A first generation vaccine, unless it turns out to be both highly effective and widely taken, won’t end the pandemic on its own. I wrote back in early summer that a first generation vaccine, on its own, probably wouldn’t get us out of the pandemic but combined with other measures would make life – and travel – more normal than it used to be. We now have a new study, with new math, backing up this view.
There are several vaccines in phase 3 trials. For the U.S. the most promising are BioNTech-Pfizer, moderna, AstraZeneca-Oxford, Johnson & Johnson and Novavax. The U.K. vaccine and the Johnson & Johnson vaccine both had to pause and restart trials while adverse health issues among trial participants were investigated. There’s also several Chinese vaccines, and China is using access to these for geopolitical advantage. With poor U.S.-Sino relations we’re unlikely to have access to them even if they prove safe and effective. (Here I leave out the Russian and Australian candidates for now.)
I’ve worried somewhat about the moderna candidate, because of the significant unloading of the company’s stock by its executives and the early promotion of results without data in advance of share sales. It’s a new technology (mRNA) that’s similar to what’s being used by the German BioNTech in cooperation with Pfizer. Both of those vaccines have to be stored at below zero temperatures and require two doses.
Let’s look at the timeline for a moment.
- Assume a December emergency use approval for a very limited population, whether health care workers or nursing home residents. It will take a few weeks for initial roll out.
- And two doses, taken 3-4 weeks apart. Plus two weeks to experience full protective immunity afte the second dose.
We’re looking at probably early March before the first people have immunity from a vaccine. And several months after that before protective immunity is conferred on a wide array of the population. But summer 2021 is likely to look a lot better than the U.S. looks today, and we may have both a weather benefit (outside of the hottest parts of the country where people stay inside) and the benefit of treatments that make getting the virus less scary as well as much of the population having had the virus recently enough that they retain some immunity.
Great, that means we can all stop wearing masks by next summer and jump on planes to go anywhere we want, right? Not so fast.
- We don’t know yet how effective these first generation vaccines will be. The FDA has said approval will require both a showing of safety (they’ll likely be too conservative, safety needs to be weighed against the vaccine benefit with nearly 1000 deaths per day some of which could be avoided) but also of greater than 50% efficacy.
- If the first vaccine attempts only get us 50% efficacy, and 50% of people stopped wearing masks, you’d need over half the population to have taken the vaccine to suppress the virus.
[I]f face mask usage stops completely, a weak vaccine would not suppress the epidemic, and further major outbreaks would occur. A moderate vaccine with coverage of 48-78% or a strong vaccine (100% effective) with coverage of 33-58% would be required to suppress the epidemic.
How effective these first vaccines turn out to be, combined with how many people take them, will drive when mask mandates go away. A ‘vaccine only’ isn’t going to do it. We’re going to be stuck wearing masks on planes for some time.
And if Joe Biden becomes President we may see a national transportation mask mandate. Reversing a federal rule is likely to be far less flexible than leaving things up to the airlines, which means mask requirements are likely to stay in place far longer than needed. We still take off our shoes and have to toss bottled water as we go through security checkpoints after all.
Bear in mind this timeline and removal of mask mandates is all specific to the United States, which is likely to get vaccines faster than some other parts of the world. So when a U.S. gets a vaccine is not indicative of when mandates go away elsewhere, or even when other countries open up their borders. For some time we may expect to have more paperwork required for international travel, some combination of ongoing testing and proof of vaccination.
@ Gary — And if Donald Trump is re-elected, we’re screwed. Those with any sense will be on lockdown for 5 years before this is over.
Your comment about “if Biden is elected means there would be a Mask mandate…so what. Better to be safe than sorry. If you wrote it that way and didn’t realize how your comment would come across, then think before writing, if you wrote it because you support Trump, I will not be reading your emails anymore since the information you may share may be tainted.
@Shelley – I am telling people what to expect, not endorsing a candidate. Gosh, this morning this site was called “View From The Left Wing”
– I have generally been very pro-mask on this site
– And wouldn’t personally base my decision for President on masks.
I guess if you can’t tell where I’m coming from politically I’m doing things right?
I will wear a Burger King paper crown, but I refuse to where a mask.
Wear
@Johhny
You win the internet today, sir 🙂
I actually doubt I will ever fly without a mask again. No downside, all upside.
9 million Americans have had Covid, and once a vaccine is approved millions will get it in a short amount of time (although of course it will take quite some time for the 100+ million that will be needed to truly end the pandemic). At some point you have to provide a way for those who aren’t a potential vector to demonstrate that and no longer have to mask themselves. The “everyone is a potential threat” idea will increasingly be nonsense.
This is much broader than you posit, Gary. To whit, if the mRNA vaccine gets approved, the number of patients that will be able receive it will be a fraction of traditional refrigerated vaccines due to the US (and most other countries) lacking sufficient cold chain infrastructure for distribution. This was nicely covered in this video:
https://www.youtube.com/watch?v=byW1GExQB84
So regardless of politics, whoever says that the vaccine is around the corner is just flat out lying.
