Opinion: Looking toward a post-vaccine COVID-19 America

Sheldon H. Jacobson and Janet A. Jokela

Immunization of health-care workers and residents of long-term care facilities has begun.  With each day bringing over 250,000 new confirmed cases and well over 2,000 additional deaths in the U.S., help is on the way to curb the COVID-19 momentum plaguing our nation. 

The full benefits of the vaccine will not be realized until tens of millions of people receive their two-dose regimen, which will likely not occur until the summer of 2021.  

What does a post-vaccine COVID-19 America look like?  Will people be able to doff their face coverings, gather in restaurants and bars with no fear of infection, and attend large sporting events to watch their favorite teams play? Many would welcome such a return to normal. However, much depends on the effectiveness of the vaccines, their ability to interrupt transmission, and their uptake within the population.  

A syringe with COVID-19 vaccine as the first Beaumont health care workers receive shots of vaccine at Beaumont Service Center in Southfield, Michigan on Dec. 15, 2020.

In the pre-vaccine COVID-19 America, with 30% of the population infected over a one-year period, with a 0.5% infection fatality rate, this would result in 500,000 annual deaths, which is precisely what we are track for by March 2021.  

In an ideal post-vaccine COVID-19 America, a vaccine that is 100% effective with 100% of the population immunized would completely eradicate the virus, driving new COVID-19 cases and deaths to zero. However, we live in the real world, with several unknowns.  

Many unknowns remain surrounding the COVID-19 vaccines that are not on the public’s radar, but should be of concern.   

First, we do not know what the effectiveness of the vaccines will be in the general population. Observing 95% effectiveness in clinical studies is remarkable, but until more widespread immunization occurs, and the number of infections in the population begins to drop, the true effectiveness rate will be unknown.  

Second, we do not know how many people will choose to get immunized. Many people overestimate the risk of the vaccines based on unknown adverse side effects. The greater risks are personal choices that people make when deciding not to be immunized. Unimmunized persons will seed localized pockets of COVID-19 outbreaks, which will continue to erupt around the country for the foreseeable future, similar to that observed with childhood diseases like measles and mumps when a critical mass of parents do not immunize their children. 

The greatest benefits of the COVID-19 vaccines will accrue when a high percentage of the population opts for immunization.  

Third, we do not know how long the vaccines will provide protection.  This will be determined as the number of infections are tracked over time.  As such, the length of immunity acquired with the vaccines will determine the need for booster shots.  This period will also provide valuable time for the development of better treatments for all stages of disease.   

Fourth, we do not know if the vaccine will prevent transmission. The vaccine is designed to protect against symptomatic disease in those vaccinated, but will it prevent the spread of replicating virus?  Someone vaccinated could be infected without symptoms, and thus could potentially spread the virus to others, some of which will not be immunized.  This question may require many months to answer.  In the meantime, face coverings and physical distancing will remain necessary to protect others, even after vaccination.       

With so many unknowns, widespread vaccine buy-in is imperative as we transition through the post-vaccine COVID-19 era. The next six months will be critical. With strategic communication from national leaders, and cooperation across all levels of government, the post-vaccine COVID-19 America can be a success for all.  

Sheldon H. Jacobson, PhD, is a founder professor of computer science at the University of Illinois at Urbana-Champaign. He applies his expertise in data-driven risk-based assessment to evaluate and inform public policy and public health. 

Janet A. Jokela, MD, MPH, is the acting regional dean of the University of Illinois College of Medicine at Urbana-Champaign. She has served as an infectious disease and public health physician throughout her career.