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Research and Innovation

Vaccine Q&A: Returning to Normal and Planning for the Future

drawing of the SARS-CoV-2 virus.

In this post, we focus on how long it might take for things to return to normal, and what we can do to be better prepared for the next pandemic.

To address those questions, we spoke with Matt Koci, a virologist and immunologist whose work focuses on host-microbe interactions in birds. Koci is a professor in NC State’s Prestage Department of Poultry Science.

This post is part of a series of Q&As in which NC State experts address questions about the vaccines on issues ranging from safety to manufacturing to how the vaccines will be distributed.

The Abstract: So now that the vaccines are being rolled out, how soon can we expect things to go back to normal?

Matt Koci: I hate to be the bearer of bad news, but it’s going to be a while AND it’s going to get a lot worse before it gets better. Now is going to be the most critical and most challenging time in our lives. We’re all exhausted from this pandemic. We’re getting complacent. It’s the holidays and we want – we need – to feel some sense of normalcy again. And now with news that vaccines are around the corner, it’s going to be really hard to resist the temptation to spike the ball and walk off the field. But we’re only at the 40-yard line.

Rolling out the vaccine to 330 million people is going to be a bigger logistical challenge than D-Day. People need to recognize that it is going to take months to make all the doses we need. It’s going to take even longer to figure out how to get it to the people who need it.

It is critical that people keep wearing masks, keep washing hands, and keep socially distant.

This isn’t exactly apples to apples, but it might help give you a sense of the size of the problem: think about how many people in the U.S. each day wake up and think “I need to go and get a COVID-19 test,” and how long those lines are. In North Carolina, over the past week or so we’ve averaged around 50,000 tests per day. That’s 0.6% of the state’s population. At 50,000 people per day, it would take 160 days to get everyone in our state one shot of the vaccine.

It takes two shots for most of the vaccines, and you need to get the same vaccine for both shots. That means you have to keep track of who’s been vaccinated, make sure they show up for their second shot, and make sure they get the same one both times.

This is all doable, but it’s not as simple as ordering a burrito on DoorDash.

Photo credit: Ketut Subiyanto

During this process, it is critical that people keep wearing masks, keep washing hands, and keep socially distant. And not just those who are doing it already. We need more people to be doing it. Dying from this virus is horrible enough. Getting sick and dying from it now, when there’s a vaccine a few months away, is especially cruel. We have to keep our eye on the ball. We need to redouble our efforts to keep each other safe.

We also need to keep in mind that how long it takes to return to some semblance of normalcy is dependent on how many people get vaccinated. Vaccination rates in the U.S. and around the world will influence how long it takes for this to be over. Recent surveys suggest only around 50% of Americans say they will get the vaccine. If that number doesn’t go up, it will take a lot longer to get back to “normal.” We need to do everything we can to make it as easy as possible for people to get vaccinated. Make sure people understand when and where they can get vaccinated, and make sure it doesn’t cost them anything to get it.

We also need to remember that a pandemic by definition is a global event. We won’t be back to normal by just focusing on controlling things here. We’re also dependent on vaccine rates around the world. We’re a global economy. We need our global trading partners to return to normal for our economic recovery. We also need it for broader international stability. As we get more and more people vaccinated here in the U.S., we need to turn our attention to other countries to make sure they are protected too.

If we assume that since we got a vaccine to this virus that we’ll get a vaccine to the next one, we’re doomed to relive this nightmare.

With a little luck, and vaccine-driven herd immunity, we’ll be able to start going back to indoor restaurants, movie theaters and schools by late summer or early fall of 2021. But we’ve lost over 300,000 people [as of Dec. 14, 2020], and will likely lose at least 200,000 more before this is all over. Nineteen years after 9/11 we still stop and read off all the names of the 2,977 lost that day. We’re now losing more than that every day.

We should never go back to “normal,” but my greatest fear is we will. Nature has thrown something new at us every couple of years: Bird flu in 1997, Nipah virus in ’98-’99, SARS in 2002, Bird flu 2004-today, Swine flu in 2009, MERS in 2012, Ebola 2013-2016, Zika 2015, Ebola 2017, 2018, 2019, 2020. That’s not to mention antibiotic-resistant bacteria and a ton of other stuff I know I’m forgetting. If we go back to normal, if we assume that since we got a vaccine to this one that we’ll get a vaccine to the next one, we’re doomed to relive this nightmare.

TA: What should we do to prepare and hopefully prevent the next pandemic?

Koci: This is the best justification for the funding priorities the federal government used to put into basic science discoveries. We still invest in science, but not at the level other countries do (relative to GDP), and not compared to the investments made by the WWII generation. Maybe that is because they were also the last generation to have experienced a pandemic, a major environmental crisis (the dust bowl) and a depression – as well as smallpox and all the childhood diseases we have trouble getting people to get vaccinated for today.

