July 31, 2020 – The world has been racing to develop a coronavirus vaccine, but even having one in hand won’t end the pandemic, according to eminent bioethicist Arthur Caplan.

Rather, the advent of a safe and effective vaccine will usher in a host of new problems that public health and political officials are only now beginning to recognize, he said.

“You get a vaccine … and its 60% effective and it reduces the intensity or severity of the disease. And we’re all happy,” said Caplan, a professor of bioethics at the NYU Grossman School of Medicine. “Everybody’s writing headlines that say, ‘COVID epidemic over. Vaccine found. Yay.’ I don't think so. I think that’s when things are going to get actually interesting.”

In a session with National Press Foundation fellows studying the science, policy and ethics surrounding vaccine development, Caplan detailed some of the ways the quest for a vaccine really doesn’t end once one is discovered. (Click here for more of Caplan on COVID’s ethical dilemmas.)

For starters, Caplan said the public needs to be prepared for a much longer wait than it might be expecting. While much of the global discourse has revolved around a vaccine being available 12-18 months from the onset of the pandemic, Caplan said that’s optimistic.

Granted, there is some reason for optimism, since the coronavirus can build off previous work trying to develop a SARS or MERS vaccine and since the entire global scientific establishment is focused on this one problem. But most vaccines take years or decades to develop.

“I think what we’re going to see is some progress in vaccination next year, not this year,” Caplan said. “And I think we’re going to have to continue our behavioral efforts – the masking and distancing and quarantining and the testing and so on – in parallel with vaccination. … It would be very, very surprising if we got a very highly effective vaccine, first one out of the box, for this particular virus.”

Even having a vaccine in hand doesn’t signal the end of COVID.

Vaccines aren’t 100% effective. The mumps vaccine is only 80% effective, whooping cough 75% and flu – in a good year – 40-60%. Elderly people often get only a weak or no immune response from the flu virus, suggesting that they may also not get much protection from a coronavirus shot.

“Tens of millions, even hundreds of millions worldwide, may not respond,” Caplan said. If a vaccine requires two doses, compliance and effectiveness drop substantially. For example, many people do not get the tetanus shot booster required every 10 years, and fewer than a third of American women have had both shots required for protection against HPV, which can cause cervical cancer.

“Vaccinating 330 million Americans or billions worldwide during pandemic – especially with multiple or staggered doses – would be logistical nightmare,” Caplan said. Those logistical concerns will be even more complex in developing countries or conflict zones.

And who would be at the front of the line? Caplan said people can likely agree that health care workers should get first dibs, and maybe those in nursing homes. But what about people in prisons, which are now raging hotbeds of coronavirus spread? As Caplan asked, would people really agree with the notion that “before we vaccinate my children, why don't you go down and vaccinate prisoners?”

“I think the answer to that should be yes, but that’s politically going to be interesting,” Caplan said.

And while the virus knows no national borders, the vaccine will.

“If I have a vaccine, is it really morally wrong … to favor my family, my community, my state, my region, or my nation first?” Caplan asked. The answer for him is no – it’s not wrong “to start with the neediest in your own country before you go to the neediest in other countries.” But that’s not the position now being taken by international bodies such as the World Health Organization.