Sometime over the next few months, the federal Food and Drug Administration could announce that one of the many vaccines now under development has proven safe and effective and is ready for widespread use. Then comes the hard question: Should the government force citizens to take it?
The answer is yes.
I expect anti-vaxxers are gearing up to lead the resistance. There will be cranky voices against the vaccine — not unlike those noisily protesting Governor Charlie Baker’s flu vaccine requirement. Some will take time off from promoting their flat-earth views to denounce science and espouse conspiracy theories. And, if President Trump announces a vaccine before the election, many people will question it.
I don’t put it past Trump to use a vaccine to help himself get reelected, but if it is just a political scam, then doctors, researchers, and regulators will denounce it as such. The big pharma companies have made clear they won’t rush things, as well. To write a vaccine off as fatally flawed even before it’s been released is to be no better than the flat earthers.
Here’s a reasonable scenario. As Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, has pointed out, no vaccine is ever 100 percent effective. The hope is for one that is 75 percent effective, but even a vaccine that triggered an antibody response in more than 50 percent of recipients would be acceptable.
A coin flip’s chance of being protected? That may seem low, but it should be enough. Here’s why: The public health goal is to achieve herd immunity — when enough people are safe from the disease (either because they’ve had it or because of a vaccine) that it begins to run out of possible victims. What’s “enough” people? Scientists aren’t sure — some say as low as 50 percent but the consensus seems to be 60 to 70 percent.
Despite the vast numbers of folks who have already had COVID-19 — including the president — we are nowhere near herd immunity. Officially there have been around 7.5 million cases in the United States (as of October 7). Those who’ve survived — about 7.3 million — make up merely 2.2 percent of the population. Researchers in a Nature study of April data, however, suggest testing issues including lack of access mean the real number could be as much as 9.5 times as high. If this undercounting has held true since, it might mean that as many as 21 percent of us have had it.
A lot. Not enough, though, for herd immunity.
But coupled with a vaccine that’s even only 50 percent effective, we can get there. If administered to nearly everyone, the vaccine plus existing immunity from 21 percent of folks who might have already had the disease means that more than 60 percent would be immune (the total is less than the sum because you don’t want to double-count the 7.3 million people who have already had it). Hurray! We’ve got herd immunity — or at least are very close.
Unless, of course, people refuse to take the vaccine. A recent poll found even if our doctors said it was safe, only 62 percent of us would take it. Many Americans, especially people of color, are justly suspicious of a medical system rife with past abuses, or have other reasons to be vaccine hesitant. Others simply fear the new or distrust the government. Still, if almost 40 percent of people decline the vaccine, we won’t even get to 50 percent immunity, meaning an ongoing pandemic.
All of which suggests the key to ending the pandemic will be to have near total vaccine compliance.
Can the US government really require that people get vaccinated?
Sure it can. But first, there’s a powerful moral argument that needs to be made: The vaccine isn’t about you. It’s about everyone else. Those who refuse to get the vaccine will in effect be imperiling the health and lives of their relatives, friends, and fellow citizens.
Sounds persuasive to me. Still, against all reason and morality, I expect some — maybe many — will refuse. Some will have good reasons, such as compromised immune systems. To help ease concerns from communities of color, the government will need to be transparent about the vaccine and about past misdeeds. For the good of all, we will have to cajole and compel the rest.
We don’t, however, have to start forcibly administering shots. All we have to do is follow Baker’s lead. His flu shot mandate — done so flu cases coupled with COVID-19 cases wouldn’t overwhelm hospitals — shows the way. Baker basically ordered that anyone going to school must get a flu shot. Outside of medical or religious exceptions, it’s “Don’t get the shot? Can’t go to school.”
The same model can be used for the soon-to-come coronavirus vaccine. Want to go to work? Get vaccinated. Want to go shopping, eat inside a restaurant, or get on a plane? The same. Indeed, the simple requirement can be that if you want to leave your house, you must get vaccinated. Maybe that seems intrusive. But it’s actually far less so than what we endured at the height of the lockdown from mid-March through mid-May, when the state shut down its entire economy.
Maybe a few diehard anti-vaxxers will resist and simply stay forever in their homes. Fine by me. As long as they can’t mix with the general population, they won’t pose any threat. While normalcy returns for the rest of us, and we work and play as we used to, they can stay stuck inside, isolated and alone, glaring out their windows as life passes them by.
Tom Keane writes regularly for the Globe Magazine. Send comments to firstname.lastname@example.org.