09/18/2020 | News release | Distributed by Public on 09/18/2020 17:23

Betting on a Vaccine Soon? Consider These 3 Potential Outcomes

Mick Costigan and Noah Flower contributed reporting to this article.

As President Trump publicly disagreed with the Centers for Disease Control and Prevention's (CDC) guidance around the distribution of a vaccine and the efficacy of masks, the public is digesting a lot of new information about the global race for a COVID-19 vaccine.

For starters, there's news the U.S. government plans to widely distribute a free vaccine as soon as possible. Russia says it could sell up to 300 million vaccines to India before the end of the year. China says they may be ready with a vaccine in November, as billionaire vaccine advocate Bill Gates predicts Pfizer will be the eventual distributor of a winning vaccine in early 2021.

All this comes about a week after AstraZeneca - a leader in the race for a COVID-19 vaccine - halted its late stage trials due to serious neurological symptoms in one participant. As Pfizer expands its own efforts to release a vaccine with limited publicly available details, concerns are mounting about the generally secretive nature of these vaccine trials, the safety of vaccine rollouts on fast-tracked timelines, and the lack of alignment between Trump and the C.D.C., which is widely considered to be the world's leading agency devoted to public health.

It's safe to say that conflicting information is rampant and uncertainty abounds around the timing and safety of a future vaccine. (And that's of course, without diving into all the dialogue on social media.)

The availability of a vaccine will have obvious repercussions for individuals. And business leaders are also considering how it will affect their organizations. But how can these leaders look at such a complex problem and make choices with confidence?

Since March, our team at Salesforce has been tracking this and many other uncertainties around COVID-19, and developing scenarios that clarify the range of possible outcomes, to help our own company and our customers make clear-eyed choices.

Typically, the art of scenario planning aims to lengthen decision-makers' planning horizons. But, in the words of Peter Schwartz, Salesforce's chief futurist and one of the authors here, 'In my nearly 50 years of scenario planning I've never seen uncertainty like that arising from the COVID-19 pandemic.'

As a result, we've found the need for scenarios on a shorter 9-month timeframe to support critical decisions for companies and governments. You can learn more about these in depth right here.

If and when a vaccine arrives, it will be a game-changer that introduces its own unique dynamics, which is why we drafted vaccine scenarios separately from the other scenarios for the spread of the pandemic. Let's take a deeper look at the three central uncertainties that define the track to a vaccine and the three potential outcomes that illustrate the range of possibilities.

Timing of availability of an effective vaccine

Most conversation about a vaccine centers on the uncertain timeline. As of this writing, only a handful of the nearly 200 vaccines being pursued had entered final (Phase III) trials or received partial approval. While millions of doses are already being manufactured in advance, for them to be released they have to clear the Food and Drug Administration's (FDA) requirement of effectiveness in at least 50% of subjects.

Relatively less attention has been paid to the challenge of effectiveness. Epidemiologists can't predict how long immunity will last in individuals; a vaccine that lasts just a few months is barely useful, while one that lasts a year is much more so. Two-year immunity is on the high end of expectations, since coronaviruses are 'notoriously famous for not granting durable immunity,' in the words of Michael T. Osterholm, the widely-respected head of the Center for Disease Research and Policy (CIDRAP) at University of Minnesota.

'However, in order to mount a global program, which will be needed in over 200 countries, at least four years' immunity and a single dose (rather than booster shots) and no cold chain would be nearly essential for WHO to have the best chance at controlling the pandemic,' says Dr. Larry Brilliant, a CNN medical analyst, founder of the Pandefense Network and a renowned epidemiologist who was part of the team that eradicated smallpox.

It is also possible that the best vaccine will only make the disease milder rather than protecting against it altogether. 'We have to be very, very careful in making assumptions that … [a vaccine] will protect us from not only illness, but from infection,' said Osterholm. 'We may not get a vaccine like that. We may ultimately get a vaccine one day that reduces the severity of illness.'

Predictions of the endgame for approval and distribution fall into three camps:

Optimistic: The Trump administration continues to insist that a vaccine will be available by the election. The FDA could announce approval before November 4, which Trump would claim to mean that the vaccine was available, in spite of the fact large-scale production will require many months more.

Mainstream: Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases (NIAID), agrees a vaccine could be approved by year's end, and the CDC is now guiding states that one could be distributed by mid-2021. This accords with the views of many epidemiologists, including Brilliant. 'I expect that by the new year we'll have 3-5 vaccines that meet the low bar of 50% efficacy established by the FDA,' he tells us. However, he does worry that rare but dangerous side effects will not be discovered with only thirty to forty thousand subjects getting the vaccine. And if they arise later, they will contribute to anti-vaccination sentiment.

Historical trend: Experts note we've never released a coronavirus vaccine for humans before and, in any event, the fastest we've ever developed an entirely new vaccine was the four years it took to create one for mumps. While optimism among epidemiologists is high that we will beat that timeline, the previous benchmark stands.