As soon as it became apparent this spring that the Covid-19 outbreak was a serious threat, talk of the necessity of a vaccine began immediately. But coming up with a new vaccine for a virus never-before-seen in humans in a real-time attempt to slow and eventually stop a pandemic — all while the death toll rises by tens of thousands each month — had never been attempted in a public health emergency of this scale. Remarkably, less than a year later, there are now two vaccines with efficacy rates higher than 90 percent that have been submitted to the Food and Drug Administration (FDA) for authorization, with more likely to follow. The vaccine distributed by Pfizer has already received approval and is being administered the coronavirus vaccine made by Moderna moved closer to approval on Thursday, which would mean millions more could be inoculated soon.
And the Covid vaccine rollout cannot come soon enough. Already-surging infection rates are expected to get worse thanks to the staggering number of people flouting public health measures like mask-wearing, and ignoring recommendations not to travel for the holidays. On December 2nd, President-Elect Joe Biden expressed his concern over this behavior at an economic roundtable on the pandemic, issuing a warning to the country: “I don’t want to scare anybody here but understand the facts: we’re likely to lose another 250,000 people, dead, between now and January, because people aren’t paying attention.” This came a few hours after Centers for Disease Control Director Dr. Robert Redfield told NBC News: “The reality is December and January and February are going to be rough times. I actually believe they’re going to be the most difficult time in the public health history of this nation.”
As promising as the Covid vaccines are, they’re neither a silver bullet, nor an excuse for people to let their guard down. Here’s what to keep in mind about the vaccination process as it goes from a hypothetical to a reality.
When can I (a member of the general public) get a vaccine?
For now, the CDC has determined that health care workers and residents of long-term care facilities will be the first to receive the Covid-19 vaccines once they are available. The United Kingdom reached this milestone on December 2nd, making it the first Western country to approve mass inoculations against the novel coronavirus. People in the United States began receiving the Pfizer vaccine on December 14th, and the first American to receive it was a New York City nurse, Sandra Lindsay. “I feel like healing is coming,” Lindsay said after receiving her coronavirus inoculation. On Friday, December 18th, Vice President Mike Pence received the vaccine on camera, despite his confusing and conflicting messages about the virus overall since the beginning of the pandemic. Other politicians in the United States, including vocal Republicans, have begun receiving the vaccine and publicly sharing their support to combat months of skepticism.
On November 30th, Dr. Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases, said that Americans who would like to get vaccinated should be able to do so by April or May 2021. By June, “100 percent of Americans that want the vaccine” should be able to get it, Lt. Gen. Paul Ostrowski, director of supply, production and distribution for Operation Warp Speed told CNN. (New York Governor Andrew Cuomo announced that the state would receive 170,000 vaccine doses on December 15th if federal regulators authorize Pfizer’s vaccine for emergency use, and that the most vulnerable — including healthcare workers and nursing home residents — would receive the vaccines first.)
What percentage of a population has to be vaccinated before we reach herd immunity?
It is estimated that around 70 percent of a population will have to achieve individual immunity, either through a vaccine (which is far preferable), or natural transmission to reach the point of herd immunity. At that stage, unvaccinated people living in the area are protected from an outbreak. They can still get infected, but because of the community-level immunity, the virus wouldn’t continue to spread, the way it is now. Once a vaccine is available, the next hurdle will be generating public buy-in and trust — a particular challenge given that American’s already-high rates of vaccine hesitancy continue to increase.
Once I’ve gotten my shot, am I immediately protected?
Nope: Covid vaccination is a process, and the full timeline for two-dose vaccines from manufacturers like Pfizer and Moderna is about a month and a half. After the first dose of the vaccine, the second dose comes three weeks later for Pfizer, and four weeks later for Moderna. Then, it takes around two weeks for the vaccine to kick in. “There may be incomplete immunity — little or maybe no significant protection — after just the first dose or even within the first week after the second dose,” says Dr. Wilbur Chen, the chief of the adult clinical studies section within the Center for Vaccine Development and Global Health at the University of Maryland School of Medicine.
So once a person is fully vaccinated and it’s now two weeks after their final dose, are they completely protected from contracting and/or transmitting the coronavirus? Not quite. According to Chen, at that point, a person would be protected against illness that could result from the novel coronavirus — including cases serious enough to lead to hospitalization or death. However, if they’re exposed to and infected with SARS-CoV-2, they may not get sick, but still shed the virus, potentially transmitting the infection to others. For this reason, Chen says that it’s important for everyone — even those who have been fully vaccinated — to continue to wear face masks and practice physical distancing, at least until there is high-level uptake in their community.
And does that mean it would be safe(r) to fly on an airplane? In theory, yes: A fully vaccinated person can start to travel again with some confidence that they are now at a lower risk of getting sick with Covid. But Chen stresses that the decreased risk doesn’t mean there is no risk at all. “The vaccines’ efficacy were not demonstrated to be 100 percent,” Chen tells Rolling Stone. “So, this is another reason for us to try and achieve the high-level population-wide immunity through vaccination.”
How concerned should I be about the side effects of the vaccine?
