This is the fourth in a six-part series on “two years and counting” for the coronavirus. Click HERE to read the series.
When COVID-19 emerged, scientists figured they could stop the disease by getting 70% or 80% of the country vaccinated. As the delta variant of the virus raged, experts said it might take 90%.
Now, as the virus enters its third year, it’s becoming clear that no level of vaccination may be enough to control the spread.
“Even if everyone were vaccinated, we would still be able to see some amount of spread,” said Stephen Kissler, a postdoctoral fellow at the Harvard T.H. Chan School of Public Health. “We’re basically at the point there that [herd immunity] threshold no longer exists.”
Herd immunity projection was just one of the areas where COVID-19 has humiliated policymakers and experts who have tried to lead the U.S. through the pandemic.
In the early days, top health officials warned that face masks weren’t effective. Now, masks are the backbone, with vaccines, of the global virus containment strategy. Fifteen days to stop the spread, the original shutdown in spring 2020, has turned into a vicious two-year debate over stay-at-home policies.
The government rushed to buy ventilators. It pumped billions of dollars into purchasing more than 100,000 units in spring 2020 only to realize that doctors were having success with other treatments, such as steroids.
Contact tracing, which was supposed to be the silver bullet in summer 2020, before vaccines were available, burned out as Americans refused to divulge much information about their recent contacts.
Hydroxychloroquine, a malaria treatment that President Trump pushed and initially approved as an effective COVID-19 defense, had emergency use authorization revoked after studies found it was doing more harm than good.
Vaccines’ fast-waning protection has disappointed experts, who are now debating whether to recommend that Americans get their fourth mRNA shots from Pfizer-BioNTech or Moderna in a little over a year.
Now, as the omicron variant sweeps the globe, variant “stealth omicron” may be next.
The Food and Drug Administration withdrew its approval for monoclonal antibody treatments from Eli Lilly and Regeneron, saying they don’t work on omicron. Republicans accused the Biden team of political meddling.
The reversals and misfires have proved humbling for the experts and cost them credibility in the eyes of a public weary of solutions that have not panned out.
“This administration has time and again squandered its opportunities and made things worse in the decisions you’ve made on testing and treatments and, most crucially, in communicating with the American people,” Sen. Richard Burr, North Carolina Republican, told health officials at a mid-January hearing on Capitol Hill. “The American people are right to be confused when it seems like you all don’t even talk amongst yourselves.”
Controlling transmission
Herd immunity was going to be tough to achieve even at the lower estimates, before the virus evolved.
About 76% of the country has received a single dose of a vaccine, and 64% are considered fully vaccinated. That means two doses in the case of the Pfizer and Moderna vaccines and one for the Johnson & Johnson shot. Just 42% have had booster shots.
That doesn’t even account for talk of a fourth shot needed for the mRNA vaccines to keep up with the latest variants.
Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, acknowledged last year that he gradually and deliberately increased the vaccination goal based on what the public might bear. He didn’t want to discourage people by putting forth a high number.
“You know when you are at herd immunity when the virus doesn’t have opportunity to go from person to person. But right now, we don’t know what that number is. And when you don’t know what the number is, what do you do? You vaccinate as many people as you possibly can, as quickly and as expeditiously as you possibly can,” Dr. Fauci said in late September. “That’s what we should be concentrating on, not any particular number.”
Dr. Fauci gave that blunt assessment at the height of the wave of the delta variant, mainly across the South, when 2,000 people per day were dying.
Now the country is facing a wave of the omicron variant. Reports say omicron is better at evading the two-dose mRNA and single-dose Johnson & Johnson shots. Serious cases are still blunted, but so-called breakthrough infections of fully vaccinated and boosted people are common.
“We learned that although vaccination reduces transmission, it really doesn’t reduce it as much as hoped. I have not heard a specific vaccination target in some time because I think the notion of how much we can control the virus’ transmission is now up in the air,” said William Schaffner, an infectious diseases specialist at Vanderbilt University.
That’s disheartening to a public that had been enticed with the prospect of a herd immunity finish line and spoiled by tales of past diseases corralled by enough vaccinations.
Smallpox was tamed by vaccination, with scientists figuring a herd immunity threshold of 80%. It is estimated that 94% of the population must be vaccinated for measles to break up chains of transmission. For polio, that threshold is about 80%.
