By: Dr. Pashko R. Camaj, Doctor of Public Health Sciences *

The summer of 2021, at least for us here in the United States (US) began with such promise. On Memorial Day, the traditional start of summer, with millions of people having been vaccinated, many of us thought that the worst of Covid might be over. A few months later, that optimism had yielded to a more somber and uncertain Labor Day (unofficial end of summer in US) as hot summer turns into the autumn. After an enthusiastic start of the vaccination initiative and a few months in, the vaccination drive hit a wall of resistance.  Add to that, the summer also marked the arrival of the more contagious Delta variant. All that early summer talk about “emerging” from the pandemic morphed into nervous questions: When will we reach a turning point in our battle against Covid 19? When and how will we finally get back to something close to “normal” again? Even with tens of millions of Americans vaccinated, reopening of schools and a recovering economy, the Covid-19 pandemic more than just lingers on, especially among the unvaccinated, here in the US and globally.   

How will next few months look:

As we have seen in the recent past, the next few months will take us through hills and valleys, especially if we continue to lag in getting more people vaccinated. But the challenge is going to remain the size and the shape, how big and distant from each other will these hills and valleys will be.  More vaccines will help to keep the hills manageable.  The novelty of this coronavirus is as like a forest fire that will not stop until it finds all the human wood that it can burn.  It’s also possible that the SARS-CoV-2 won’t follow the path set by the pandemics of the past. After all, it is a different, novel and seemingly more transmissible pathogen. And with a death toll of more than 4.7 million people so far, this pandemic is already more than twice as deadly as any outbreak since the 1918 Spanish flu. Despite brutal initial waves and relatively high vaccination rates, countries including the US the numbers of new infections have been on the rise.  Immunization is helping to moderate incidences of severe cases and deaths, but surging new infections mean the virus is reaching the young and others who remain unvaccinated, leading to rising rates of serious disease in those groups. What seems clear is that the pandemic will not be over in six months. The current outbreak may be tamed only once most people — perhaps 85% to 90% of the global population — have a degree of immunity, through vaccination or previous infection. Some epidemiologists now expect the coronavirus to be endemic, meaning it may be here to stay in cycles like the common flu. But even if the virus persists, it doesn’t mean we will be in a perpetual pandemic. 

Be that as it may, the next few months will be rough. One key danger is if a vaccine-resistant variant develops.  Though it is not very likely to be more virulent that its predecessors, new variants tend be more transmissible, which present a new and everchanging challenge.  Our future battle with SARS-CoV-2, it appears, may be more about domesticating the virus than eliminating it. With widespread vaccination, many of us will still be exposed, maybe even temporarily impacted, but it won’t often be a big deal. Most of the time, we might not even notice. Positive tests, too, may be less alarming. In the absence of symptoms, detecting hunks of virus might simply indicate that immune cells have squashed the pathogen, leaving only debris behind. With the highly sensitive tests, it is very likely that we only need a few viral ‘skeletons’ to test positive.  The virus will become less of a pathogen, and more of a passenger—one that keeps the defensive wheels turning, for the short time that it’s there. Over time, our immunity towards this novel virus will keep growing through vaccination and natural infection; that’s already started.

Vaccines and Immunity:

Vaccines do not provide a perfect immunity for all-something we call a ‘sterilizing’ immunity. Sterilizing immunity means that the immune system can stop a pathogen, including viruses, from replicating within your body. This typically happens when immune cells in the body can bind to the pathogen in places that prevent it from being able to enter a cell where it can start making copies of itself. Some of these immune cells may produce sterilizing antibodies, which are proteins that recognize specific proteins and structures on the surfaces of pathogens.

To achieve sterilizing immunity, our body needs to produce enough neutralizing antibodies and it needs to be able to do so in the long term. Ideally, it leads to life-long immunity. Most vaccines produce an immune response that is not sterilizing, and neither do they need it to be effective at preventing disease. Many vaccines are primarily intended to prevent disease and do not necessarily protect against infection (e.g., a positive covid test). For most of vaccination history, humans have been guided by stopping sickness, and that’s been enough. The very successful smallpox vaccine wasn’t sterilizing; it still helped us eradicate a pathogen. Even measles, a virus that’s much more contagious than SARS-CoV-2, can offer an optimistic example. Some people do end up getting infected after vaccination. But the vaccine has, in the decades since its premiere, largely driven measles into the ground in the US, apart from recent outbreaks largely linked to low immunization rates. And the few immunized people who do fall ill tend to get what’s called ‘modified measles’, which is a much milder version of the disease.  The measles vaccine is not perfect. Neither is a Covid vaccine- no vaccine is. But that doesn’t make them useless. Nothing could be further from the truth.  Even with all the negative publicity towards the vaccines and protection they offer, from many ‘scientists’ that lurk on various platforms such as social media, being vaccinated is the best way of preventing a disease.  For sure and by far, much better to be exposed to the virus after, rather than before the vaccine.  The truth is in the numbers: more than 95% of all US hospitalizations and deaths from Covid during this latest wave have been among the unvaccinated population.

Sterilizing or Functional Immunity:

We know that reaching a sterilizing immunity is almost impossible, our immune systems cannot, in fact, be trained to achieve perfection. That is neither a surprise nor a shortcoming of Covid-19 vaccines, or any other vaccines.  An inoculation that guards exceptionally well against disease – offering as much protection as it can – can still end an outbreak. Life would certainly be easier if vaccines offered invincible armor which pathogens simply bounce off. But the vaccines do not do that. Assuming or expecting them to do that, is misguided and can be dangerous. The fallibility of sterilizing immunity is a reminder that just about any immune response can be overwhelmed if exposures are heavy and frequent enough.  So instead of a sterilizing immunity, the best we can do is to strive for is functional immunity, more like a seat belt in your car, it does not prevent collisions, but it may save your life.

In answer to the question posed at the beginning of this article, the pandemic will end at different times in different places, just as previous outbreaks have.  Governments, local and global, will have to decide how much of the disease they are comfortable living with. It’s likely to be messy, leaving a legacy for years to come.  We will have to find a way to co-exist with it, tenuously, as safely as we can. So, keeping the virus at bay will also require focusing a lot more attention on improving and expanding access to treatments, particularly medications that can be taken orally outside a hospital or infusion center. Until then, many of us, especially and specifically, the unvaccinated, will need to brace for many more months in the hills and valleys of the pandemic’s grip. 

* Vice President of the Pan-Albanian Federation of America – VATRA.