What to Expect

The big news of the day, of course, is that, following its emergency use authorization by the Food and Drug Administration, deliveries of Pfizer’s COVID-19 are beginning to stream from Pfizer’s warehouses to various pre-prepared destinations around the country. Those will soon be used to inoculated people according to the priorities in their individual jurisdictions. You can see the State of Illinois’s vaccination plan here. The top priorities are

• Healthcare workers
• Residents of long-term care facilities
• Essential frontline workers< including first responders
• Those with high risk medical conditions and adults over age 65

IMO there are aspects of those priorities that are misguided and even perverse. For example, residents of long-term can be protected by inoculating people who work in long-term care facilities before inoculating the residents themselves and they are, presumably, healthier than the residents.

Let’s divide the rest of the expectations into known knowns and known unknowns. I could color code these but I’m too lazy.

Known knowns

• The inoculations will be voluntary
• The initial inoculations will be limited in number. If the numbers given by Pfizer can be trusted, here in the U. S. we will have either hundreds of thousands or, possibly, a few million doses.
• Some people will be discouraged from getting the second inoculation by the side effects or the severity of their immune responses. That’s what happened during the clinical trials which is why I consider this a known known.
• Allocations will be partly practical and partly political. That’s simply the way things work when governments are involved which I why I consider this a known known.
• A black market in COVID-19 inoculations will arise. Whenever resources of anything are allocated a black market arises which is why I think this is a known known.
• There will also be some counterfeits. See above for why this is a known known.
• There will be some adverse reactions. Again, this is just the way things work.
• People who receive inoculations will start letting down their guards, engaging in behaviors they might not had they not been inoculated. Ditto.

Known unknowns

• We don’t know how many people in the U. S. will receive inoculations in this first round.
• We don’t know whether the Pfizer vaccine will prevent the inoculated from spreading the virus.
• We don’t know how many people who get inoculated will eschew a second dose.
• We don’t know how practical or how political the inoculations will be.
• We don’t know how many people will die simply from being inoculated. If we’re very, very lucky it will be zero but I’m skeptical. IMO prioritizing long-term care residents maximizes the likelihood of the number being non-zero.
• We don’t know what adverse reactions will be observed that weren’t seen in clinical trials.
• We don’t know how long the vaccine will promote people remaining asymptomatic or not spreading the disease (if it does, indeed, prevent people from spreading the disease)
• We don’t know whether the virus can or will adapt to the vaccine
• We don’t know whether the Pfizer vaccine has long-term adverse effects. That’s true for any new vaccine but IMO particularly true for this one because it employs a novel modality
• We don’t know how big the black market will be
• We don’t know how big the market for counterfeits will be
• We don’t known what the public reactions to the black market, counterfeits, or potential misallocations will be
• We don’t known how the general public will react to the adverse reactions or deaths
• We don’t know how how the media will react to the adverse reactions or deaths
• We don’t know when additional vaccines will receive emergency use authorization
• We don’t know when or if “herd immunity” can ever be reached

Please tell me what I’ve missed and I’ll add it to one of the lists. Also if any of my “known unknowns” are, in fact, known, please inform me an I’ll recategorize them.

It is possible that in the near term the inoculations will actually have the perverse effect of increasing the number of cases of COVID-19 diagnosed. We don’t know what the reaction to that will be, either.

Please don’t construe anything I’ve said in the post above as my attempting to discourage people from getting inoculated. That is not my intent. My intent is to try to control expectations.

Update

Bullet items which have been added to the lists have been added in blue.