Editor’s note, March 9: The Centers for Disease Control and Prevention on March 8 issued new guidelines for fully vaccinated people. Read about the new guidelines here, and for Vox’s latest coverage of vaccine efforts in the US and worldwide, see our storystream.
Now that the vaccines are arriving, people are starting to dream.
They say things like, “The second everyone in my family is vaccinated, we’re going on a big trip to Asia!” or “As soon as my five closest friends and I get the shot, I’m spending a weekend at a cabin with them. No masks, no social distancing.”
While many of us are thinking about the Covid-19 pandemic in binary terms — there’s “life before I get the shot” and “life after I get the shot” — experts are cautioning us to think more gradually. Not everything will change the second that syringe enters your arm.
“Realistically, it’s definitely not going to be an on/off switch on normal,” said Eleanor Murray, a Boston University epidemiologist.
The best way to set realistic expectations around what life will look like in 2021 is to think of it in three stages. Stage 1 is what you can safely do once you and your close friends or family are vaccinated. Stage 2 is what you can safely do once your city or state has reached herd immunity, where enough people are protected against infection that the virus can’t easily spark new outbreaks. Stage 3 is what you can do once herd immunity is reached internationally. (Note that there’s a good chance we won’t reach that last stage in 2021.)
A lot will depend on the answer to a crucial open question: Are the vaccines only good at preventing symptomatic disease, or are they also good at preventing infection and transmission?
“One can imagine a scenario where you are vaccinated and you develop a protective immune response. You will not get sick, you will not die, but the virus will still be able to grow in your nose and transmit to other people,” said Barry Bloom, a professor of immunology and infectious diseases at Harvard.
Bloom and other experts are optimistic that the vaccines help reduce infection and transmission, but nobody knows by how much. “We just need more data on transmission,” he said. “Hopefully it will come out of the trials in a couple of months.”
In the meantime, even vaccinated people have to assume they can still become infected and pass along the virus. That means they need to keep wearing masks and social distancing whenever they’re around unvaccinated people.
But as more and more people get vaccinated, the question will arise: What about when you’re among people who’ve all been vaccinated? That brings us to stage 1.
Stage 1: You and your close friends or family are vaccinated
Let’s say you and your five closest friends have been vaccinated. Can you all rent a cabin in the woods and spend a weekend together, without masks or social distancing?
The answer is: It’s likely to be fine — with some caveats.
For one thing, vaccines don’t work instantly. “You need to wait at minimum two weeks after the first shot to see any kind of protection, but really you need to wait at least a week after the second shot,” said Angela Rasmussen, a virologist affiliated with Georgetown University.
Then there’s the fact that the vaccine may not work equally well in everyone. Some people may have health issues that keep their bodies from mounting quite as successful an immune response. “The fact is, I’m not absolutely sure that everybody who receives the vaccine develops a protective response,” Bloom said.
The Pfizer/BioNTech and Moderna vaccines showed 95 percent efficacy at preventing symptomatic disease in trials after two doses. But they’re not 100 percent. There’s still a chance you could pick up the virus from one of your vaccinated friends and develop symptoms. Although the vaccines are very good at preventing the severe symptoms that land people in the hospital, experts can’t rule out the possibility that you’ll develop milder symptoms, which could conceivably turn chronic or “long-haul.”
So the weekend getaway will not be completely safe. But, Rasmussen said, “if your entire group of friends have all gotten the full vaccine regimen and at least a week has passed since their second shot, it probably is okay for you to get together with them in a closed setting, where you’re not interacting with the public. So maybe a vacation where you all get an Airbnb and hang out — but without going bar-hopping! — would be okay.”
Murray agreed the risk would be relatively low, provided you and your friends have no underlying conditions and don’t live with vulnerable unvaccinated people whom you want to protect from infection. “But when you come back and go to the grocery store,” she said, “I’d expect that you’re still wearing masks.”
That’s because there’s a big difference between being in a closed bubble, where you know that everyone is vaccinated, and being in the public domain, where you risk infecting unvaccinated people.
Asked if she would go on the cabin weekend trip, Murray said, “I would probably be comfortable,” but that’s because she doesn’t live near any unvaccinated parents or grandparents whom she needs to keep safe, and because she expects to be in the last group of people to get the vaccine — by which point herd immunity will have built up more, driving down the chances that any of her friends would show up at the cabin unwittingly infected.
