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It won’t be easy: Polling suggests that fewer than 65 percent of adults are either vaccinated already or eager to get a shot as soon as possible. But even if vaccinators do manage to hit Biden’s Independence Day target, the U.S. will still have a long way to go before it achieves the kind of lasting protection known as herd immunity — that is, the point when an estimated 75 to 90 percent of all Americans regardless of age have been vaccinated and the virus runs out of hosts to spread to.
As a result, experts now believe that the country as a whole is unlikely to reach that epidemiological milestone anytime soon — if ever.
So what happens when America falls short of herd immunity?
Overall, cases will likely plummet; deaths and hospitalizations will too. But in the absence of full population-wide protection, communities with lower levels of vaccination may face higher levels of risk. Businesses and institutions may cater to vaccinated and unvaccinated Americans in different ways. Socializing could follow a similar path. New incentives, like the promise of travel without testing and quarantines, might boost vaccine acceptance — or trigger a backlash.
“We need to figure out how to coexist with coronavirus by reducing our risk as much as possible while also resuming much of pre-pandemic life,” says Dr. Leana Wen, an emergency physician and public health professor who previously served as Baltimore’s health commissioner. “That’s a very difficult concept, I think, to understand — much less to live with.”
Yahoo News spoke to Wen about what Americans should expect from the next phase of the pandemic — and the “new normal” it’s about to usher in.
Yahoo: In the latest Yahoo News/YouGov poll, 57 percent of U.S. adults said they’d received at least one vaccine shot. That’s in line with CDC numbers. But there was only another 6 percent who said they want to get vaccinated as soon as possible. Do we have any chance of reaching herd immunity through vaccination?
Wen: We need to still aim to reach herd immunity while accepting that we are probably not going to get there. If we have 30 percent of American adults who say they will not get vaccinated, that might be our ceiling. Mathematically, it just doesn’t add up. Therefore, we need to figure out how to coexist with coronavirus by reducing our risk as much as possible while also resuming much of pre-pandemic normal. That’s a very difficult concept, I think, to understand — much less to live with.
What about immunity acquired through infection? Doesn’t that count toward herd immunity?
There are two reasons why we’re focusing on vaccination: One is that we don’t know how long immunity from infection lasts; the other is that we don’t know how to measure it, exactly. Are we saying that everybody should have their antibodies tested? Antibodies may not always correlate to immunity. And what about a mild case of COVID compared to a severe case? How would that influence immunity? So I think it becomes very difficult to rely on immunity through infection — and not necessary, when we have vaccines widely available.
So what you’re saying is that getting a certain percentage of the population vaccinated gives us the most certainty going forward.
Let’s talk about what life will actually be like after America falls short of herd immunity. It doesn’t mean, for example, that the pandemic will never end and that we’ll have to keep living in a state of emergency forever.
Correct. It doesn’t. At a certain point way before we reach herd immunity, we are going to see a drop-off in the level of infections. In fact, it looks like we're seeing that now. You look at Israel: Arguably they have not reached herd immunity, but they've seen very steep decline. Just as we had exponential growth, there's exponential decay. I think it's very reasonable that we will reach the point of exponential decay fairly soon, as vaccination continues to take effect.
The problem with that is that it’s going to make our goal of reaching herd immunity even harder. I think what's going to happen in the next several months is that we're going to see the number of infections significantly decline. The summer months are going to come, states will lift restrictions, and all those people who were on the fence before — who were like, “Well, I don't know if coronavirus is that big of an issue; I have some concerns about the vaccines” — now they're going to say, “Coronavirus isn't that big of an issue anymore, and I can do whatever I want to, regardless of vaccination. So I'm just not going to get vaccinated.” The better things get, the harder it is going to be to motivate those people.
It sounds like we’re about to enter a gray area of sorts. On the one hand, COVID won’t be as much of a clear and present danger; on the other, we won’t be in some sort of nirvana of herd immunity where the virus isn’t a threat at all. But how big of a threat will it be?
I imagine that there will be many pockets of the country that reach herd immunity locally — where, say, 80 percent of the people there get vaccinated in 2021. Those areas might see substantially lower levels of community transmission. However, in other places with lower levels of vaccination, there will be outbreaks continuing through 2021. And because we’re not an island, these outbreaks will spread to other places.
We also don't know about more contagious variants or variants that might evade the protection of the vaccines. There is a lot unknown here, and it’s hard to plan contingencies around. But we do have to just accept them that we’re not going to be eradicating COVID anytime soon.
What’s that going to look like in terms of what Americans are allowed to do or not allowed to do?
I cannot imagine that Americans will accept something that even comes close to a vaccine passport. It's just so antithetical to American values. And I actually think that the more we use that terminology, the more it's going to detract from our goal of reaching some of these unvaccinated people. They're going to dig in their heels even deeper.
So what do you expect to happen instead?
There's another way to think about this, which is to think about proof of vaccination as an E-ZPass or as TSA PreCheck — you're still able to do everything you want to do regardless of vaccination; it just takes more steps.
What’s an example of how that would work?
Maybe you can travel regardless of vaccination, but they're going to make you get a test pre-departure, quarantine when you arrive and then get another test before you can actually start your vacation. But if you're vaccinated, you can skip all those steps. And so it ends up being that you can do more things more easily with the vaccine. That's one type of scenario.
Another scenario is that people are going to self-associate with others who are also fully vaccinated. They want to feel that they're better protected. I certainly foresee weddings and dinner parties and other things where proof of vaccination is required.
Either way, we should not be judging or shaming fully vaccinated people for going back to normal, including being indoors without masks at restaurants and other settings. We need to say that those who are vaccinated actually pose a very low threat to public health. If masks, for instance, are seen to be performative, then we can't enforce them in settings where they're actually really important. And if we don’t let vaccinated people return to normal, then unvaccinated people will say, “If vaccines are as effective as you say they are, then why does life not change at all after getting vaccinated?”
Will businesses and institutions play a role in this process?
Absolutely. Some businesses will have extraordinary demand from their customers saying, “We want fully-vaccinated-only for certain things.” One example would be high-intensity indoor exercise classes that can only happen if everybody is fully vaccinated. Businesses and entities should be allowed to innovate and provide the kind of environment that their customers want.
Do you see signs that this is already happening?
Oh, definitely. A lot of different businesses have been considering this. Airlines, for sure. Individuals too — there are whole etiquette guides being written on how to ask others about their vaccination status. I am not in the market, but I understand that’s happening on a lot of dating websites now. There’s going to be market pressure and social pressure being applied on behalf of vaccination.
Do you think that pressure will incentivize a significant number of holdouts to get vaccinated?
Absolutely. Part of the problem is that the Biden administration focused their vaccination rollout on a societal level. They basically said, “Let's get as many people vaccinated as possible, then we will remove restrictions.”
They’ve focused on us. But that's not how a lot of Americans think. We are much more individualistic as a country. I wish instead that they took the approach of saying, “The light at the end of the tunnel isn't about getting everyone vaccinated and reaching herd immunity. The end of the tunnel is your light at the end of the tunnel — and two weeks after you’re fully vaccinated, you get back to life as normal.” I think a lot more people would be motivated by that individual-level approach.
And that’s where market pressure and social pressure come in — helping at least some people see what’s in it for them?
Right. That's why I have really liked what these colleges and universities are doing in mandating vaccines for returning students. They’re giving them this promise of a great fall. If you're vaccinated, you can essentially return to pre-pandemic normal. You can have your college experience. No social distancing. That's the kind of incentive we really need to be pushing.
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