It’s been two weeks since U.S. officials launched what ought to be the largest vaccination campaign in the nation’s history. So far, things are going poorly.
How poorly? Untold numbers of vaccine doses will expire before they can be injected into American arms, while communities around the country are reporting more corpses than their mortuaries can handle.
Operation Warp Speed has failed to come anywhere close to its original goal of vaccinating 20 million people against the coronavirus by the end of 2020. Of the 14 million vaccine doses that have been produced and delivered to hospitals and health departments across the country, just an estimated three million people have been vaccinated. The rest of the lifesaving doses, presumably, remain stored in deep freezers — where several million of them could well expire before they can be put to use.
That’s an astonishing failure — one that stands out in a year of astonishing failures. The situation is made grimmer by how familiar the underlying narrative is: Poor coordination at the federal level, combined with a lack of funding and support for state and local entities, has resulted in a string of avoidable missteps and needless delays. We have been here before, in other words. With testing. With shutdowns. With contact tracing. With genomic surveillance.
The vaccine has been billed as the solution to this crisis — an incredible feat of science that would ultimately save us from the government’s widespread incompetence. But in the end, vaccines are a lot like other public health measures. Their success depends on their implementation.
The implementation of these shots is complicated by a number of factors, including cold-storage requirements, which in turn necessitate special training for nurses and doctors. Training takes time and money, both of which are in short supply in most states. Some hospitals have said they don’t know which vaccine they are going to receive, or how many doses, or when. The federal tracking system that monitors vaccine shipments and whereabouts and the chain of communication among federal, state and local health officials have been disorganized.
With distribution of a coronavirus vaccine beginning in the U.S., here are answers to some questions you may be wondering about:
- If I live in the U.S., when can I get the vaccine? While the exact order of vaccine recipients may vary by state, most will likely put medical workers and residents of long-term care facilities first. If you want to understand how this decision is getting made, this article will help.
- When can I return to normal life after being vaccinated? Life will return to normal only when society as a whole gains enough protection against the coronavirus. Once countries authorize a vaccine, they’ll only be able to vaccinate a few percent of their citizens at most in the first couple months. The unvaccinated majority will still remain vulnerable to getting infected. A growing number of coronavirus vaccines are showing robust protection against becoming sick. But it’s also possible for people to spread the virus without even knowing they’re infected because they experience only mild symptoms or none at all. Scientists don’t yet know if the vaccines also block the transmission of the coronavirus. So for the time being, even vaccinated people will need to wear masks, avoid indoor crowds, and so on. Once enough people get vaccinated, it will become very difficult for the coronavirus to find vulnerable people to infect. Depending on how quickly we as a society achieve that goal, life might start approaching something like normal by the fall 2021.
- If I’ve been vaccinated, do I still need to wear a mask? Yes, but not forever. Here’s why. The coronavirus vaccines are injected deep into the muscles and stimulate the immune system to produce antibodies. This appears to be enough protection to keep the vaccinated person from getting ill. But what’s not clear is whether it’s possible for the virus to bloom in the nose — and be sneezed or breathed out to infect others — even as antibodies elsewhere in the body have mobilized to prevent the vaccinated person from getting sick. The vaccine clinical trials were designed to determine whether vaccinated people are protected from illness — not to find out whether they could still spread the coronavirus. Based on studies of flu vaccine and even patients infected with Covid-19, researchers have reason to be hopeful that vaccinated people won’t spread the virus, but more research is needed. In the meantime, everyone — even vaccinated people — will need to think of themselves as possible silent spreaders and keep wearing a mask. Read more here.
- Will it hurt? What are the side effects? The Pfizer and BioNTech vaccine is delivered as a shot in the arm, like other typical vaccines. The injection into your arm won’t feel different than any other vaccine, but the rate of short-lived side effects does appear higher than a flu shot. Tens of thousands of people have already received the vaccines, and none of them have reported any serious health problems. The side effects, which can resemble the symptoms of Covid-19, last about a day and appear more likely after the second dose. Early reports from vaccine trials suggest some people might need to take a day off from work because they feel lousy after receiving the second dose. In the Pfizer study, about half developed fatigue. Other side effects occurred in at least 25 to 33 percent of patients, sometimes more, including headaches, chills and muscle pain. While these experiences aren’t pleasant, they are a good sign that your own immune system is mounting a potent response to the vaccine that will provide long-lasting immunity.
- Will mRNA vaccines change my genes? No. The vaccines from Moderna and Pfizer use a genetic molecule to prime the immune system. That molecule, known as mRNA, is eventually destroyed by the body. The mRNA is packaged in an oily bubble that can fuse to a cell, allowing the molecule to slip in. The cell uses the mRNA to make proteins from the coronavirus, which can stimulate the immune system. At any moment, each of our cells may contain hundreds of thousands of mRNA molecules, which they produce in order to make proteins of their own. Once those proteins are made, our cells then shred the mRNA with special enzymes. The mRNA molecules our cells make can only survive a matter of minutes. The mRNA in vaccines is engineered to withstand the cell’s enzymes a bit longer, so that the cells can make extra virus proteins and prompt a stronger immune response. But the mRNA can only last for a few days at most before they are destroyed.
In state after state, the results have been chaotic. In one Kentucky community, doses were nearly wasted when one nursing home ordered more than it needed. (Pharmacists saved the shots from the garbage bin by offering them to lucky customers on the spot.) In Palo Alto, Calif., faulty algorithms initially excluded frontline hospital residents from getting vaccinated. In New York and Boston, doctors who are at low risk have been caught cutting ahead of those at high risk. In Wisconsin, some 500 doses were deliberately wasted by a hospital employee. In Florida, seniors are waiting in line overnight in some cases.
If it’s been this difficult to vaccinate nursing home residents and health care workers — which should have been the easy part, by most accounts — one shudders to think what the picture will look like when larger, more diffuse populations become eligible for the shot.
Officials say that early stumbles are unavoidable in an effort this large and that the pace of vaccination will likely pick up in the coming weeks, as kinks are ironed out and holidays pass. Hopefully, that’s the case. A major Covid surge — and the burden it has placed on health care facilities — has clearly made things harder than they might have been. But the chaos and confusion are widespread and concerning. The national track record on pandemic response is not reassuring.
Other countries are trying to offer the vaccine to as many people as possible. In Britain and Canada, for example, officials are planning to deploy all of their current vaccine supply immediately, rather than reserve half of it so those who get a first shot can quickly get their booster. Modeling has suggested that this approach could avert some 42 percent of symptomatic cases. Ideally, U.S. officials would at least consider similar measures. But more doses won’t make any difference if we can’t even manage the doses we have now.
Whatever the solutions are to the vaccine challenge, the root problem is clear. Officials have long prioritized medicine (in this instance, developing the coronavirus vaccines) while neglecting public health (i.e., developing programs to vaccinate people). It’s much easier to get people excited about miracle shots, produced in record time, than about a dramatic expansion of cold storage, or establishment of vaccine clinics, or adequate training of doctors and nurses. But it takes all of these to stop a pandemic.
It would be heartening if, after this wretched year, there was a decisive shift in that calculus, so that when the next pandemic descends, disease prevention — in all its glorious dullness — is given its due.