I am not an anti-masker. I wear it everywhere. But there is a breaking point at some point in time. If I receive an FDA approved vaccine at 50% efficacy plus I have a negative COVID test just before my flight (even the rapid nasal test which is 96% accurate) there is not good reason why I should have to wear a mask on that flight. The chances of someone under those circumstances transmitting the virus to someone else is so minimal that they should be exempt from wearing a mask if they so choose. And if the vaccine is in the 75% efficacy range I do not see any reason why someone should be required to wear a mask if they are vaccinated. At that efficacy they are more likely to transmit the common flu or cold than COVID. Again, I am not an anti-masker, but try wearing a mask on a 15 hour flight to Asia. It isn’t fun!
I’m not wearing a mask one day after whatever vaccine I take kicks in. Anyone who doesn’t like it can fight me. Time to take our rights back.
Say there is an effective vaccine on Jan. 1. Now they have to manufacture, distribute, and convince people to get the vaccine. Which means that masking in general, will go on for at least 2 years. Possibly much longer! I think we have to treat Covid-19 as endemic to world society and get used to it!
@VML I watched that video when it came out, nice explainer, they do a great job. But the cold storage logistics issue isn’t something that just came up. The moderna vaccine doesn’t need to be nearly as cold as the pfizer one. there’s going to be problems of spoilage and waste, but large pharmacy chains are going to be distributors.
Ramp up in supply is going to be a binding constraint though. First we’re going to probably vaccinate front line workers, and vulnerable populations like those in nursing homes (even though the young are more likely to spread it, and vaccinating them might control the pandemic quicker). Even with an EUA in December it’ll be sometime in Q2 when it’s broadly available, probably late Q2, and of course that timeline could slip and we don’t have data off the trials yet.
@VML FedEx Express and UPS already have distribution plans in place. Both of these companies already distribute the vast majority of vaccines in the US. The issues of scaling up millions of doses and then convincing people to get the vaccine. Those are the big bottlenecks.
@Bob – a perfect exercise in how to completely misread or misrepresent what I’ve written.
“Health experts have no idea when things are going to start getting better.”
Really? Perhaps not with specific date certainty but experts absolutely model this.
“Nobody yet knows what the efficacy of the vaccine(s) are going to be.”
I make this point explicitly in the post.
“Yet have no fear everyone, Gary Leff knows that the vaccine means travel is going to be better in the summer.”
No, I offer the best case to explain why a vaccine’s approval won’t end mask wearing and unless the vaccine is highly effective even widespread rollout won’t be the end of mask wearing.
I took a best case of a December EUA and played out what that would mean for the continued need to wear masks, based on best available latest research which I link to.
Just look at Singapore. They wear masks even though they have 1-2 new cases a day and 28 dead during the entire epidemic.
Just look at Taiwan (Republic of China), not to be confused with the People’s Republic of China. 200 days with no cases. They still wear masks.
America won’t be so careful. Covid-19 won’t go away in 2021. It could get better but will still be here. 2022 is a possibility if we are naughty like not wearing masks or wearing them with huge gaps around the nose.
@derek – Singapore’s low death totals aren’t because of masks, they did a great job containing the pandemic at the very start but failed to protect their guest worker dorms which are tight spaces with lots of people – the virus spread- but those people are very young.
Now, I expect I’ll be wearing masks for awhile in a number of settings, including when I travel during flu season.
https://viewfromthewing.com/whats-grosser-than-gross-airline-club-lounge-edition/
All those who think a vaccine is coming quickly or may do the job better read this first…
https://www.bloomberg.com/opinion/articles/2020-11-02/early-moderna-pfizer-covid-19-vaccine-chances-have-math-problems
I don’t understand the aversion to the mask mandate, Gary. Yes, TSA and shoes.
But masks reduce transmission and (to a lessor extent) reception to water-droplet-bound viruses. That has objectively better outcomes than shoe-checking security processes.
Also this article seems to reenforce we will need them. The why the resistance? Is self-governing working well in this country?
@Andrew – I’m pro-mask. Masks are already required on planes. If mandated by the federal government those mandates will be difficult to lift when the original reason for them has passed.
@Douglas Swalen – nothing really new in this piece. Clinical trials need infections, hopefully in the placebo group, in order to determine effectiveness. The vaccine group needs to show substantially fewer infections than the placebo group and we have to wait until there’s a predetermined number of infections in order to evaluate. The growth in the pandemic in the U.S. makes U.S. clinical trials more likely to get there quickly versus if the virus wasn’t spreading uncontrolled here. (There’s a reason why so many clinical trials went to Brazil earlier, for instace.)
I’m definitely in Bob’s camp. It’s ALL speculation, models or no models. Think way back to previous years . . . did you ever wear a mask regardless of world health issues (and there were many)?
As I’ve mentioned before, basing assessments upon the mere 50% efficacy requirement to be able to approve a vaccine, you need to keep in mind that that number is merely a benchmark figure intended to power the clinical trials, and is not indicative of the actual expectations. The efficacy across vaccine candidates currently in Stage III is likely to be much higher; 75-90% seems a probable range for most of them, based on most of the professional assessments I’ve seen across public sources.
My prediction is that the pandemic, in the industrialized world, will be technically over sometime in Q3/2021, due to wide vaccination campaigns. As far as government restrictions go – in terms of travel bans, quarantines, and other requirements – there may be a lag after that. But we should nonetheless expect a rapid relaxing of those restrictions after covid-19 is no longer a pandemic, as reopening will be crucial to economic recovery for all countries.