No one should take this out of context. But it’s an unpleasant and underreported fact that in terms of ending the pandemic, the COVID-19 vaccines have been oversold. So far, they have not shown convincing evidence of bringing the pandemic to a halt and it is becoming increasingly unlikely they will do so in 2021.
This should not be misconstrued as a rationale to avoid the vaccine. Anyone who is eligible to be vaccinated but has not done so should get the vaccine immediately; vaccines remain our best weapon against the virus. They have been quite effective at ensuring people do not contract or transmit the virus. And if one should contract COVID-19, vaccination is undeniably effective in minimizing severe illness and death. But quite or undeniably effective is not the same as completely effective. Infection, transmission and severe illness are still occurring, albeit at a significantly lower rate than previously.
This is also happening in other, even more highly vaccinated countries than the U.S. Israel, Iceland and the U.K., each of which has a higher vaccination rate than the U.S., are all experiencing higher case averages than they did one year ago, before the vaccine was deployed. No one expected that.
The inclination has been to blame the unvaccinated, and they certainly shoulder an important share of responsibility, but some percentage of the population remaining unvaccinated is inevitable everywhere. All the aforementioned countries have their unvaccinated as well. Universal vaccination is a desirable but not necessarily attainable goal. As important in accounting for the current spread is the emergence of the highly contagious delta variant. In effect, nature has countered our best punch to date. Given this, we must restructure our approach to COVID-19.
This approach should start with affordable (take note, Biden administration) home testing with 15-minute results, which would help us return to our daily routines with less risk. A positive rapid test can help detect asymptomatic but still contagious people. These tests, currently being performed routinely in much of Europe and Israel, are not perfect — a positive test needs further confirmation with a more accurate test and a negative test does not guarantee absence of infection. But they are reliable enough that those who test positive can isolate and break infection chains in family gatherings, social situations and workplaces.
Our major scientific priorities should be a universal coronavirus vaccine that would protect us from all the variants of coronavirus as well as an oral treatment for COVID-19. Regarding an oral treatment, history teaches that AIDS, caused by HIV, has been with us nearly 50 years. For 20 years, it was a scourge, killing tens of thousands of people in the U.S. What finally brought HIV under control were reliable antiviral medications that could be taken by mouth (despite years of research, we still do not have a vaccine for AIDS). In halting disease, new treatments work in conjunction with preventive vaccines.
We mustn’t forget the principles of Contagion Control 101: masking, especially in crowded indoor areas with poor ventilation and social distancing, especially important in areas where vaccination rates are low and infection rates are high. Local governments across the country should review their standards for ventilation in buildings in their areas. In addition, whenever possible, schools and businesses should keep windows open for better ventilation. This will mean adjusting to higher indoor temperatures in the summer and lower temperatures in the winter, but that is a small price to pay to minimize aerosol transmission of the virus.
There is a private element to fighting the virus. One of the greatest risk factors for serious COVID infection and death is obesity. This makes it imperative to emphasize how important losing weight and maintaining personal fitness are.
Finally, we return to vaccination. If our desired goal is, as it should be, to get as many people vaccinated as possible, then demonizing the unvaccinated defeats that purpose. We should encourage rather than ostracize because we are all in this together.
The Israelis, who have 1 million unvaccinated out of a population of 9 million, are rethinking their approach. Hagai Levine, an Israeli public health professor, recently told the Jerusalem Post that Israel’s leaders should take time to understand the part of the population that is choosing not to get vaccinated, and manage its response to them professionally.
If discussions around vaccination were removed from the political sphere to the professional arena, this data might be more convincing, Levine told the Post: “There is a well-known Hebrew idiom, ‘not with might but with brains.’ “
The vaccination needs to become a social norm and not something to be elevated as Israel’s only savior, which would make inoculation more approachable for some people who still have their doubts, Levine added.
COVID-19 is a cunning enemy and is doing an extraordinary job of circumventing our defenses. A prolonged battle awaits us, and we must attack on every available front.
Dr. Cory Franklin is a retired intensive care physician.
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