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What’s the backup plan if a COVID-19 vaccine comes up short?

A vaccine could be the savior against the coronavirus—and scientists are marshaling all their resources to find one. Over the past few weeks, eight vaccine candidates have progressed to advanced clinical trials.

But despite encouraging early data, some researchers and pharmaceutical experts have indicated that the predictions of a vaccine by early 2021 may be too optimistic, and arrival may still be a long way off. We need to start planning accordingly.

Add to this the concern that even if a vaccine is approved and manufactured quickly, many people won’t line up to take it. A new survey from WebMD found that only 42{ce8ce7cc98bffdc4302011057a79600ea02c464c5536f1477c12acdb8bd79c00} of respondents said they planned to get a COVID-19 vaccine in the first year—and only 26{ce8ce7cc98bffdc4302011057a79600ea02c464c5536f1477c12acdb8bd79c00} said they would get vaccinated in the first three months. Nearly 60{ce8ce7cc98bffdc4302011057a79600ea02c464c5536f1477c12acdb8bd79c00} of respondents are either unsure they’ll get vaccinated or say they don’t plan to get it at all.

Additionally, even doctors haven’t reached a consensus on whether they’ll push their patients to get vaccinated. A new Medscape poll of more than 7,000 health care professionals (free registration required) found that only about half would recommend that patients get a vaccine when it’s first made available. Many respondents expressed concerns about the vaccine’s safety, fearing that adverse effects would outweigh the risk of COVID-19.

Wariness about vaccines isn’t unique to COVID-19. Less than 50{ce8ce7cc98bffdc4302011057a79600ea02c464c5536f1477c12acdb8bd79c00} of Americans got the flu shot from 2018–2019. Thirty percent of seniors haven’t received the vaccine to protect against pneumonia. Even though the shingles vaccine is more than 90{ce8ce7cc98bffdc4302011057a79600ea02c464c5536f1477c12acdb8bd79c00} effective, only 30{ce8ce7cc98bffdc4302011057a79600ea02c464c5536f1477c12acdb8bd79c00} of people who meet criteria to receive it have done so.  

Some Americans suggest that we shouldn’t open schools until there’s a vaccine, or say they don’t feel comfortable returning to an office setting until there’s widespread vaccination. But that reality is some way off. Now is the time for us to move beyond an all-or-none approach where we put our lives on hold while we await a vaccine.

In order to do that, we must be transparent and have difficult conversations about risk. We need to address the tradeoff between a potential decrease in infection rates during a lockdown and potential business failures, job loss, and the impact of continued social isolation on substance abuse and mental health.

For example, CDC Director Dr. Robert R. Redfield recently spoke about the public health consequences of keeping kids out of school—including a recent increase in teen suicides and drug use. Particularly vulnerable communities may face possible food insecurity, academic delay, and even parental stress leading to child abuse.

We must also find ways to live with COVID-19. That requires more accurate, faster diagnostic tests, more robust research to understand how the infection spreads, as well as wider adoption of technologies to help with contact tracing. We need to let science lead the way.

We’re all hopeful that a COVID-19 vaccine is truly just around the corner. But please, let’s plan for the possibility that it won’t be the golden key to unlock us from our quarantines.

Hansa Bhargava, M.D., is senior medical director of WebMD. John Whyte, M.D., M.P.H., is chief medical officer of WebMD.

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