Not widely, but distributed to at-risk populations is still a reasonable hope. By then we'll also hopefully know more about the long term effects, and have even more treatment options for when people are positive to make severe cases less likely.
If that happens, and I think there is reason to hope it might, by spring we may be able to get back to some amount of normalcy with relative safety.
There are numerous safety hurdles to overcome in addition to determining whether a vaccine offers durable immunity to the elderly. There may be a need for one or more boosters, for example. Vaccines have paradoxical potential to worsen disease in some people with some viral diseases. This covers some of the problems:
How realistic is a 12- to 18-month timeframe for a COVID-19 vaccine?
This prediction, made early in the pandemic, raised a lot of eyebrows in the vaccine scientific and development community. We would all like to see a vaccine quickly, but the fastest vaccine developed to date has been for mumps, and that took four years. With any new disease, especially one that is proving to be as complex as COVID-19, we will have to move carefully.
We can expect that by end of this year, or early 2021, one or more vaccines will have data from thousands of healthy volunteers indicating safety, tolerability, and stimulation of an immune response that may be protective. But to be confident that a vaccine is truly safe and protective, that is not enough.
With any new disease, especially one that is proving to be as complex as COVID-19, we will have to move carefully.”
– Rick Malley
To show that the vaccine prevents disease, we have to vaccinate a large cohort of people while the virus is actively circulating, to see how many vaccinated versus unvaccinated people develop COVID-19. As the number of COVID-19 cases drops in the U.S. and Europe, getting enough patients to prove efficacy becomes a major logistical challenge. Moreover, a vaccine can have side effects that only become evident when tested in subjects of all ages, who are monitored over a period of time. Some vaccine candidates have actually made disease worse in people who eventually do become infected. History tells us that vaccines can fail, in either early or late stages of development.
Finally, once we have a COVID-19 vaccine, billions of doses would need to be manufactured to cover much of the world population and provide the “herd immunity” that curbs the spread of the virus. Never has a vaccine been rolled out at such a scale, and massive new factories would likely need to be built.
Recognizing this, some manufacturers are starting to build manufacturing plants ahead of time. Still, until enough doses are available, we may need to roll out the vaccine in stages, starting with people who are most vulnerable or at highest risk for being exposed to COVID-19 — the elderly, some immunocompromised patients, health care professionals, and other essential workers.
Is there reason to take special care with a COVID-19 vaccine?
All vaccines can run into safety issues during testing, but we may need to pay even greater attention to safety in the case of COVID-19. What started as a respiratory illness is now evolving into a much more complicated syndrome with many varied and unpredictable effects. That includes runaway immune reactions in some people that we still don’t understand.
Getting safety issues wrong with a COVID-19 vaccine could set us back for years or even decades.”
– Rick Malley
In particular, we have recently learned that this virus can cause a
multi-system inflammatory syndrome in children (MIS-C), which likely starts several weeks after the child has been exposed. To date, we do not understand why some children develop this syndrome while the majority do not, or why this syndrome targets children specifically. We need to learn much more about how people’s immune responses sometimes protect them and other times contribute to more damage, so we can avoid triggering harmful responses with a vaccine.
While there is urgency to find a way out of this pandemic, safety considerations must remain an absolute priority. As with most vaccines, a COVID-19 vaccine would be given to mostly healthy people whose risk of severe complications from the virus is not very high. Therefore, serious side effects from the vaccine itself must be extremely rare to make it acceptable to most.
And general acceptance of a COVID-19 vaccine is not a given: a recent study and polls suggest that a quarter to a
half of the U.S. population would not be willing to receive it. Some people may legitimately fear that if a vaccine is developed too quickly, there won’t be time to adequately test it. Getting safety issues wrong with a COVID-19 vaccine could set us back for years or even decades.
Should we be optimistic about the development of a COVID-19 vaccine?
Yes, I think so. On the one hand, a vaccine has never been developed against a coronavirus — including SARS, MERS, or coronaviruses causing the common cold. At the same time, never in the history of medicine has such an intense global effort been focused on the development of a specific vaccine. Vaccine development is often described as an empirical science: different approaches are tried, many fail, but one or two prove to be successful. There are now more than 150 different candidate COVID-19 vaccines in different stages of development, which gives me hope that one or more of these will help us get rid of this virus.
An oft-cited timeline suggests that a COVID-19 vaccine could be available by early 2021. Vaccine expert Rick Malley at Boston Children’s Hospital weighs in.
discoveries.childrenshospital.org
www.nytimes.com
cyclonefanatic.com
www.theguardian.com