Delivering an effective vaccine is only part of the equation. The region's recovery from COVID-19 also will hinge on Long Islanders' willingness to take the shot, experts say.
The public's appetite for inoculations will be a wild card, said Julie Swann, an expert in health care supply chains who advised the Centers for Disease Control and Prevention during the H1N1 outbreak in 2009.
"We could get [the vaccine] out there, but people won't believe [in] it and they won't take it," she said. At minimum, recipients need to be reassured that they're not a "guinea pig in an experiment."
Skepticism runs particularly high in Long Island's "very vocal" anti-vaccine community, said Kevin Law, CEO of the Long Island Association business group.
Americans overall are split on the vaccine, according to pollsters. A September survey by Pew Research Center found that 49% of U.S. adults said they definitely or probably would not get a vaccine when it becomes available. The number of vaccine skeptics dropped to 42% in a Gallup Panel survey conducted in October, a number that still would leave broad swaths of the population without immunity.
The clock is ticking. Earlier this month, Pfizer Inc. and its German partner, Biopharmaceutical New Technologies, known as BioNTech, filed for emergency use authorization with the Food and Drug Administration for its vaccine candidate, BNT162b2.
Pfizer has launched a pilot program with Texas, Tennessee, New Mexico and Rhode Island to smooth wrinkles in delivery and deployment of the initial 100 million doses pending FDA approval.
Moderna, which like Pfizer has reported vaccine efficacy of more than 90% in late-stage trials, is expected to follow shortly in seeking FDA approval.
The vaccine will be administered through pharmacies, clinics, doctors' offices, public health sites, Indian health facilities and other sites, according to the federal Operation Warp Speed plan. The Defense Department will assist with logistics.
The CDC website is directing inquiries on finding a vaccine to nwsdy.li/vaccine, which will update once a COVID-19 vaccine is widely available.
In the meantime, herd immunity — requiring 60% to 70% of the population to have antibodies after having the virus or through vaccination, according to the World Health Organization — remains a distant goal for Long Island.
Swann, who heads the department of Industrial and Systems Engineering at North Carolina State University, calculates that between 70% and 85% of Long Islanders remain susceptible to the virus.
Her back-of-the-envelope estimate (derived by working backward from the number of COVID deaths) means that roughly 15% to 30% of Long Islanders have had COVID-19, far higher than the 4% (108,000) count of official confirmed cases.
But still, "we're not close to herd immunity," Swann said.
Long Island's history as a hotbed of campaigns against vaccines could carry over to COVID-19 inoculations.
Some activists maintain that vaccines cause autism, a position refuted by the CDC and mainstream medical research.
One Long Islander who said he will not be taking a COVID-19 vaccine is John Gilmore, executive director of the Autism Action Network, who wrote in Creations Magazine of a "global fight between the parents of the world against the cartel" of pharmaceutical companies that make vaccines.
"I'm not going to get it," the Long Beach resident said of the COVID-19 vaccine. "I think some people would drive over their own children on the way to getting the shot, and there are a lot of people who would never get it."
Gilmore said his chances of dying from COVID-19 are less than his chances of dying from the flu, whose vaccine he also shuns.
A CDC study published in October of about 9,000 Veterans Health Administration patients, however, found that hospitalized COVID-19 patients were more than five times more likely to die (21%) than those with the flu (3.8%).
Presenting an unambiguous message about the vaccine's benefits could tilt the scales for the undecided, said Tinglong Dai, a professor of operations management and business analytics at Johns Hopkins University.
Seeing President-elect Joe Biden roll up his sleeve and get the vaccine, for example, would encourage those who are hesitant, he said.
"Messaging from the government really matters," Dai said. "It's important for the public to be confident. The way to achieve that is to be fully transparent."
The local environment counts as well. "If your neighbors, co-workers, friends get vaccinated, so will you," said Dai, who specializes in health care.
Dai said some people who refuse to be vaccinated may become "free riders," who aren't vaccinated, but are shielded from infection by their neighbors, co-workers and family members who are.
New York and other states already have drawn up tentative plans for the sequence of vaccination, though that could be overridden at the federal level.
New York calls for staff at emergency departments and intensive care units, and staff and at-risk residents at long-term care facilities to be first in line.
Once vaccines reach the broader population, however, questions of acceptance could emerge.
No government edict to take a COVID-19 vaccine exists, but mandates from schools and workplaces are an open issue, legal experts say.
Michael Schmidt, a Melville resident and a labor and employment attorney with Manhattan-based Cozen O'Connor, said the vaccine regulatory environment remains hazy.
The Equal Employment Opportunity Commission has taken the position that employers "generally can mandate a flu vaccine unless the employee has a lawful religious exemption" or a medical condition that precludes vaccination, he said.
Someone with a philosophical or political objection to vaccines would not qualify for a religious exemption, he said.
Businesses have been inquiring about whether the policy that applies to the flu vaccine would extend to the COVID-19 vaccine, but state and federal agencies have yet to provide guidance, Schmidt said.
Swann said vaccine mandates could target high-risk occupations like prison guard and meatpacker though regulations could vary from state to state.
Thomas A. Cook, managing director of East Moriches trade consultancy Blue Tiger International, said companies may face a standoff with recalcitrant workers.
"What happens in a Long Island company that's got 200 employees and they make a statement: 'You've got to get the vaccine' and the employee says, 'I don't want to'?
Cook also said that when a vaccine reaches the market, people may let down their guard even before it is distributed widely.
Pfizer and BioNTech project that they will produce up to 50 million vaccine doses worldwide in 2020 and up to 1.3 billion doses by the end of 2021.
"The psychological impact may start to affect behavior even before the vaccine is distributed broadly," Cook said.
Law said a recent spike in COVID cases portends a "bumpy ride in the next few months."
Still, he predicted, most Long Islanders will want to get the vaccine, which "will bode well for returning to normalcy in the second half of next year."
Swann forecast prepandemic normalcy could return by the end of next summer and that schools will resume full-time in-person classes next fall though perhaps with face masks.
She said her personal green light will flash once a 95% effective vaccine is distributed and is adopted by 70% of the population.
"I'd eat in a restaurant, which I haven't done in a while."
Who Is First in Line for a Vaccine
New York State's Department of Health has rolled out a distribution plan, including the sequence for allocating vaccine that is expected to be in short supply in the initial stages. Below is the sequence of distribution:
Health care workers providing patient care, with priority given to those in intensive care units, emergency units and those providing emergency medical services.
Long-term care facility workers who interact with residents.
At-risk long-term care facility patients
Police, fire and national guard first responders.
Teachers, school staff and child care providers.
Public health workers.
Workers who interact with the public and maintain critical infrastructure, including pharmacists, grocery store workers, transit employees.
Other long-term care facility patients and those living in other congregate settings deemed to be at high risk.
People in the general population with comorbidities and health conditions that put them at high risk.
People over 65.
People under 65 with comorbidities and health conditions.
All other essential workers.
Healthy adults and children.
Within those categories, the vaccine will be delivered first to those deemed to be at higher risk and those who live in COVID-19 hot zones.
The state's sequence could be revised by new federal guidelines and updated data on vaccine side effects and levels of protection afforded to subgroups such as senior citizens.
A note to our community:
As a public service, this article is available for all. Newsday readers support our strong local journalism by subscribing. Please show you value this important work by becoming a subscriber now.SUBSCRIBE