Covid-19 vaccines: the Beginning of the End?

Or the End of the Beginning?

The whole world is optimistic about vaccines and the stock market is at all-time high. But is it really over for Covid-19?

Prof. Francois Balloux suggested it may be more complex:

Prof Francois Balloux @BallouxFrancois

I believe the incoming #COVID19 vaccines tend to be effective and safe. I also predict widespread vaccination campaigns will save lives. Though, I doubt vaccines will significantly shorten the timeline of the pandemic, which I predict to be around mid/late 2021 (± 6 months) 1/

I understand there are two issues:

• Logistics: “Even many of richest countries will fail to achieve high vaccination coverage before the peak of the pandemic will be largely over.”

• Mutations: “Immunisation by the incoming vaccines may be fairly easy for #SARSCoV2 to bypass.”

First, how long will it take to vaccinate all people at risk? It took 7 months for France, Germany, and the UK to have mass testing capacities and go from about 50,000 to 300,000 tests per day. We can imagine a similar ramp up period to reach mass vaccination. There are 67 million people in France. 17 million of them (~25%) are “at risk” based on their age or medical conditions. With 50,000 vaccinations per day it’ll take 1 year to vaccinate them all. With 300,000 vaccinations per day it’ll take 2 months.

However, the Pfizer and Moderna vaccines both require two doses, 3 to 4 weeks apart. So we should divide the previous figures by two. Which means it’ll take between 4 months (at 300,000 shots per day) and 2 years (at 50,000 shots per day) to vaccinate all French people at risk (and only them).

I don’t know if it makes sense to compare testing to vaccination. Vaccination may actually be more complicated. For instance, the Pfizer vaccine needs to be kept at -70°C, but according to this article: “This will be a challenge in all settings because hospitals even in big cities do not have storage facilities for a vaccine at that ultra-low temperature.” So even 50,000 shots per day may be optimistic…

Then, the virus won’t stop evolving when the vaccine arrives. As noted by Prof Balloux: “We already know about at least two major 'vaccine / monoclonal antibody escape mutations' that have been rising in frequency even before vaccination has started.”

That’s why he thinks Covid will stay and people will be vaccinated and infected multiple times, like for the flu. Vaccines will help to reduce mortality but they won’t make Covid disappear.

On top of that, because of anti-vaxxers in the West and bad infrastructure in developing countries there will still be “pockets” of Covid-19 where the virus will continue to mutate and eventually reach already vaccinated populations…

If Prof Balloux is right then countries like Australia, Singapore or Uruguay that totally closed their borders and managed to have almost no Covid will struggle. If herd-immunity can’t be reached through vaccination, they will have to stay closed and test & vaccinate all people arriving.

Prof Francois Balloux @BallouxFrancois

@maniel_dorton This is an interesting question. I feel places like Vietnam should be reasonably OK given the young age of their populations. Returning to normality may be challenging for some countries in Oceania and East Asia with older demographies.

It any case, even if Prof Balloux is wrong, the next few months will be tough. All vaccines haven’t been approved and mass vaccination hasn’t started yet. Covid-19 seems to have the same seasonality as the flu, so we can unfortunately expect a peak in Covid deaths and cases in February. And restrictions and lockdowns.

So as Churchill famously said after the Second Battle of El Alamein: “Now this is not the end. It is not even the beginning of the end. but it is, perhaps, the end of the beginning.”

Antoine