An ongoing global pandemic and insurgents storming the Capital Building aside, I think most of us can agree the outlook for 2021 is positive. And when I say positive, what I mean is: definitely not awesome, but also there are two FDA-approved COVID-19 vaccines (with at least 3 others on the way) as of press time. Our country has definitely come a long way since HighPoint Associates published On COVID-19 and Racial Inequality in June 2020, a piece that was much more of an analysis of the current facts at that moment in time. We are now looking at the potential end of this pandemic and some semblance of a return to normalcy. While I invite anyone who’s game to join me in my optimism, it does come with a healthy dose of caution, courtesy of my career in biopharmaceuticals, specifically in commercialization.
There’s no denying rollout of the vaccines has been a bit challenging thus far, which is shocking to exactly no one. Given the sheer volume of people needing the vaccine as soon as humanly possible (the elderly, healthcare workers and first responders, those with compromised immune systems), both approved vaccines requiring two doses, limited supply, cold chain logistics, and medical staff having to give the injections, supply and administration of the COVID-19 vaccines were always going to be challenging. Add to this: some areas of the U.S. don’t have enough of the vaccines to meet demand while other areas have too much.
So during this time of countless challenges and a number of unknowns, here’s what’s tempering my optimism about a successful coronavirus vaccine campaign:
- Issues of public trust
A lot of people are concerned about the vaccine. I’m not just referring to Black Americans still living with the reality of social discrepancies in health care or those who can easily recall the Tuskegee Study and are understandably nervous about receiving the vaccine. Nor am I talking about anti-vaxxers or those who believe COVID-19 is a global hoax. Shockingly, there is a large number of healthcare workers in nursing homes and medical facilities who have seen first-hand what COVID-19 does to the human body and yet have hesitations about getting vaccinated. And not without some level of justification: The vaccines were developed and approved by the FDA in record time, approximately one year. By contrast, this was a quarter of the time of the previous recordholder, mumps, which was developed in just four years. Then there are the long-term side effects being mostly unknown. What we do know is, the side effects of getting COVID-19 are exponentially worse for many people than any potential side effects associated with getting vaccinated.
- The race against time
The word of the day is variants. So far there are three main COVID-19 mutations and that number will only increase over time. That means our country (and the world) needs to get as many people vaccinated in as short amount of time as possible to get ahead of the inevitable increase in additional variants. As of now, the antibodies that we generate as a result of the two approved vaccines recognize these variants. How quickly can vaccine manufacturers pump out doses of these vaccines as well as modified versions that are more effective against these variants? Will our medical staff be able to keep up with patient demand? Both wait to be seen. But the faster we vaccinate people, the more successful we will be in terms of administering vaccines and boosters that address variants of the COVID-19 virus.
- Equitable and fair allocation of vaccines
With a finite number of vaccine doses, deciding who gets vaccinated can feel a bit random, although most states have a logic to their phasing. Each state does the deciding for its own residents, which means chosen vaccine candidates may look very different in some conservative states versus their liberal counterparts. And what about vaccinating non-citizens, many of whom are essential workers in critical segments of our economy?
- Vaccines alone won’t save us
If there’s one thing we’ve learned over the past 12 months, it’s that for every person who wears a mask and socially distances, there are others that just can’t pass up a party boat, or a 100-person wedding, or going to a local bar without a mask. Even when we reach the 70% threshold for herd immunity, there will still be new COVID-19 infections. And those infected could unknowingly spread it to others, including people who aren’t vaccinated due to vaccine access issues or for health reasons. Therefore, in order to eradicate COVID-19 as best we can, we will need to maintain our mask-wearing and social distancing practices for the foreseeable future. This is one area where I’m far more cautious than optimistic.
For me, 2021 is the year of practical optimism. I’m personally in awe of how far we’ve come in developing approved vaccines in an impressively short period of time, but there is still much to be seen in terms of rollout, human behavior, and variant management before we can fully return to pre-pandemic mindset and behavior.
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Derrell Porter, M.D. is an HPA consultant and CEO/Founder of Cellevolve Bio, a novel commercialization-focused cell therapy company, and formerly CCO at Atara Biotherapeutics, an off the shelf cell therapy company, following executive roles at Gilead Sciences, AbbVie and Amgen. He started his career at McKinsey & Company in Los Angeles. He holds an M.D. from the University of Pennsylvania School of Medicine, an MBA from The Wharton School, and a B.S. in Psychobiology from UCLA.