Americans’ opinions about the COVID-19 vaccines are largely wrong.
We persist in thinking they should prevent all SARS-CoV-2 infections, but given the biology of the virus and the way our immune systems respond to either infection or vaccination that does not happen.
As with other vaccines, the goal is to prevent serious and deadly outcomes, not to prevent all cases of transmission and infection.
By acknowledging this reality, we will be able to better target vaccines – and other COVID interventions – to help us transition from pandemic to endemic infections, and what we should think of as co-existing with the virus.
COVID is fundamentally different from many other infectious diseases for which we have effective vaccines. Like SARS-CoV-2, measles is a virus that is transmitted largely through the air but is even more contagious than COVID-19 and also deadly.
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Before the measles vaccine was invented, about 2.6 million people, mostly children, died per year from measles-related pneumonia, brain infections and other complications. The measles vaccine blocks almost all infections and reduces deaths by 95%. As with COVID, it is largely the unvaccinated who die of measles.
So, do the vaccines work?
Why can the measles vaccine eliminate infections but the COVID vaccine can’t Because it is a race between the memory immune response and the incubation period (the time it takes for a person to develop symptoms after they are exposed to the virus). The longer the incubation period, the more time the memory immune cells have to rev up and produce antibodies against the virus. It can take up to five days for those memory immune cells to kick in.
Measles has an incubation period of 10 to 14 days. In that race between the immune system and the virus, the immune system wins.
But the median incubation period for COVID-19 appears to be less than three days. Thus, current COVID vaccines cannot prevent the SARS-CoV-2 virus from taking hold and causing infection.
Furthermore, the strategies that worked to defeat smallpox and control Ebola – like “ring vaccination,” which targets vaccination at concentric circles of susceptible persons around a case – will not work against COVID-19. The incubation times for smallpox and Ebola are longer and almost everyone infected with these viruses have symptoms recognizable even to the layperson.
Unless we boost people every four to six months, even vaccinated people can get infected with COVID-19. The memory immune response is not fast enough to prevent all infections.
But this does not mean the COVID vaccines aren’t working. Vaccines are not designed to prevent all infections. They are designed to prevent severe disease and death, and at this, the COVID vaccines are succeeding superbly.
Although many people – unvaccinated and vaccinated – are getting infected with COVID now, fewer vaccinated people are being hospitalized or dying. The chance of a vaccinated person dying from COVID is 1 in 34,000.
The more people are vaccinated, the better our chances are to “flatten the curve,” preserve the health system so it can care for patients with or without COVID and ensure people can get back to work quickly if they become sick.
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If we can come to a consensus around the proper use of vaccines, we can accelerate the transition from pandemic to endemic COVID-19.
To prevent transmission, we need to improve air filtration and the wearing of masks. We need to upgrade indoor air ventilation and air filtration to MERV 13 in all public buildings – schools, government buildings, retail stores, restaurants, bars, gyms, theaters, transportation hubs, really anywhere people gather indoors, outside their homes. In the transition, we should place enough HEPA air filtration units in those indoor public spaces to mitigate risk.
Similarly, Americans need to use N95, KN 95, or KF 94 masks during periods of high COVID transmission, such as around the winter holidays, and immediately after infection.
To prevent serious complications, we need to vaccinate as many people as possible with three doses. United Airlines announced this month that since its COVID-19 vaccine mandate went into effect last summer, no employee has died.
It is clear that mandates are the most effective way to save lives. The only way to efficiently enforce vaccination requirements is through a digital vaccine certificate system. Such a system should protect individual privacy and be equitable.
We now have improved treatments
Serious complications can also be reduced by using effective monoclonal antibodies as well as oral antiviral medications – Paxlovid (nirmatrelvir/ritonavir) or molnulpiravir. Given the short window for effective treatment, we need to establish a close link between testing and treating.
We need to change our approach to isolation for COVID. It should be more like what we do for influenza. When you’re sick, you should stay home, away from co-workers and family members. When you are well enough to work or go to school, you should wear a high-quality mask and be allowed to return to your regular activities.
Rapid antigen tests, if available, can be used. If someone tests positive even after their symptoms resolve, then they should stay home longer.
After two years, we all want and need to move on in some way. We need to accept that COVID vaccines don’t prevent infection but avert serious complications and death. That is victory enough. And when combined with the other interventions, enough to allow us to live a normal life.
Ezekiel J. Emanuel is co-director of the Healthcare Transformation Institute at the University of Pennsylvania. Rick Bright is CEO of the Pandemic Prevention Institute at the Rockefeller Foundation. Michael Osterholm is director of the Center for Infectious Disease Research and Policy at University of Minnesota. Luciana Borio is a senior fellow at the Council on Foreign Relations.
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This article originally appeared on USA TODAY: COVID vaccines aren't perfect. But they're saving lives.