Waiting for a Vaccine

Many plans, memos, letters and campaigns from colleges and universities about COVID-19 have often included six words: “until a vaccine becomes widely available.”

Although an available vaccine for SARS-CoV-2, the virus that causes the COVID-19 disease, appears closer on the horizon now than it did last spring, medical and public health experts say it may not be an easy fix for the problems facing colleges and universities. Additionally, whether colleges and universities will be able to inoculate their student bodies themselves is still unclear.

Last week, the drug company Pfizer released promising data about a vaccine candidate it had co-developed with German company BioNTech, revealing that preliminary results suggest the vaccine is 90 percent effective.

But what exactly the vaccine is effective against is going to matter a lot for the timeline of the pandemic, said Dr. Aileen Marty, a professor and infectious disease specialist at Florida International University’s Herbert Wertheim College of Medicine.

Scientists usually care about whether a vaccine prevents symptoms of a virus, but because SARS-CoV-2 can be spread by people who show no symptoms, a vaccine’s effect on virus transmission specifically will be important.

Though available research on Pfizer’s vaccine candidate has shown that it is 90 percent effective at preventing symptoms of COVID-19, it is still unclear whether it interrupts transmission of the virus SARS-CoV-2, Marty said. In Pfizer’s preliminary study, only participants who showed symptoms were tested for the virus.

“If an individual gets the vaccine, it means that that person is going to have a stronger response and be more able to control getting symptoms from that virus, but it does not mean that the person cannot acquire the virus,” she said. “If this vaccine does nothing for transmission, then you have to make sure that virtually every human being gets the vaccine.”

If a vaccine does impact transmission at 90 percent efficacy, then vaccinating only about 80 percent of a population would still have an effect on the pandemic, she said.

But even with a very effective vaccine, there may be a few snags for colleges.

While a few vaccine candidates may be authorized for emergency use by the Food and Drug Administration by the end of the year, the first doses are very likely going to go to health-care workers (many of whom work in higher education) and first responders. Pfizer has said of its vaccine candidate that it could optimistically manufacture 50 million doses by the end of the year, with half going to the U.S. But because the Pfizer vaccine requires two shots, that would only inoculate 12.5 million Americans, about 3 to 4 percent of the U.S. population.

There is debate about who should be in the second cohort to get shots, said Catherine Troisi, a professor of epidemiology and community health at University of Texas Health Science Center at Houston School of Public Health and a member of the American Public Health Association, but most college students in good health are unlikely to be anywhere near the front of the line. (Athletics programs and associations may have the leverage to get their players vaccinated before most other students, Marty said.)

Some research has also shown that young people may be less likely to get vaccinated for COVID-19 even if a vaccination is available, raising questions about whether colleges may require it for their students.

And until a high percentage of the population is inoculated with a highly effective vaccine, it’s unlikely that colleges will be able to roll back the safety measures they’ve taken. Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, told CNN he predicts that by April the vaccine may be widely available, but reaching herd immunity after that point may take months. And until a high vaccination rate is achieved, masks, social distancing, restrictions on gatherings and enhanced cleaning will be here to stay.

“I still foresee that people are going to be rigidly wearing their masks and physically distancing six feet from others, washing their hands regularly with hand sanitizer, soap and water, wiping surfaces and avoiding crowds. I still see that happening for the foreseeable future,” said Gerri Taylor, co-chair of the American College Health Association’s COVID-19 task force. “Until we have a very high level of immunization coverage in this country, I think we’re going to have to be very, very careful, especially with our at-risk population.”

Even people who have been vaccinated will still need to wear masks and social distance. It’s the right message for the rest of the public, Marty said, and being vaccinated isn’t a guarantee against getting sick.

“If a lot of people unmask, then you’re much more likely to obtain a high viral load that can overcome whatever level of immunity you developed from the vaccine,” she said.

Dr. Peter Hotez, a professor and dean for the National School of Tropical Medicine at Baylor College of Medicine, predicted that colleges may be able to operate a bit closer to normal by next fall. Modeling from Baylor has found that about 70 percent of the population needs to be vaccinated with a vaccine that is over 60 percent effective to interrupt transmission. He believes we may reach that stage by the summer.

“My prediction is we’ll have several vaccines approved probably through emergency use authorization by the FDA so that by this time next year, a significant percentage of the American population will be vaccinated, and things will be unquestionably much, much better than they are now,” he said. “In terms of opening up colleges, definitely by next fall semester things are going to look pretty much like they have in the past.”

Slightly complicating the matter is the fact that colleges often have students who are 17 years old. Most current vaccine candidates are only being tested so far on adults. If a vaccine were to be licensed by the FDA for only the over-18 age group, younger students may prove to be an issue for colleges. If a vaccine is indeed licensed for the younger cohort, they will still need parental permission.

Can Colleges Distribute a Vaccine?

Whether colleges will be able to personally distribute the vaccine to their students en masse, as some do with flu shots, is still unclear. What type of vaccine finally makes it to market is one factor.

Two of the vaccine candidates currently in Phase 3 clinical trials use messenger RNA -- the strands of genetic material that instruct cells on what proteins to build -- as part of their immunization mechanism. The Pfizer vaccine with suggested 90 percent efficacy is among them.

But this type of vaccine requires deep freezing to -94 degrees Fahrenheit until shortly before injection. Often there are guidelines even as to how many times containers may be opened within a time period, Troisi said. That means an intricate transportation system would be required, as well as powerful freezers at doctor’s offices and other vaccine centers that intend to store the doses for more than a few days.

Some universities may have such freezers for research purposes, Troisi said, but most likely do not.

Several experts said that while it is still unclear, they anticipate that universities may be part of the distribution model in the U.S., especially if distribution is happening during the academic year. But regardless of vaccine type, distribution would require significant resources from colleges.

“Some colleges that are smaller or don’t have the resources will have difficulty providing systems to provide the immunizations,” said Taylor. “If colleges are continuing to do the testing, which we feel is very important, they will need to have possibly additional staffing, or companies come in to do the immunizations, and resources in terms of a location to provide the immunization,” along with refrigeration. Alarm systems and backup plans may be necessary to deal with power outages.

Over all, a vaccine is not a panacea for the problems facing higher education. A return to “normal” may still be many months ahead.