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What's the backup plan if there's no COVID-19 vaccine?

Analysis: Recent news from vaccine trials has been promising, but some experts worry that the U.S. needs a Plan B.
Image: FILE PHOTO: Employee Philipp Hoffmann, of German biopharmaceutical company CureVac, demonstrates research workflow on a vaccine for the coronavirus (COVID-19) disease at a laboratory in Tuebingen
An employee at the German biopharmaceutical company CureVac doing research on a vaccine for the coronavirus at a lab in Tuebingen.Andreas Gebert / Reuters file

WASHINGTON — Americans struggling through the worsening coronavirus outbreak got some rare good news this week as researchers delivered encouraging updates about potential vaccines. Even Dr. Anthony Fauci, whose gloomy warnings have frustrated President Donald Trump, has sounded consistently enthusiastic about the prospects.

It’s a heartening thought that even as the country has failed to contain the virus or implement the kinds of public health measures experts have called for, there’s a deus ex machina coming to rescue us if we can just hold out long enough.

But some experts are worried about Americans getting too used to the idea that a miracle vaccine or treatment is around the corner. While there’s broad agreement the latest news is promising, some are concerned that the prospect of future relief could breed complacency amid raging outbreaks that are killing hundreds of people each day.

“I think we absolutely have to have a backup plan in place,” Carl Bergstrom, a biologist at the University of Washington, said. “It's something that’s not talked about enough.”

Even in a best-case scenario, the country may be six months or more away from widespread inoculations. And we may not be in a best-case scenario, which could require policymakers and the public to develop plans for the long haul.

“So far the story of the vaccine development seems to be that none of the things that could have gone wrong have gone wrong,” Bergstrom said. “That doesn't mean we’re home free by any means.”

If there’s a Plan B, it’s not clear what it is at the moment. The White House and its allies in Congress are struggling to negotiate even the next temporary relief bill, and Trump has repeatedly speculated that the U.S. will soon find a vaccine or cure, or that the virus will “disappear” on its own.

That has some people nervous. Ken Frazier, CEO of the pharmaceutical giant Merck, recently warned that anyone hyping a medical breakthrough before 2021 was doing a “grave disservice to the public” given the inherent challenges of developing and administering a vaccine.

“The reality of the world is that this time next year very well may look like what we're experiencing now,” Frazier said in an interview with Harvard Business School professor Tsedal Neeley. "I think when we do tell people that a vaccine's coming right away, we allow politicians to actually tell the public not to do the things that the public needs to do, like wear the damn masks,” he added.

While multiple vaccine candidates in the U.K., China and America are progressing well, it’s possible the next phase of larger trials could reveal more serious side effects or limits to their effectiveness. And if public expectations are too high, some worry it could put pressure on officials — especially in an election year — to authorize their use too quickly. (The head of the FDA has insisted it will not “cut corners” on safety.)

Even if a vaccine hits every mark on safety and effectiveness, there’s a possibility governments could struggle to distribute it quickly. The Trump administration is buying up hundreds of millions of doses of vaccine candidates in advance in the hopes that it can move quickly if they’re approved, but roadblocks could still emerge.

Topher Spiro, vice president of health policy at the left-leaning Center for American Progress, has spent months researching the logistics of inoculating the public against coronavirus once a vaccine is approved.

Potential problems he’s looked at include failing to produce enough glass vials to bureaucratic snafus over who administers the vaccine to simply struggling to convince enough people that it’s safe to get vaccinated. An Associated Press poll this week found 20 percent of respondents said they did not plan to get a vaccine if it became available, with another 31 percent unsure.

“We shouldn't get ahead of ourselves and we should start preparing for the possibility we have a vaccine, but that does not mean we should stop looking for strategies to contain the virus in the meantime,” Spiro said.

Avik Roy, president of the conservative Foundation for Research on Equal Opportunity, co-wrote a coronavirus response framework in April that argued officials should assume for planning purposes that advances in vaccines or treatments don’t materialize.

“I spent a dozen years as an investor in biotech companies,” Roy said. “When you're close to the ground in development of novel treatments, you're acutely aware of how often they fail, how often data that looks promising in the early stages doesn't pan out in the late stages."

According to Roy, accepting the prospect of no vaccine as an organizing principle could lend more urgency to installing security measures like temperature scanners, protecting vulnerable populations like seniors, and advancing plans to safely reopen schools.

“If we’re going to say it’s OK to lock down the economy and keep schools closed because we'll have a vaccine in six months, that involves a lot of premature assumptions,” he said.

Many expert suggestions involve redoubling current efforts to confront the virus.

Improving testing availability and turnaround times, which the White House has been reluctant to put more federal dollars into, could help detect outbreaks before they get out of hand. Hiring and training more contact tracers, and maybe even experimenting with apps to assist them, could help track the spread of the virus. Finding effective treatments that speed up recovery and increase survivability could make the pandemic easier to manage as a day-to-day threat. Former Obama health official Andy Slavitt has called for a national push to produce high-quality N95 masks for daily public use, rather than the more common cotton masks.

Any struggles on the vaccine front could affect the economic response as well. The longer the crisis persists, the more that temporary shifts like virtual offices or increased e-commerce sales could become entrenched habits. That could make aid programs like Paycheck Protection that are built on maintaining existing businesses, which may no longer be viable in a world ravaged by coronavirus, harder to sustain. As it stands, many businesses are already closing their doors permanently.

“The CARES Act was mainly based on the premise that we would freeze jobs and firms in place and then everyone would go back,” University of Chicago economics professor Steven Davis told NBC News. “There’s a great deal of evidence that the post-pandemic economy will look significantly different and many of the lost jobs are not coming back.”

Then there’s the less desirable backup scenario: The virus wins.

If enough people are infected waiting for a vaccine to emerge, the country could approach herd immunity and gain at least temporary respite from major outbreaks. Some experts have estimated reaching that point would require as much as 60 percent to 70 percent of the population to get infected, while others see a potentially lower threshold. According to a study this week by the CDC, America is still a long way off either way, with only 24 percent of even worst-hit New York City believed to have antibodies against the virus.

But some argue we’re likelier to reach that point earlier than we might think if current outbreaks worsen.

Former FDA Commissioner Scott Gottlieb, a CNBC contributor who sits on the board of Pfizer, predicted that by early 2021, “we will either have a vaccine, or we will have herd immunity.”

The country probably won’t be celebrating either way, however.

“We are a long way from it now, and a lot of death and disease until we get there,” Gottlieb said.