. I think there is clear evidence that the vaccines are and will continue to be making a difference.”

Dr. Mark Herbert, an infectious disease specialist with Mount Carmel Health System, says despite problems with distribution and lack of long-term data, vaccines have the power to change the course of the Covid-19 pandemic. “It’s been wonderful to see the number of people who are immunized catch up and surpass the number of people who’ve been infected. My hope is that we reach a place where we control the virus, and the virus doesn’t control us.”

Herd immunity

The Holy Grail in freedom from Covid-19 is herd immunity, which occurs when enough people in a community are protected from a disease that transmission effectively stops. Estimates vary, but most public health leaders predict that will happen when at least 70 of the population is immunized.

The road from here to there is neither straightforward nor predictable, local healthcare leaders agree. Barriers include inequities in access to health care, vagaries in supply and distribution and public buy-in on the importance of being vaccinated.

The dizzying speed at which science has learned and manipulated information about the coronavirus has itself caused some unease, Koletar says. Even the name Operation Warp Speed carries emotional baggage. “The term ‘warp’ implies that something is wrong,” she says.

The fact that people started receiving vaccines just months after Covid appeared in this country is testament to scientific progress and substantial federal financial investment. By contrast, there still is no vaccine for HIV.

“People wonder, did it go too fast? The difference today is that we weren’t starting from scratch. We had other coronaviruses out there, and we already had vaccine candidates,” says COSI President and CEO Frederic Bertley, a specialist in immunology and vaccine development. He and others say that while the Food and Drug Administration fast-tracked clinical trials, safety precautions were not shortchanged.

“I do believe they are safe,” Koletar says of the vaccines. “That said, we don’t have long-term data on anything. I tell people there are no guarantees in life. Everything has a risk-benefit, but these seem extraordinarily good at preventing serious illness.” Also, she notes, “It’s not just about you. It’s about someone else.”

Social responsibility

Herbert says there is a social responsibility to protect the vulnerable and those who care for them. “People in their 20s and 30s have a responsibility to protect their parents and their grandparents, and to protect their children. Children’s lives have been greatly disrupted. I’d like to see children have more normal lives.”

Personal experiences play a role, Koletar says. “My father had polio as a child, and I’m pretty sure my sister and I were No. 1 and 2 on the list to get the polio vaccine. My job is not to talk anybody into anything, however, anyone who is eligible to get the vaccine should get it.”

Getting the vaccine has not been easy in many cases. Across the community, reports of hours-long waits, difficulty scheduling and people being turned away amped up frustrations.

Koletar says a certain amount of hype led to unrealistic expectations early on. “It’s quite the logistical dance, doing these large-scale vaccinations while we’re still in the midst of a pandemic.” However, she adds, “I think we’ll get there.”

Herbert says problems with vaccine distribution also have emphasized inequities in access to healthcare among different populations. Mount Carmel’s community outreach and street medicine programs aim to take the vaccine to marginalized and underserved communities, such as the city’s homeless, says Virginia Ruef, regional pharmacy manager. That effort will be aided immensely as one-dose vaccines and those with longer shelf lives become widely available, she says.

Variants are out there

The future of vaccines also must take into account coronavirus variants, or mutations, some of which may be more dangerous than earlier versions. Herbert says it’s important to note that all viruses change and mutate on a regular basis in order to thrive, but that it’s possible to modify vaccines so they’re still able to impede the virus’ ability to attach to a cell and replicate.

Bertley says what matters is where and how many mutations occur, specifically on the spike protein that the virus uses to grab onto cells. Even in newer variants, vaccines seem to offer protection against serious illness that would require hospitalization.

Setting a date for a return to “normal” is a tricky proposition. “All things being equal, once we’re able to go to scale and achieve herd immunity, I see a return to normal,” says Bertley, who expects that everyone in the United States should be able to receive a vaccine by the end of the year. But he believes we will continue to live in “a new steady state of Zoom meetings, hand sanitizer and masks. There is light at the end of the tunnel. The tunnel is not short.”

Healthcare leaders have ongoing concerns about asymptomatic transmission, which might still occur even with the vaccine. “That’s why social distancing, masking and hand hygiene will still be in place for a long time to come,” Ruef says. “I think of the vaccine kind of like a seatbelt. Can you drive a car without a seatbelt? Yes, you can. But you are much safer, and those around you are much safer, with one. The vaccine adds an extra layer of protection.”

Laurie Allen is a freelance writer.