Vaccination is not entire answer to COVID-19

As the Pfizer-BioNTech vaccine is now being shipped out, and with Moderna’s mRNA vaccine about to achieve Food and Drug Administration (FDA) approval, Americans begin to breathe easier believing that vaccination is the answer to our prayers, an end to the COVID-19 nightmare.

Such confidence is misplaced. Vaccination is part of the answer but not the complete solution.

The goal of vaccination is to make all Americans immune to the virus. This is impossible for two reasons. First, there is vaccine efficacy. The most optimistic, early reports suggest 94 percent effectiveness. Even if everyone were vaccinated, 6 percent or 19.8 million Americans would remain susceptible, i.e., could become infected.

A second reason we cannot achieve anything close to 100 percent immunity is that many will not accept vaccination. A report showed 9 to 20 percent of those surveyed, depending on the country, would refuse vaccination but is likely to be large. If 40 percent remain susceptible, we may not develop herd immunity.

Anthony Fauci, Director of the National Institute of Allergy and Infectious Diseases for more than 35 years, claimed that herd immunity is both “dangerous” as well as “nonsense.” In fact, herd immunity makes perfect epidemiologic sense. Herd immunity is precisely what we seek: that is the only way to stop this or any pandemic. When we achieve some magic number of immune people, the virus cannot “get to” susceptible individuals to infect them. The herd of immune individuals form a protective barrier around the susceptible. It should be noted that I signed the Great Barrington Declaration, and Fauci has been very critical of it.

Herd immunity achieved by mass vaccination is called artificial or medical herd immunity. Herd immunity acquired through infection and recovery is called natural herd immunity. Fauci was presumably referring to natural herd immunity as dangerous. While this is true for the elderly with multiple comorbid conditions, COVID-19 is not dangerous to the general, healthy population or to children. Their actual case fatality rates are approximately 0.1 percent and 0.03 percent respectively, similar to the seasonal flu.  

Our response to COVID-19 — lockdowns of businesses and schools, social distancing and Personal Protective Equipment (PPE) — has caused massive damage to our country and to our people. Some say the response is more harmful than the pandemic, especially to our freedoms, starting with bans on religious gatherings in New York and California. New York Mayor Bill de Blasio (D) defended his ban while saying Black Lives Matter violent protests were allowed because of “profound meaning.” Isn’t prayer the ultimate form of profound meaning?

The lockdowns, social isolation, and school closures have caused grave harm. The Centers for Disease Control and Prevention (CDC) reported a rise in symptoms of depression (31 percent), stress-related disorders (26 percent) and illicit drug use (13 percent). Suicides have increased three-four times nationally compared to 2019. The financial damage has been devastating. Independent, mom and pop restaurants are closing, many permanently, at alarming rates. One survey suggested as many as 43 percent of the 4.6 million small U.S. businesses have been harmed or destroyed outright. Meanwhile, the big box stores and restaurant chains remain open for business. 

Washington’s approach to COVID-19 continues to be social distancing; a national mask mandate planned by President-elect Joe Biden; enforce a nighttime curfew in some locations; and plans to increase lockdowns as well as close more schools. Meanwhile, officials hope that mass vaccinations will eventually stop the pandemic. Problems with this plan include the ongoing damage to both people and our economy as well as the unrealistic hope for artificial herd immunity by vaccination.

A better solution involves a three-pronged approach. (1) Offer vaccination to all willing recipients so they can eventually develop some amount of artificial (medical) herd immunity. (2) Stop the lockdowns, closures and distancing. Allow Americans to return to work, play and prayer. Allow the virus to spread in the very low risk general population, so we can develop natural herd immunity. (3) Until we have achieved full protection by herd immunity, offer the high-risk population strict quarantine as well as vaccination.

The three-pronged approach requires no one to admit error. Simply change our stance to give our people and our nation the best and quickest chance to stop the pandemic and to recover from the self-imposed devastation.

Deane Waldman, M.D. MBA, is emeritus professor of Pediatrics, Pathology, and Decision Science; former director of Center for Healthcare Policy at Texas Public Policy Foundation; and author of multi-award-winning book, “Curing the Cancer in U.S. Healthcare: StatesCare and Market-Based Medicine.”