As the new COVID vaccines begin to come to market, there is concern among public health officials that a substantial proportion of the population will refuse the vaccine. I doubt it. In fact, I suspect that it’s just a matter of time before antivaxxers will be begging to get it.
Why? Because they’ll witness it working in a way they are currently unable to see other vaccines work.
It’s just a matter of time.
Nearly all vaccines work in two different ways.
1. Vaccines stimulate the production of antibodies. Antibodies are proteins that recognize specific bacteria or viruses and bind to them, thereby signaling to immune cells that they are targets for swift destruction. Each antibody binds to a specific site on a specific bacteria or virus.
That’s how vaccines lead to antibodies, but that’s NOT how they protect the whole population. Even the best vaccines are not 100% effective, and we can’t vaccinate 100% of the population. For example, babies can’t be vaccinated for specific diseases until they can mount the appropriate antibody response. Immuno-compromised people may not be able to mount an immune response at all.
In a vaccine-naive population, this is the primary way that vaccines provide protection.
2. Widespread vaccination leads to herd immunity, dramatically reducing the chance that an infected person will encounter an unprotected person who is susceptible to the disease.
Consider diphtheria vaccine:
Imagine that little Ainsley comes in close contact with 10 children per day. Now imagine that Ainsley develops diphtheria. Who is likely to catch diphtheria from Ainsley? If 99% of children are vaccinated and the vaccine is 95% effective, the odds are low that any of the 10 children she comes in contract with could get diphtheria. Thus, the outbreak of diphtheria ends with Ainsley (though it may end poor Ainsley’s life).
Now imagine that only 50% of children are vaccinated against diphtheria. That means that half the children are likely to be susceptible, and therefore diphtheria is almost certain to be transmitted. And since the children who catch diphtheria from Ainsley are going to expose additional children who aren’t vaccinated, the disease begins to spread like wild fire.
In other words, in 2020 if Ainsley’s mother doesn’t vaccinate her against diphtheria and she never gets diphtheria, it’s NOT because she was breastfed, eats organic food and has a strong immune system. It’s because herd immunity ensures that she’s never exposed to diphtheria.
This is the primary way that vaccines work in a population that is largely vaccinated.
Why does that matter?
It’s impossible to “see” herd immunity at work. In a population that is largely vaccinated against diphtheria (or any other childhood illness), the incidence of the disease is so low that most people will never see a case in their lifetime. It’s easy for parents to pretend that diphtheria poses no threat to their children and that vaccines are unnecessary. How could their children get diphtheria if it appears that no one has diphtheria?
In contrast, it’s easy to “see” the impact of antibody production in vaccine-naive populations.
Consider polio in the 1950’s. Summer outbreaks led to tens of thousands of cases (most in children) leaving hundreds paralyzed or dead. By some accounts, second only to the atomic bomb it was what most Americans feared most.
Frantic parents were eager to enroll their children in the vaccine trial.
The first large-scale clinical trial of Salk’s vaccine began in 1954 and enrolled more than 1 million participants. It was the first vaccine trial to implement a double-blind, placebo-controlled design …
The scientist leading the vaccine trial, Dr. Thomas Francis, Jr. from the University of Michigan, announced the positive results at a press conference on April 12, 1955. Later that same day, the U.S. government declared Salk’s vaccine safe and effective for use …
The rate of polio among vaccinated children was reduced by nearly 90% compared to those children who had received the placebo. Parents rushed to get their children vaccinated because the benefits of the vaccine were glaringly obvious. It’s very easy to see the impact of an effective vaccine in a vaccine naive-population.
If the new COVID vaccines are similarly effective (and early results suggest that they are), their impact will be even more obvious. In contrast to polio, which at its height sickened tens of thousands of Americans each year, COVID has sickened millions and killed hundreds of thousands in less than a year. The incidence of COVID and COVID deaths will immediately begin to drop dramatically as soon as vaccination starts and it will be obvious that those who received the vaccine are protected and can return to a normal existence.
In other words, it will be clear to even the most obstinate antivaxxer that the COVID vaccines really work. Will there be unanticipated risks to the vaccine? That’s always a possibility, but in a vaccine-naive population like ours the benefits will outweigh all but the most serious risks.
That’s the one silver lining to the vaccine shortage that is going to persist for many months. There isn’t enough to give to everyone so only those who really want it will be able to get it. The benefits of the vaccines will become apparent and antivaxxers will want those benefits, too. It’s just a matter of time.