Photo credit: Chokniti Khongchum

People need to recognize that we have a vaccine in record time largely because of the investments we made in from the 1950s through the 1980s. Those investments established the infrastructure and foundational scientific understanding that today’s scientists leveraged to meet this moment. If we’re going to be ready for the next pandemic, which hopefully will be in another 100 years, we need to make sure we set up our grandkids and great-grandkids as well as we were set up by our grandparents and great-grandparents. The old adage is to “leave it better than you found it.”

TA: Is there anything else you’re worried about?

Koci: Yes. Pursuing nationalistic vaccine policies could make things worse before the COVID-pandemic 19 is over.

I know we’re all sick of hearing “we’re all in this together,” but in the end that mindset is what got us a vaccine.

This has been a worldwide disaster, and the solutions have come from the world’s scientists working together. Scientists have focused on science. They have collaborated and shared information and reagents regardless of borders and nationalities. No single country has achieved anything in this fight on their own. While I understand the impulse to try and make sure your own people are vaccinated first, the pandemic really isn’t under control anywhere until it’s under control everywhere. Playing international politics with the vaccine is dangerous. We risk turning the vaccines into precious commodities like oil, gold, and water. Wars have started over things like that.

As things start to return to normal and people finally have the opportunity to grieve over the losses of the past year, there will likely be some who seek to exploit that. Those people will try to blame others for what happened. We have to resist efforts to pit one country or culture against another. We have to remember that it was international collaborations that got us through this. Distrust and resentment will only make it harder for science to work collaboratively moving forward. And that will make it harder for us to know when some new pathogen has crawled out of a cave, a jungle, or a farm. It will make it harder for everyone to get access to the data and samples needed to contribute to the solution. Ultimately, cutting ourselves off from the rest of the world will make it harder for everyone to trust new solutions when they are developed.

I know we’re all sick of hearing “we’re all in this together,” but in the end that mindset is what got us a vaccine. The way we prevent the next pandemic is by embracing what worked and continuing to work together.

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  1. All pandemics reach a social end as well. Once vaccines are widely available and deaths are declining (hopefully by spring), I don’t think you’ll find many people — or local governments — willing to maintain the strict lockdowns.

    Businesses are major donors to re-election campaigns. And you can’t collect sales and property taxes from restaurants that have closed for good.

  2. Hi Marla — I’d like to respond to your question: “Are we tinkering with survival of the fittest?” In some ways, maybe, but this vaccine, or any vaccine, is no more guilty of this than any aspect of medicine. Taking antibiotics, allergy and asthma meds, fertility treatments, eyeglasses, even plastic surgery that improves your mating potential, all of these muck with the "natural" selection pressure some of us would have experienced. Without my Claritin during pollen season, I would be an easy meal for a large predator. But while medicine may keep some genes around that might have been selected against in some circumstances, you can also think of it like this. Sure, some people may have genes that make them more susceptible to some diseases, that doesn’t mean they don’t carry other genes that make them more resistant to others. The more diversity we keep around the better for us all in the long run.

    Is there a human population size that will exceed the carrying capacity of the Earth? Almost certainly. How close to it are we? I don’t know. There is bound to be a limit, but our ingenuity keeps pushing that barrier back. Do vaccines contribute to us potentially hitting that wall sooner? That seems to make intuitive sense, but most UN population data suggests that as we increase global levels of education (especially for girls) and living standards, and decrease disease burdens, every culture ends up having fewer children. So, in a way, the use of vaccines to manage diseases globally is one of the best things we can do for the planet over the long-term. This website does a great job explaining the trends and predictions for global population and its’ relationship to disease and standards of living (https://www.gapminder.org/tools).

    Now the last part of your question, why do we need 2 doses of the vaccine. That is more in my lane. Immune memory works a lot like other memory. The more you do something, the more you practice, the better your performance will be. We know how long it takes the immune system to respond to most vaccines and produce the cells and proteins needed to fight off the virus, typically about 7-14 days for the peak response. That initial response should generate immune memory but if you want to make sure; it’s best to give a second shot a few weeks later. Think of it as a follow-up pop quiz after the initial test, just to make sure the student remembers the materials. That way when the immune system sees the real virus it will respond with automatic recall, instead of having to work back through the problem, counting on its fingers and toes.

  3. I wonder if we vaccinate against disease the human population will be too much for the earth to sustain. I know that is probably heresy. Are we tinkering with “survival of the fittest “?
    Can you explain why we need 2 doses of the vaccine? Loved your articles. Very clear for the layperson.