Vaccines alone can’t save us.
We’ve always needed to combine them with basic public health measures. And now, our failure to do that could undermine them.
The morning the first batch of Pfizer vaccine was set to leave the company’s facility in West Michigan, I was asked on CNN for my reflections on what laid ahead.
I was excited and relieved, as we all were...but only cautiously. The prevailing wisdom is that a vaccine was the final “answer” to our pandemic woes—that these vials of mRNA would buy us out of our collective failure to control the pandemic. But as I watched workers put the final seal on boxes containing nothing short of a medical miracle, I couldn’t mask my suspicion that the work was only just getting started. After all, the existence of a vaccine alone doesn’t stop a virus by itself—vaccinations deployed into peoples’ arms do.
And there’s a lot of work that goes into turning a vaccine into a vaccination. I know from experience. When I was Health Director in Detroit, two residents who had never been in contact with each other developed Hepatitis A on the same weekend. Each individual had independently cleaned up sewage, which had backed up into his basement following a violent August rainstorm.
Hep A has a long incubation period—and if you can vaccinate people before the symptoms manifest, you can prevent their symptoms. We knew we had days to act before countless others who had been exposed might develop symptoms. So we quickly organized two makeshift Hep A vaccine clinics, and put out a call to get Detroit residents who might have come in contact with Hep A to come in for vaccination. It was a GARGANTUAN amount of work—standing up a facility that could reliably take in patients, screen them for exposure to sewage, vaccinate them, and keep a record of the vaccination—all while working with the media to explain what happened and what we were doing about it. Getting vaccinations into people’s arms quickly is a lot harder than it seems—even when you’re trying to do it for a city, let alone the entire country.
It takes tremendous logistical and operational planning and execution and even more steady, thoughtful, and honest public communication...but then so does the rest of public health—something we’ve been failing at for nearly a year now! Whether it’s mass testing, contact-tracing, surveillance, or quarantines, the core of public health requires us to collect, maintain, and act on large amounts of data in real-time and to execute on time-sensitive actions to stop the spread of disease. More importantly, we have to earn and maintain the public’s trust as we do this: the public has to understand and cooperate with our efforts for them to be successful.
Our failure to deploy the vaccine at scale with any degree of speed was foretold in our failure to conduct the rest of our COVID19 response efficiently. Unfortunately, our approach to deploying these vaccines into an underfunded, mistrusted public health system is like having designed a supercharged McLaren X-1 engine that we proceed to drop into the body of a beat-up 1970s Ford Pinto.
Right now, cases appear to be on a steady downturn. But they could jump again at any moment as new highly-transmissible strains with some resistance to immunity among those who’d previously been infected should remind us. We’re not even close to being out of the woods. As cases decline, this is, in fact, the time to beef up our basic public health blocking and tackling. But instead, we seem to be letting down our guard because the vaccines are on the way.
Basic measures like aggressive testing, contact-tracing, and quarantine don’t rely on our immune systems to work—they rely on our attention to detail to keep the virus contained. They remain fundamental to slowing the spread of these new variants, just like they should have been for stopping the spread of the virus earlier on. Our failure to use them appropriately should not be confused with how effective they can be if deployed effectively.
Our failure to do the most basic public health work of virus containment could impair our vaccines, too. In fact, basic public health work is probably MORE critical today than it was on day one of the pandemic. Here’s why: The virus has told us it has the capacity to mutate and to evade our immunity. None of the variants that we know of has yet to fully evade our vaccine-mediated immunity—yet. But the astonishing speed with which new variants have emerged and propagated reminds us that every day we allow this virus time, the probability that a strain can fully evade our vaccines increases. Guess what we’ll have left to defend ourselves then? Good old-fashioned public health tactics like testing, contact-tracing, quarantining, and yes...lockdowns.
Don’t get me wrong: vaccines are the most powerful tool in our public health arsenal right now. But they are not—and were never—the tool. Instead, vaccines are one tool, among many, that must be used together to bring this pandemic to its end.