Many health experts have been stressing that those who have received the coronavirus vaccine shouldn't let their guard down — that they can still carry and spread the virus and that the pandemic is far from over. But one local epidemiologist, Dr. Julia Marcus of Harvard Medical School and the Harvatrd Pilgrim Health Care Institute, is calling for more positivity, saying that pessimism comes at a cost. Marcus spoke with GBH All Things Considered host Arun Rath. This transcript has been edited for clarity.
Arun Rath: As someone who is part of the media, I feel like there have been mixed messages. I've talked to epidemiologists on this show and others that sound practically giddy about the vaccine. At the same time, there does seem like there's this other message. Dr. Fauci recently said we should just consider the vaccine part of the toolkit, not as game-changing as we would want to think about it.
Dr. Julia Marcus: There's some truth to both of those things. I count myself among the epidemiologists who are giddy about these vaccines. They have far exceeded expectations in terms of reducing risk of disease, and particularly severe disease and death. There have been no hospitalizations or deaths among anybody who's been vaccinated or in any of the clinical trials for these vaccines, which is really remarkable. We are starting to see some data suggesting that they are going to reduce transmission to some extent, although they are probably not going to eliminate it. It is actually important to continue to caution people, particularly when they are around people who are not vaccinated, and especially if those people are vulnerable. At the same time, I think we need to make sure that people understand there is a reduction in risk here. While vaccines don't immediately change everything, they do changed some things, particularly for the people who are vaccinated. Over time, as more people are vaccinated and infections start to wane, we are going to see some changes in terms of public spaces. We can't do that yet, but eventually we are going to get there, and that really is the goal of vaccine.
Rath: I just want to underscore that point about the vaccines, because I do love saying that - that of the huge number of people who received the vaccine, whether in trials or since the trials, not one of them has died from COVID-19.
Marcus: That's right. It's remarkable.
Rath: Is that as amazing as it sounds?
Marcus: It is, it is. It really is amazing. Something to be clear about is that when we hear about the efficacy in trials, let's say 95% efficacy, and people say, well, that's not 100%, that's true. But we also want to be clear about what that efficacy is measuring. Its efficacy against any symptomatic disease. When we actually look at severe disease, hospitalization and death — and those are the things that people really want to avoid — we've seen none of those things happen in anybody who's been vaccinated. That's not to say that it's impossible that they will happen in the real world as many, many more people are vaccinated. But that's what the data are showing.
Rath: Is there guidance that's floating around that is counterproductive? Is there harm in being more cautious, in underselling the vaccine?
Marcus: There are tradeoffs to everything. There are a couple of things that you brought up there. One is about underselling the vaccine, which of course we don't want to do in a situation where the way that we will get ourselves out of this mess is having as many people vaccinated as possible, particularly people who are at high risk. The other thing you brought up is, is there a cost to being too cautious? You could say there's not, and actually we should be as cautious as possible. But for some people, the people who are now asking — I saw a tweet from somebody who said they're an elderly cancer patient and they have not touched anyone in many, many months. Can they hug their grandkids now that they're vaccinated? And the answer to somebody who's asking that question right now is, no, you cannot. You must continue to be as cautious as you were. So I think what we need to do is build on the message that we're hearing, which is vaccines are great but nothing changes, and also add that something does change for people who are vaccinated. They have a vastly reduced risk of disease, and particularly of severe disease, and they may still be able to transmit the virus asymptomatically to the people around them. Once people have that information, they can make some informed decisions in their lives, particularly for people for whom isolation is coming at a great cost.
Rath: For people who have been vaccinated, as an epidemiologist, what advice do you give them now for how they should conduct their lives?
Marcus: I think we need to be clear that precautions need to remain in public spaces. That's because both vaccine status and vulnerability are not things that are readily identifiable in public, and so we can't really have a situation where we're allowing certain activities for people who've been vaccinated and not for others. Also, the ethics of that become quite complex. But people do have a lot of interactions in their personal lives and make decisions that are well within public health guidelines. For example, right now in Massachusetts, you can gather with 10 people indoors. I think it's worth telling people that if they've been vaccinated and the people that they are seeing have been vaccinated - let's say a close loved one - there is a vastly reduced risk in that situation. But they need to continue to be cautious around people who have not been vaccinated because there is potentially this risk.
Rath: It's very interesting to think about the public health formula here. Something I hadn't really considered before is a potential danger to excessive caution being that people are socially isolated longer, and kids are kept out of school longer. All of these attendant things are all part of the public health that we're trying to take care of.
Marcus: That's right. I think with every risk mitigation strategy that is trying to reduce infections, there is going to be some tradeoff. In some cases, those tradeoffs are fairly minimal, but in other cases they are substantial. Schools are a great example. In many cases there are competing risks - risks to teachers of being in school and risks to kids of being out of school. There are no easy answers in many of these situations, but I think it's important to keep our focus on the big picture of maximizing public health and not just minimizing infections so that we at least see what those trade-offs are and take them into consideration when we make decisions about public health messaging and public health policies.