Stage 2: Your city or state has reached herd immunity
In public settings, Americans should continue with masking and social distancing until 75 to 85 percent of the population is vaccinated, according to Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases. He estimates that around that stage — which could come in mid-fall — the US will reach herd immunity. (This is just an estimate, though, and it’s liable to change depending on Covid-19 variants, vaccine uptake rates, and other factors.)
Rather than achieving national immunity all at once, we’re likely to see regions within the US passing the immunity threshold at different times. As each city or state announces that it’s past the threshold, it’ll probably start rolling back requirements gradually. We might see restaurants open up for indoor dining, but with servers continuing to wear masks.
“I think probably masks will be one of the last things to roll back,” Murray said, “because masks don’t have a commercial cost to them. They’re something that’s helpful and doesn’t necessarily cost the economy anything.” Given that there’s a lot of travel between jurisdictions, masks may not be rolled back until the whole country reaches herd immunity.
Once a jurisdiction reaches immunity, people there will be able to safely return to venues like schools, movie theaters, and indoor dining at restaurants (though of course state and local governments have been making these decisions all throughout the pandemic, weighing the indispensability and risks of different venues). The idea is that if, say, 80 percent of people are vaccinated, that creates an “umbrella” of immunity, as Fauci put it, that “would be able to protect even the vulnerables who have not been vaccinated, or those in which the vaccine has not been effective.”
Rasmussen emphasized that if we want to feel not just 95 percent but more like 99 percent safe in public spaces, we need as many people as possible to get vaccinated, because that’s what stops community transmission.
“You can have a lot of great vaccines, but they don’t completely eradicate these viruses unless they’re taken up very, very widely,” she said. “But people are still not thinking about vaccines as a population-level intervention. They’re thinking about them as an individual intervention. It’s very exemplary of this pandemic.”
From the beginning, health experts have tried to get the public to understand that when it comes to the coronavirus, nobody is truly safe until everybody is safe.
Stage 2, for that reason, is not the time for international travel to countries that have not yet achieved herd immunity or that have little health care infrastructure.
If a large region in your country passes the immunity threshold, domestic travel — say, to see vaccinated family members a couple of states over — may be fine. But for your safety and for the sake of people abroad, it’s best to hold off on big international trips.
Stage 3: Herd immunity is reached internationally
Let’s manage expectations right off the bat. There’s a good chance we won’t reach this stage until 2022 or later. That’s because access to the vaccines is far from equal around the world.
“What we’re seeing is the US, Canada, and Europe are getting pretty good access to the vaccine, but if you’re hoping to go to Mozambique or something, a lot of those other countries are not necessarily able to purchase the vaccine and it’ll be a lot longer for those countries,” Murray said.
That’s why it’s so important to have groups like the Covax Facility, a unique financing mechanism that has gotten 190 countries (92 of which are lower-income countries) to pool their resources to end the pandemic faster. It aims to deliver 2 billion vaccine doses by the end of this year to participating countries, regardless of their ability to pay.
How long it takes for various countries to reach herd immunity will depend in part on how fast they can access vaccines and what share of their populations are willing to get the shot. But as mentioned above, there’s another crucial factor.
“It’s really going to come down to what we learn over the next few months about how well the vaccine prevents infection and transmission,” Murray said, adding that she doesn’t expect we’ll have an answer to that until March at the earliest.
If it turns out that the vaccines prevent infection and transmission almost as well as they prevent symptomatic disease, we may see some countries opening their borders to tourists who provide proof of vaccination, in an effort to get the tourism sector and the broader economy going again.
“If we do find that it prevents 95 percent of infections, then I’d say yeah, if you and all your friends are vaccinated, plan that Fiji vacation, go wild, spend your tourism dollars helping economies of places that can’t yet afford the vaccine!” Murray said. “But if it turns out that no … then it would be really inappropriate to be going somewhere where they can’t afford the vaccine and still spreading disease.”
In that scenario, we may have to wait until 2022 or later for travel to some countries to resume.
For now, remember that keeping up with the measures we know curb the spread of the virus — like masking and social distancing — is the best way to ensure we can all get back to normal faster. Yes, we are all sick of them. But the more we stick to them over the next few months, the sooner we can abandon them for good.
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