• COVID-19
• immunology
• health policy
• public health
• medical education & training

In November 2020, three vaccine developers: AstraZeneca, Moderna and Pfizer/BioNTech have released encouraging data regarding the safety and efficacy of their potential COVID-19 vaccines. The Medicines and Healthcare products Regulatory Agency has already given rapid temporary regulatory approval to the Pfizer/BioNTech vaccine for use in the UK, and it is only a matter of time until regulatory agencies such as the Food and Drug Administration and European Medicines Agency approve one or more candidates for widespread human use.

Initially, the focus will be placed on increased production, safe distribution and vaccination of high-risk individuals and healthcare workers. However, as production and availability of vaccines increase, governments will move on to vaccinate the general population in order to reach herd immunity as quickly as possible and to facilitate normalisation of everyday life.

The herd immunity threshold for SARS-CoV-2 is estimated at 67%,1 but the exact percentage of population required to be vaccinated to reach it will depend mostly on the efficacy of the used vaccine. This will be further complicated by use of different vaccines with significantly different efficacies. Therefore, the goal should not be to vaccinate a fixed percentage of the population but to strive and vaccinate as high a proportion as possible, if not the whole population.

Efforts aimed at reaching herd immunity to SARS-CoV-2 will certainly be hindered by vaccine hesitancy both in the USA2 and Europe and elsewhere,3 with significant geographical differences in vaccine uptake, where entire regions, and sometimes whole countries, will likely fail to achieve sufficient vaccine uptake to reach herd immunity levels. This could prove problematic since it will lead to new COVID-19 outbreaks occurring periodically, thus impeding postpandemic recovery.

What would happen if we fail to defeat COVID-19 through widespread vaccination and how could our future coexistence with this virus look like? A potential answer to this question came recently from an unexpected source: the airline companies! Several international ones, including Qantas, Korean Air and Air New Zealand, have all announced that they are seriously considering requiring all their international passengers to be vaccinated and to provide proof of their COVID-19 vaccination status as soon as vaccines become widely available.4

Such statements sound as if they were taken directly from a dystopian novel, where an already split world has been divided even further between those that were vaccinated and those that were not. It is not particularly hard to imagine a reality in which COVID-19 vaccination proof is required not only for international flights but also for participation in all social activities involving large numbers of people, such as concerts, sport events, theatre plays and cinema screenings, where unvaccinated individuals will be forced to continue practising a form of social distancing. Furthermore, some public services like state childcare and education might also remain available to vaccinated individuals only. Most importantly, SARS-CoV-2 will continue to circulate in the population, causing completely preventable deaths. Even though such a future provides for grim reading, it could still be completely avoidable, if we plan accordingly and take proper actions.

Instead of focusing on divisions, our aim should be on emphasising the benefits of vaccination and on fighting the misinformation, fear, uncertainty and doubt sown by the antivaxxer and antiscience movements in order to minimise the worldwide impact of COVID-19 vaccine hesitancy. If we wait for vaccines to become widely available to start conducting educational interventions in that regard, it may be too late to achieve meaningful impact.

Finally, once widespread vaccination becomes available, vaccination refusal will replace COVID-19 as the leading worldwide health problem. If we all hope to get our lives back to normality after 2020 and to be reading about pandemics and future dystopias only in the books, we really ought to start fighting vaccine hesitancy by increasingly educating the general public about the benefits of vaccines as soon as possible.