A rough roadmap to a COVID-19 vaccine

Nine months into 2020, there’s one question on a lot of people’s minds: “Are we there yet?”
We want to get back to watching weird movies in theaters, eating inside restaurants instead of on the sidewalks, and hanging out with our friends, without that pandemic dread setting in.
Bad news. We are not there yet. But even in the United States, which still has the highest death toll and case count in the world, there are some signs of progress.
In the US, which has relegated contact tracing efforts to the sidelines, and whose testing program is a muddled mess, most of the focus is on finding a vaccine. It’s where a lot of people have pinned their “are we there yet” hopes. “When we have a vaccine” is also when people hope they can put down their masks and their worries, and live like it’s 2019 again.
Even if we don’t have a definitive ETA, we do have a rough roadmap. This is what it’s going to take for us to install a vaccine-based antivirus program:


Development – This is straightforward. We have to make and test the vaccine before we give it out. A few vaccines are already being tested on tens of thousands of volunteers. If these massive studies can show that the vaccines are both safe and effective, then that’s going to be the first major hurdle to people getting a vaccine.
Approval – Once a company has a vaccine with lots of data showing that it works, the next step (at least in the US) is for the Food and Drug Administration to approve it. Because of the urgency of the pandemic, it’s possible that the FDA might decide to issue an Emergency Use Authorization, or EUA, to get the vaccine out faster.
Trust – In order for a vaccine to work, people have to take it. That means they have to trust the data from the company, and they have to trust the people approving it. If the FDA goes with emergency approval, they’re also likely to face a skeptical public, who may worry that safety has been sacrificed at the altar of speed or political gain.
This part of the road is going to be especially bumpy, as we saw this week with the release of several documents from the CDC asking governments to start getting ready to distribute vaccines that might be available in small quantities as early as late October – right before the presidential election.
“This timeline of the initial deployment at the end of October is deeply worrisome for the politicization of public health and the potential safety ramifications,” Saskia Popescu, an infection prevention epidemiologist, told The New York Times. “It’s hard not to see this as a push for a pre-election vaccine.”
If a vaccine does come out then – something that experts have said is unlikely – officials will have to strongly demonstrate that the vaccine is not a political ploy designed to garner votes.
“I would immediately resign if there is undue interference in this process,” said Moncef Slaoui, the scientific lead of the US’s vaccine development program, in a candid interview with Science this week. A former executive with GlaxoSmithKline, he also said, “The science is what is going to guide us.” Whether that will be enough to convince the public is still up in the air.
Logistics – One of the reasons that the CDC sent local and state governments those documents is that a few of the top vaccine candidates are really finicky. We’re facing a wildly complex distribution process that could involve multiple doses per person and super-chilled storage temperatures to keep the vaccine ready-to-use. Distributing the shot(s) will require needles, sure, but will also probably need freezers, refrigerated trucks, dry ice, and a whole lot of training.
There’s also the question of who will get the vaccine first. Once a vaccine has data, approval, and a willing population, it still has to be produced, and that’s going to take time. By most estimates, including the CDC’s early guidance, there won’t be enough vaccines for everyone until sometime next year. The National Institutes of Health are already working on a plan for who will get the vaccine first, with health care workers and high-risk populations at the top of the list.
Are we there yet? No. But we’re getting closer.