This one’s complicated. Like any other inoculation, the Covid vaccines come with the possibility of some side effects. The most common for the Pfizer and Moderna vaccines are fatigue, muscle pain, headaches, chills, and/or a slight fever. And though these sound similar to the symptoms of mild cases of Covid-19, unlike the viral infection, the vaccines’ side effects tend to stick around for 24 to 48 hours (sometimes less) and are typically alleviated with over-the-counter pain relievers. Dr. Florian Krammer, a vaccinologist at the Icahn School of Medicine at Mount Sinai who participated in the Pfizer trial referred to the vaccine’s side effects as “unpleasant but not dangerous.” Additionally, Pfizer and Moderna both reported that there were no serious safety concerns associated with the vaccines.
When deciding whether to receive the Covid vaccine — or any other medical intervention, really — it’s important to weigh the risks and benefits. In this case, the benefits of avoiding Covid-19 — especially when you consider the potential long-term effects of the virus and more than 270,000 deaths from the virus in the U.S. — significantly outweigh the risk of enduring a few days of discomfort. At the same time, health care practitioners need to be transparent about the possibility of side effects, rather than trying to downplay them in an attempt to put patients at ease. This way the patient can mentally and physically prepare for the potential symptoms, and the person administering the vaccine can reassure them that any pain is treatable and temporary.
But the skepticism and fears are, naturally, intense: It’s one of the reasons why former Presidents Barack Obama, George W. Bush, and Bill Clinton have publicly supported the vaccine and said they would receive the vaccine on camera, to help alleviate some people’s concerns and promote confidence among the general public. In an interview with SiriusXM host Joe Madison (scheduled to air Thursday), Obama said that if Dr. Fauci said a coronavirus vaccine is safe, he believes him. “People like Anthony Fauci, who I know, and I’ve worked with, I trust completely,” Obama said. “So, if Anthony Fauci tells me this vaccine is safe, and can vaccinate, you know, immunize you from getting Covid, absolutely, I’m going to take it.”
Will we still have to wear face masks and socially distance after people start getting vaccines?
Yes — at least initially. As Fauci has said repeatedly since April, “It’s not going to be a light switch” where one day the pandemic is suddenly over and everything is back to normal. Part of that is because while the high efficacy of the Pfizer and Moderna vaccines is promising, Dr. Brandon Dionne, assistant clinical professor at Northeastern University’s School of Pharmacy and an infectious disease specialist, says that there are still plenty of unanswered questions. These include how long the immunity lasts, how much asymptomatic transmission by vaccinated people will occur, and how many people are willing to receive the vaccine.
“Over time, as the vaccine becomes more readily available, we learn more about the durability of immunity and real-world effectiveness provided by the vaccine, and, hopefully, uptake reaches a critical threshold where we can achieve herd immunity, we should be able to scale back on the other preventive measures, but it’s not clear exactly when that will be,” he tells Rolling Stone. Some experts are predicting that will happen by the third or fourth quarter of 2021, but Dionne says that could change depending on some of the unknowns.
Should I try to get one vaccine over another?
Both the Pfizer and Moderna vaccines have received emergency approval by the FDA for use in the U.S., while the candidates from Johnson & Johnson and several other manufacturers are in the final phases of clinical trials. At year’s end, the U.K. gave emergency authorization to the coronavirus vaccine developed by AstraZeneca and the University of Oxford — currently the cheapest option. The U.S. has yet to approve AstraZeneca. This means that in all likelihood, there will be at least two vaccine options. So does this mean there will be one vaccine that’s “better” than the rest?
Chen frames it in a different way. “We’re not thinking in terms of one of these vaccines being technically better than the other. As long as a vaccine is successful — meaning that the vaccine has properly been reviewed and approved through the FDA — it’s in play, and I would love to have more of them be successful,” Chen tells Rolling Stone.
When Covid vaccines are eventually offered to the general public, Chen does have some advice: “The first opportunity to get vaccinated — whichever vaccine that’s being provided — take it. From the perspective of a person who’s trying to deploy vaccines and the perspective of the person who’s receiving vaccines, I think we should consider them all equal.”
Chen also notes that those receiving two-dose vaccines, like the ones from Pfizer and Moderna, should make sure to complete the series with the same vaccination they received first. “We don’t want people to be receiving one dose of the Pfizer followed by one dose with Moderna, because we don’t know if that will confer the full potential protection of a proper two-dose vaccine,” he explains.
When will children be able to get a Covid vaccine?
That depends on when data from clinical trials involving children becomes available. Right now, Pfizer is testing the vaccine on children as young as 12, but is the only major pharmaceutical manufacturer to do so at this stage. In an appearance on Meet the Press on Sunday, Fauci estimated that we’re likely months away from the vaccination of school-age children.
“Before you put [the Covid-19 vaccine] into the children, you’re going to want to make sure you have a degree of efficacy and safety that is established in an adult population,” he explained. But, the research will continue to move quickly: Fauci said that the research process will start “very likely in January, to get it to the children sooner rather than later.”
When a vaccine is shown to be safe and effective in adults, it usually is in children as well — but not universally, according to Dr. Amy Edwards, a pediatric infectious disease specialist at University Hospitals Rainbow Babies & Children’s Hospital in Cleveland, Ohio. “Children’s immune systems are very different than adults’, as evidenced by their vastly different reaction to being challenged with a novel virus,” she tells Rolling Stone. “A vaccine that is effective in adults may or may not work as well in children.”
Editor’s note: This story has been updated to better reflect the difference between infection and illness. It was updated once more to include the U.K.’s authorization of AstraZeneca.