Listen: The Vaccine Is Here! What Now?

With the arrival of the COVID-19 vaccines, hopes abound—but so do questions. With the time between the first inoculation and herd immunity likely to stretch for many months, Americans face a period of “vaccine purgatory,” as staff writer Sarah Zhang has noted.

She joins staff writer James Hamblin and executive producer Katherine Wells on the podcast Social Distance to explain what to expect in the near future and to answer listener questions about the vaccines.

Listen to their conversation here:

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What follows is a transcript of the episode, edited and condensed for clarity:

Katherine Wells: Sarah, not to get to the point too quickly, but ... the vaccine!

Sarah Zhang: Yeah—it’s here! I don’t know about you guys, but I actually got a little emotional watching the first trucks coming out of the factory. I never thought I would feel emotional seeing UPS and FedEx trucks.

It’s just been such a long process. For much of the year, as I was reporting on vaccines, I was really just trying to tamp down people’s expectations. Because all of the scientists I was talking to were saying, “We don’t know how effective the vaccine might be. It might only be 50 percent. It’s going to take a long time to manufacture and distribute”—and so on. [There were] all of these reasons that we should not put too much hope in vaccines. And then the results came out, and they are so good; much better than anyone really expected. And now they are finally on the road and making it into people’s arms. It really feels like the beginning of the end.

Wells: It does—but it’s such a sort of weirdly poignant moment, because it’s the beginning of what will be an incredibly long end.

Zhang: It’s like this weird in-between time where people are still getting sick [from] COVID-19. Some people are getting vaccinated. Other people don’t know when they’re getting vaccinated. And we’ve adjusted to that kind of pandemic normal. And now we’re about to go through another period of flux where we’re not really sure what to do, and who knows how long that will last?

Wells: Maybe we could just start with the basics. What is the order in which people get it?

Zhang: The very first priority group is health-care workers and people in long-term care facilities. If health-care workers get sick, no one’s going to get care. And long-term care facilities have been the site of 40 percent of the deaths, so getting everyone in those facilities vaccinated will probably do a lot to drive down the number of people who are dying from COVID-19.

Wells: A listener named Karen wrote in and asked: “I’ve been reading a lot about the order in which vaccines will be distributed. I haven’t heard any mention of prisoners. They’re at high risk given close quarters. When will they get the vaccine?”

Zhang: That’s a great question. I was just looking at the state plans earlier, and I think Massachusetts might be the one state that has actually put prisoners in the first group.

Wells: So most states are not, huh?

Zhang: Most states are not. If you’re just talking about who is at risk for COVID-19, obviously people in prisons are. We’ve seen big outbreaks in prisons in the past few months, but that also sort of requires the state to prioritize people who are in prison over people who are elderly, for example. That’s really a political calculus.

James Hamblin: Something that’s been really heartening so far is that there’s been a pretty apolitical reception [to the vaccine]. Donald Trump is saying he’s willing to get it. Joe Biden will get it. Anthony Fauci will get it. There isn’t a party that is actively sowing distrust. Do you see a potential, though, [that] once you start getting into these political decisions it could foster distrust and conspiracy theories and drive down acceptance rates?

Zhang: Absolutely. You mentioned that politicians say they’re going to get it. I hope Trump continues to say that. I hope he doesn’t try to sow doubt once he’s out of office. One way to think about getting vaccinated is that it protects you, of course. But the only way to end the pandemic is: If enough people get vaccinated, there’s herd immunity and the virus simply stops spreading. It’s not that we’re just each individually trying to become immune. We’re all trying to together get to herd immunity. The order is going to vary from place to place. It might not seem perfectly consistent, but ultimately it’s not about the order. It’s about getting enough people vaccinated.

Hamblin: Right. And we’re still, just to contextualize, very far from that “enough.” We have had millions of cases, but less than 10 percent of Americans have had a confirmed case. And herd immunity—if you listen to Anthony Fauci, he’s putting it at like 75/85 percent of people. We’re really far from where we could just extinguish the virus.

Zhang: The biggest bottleneck will probably just be: Do we have enough vaccines available? Assuming everything goes according to plan, you can start talking about a timescale of next summer. That’s also good, because this virus seems pretty seasonal. And so, with the vaccine—and with it getting warmer and people spending more time outside—I think we will probably see COVID-19 rates going down quite a bit in the late spring and summer.

Wells: We have gotten a lot of questions from listeners about the vaccine. Here’s a question from Halee: “If one person is vaccinated and one person isn’t, is it relatively safe for those two people to spend time together in person, one on one?”

