Is the end of pandemic nearer? McKinsey’s most recent update takes on the question.
Article by Sarun Charumilind, Matt Craven, Jessica Lamb, Adam Sabow, and Matt Wilson
Since we published our first outlook, on September 21st, the COVID-19 pandemic has raged on, with more than 25 million additional cases and more than 400,000 additional deaths. While the situation looks somewhat better in parts of the Southern Hemisphere, much of Europe and North America is in the midst of a “fall wave,” with the prospect of a difficult winter ahead. Yet the past two weeks have brought renewed hope, headlined by final data from the Pfizer/BioNTech vaccine trial and interim data from the Moderna trial, both showing efficacy of approximately 95 percent; and progress on therapeutics. Is an earlier end to the pandemic now more likely?
The short answer is that the latest developments serve mainly to reduce the uncertainty of the timeline. The positive readouts from the vaccine trials mean that the United States will most likely reach an epidemiological end to the pandemic (herd immunity) in Q3 or Q4 2021. An earlier timeline to reach herd immunity—for example, Q1/Q2 of 2021—is now less likely, as is a later timeline (2022). If we are able to pair these vaccines with more effective implementation of public-health measures and effective scale-up of new treatments and diagnostics, alongside the benefits of seasonality, we may also be able to reduce mortality enough in Q2 to enable the United States to transition toward normalcy.
A secondary effect of the recent vaccine trials is to make Q3 2021 more likely for herd immunity than Q4. That said, major questions are still outstanding, even about vaccines, such as long-term safety, timely and effective distribution, and vaccine acceptance by the population, to say nothing of lingering epidemiological questions such as the duration of immunity.
These are estimates for the United States, which is likely to have fast and ready access to vaccines. We will consider timelines for other countries in forthcoming updates; they will vary based on the timing of access and distribution of vaccines and other factors. In this update, we review the most recent findings, look deeper at five implications of the ongoing scientific research, and discuss why our timeline estimates have not shifted meaningfully.
Revelations from vaccine and antibody trials
The world has cheered announcements over the past two weeks by Pfizer and its partner BioNTech, and from Moderna. Their COVID-19 vaccine candidates are showing efficacy rates that are higher than many dared hope for. One is a final result, and the other is an initial result whose sample size is large enough to give reasonable confidence in the data. At about 95 percent, efficacy is higher than expected by most experts. It exceeds the optimistic case that we included in our September article. Higher efficacy provides greater benefit to any vaccinated individual and may help to encourage uptake among some segments of the population. It also reduces the fraction of the population required to reach herd immunity. Moderna also announced that its vaccine is more shelf-stable than expected and would need only refrigeration to keep it stable for 30 days—another piece of good news. Finally, there are a number of other vaccines in late-stage trials from which data is expected in the coming months.
Caution is still warranted. The safety records of the Pfizer and Moderna vaccines appear promising so far (no serious side effects reported), but the coming months will provide a fuller picture as the sample size grows. We don’t yet know how long the protection the vaccines offer will last. The Pfizer trial has enrolled some children (ages 12 and older), but efficacy in those under 18 remains unclear.
Beyond vaccines, science is also progressing in therapeutics for COVID-19. For example, Eli Lilly’s antibody bamlanivimab was granted Emergency Use Authorization (EUA) by the US Food and Drug Administration on November 9, and Regeneron’s EUA for its antibody cocktail REGN-COV2 for EUA was approved on November 22. Emerging data on these antibodies suggest that they can reduce the need for hospitalization of high-risk patients, and hold potential for post-exposure prophylaxis. While they are not recommended for use in hospitalized patients, these antibodies add to the growing armamentarium of treatments and protocols for COVID-19, where every incremental advance could help to reduce mortality. Collectively, these treatments and changes in clinical practice have lowered mortality for those hospitalized by 18 percent or more.
Vaccine age restrictions elevate coverage requirements to reach herd immunity
It appears that the two vaccines mentioned will be indicated first for use in adults.7 It’s not clear when use in children will be indicated. One consequence is that the vaccines’ contribution to population-wide herd immunity will depend on adults, at least until vaccines are approved for use in younger populations. If vaccines are efficacious, safe, and distributed to all ages, vaccine coverage rates of about 45 to 65 percent—in combination with projected levels of natural immunity—could achieve herd immunity.
On the other hand, if vaccines are efficacious but distributed only to adults, who comprise only 76 percent of the US population, then higher vaccine coverage rates—approximately 60 to 85 percent—could be required to achieve herd immunity.
Another consequence is that older children, who have twice the COVID-19 incidence of younger children and who have higher viral loads (and therefore greater potential contagiousness) than adults may not have immediate access to vaccines.
We recognize that calculating herd immunity thresholds is complex. Basic formulas fail to account for variations in the way populations interact in different places. For this reason we include relatively wide ranges.
Unclear impact of vaccines on transmission could raise the bar on coverage
Vaccine trials and regulatory approval will be based on safety and efficacy in reducing virologically confirmed, symptomatic disease among individuals. That’s not the same as reducing transmission. This distinction will have much to say about whether the United States reaches normalcy in Q2 or Q3 of 2021. In practice, we have data on whether people who are vaccinated are less likely to get sick with COVID-19 (and less likely to get severe disease), but we won’t have data on how likely they are to transmit to others. It’s an important distinction because what will drive herd immunity is reduction in transmission. If vaccines are only 75 percent effective at reducing transmission, then coverage of about 60 to 80 percent of the population will be needed for herd immunity. And if a vaccine is only 50 percent effective at reducing transmission, coverage of over 90 percent would be required.
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About the author(s)
Sarun Charumilind and Jessica Lamb are both partners in McKinsey’s Philadelphia office, Matt Craven is a partner in the Silicon Valley office, Adam Sabow is a senior partner in the Chicago office, and Matt Wilson is a senior partner in the New York office.
The authors wish to thank Gaurav Agrawal, Xavier Azcue, Jennifer Heller, Anthony Ramirez, Taylor Ray, and Sven Smit for their contributions to this article.
