The COVID-19 pandemic may feel like it is never going to end. In the United States alone, we are seeing a surge larger than ever, with over the 150,000 new cases daily hitting most severely across middle America and growing in the Northeast and West.

However, a recent development may completely change the way we manage this pandemic. Pfizer Inc, in partnership with the German drug manufacturer BioNTech, announced on Nov. 9 that their vaccine candidate, administered via a two-dose injection spread over three-week intervals, is 90% effective at preventing COVID-19. Contingent upon collection of data from their health and safety board, 15-20 million Americans may receive a full vaccination by the end of the year. 90% stands well above the FDA’s 50% effectiveness threshold currently in place for coronavirus vaccines. This is a promising sign as we move forward into the next stage of the pandemic.

The U.S. government is eagerly awaiting the final, conclusive results of this study and expects to secure millions of doses. While the Trump Administration’s Operation Warp Speed did not fund the vaccine’s research and development costs, Pfizer and the federal government reached an agreement to secure 100 million doses for the U.S. as they become available. As part of Operation Warp Speed, the government is funding numerous other studies in hopes of developing multiple successful vaccines. As a policy decision, this is critically important. Just as a diverse investment portfolio can assure gains even when one investment fails, funding multiple vaccine trials promises to produce many successful vaccines even when some trials fail. With each additional vaccine that reaches completion with positive results, the world will be better equipped to respond to the pandemic. 

One widely ignored but major concern is the equitable distribution of vaccines. The World Health Organization (WHO) has given guidance on who should receive the vaccines first, prioritizing health-care workers and first responders, then those with medical conditions deemed “high risk” and the elderly, followed by the rest of the population as doses become available. 

The WHO also warned against the failings of the 2009 swine flu pandemic, where lower to middle-income nations received vaccine doses too late. By the time doses were made readily available to these countries, the pandemic was already “over.” COVID-19 is global, but nations that can afford to buy hundreds of millions of doses for its citizens can exacerbate inequalities. So far, governments have taken minimal steps to address this, as selfishness can impede global progress. However, The Bill and Melinda Gates Foundation has already pledged $70 million to distribute doses to those who cannot afford them across the world. 

The Pfizer vaccine in particular poses another problem that may exacerbate issues of global accessibility: its storage needs. Storing a vaccine is usually not a problem, but Pfizer’s use of mRNA as the vector to activate the immune response requires the vaccine to be kept at incredibly cold temperatures. This “deep freeze” of minus 70˚ Celsius or colder requires specific freezers that few hospitals have, even in the United States. Pfizer is devising a solution to this, which could help not only Western nations but lower to middle-income nations to an even greater degree. This solution involves a portable cold storage unit that can be refilled with ice for up to 15 days. Luckily, other trial vaccines may not have this storage problem. Johnson & Johnson and Novavax’s trial vaccines can be stored in regular refrigeration, and Moderna’s, while using the same mRNA technology, will not require storage at sub-zero temperatures.

Vaccine distribution faces another obstacle: noncompliance. Noncompliance is a large concern in the U.S., which we have seen evident even with mask wearing. Claims of “personal choice” and “freedom” obfuscate the successful control of COVID-19 without a vaccine and will likely endure when a vaccine is rolled out on a large scale for the general public. However, vaccination mandates are already in place and are not unprecedented in any way. 

All 50 states have some degree of vaccination requirements for students in public schooling, with varying exemptions depending on the state. American University also mandates similar requirements for all students attending. States with exemptions include justifications ranging from philosophical to medical or religious. With this fractured strategy, it becomes difficult to enact sweeping policy changes within a coherent federal strategy. An important policy goal is to ensure a swift and comprehensive recovery from this pandemic, and assuring we minimize the lives lost to the highest degree possible requires a strong and uniform federal vaccination strategy. 

President-Elect Joe Biden’s campaign promises were founded on the message of national unity, and his COVID-19 strategy exemplifies this. In his plan, he includes a mention of equity, implying that the vaccine will be free for all Americans. While this is a good step, the U.S. should seek to lead humanitarian vaccination missions and avoid the current state of nationalism we have been cultivating intensely over the past four years. Additionally, Biden’s plan currently fails to mention vaccination compliance, either in regards to schools or workplaces. Public schools would be an important setting in which to require COVID-19 vaccinations as soon as they are widely available, thus reducing community spread and minimizing disruptions to the schooling system which have impacted millions. 

Public school vaccination mandates could increase equity among lower-income communities, which are more likely to have an online-only schooling system than wealthier communities. It can be challenging for lower-income folks to balance the number of devices needed for online schooling, especially if a parent or guardian needs a computer for remote work. Mandating a vaccine in public schools may allow remote-only districts to open up for full or partial in-person instruction with a minimized risk of COVID-19. 

Finally, an essential component of the nation’s COVID-19 strategy involves cooperation between the Trump Administration and transition team of President-Elect Biden. The president-elect is navigating a difficult path leading up to his inauguration, with an uncooperative president unwilling to accept the results of the election. Biden is still committed to having a cohesive COVID-19 plan on day-one in office, and he is currently meeting with governors and non-federal members of the public health community. The sooner the Trump Administration complies to the standards of providing briefings, transition materials and international intelligence to the president-elect, the better off America will be. When Pfizer can begin to deliver doses during the remaining days of the Trump Administration, and then continue through Biden’s first year in office, it is essential the incoming administration has access to all federal information.

We all want an end to COVID-19. However, it needs to be ended scientifically, systematically and equitably. Otherwise, we may fail to accomplish the end goal: normalcy. Without a comprehensive, cooperative and international approach, the spread will continue and may shrink to national endemics in developing nations — perpetuating a harmful system of inequality between higher-income and low-income nations. We may still have to deal with restrictions until the end of 2021, perhaps longer if our approach is unsuccessful, but this vaccine can give us hope.

Let’s work together on this and emerge united.

Featured image: Photo by CDC on Unsplash.