Hamblin: It should be. From what we know right now, people are reliably developing antibody responses after infection. And we are not seeing people get sick twice. We don’t know that that will continue to hold through the course of 2021. But, yeah; it should be safe. We don’t know that vaccinated people can’t temporarily carry the virus even if they’re not sick. They’re not going to become massive spreaders of this virus—but they might, say, for a day or two, have some virus that they could spread. It remains to be seen how much risk that vaccinated person might be introducing to the unvaccinated person. Probably very, very low risk, but we can’t rule it out just yet.

Zhang: The other thing is: Is the person who got vaccinated a health-care worker who is around COVID-19 patients all the time? If that’s the case, I think that’s different than if they are just another person. This isn’t a question of what’s totally safe. It’s: What is the risk, given the uncertainty so far—though likely—that the vaccine will prevent transmission.

Wells: Mary asks: “I had COVID-19 last March. I’ve been donating plasma regularly, and I’m still testing positive for antibodies. Should I also get the vaccine? What is the recommendation?”

Zhang: You probably don’t need to get [it] right now, but once the vaccine is widely available, there’s no reason not to get it. There are a lot of questions about whether vaccine-induced immunity or natural immunity is better. An overall generalization is: Natural immunity is a lot more variable from person to person, because it kind of depends on how much virus you got at the beginning. Whereas with a vaccine, everyone gets the same dose. So that immunity is just a lot more consistent if you happen to be a person who maybe did not have a great immune response. It sounds like maybe your listener did because they’re still testing for antibodies, but it’s just kind of a little extra consistency once the vaccine is widely available.

Wells: Mitch wrote in asking about COVID and pregnancy. His wife works in a rehab hospital that takes COVID-positive patients, and he says they’re expecting to get the vaccine in the next couple of weeks. His wife is very ready to get it, but she’s nursing. Assuming she is allowed to get it, what could be the possible risks?

Zhang: We let pregnant and nursing women get flu vaccines and other vaccines. There’s no reason to think that there’s any particular risk. The FDA has said pregnant and nursing women can get it. They are kind of being extra super conservative, because no pregnant women were in the clinical trials. But just given what we know about how vaccines work, there’s no reason to think that it will be particularly dangerous for them. And there is data to suggest that the risk of COVID-19 when you’re pregnant is higher.

Hamblin: Amanda asks: “How long will it be before kids can be vaccinated? Were kids included in these trials?”

Zhang: No. Kids as young as 12 are currently in clinical trials for Pfizer and Moderna’s vaccines, but they were not included in these the first clinical trials.

Wells: And why weren’t they? Is that typical?

Zhang: Yeah, they usually start with adults. And then if it’s safe in adults, you go down to kids. I would maybe not expect kids to get vaccinated in the next year. It depends on how old the kids are. I think for those under 12: definitely not. Teens: possibly.

We just don’t actually have the data on how well the vaccine works in kids. It probably will work given how well it’s working right now—but the other consideration, of course, is making sure that it’s safe in kids, and the side effects are well tolerated.

Wells: We just talked about how we don’t have the data for pregnant women, but [for them] we think the benefits outweigh the risks. What’s different?

Zhang: The [COVID] risks to kids are just so much lower than for adults that I think we want to make sure the benefits are very, very, very clear before we start giving [the vaccine] to kids.

Wells: Got it—so it’s because kids have generally not really gotten that sick. Maybe something that would help give a little context for all of these answers is understanding a little bit more about how the vaccine actually works. We had a question from Nathan, who said: “I’m wondering if you would be able to discuss the technology behind the BioNTech and Moderna vaccines, what it means for the future of vaccines, and what it means for a future treatment of other diseases. I have been shocked speaking to learned friends who’ve stated they will not take the vaccine for a number of reasons, including fear of the new technology.”

Zhang: These are mRNA vaccines. And yeah, we’ve never had mRNA vaccines approved before—but we’ve had years and years of research going into mRNA vaccines, which is part of the reason we haven’t actually been able to get them out so quickly. It really builds on years and years of scientists in the lab trying to figure out really minute details about how to make sure RNA does or doesn’t elicit the right immune response.

So the way they work is that instead of injecting a weakened virus or an inactivated virus or a fragmented virus—this is what all our other vaccines are—you actually just inject a piece of mRNA, which codes for the spike protein of the virus. It’s kind of like giving your immune system like a little wanted poster, so that when it actually sees the coronavirus it can recognize it and gear up into action right away. So it's true that we have not had vaccines made with mRNA before, but one of the advantages is that you’re not injecting an actual virus. There’s no way for you to get COVID-19 by getting this vaccine. That’s actually in some ways safer, [because] all you’re getting is this one, by itself, harmless piece of protein that is being made in your body after you get the mRNA. Concerns around vaccines are usually around whether the vaccine provokes an unexpected immune reaction. At this point, there’ve been tens of thousands of people in this clinical trial—so if this is happening in even 0.1 percent of people, we would have seen it by now. We’re not seeing very serious side effects at all.