The vaccine is not a magic bullet

There is great anticipation that vaccination against SARS-CoV-2 could begin in Germany before Christmas, but Dr Petra Dickmann of Jena University Hospital warns against neglecting existing measures to counter the spread of the virus. The doctor and communications expert stresses that even with a vaccine, it will be a long time before our lives are the same as they were before the pandemic. (The interview was held on 27 November 2020.)

Several dozen potential vaccines against SARS-CoV-2 are in development around the world and two are possibly about to be approved in Europe. Does this mean that we will soon be able to breathe a sigh of relief?

Hope is indeed riding high for a vaccine against COVID-19. However, I’m somewhat sceptical about the current discussion. This vaccine development is certainly unprecedented; there has never been such an effort, with so many people involved worldwide, with such enormous sums of money in-vested in developing a vaccine. Now we have two candidates with good results, which will probably be approved shortly. However, we must first wait and see what the data really look like. As of yet, no scientific studies have been published; everything we know has come from press releases of the respective companies or the media and that makes it difficult to reach a sound assessment. Of course, I’m happy about these results, if they are accurate. But we must not reduce the debate about the pandemic to vaccine development alone.

What do you mean by that?

Ever since the first positive reports about the effectiveness of the two vaccine candidates awaiting approval, we have talked almost exclusively about the vaccine. And that doesn’t just refer to the media interest. Policy is also strongly fixated on it and large amounts of money are being put into the logistics of vaccination, such as setting up and equipping vaccination centres. The EU is using enormous sums to secure millions of vaccine doses, etc. As a result, we are losing sight of the fact that we cannot overcome the pandemic through pharmaceutical intervention alone. We still have an urgent need for the non-pharmaceutical interventions. These include behavioural measures such as social distancing and hygiene rules, but also the way we organise our social surroundings in schools and in public spaces. However high and however justified the current hope for a vaccine, we cannot allow ourselves to neglect other possibilities for intervention.

What is currently most important, in your view?

Communication! As with the non-pharmaceutical interventions I have just mentioned, such as distancing rules and reorganising social spaces, which we have been carrying out for the last nine months, pharmaceutical intervention also requires a great deal of communication. You have to get people on your side in order to make an impact. In the case of the prospective vaccine, I have the impression that many people believe we no longer need any communication. However, the vaccine is not a magic bullet that solves all problems. I can see us facing a huge problem if we fail to communicate properly about the vaccine.

In what way?

From our experience of useful vaccinations, using safe, tried and tested vaccines, such as vaccination against measles or the flu jab, we know that it is infinitely difficult to create a willingness in society to take part in vaccination campaigns. Fundamental to this is the understanding that vac-cination does not just mean individual protection against disease, but also contributes towards protecting the health of the population. Many people reject vaccination because they do not feel affected, as they are not part of any risk group. But that is not the point. Vaccinations belong to the sphere of public health and do not primarily concern individual medicine. Different concepts and approaches apply to public health and these have not yet been fully exploited in communication around vaccination. On the contrary, we often observe a very personal and emotional debate about the effects of vaccinations on the individual, with accusations and suspicions on all sides. Communication on vaccines just seems to attract conspiracy theories.

In your estimation, when will the first vaccinations be given in Germany?

As I have already described, there is a strong desire to start vaccinating as soon as possible. I sometimes have the impression that the vaccine is seen as a kind of saviour. And naturally, we would like to have it by Christmas at the latest. However, I don’t think it’s realistic to expect that we will really be able to vaccinate on a large scale by Christmas. If all goes well, the first pilot series could start up before Christmas, in which it will first be tested how vaccination centres work and how people will be vaccinated in hospitals or nursing homes. But initially, there will not be mass vaccination.

Who is going to receive the vaccine first?