Losing the herd immunity goal may be hurting the vaccination campaign. Some holdouts say they don’t understand the point of getting the shots after hearing about breakthrough infections.
“If you are vaccinated, you can still transmit. What is the rationale for the mandates? There is no rationale,” Sen. Ron Johnson, Wisconsin Republican, said during a hearing on side effects from the shots.
Others want to know why antibodies from a previous bout of COVID-19 aren’t good enough.
“It is very much a ‘This is what you have to do, so this is how you go do it’” type of situation, said Andrea Ennis, an associate at the Tully Rinckey law firm who works with federal employees facing mandates. “That ‘why’ is missing from the conversation.”
Waning immunity
The COVID-19 vaccines were developed in record time and designed to stave off severe disease, hospitalization and death, though researchers hoped they also would cut transmission.
Early on, that was happening. Those who were vaccinated were contracting COVID-19 at lower levels, were experiencing less-severe cases if infected and were less likely to infect others.
But effectiveness waned with time and with the virus’ evolution.
Even before the omicron variant emerged, a massive study involving 780,000 U.S. military veterans published in November in the journal Science found that in the basic course of vaccines — two doses of Pfizer or Moderna or a single dose of Johnson & Johnson — protection against any infection at all plummeted from 87.9% in February to 48.1% by October.
Pfizer’s protection dropped from 86.9% to 43.3%, and Moderna’s from 89.2% to 58%. Protection against infection from the J&J vaccine plummeted from 86.4% in March to 13.1% in September, according to researchers from the Public Health Institute, the Veterans Affairs Medical Center and the University of Texas Health Science Center.
“We would discourage a strict goal of a threshold where we think if we reach that, that community transmission will then cease,” Dr. Jefferson Jones, a medical officer at the Centers for Disease Control and Prevention, told a Nov. 2 meeting of advisers who voted in support of offering the Pfizer vaccine to children ages 5 to 11. “It’s going to be very complicated with waning immunity, and you have protection against infection versus protection against severe disease and, I think, thinking we’ll be able to achieve some kind of threshold where there will be no more transmission of infections may be not possible.”
The White House is taking a more-vaccination-is-better stance. It argues the personal benefits of more shots instead of a global threshold to wrangle the pandemic.
“I get wanting to get a sense of the herd immunity, but that’s not our focus right now. Our focus is to make sure that we do everything that we can to get people vaccinated,” principal deputy White House press secretary Karine Jean-Pierre said on Nov. 5, one day after the Labor Department issued a vaccinate-or-test rule on large employers.
There are plenty of reasons for more vaccination.
Rolling data at the federal, state and county levels consistently show that vaccinated people have lower relative risks of infection or disease. King County, Washington, measured risks among people of the same age and found that unvaccinated people were 2.5 times more likely to be infected, 11 times more likely to be hospitalized and 17 times more likely to die from COVID-19 than those vaccinated.
Boston College and Tyson Foods told The Washington Times last fall that they saw a marked drop in COVID-19 cases after they imposed vaccine mandates and lifted uptake to more than 95%, though that was before the omicron surge shifted attention to hospitalizations instead of simple infections, which have soared.
United Airlines, which loudly and proudly imposed a mandate months ago, said its rules are preventing severe disease and death.
Even though 3,000 United Airlines workers were infected with the virus amid the omicron wave in January, “zero of our vaccinated employees are currently hospitalized,” CEO Scott Kirby said in a Jan. 11 letter to employees. “Prior to our vaccine requirement, tragically, more than one United employee on average per week was dying from COVID.”
There is growing evidence that those who survive infection and then get vaccinated have the most robust protection of all. Those who are vaccinated probably will be exposed to the virus at some point in their lives.
“Many of the people who have the strongest and durable immunity are people who were previously infected and then gotten the vaccine,” Mr. Kissler said. “As we move forward, we’re all going to end up in that camp.”
Yet it might be time to retire the idea that the coronavirus will be eliminated.
“There is a lot of immunity in the United States right now from a combination of prior infection and vaccines. But there is always going to be a baseline number of cases, hospitalizations and deaths,” said Amesh Adalja, a senior scholar at the Johns Hopkins Center for Health Security.
For more information, visit The Washington Times COVID-19 resource page.
• Tom Howell Jr. can be reached at thowell@washingtontimes.com.
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