Other than hoping that SARS-CoV-2, the virus that causes COVID-19, would just disappear or that we could all collectively skip the year 2020, the two most common yearnings I hear, see and read about in relation to COVID-19 are: let me get the virus and get it over with, and let’s hurry up and get a vaccine out there like some other countries are doing (I’m looking at you, China and Russia).
On the subject of hoping one gets the virus so that one can ‘get it over with’, where to begin? How about with the fact that
there are no clear and universal predictive factors that can tell us who is going to get severe disease and who is going to get mild disease.
We know that underlying health conditions, those that are elderly and those that are immunocompromised are at the highest risk of bad outcomes. But we should not confuse those who are at highest risk of bad outcomes as being those who are the only people at risk of bad outcomes. As the evidence emerges from around the world, we continue to observe younger people contracting the virus, suffering serious illness, requiring hospitalisation and dying.
But let’s suppose in our wish to get the virus and get it over with, we could be granted a mild case of COVID-19. Even then, we would be misguided. We now know that there are thousands of people who have contracted mild COVID-19, never having been hospitalised, never having suffered the typical symptoms and eventually having tested negative but these individuals continue to report troubling long-term effects including neurological deficit, fibromyalgia and mind-numbing fatigue.
And don’t fall for the invincibility bias that once you’ve contracted COVID-19, you can’t get it again (that has been disproven) or that if you do get it again, it will be really mild (we don’t have enough evidence to say that at this stage). And without a doubt, the other reason you don’t want to wish for COVID-19 is that even if you didn’t get a serious case, even if you didn’t have any long-term effects, and even if you don’t get a second infection (or a very mild one), you might infect someone else who might not be so lucky.
Let’s turn to the vaccine wish. There are more than 50 vaccine candidates in various stages of clinical trial development. And by the sounds of it, we might need every one of them in order to somehow vaccinate close to eight billion people.
However, some countries like China and Russia have gone ahead and started to roll out large vaccination programmes, despite the fact that phase 3 efficacy and safety results from their vaccine candidates have not been analysed. This has prompted some in Western European and North American circles to wish for something similar.
Let’s be clear about the pitfalls here. By accelerating the approval and distribution of vaccine candidates where a full read-out and understanding of the efficacy and safety results has not occurred, we run the risk of harming a lot of people. Remember that we’re giving vaccines to healthy people. Let’s also be clear that when vaccine trials pause (see AstraZeneca and Johnson & Johnson) due to adverse events, this is a good thing.
As I and others have opined previously, it demonstrates that the system of checks and balances is working and that we are adhering to strict principles that govern how clinical trials ought to be conducted. So wishing for an accelerated approval, given the trade-off required on safety and efficacy, is simply a bad idea.
But another reason you don’t want to wish for an accelerated vaccine is a much more subtle and nuanced justification. Frankly, the optics of it are horrible. Yes, you heard me. We need to convince people that a vaccine is safe and that it has been properly vetted and studied if we’re going to get uptake. And if we’re going to control this virus so that we can all go back to living normally, we’re definitely going to need uptake. Massive uptake. Like 70% of the population uptake.
The psychology of this point is, I’m sure, not lost on the reader. We have seen some Western governments promise vaccines on a certain date which has generated raised eyebrows from people who are used to the slow, methodical nature of these sorts of things.
That a vaccine to control a novel disease we had never even heard of 11 months ago might take about a year and a half to produce is strangely comforting. Anything else is not. As we approach the end of this annus horribilis, we must ground our wishes, hopes and prayers in a reality that reflects what we are actually seeing and not what we want to see.