This is an extremely important decision that has to be taken as long as the vaccine is in short supply. The [German National Academy of Natural Sciences] Leopoldina and the German Ethics Council have therefore just made an initial prioritisation, which identifies three groups of people who should be the first to be offered the vaccine. First is the group of medical staff who come into direct contact with COVID-19 patients and who therefore face the greatest risk of infection. The second comprises people who are especially vulnerable – those with pre-existing conditions and the elderly, who risk becoming seriously ill. And the third group to be prioritised is people working in particularly critical areas of the social infrastructure, who need protection so that services such as the health authorities, police and fire service, but also schools and nurseries, can continue to function.

This recommendation follows medical and ethical principles and is based on risk-benefit assessments. But it is also not without problems, because by prioritising particular groups, other people are pushed to the back of the queue. And to be honest, it must also be said that we don’t exactly know yet how well vaccination will protect patients with multimorbidity, for example. This will only emerge from the results of studies.

How long will it be before people who do not belong to one of those groups can be vaccinated?

That depends on how many people actually have the vaccination and how well the logistics work. But it also depends on the amounts of vaccine that can be made available. Therefore, it’s very difficult to estimate at the moment. But I suspect that the process will extend into next summer. We will be in a good position if we manage to obtain enough vaccine for a significant part of the population by next winter.

In order to achieve this goal, should vaccination against coronavirus be compulsory?

No. People should decide independently whether or not to be vaccinated. Physical integrity is protected by the constitution and a vaccination is a medical intervention. For this reason, every individual should decide whether or not he or she wishes to be vaccinated. I consider this to be correct and important.

We can of course motivate people more strongly to be vaccinated if we do the same as with the measles vaccination. If we say that anyone who works in the care sector or wants to send their children to nursery can only do so if they have proof of vaccination for themselves or their children. However, this is a highly sensitive topic from an ethical point of view and I would argue that we should not open this debate during an acute pandemic, but instead ensure that the vaccine is accepted voluntarily.

In your opinion, therefore, how will the coronavirus vaccine be received?

That’s hard to say. In the first instance, we could assume that there would be great willingness, because we’re all waiting to be able to return to normality at last and leave behind the restrictions on our social lives. However, as current surveys show, the willingness to be vaccinated is only just over 50 per cent. I’m aware that there’s a large proportion of people who are adopting a rather wait-and-see attitude.

Why do you think that is the case?

I think it’s because most people estimate their risk of being infected to be lower than it actually is. Therefore, they perhaps don’t consider the vaccine to be terribly urgent for them. Many also say that they first want to see how safe and effective the vaccine is, which is perfectly understandable, given how short the development time has been. In any case, I haven’t noticed any vaccine euphoria so far.

And then there are also the dedicated opponents to vaccination.

Yes, they exist. And they are genuinely dangerous, insofar as they simply instrumentalise the understandable uncertainty of a lot of people. We can only counter this with sound communication on risk, with factually underpinned arguments, with transparency and very broad-based information for all population groups. We must therefore address not only interested, open-minded groups, but also those who are reticent or initially sceptical. We won’t get the anti-vaxxers themselves on board! They’ll continue to be active and loud and will exploit every weak point of the vaccine for their own aims. And at the moment, there are still weak points: for example, the distribution, the logistics, the vaccine testing. Here, I appeal to all responsible departments in the state govern-ments, in the Federal Centre for Health Education and in the Federal Ministry of Health. The current “Messiah-style” communication, along the lines of “Hurrah, we have a vaccine!”, doesn’t bring us any further, but in some cases plays straight into the hands of the anti-vaxxers. We need better communication on vaccines, to win people’s support. Even the best vaccine is of no use to us if too few people are willing to have it.

When will we be able to see any effects from vaccination, such as falling numbers of new infections?

If initial pilot vaccination programmes actually do take place this year and vaccination kicks off on a larger scale at the start of the new year, we will perhaps be able to see some effects in late spring. However, this will largely depend on the scale of vaccination coverage, that is to say on the general acceptance of the vaccine. In any case, non-pharmaceutical interventions to contain the pandemic will still be needed to a great extent in the coming months. And these will always remain an important support. The vaccine cannot replace the hygiene and distancing rules. Social changes and hygiene rules in schools and public institutions will also have to be maintained, even with a vaccine. For a long time yet, we will not be able to live our lives in the same way as before the pandemic.