Why can’t we get more people to accept a COVID-19 vaccine so we can get rid of masks?

And more than that...

I was recently asked this question on another forum:
What are effective ways to encourage people to get vaccinated against Covid-19 instead of relying solely on wearing masks?

Sadly, it’s been my experience that even intelligent people who are concerned, or worse, seriously and intentionally misguided about the COVID-19 vaccines can rarely be convinced to get fully vaccinated and then maintain all the boosters. But that said, I have to say: Vaccines are generally not going to prevent you from getting a viral infection, and the goal of the COVID-19 vaccines never was to achieve a “sterilizing” vaccine (stop the virus from getting you infected at all), but was rather to reduce the severity of your illness, prevent hospitalizations and deaths where at all possible. With the original mRNA vaccines we were incredibly lucky they were so efficacious against the strain ov SARS-CoV-2 as they were. And the vaccines were developed in record time because of nearly 40 years of work on the mRNA process. AND they sailed through all three phases of testing in record time meeting standard enrollment numbers and endpoints because the pandemic was in full swing, and lots of people in the control groups were getting infected while damned few in the vaccine group were suffering infection. In other words, because of a confluence of circumstances, the vaccines underwent full testing so fast because everything aligned. And they were very effective at preventing illness or if you got sick, limiting the severity.

In very general terms,m the purpose of a vaccine isn’t to prevent an illness by creating antibodies (the humoral immune response) but to train the B- and T-cells of the cellular immune system to recognize foreign antigen tissue the next time it appears, and start the process of creating antibodies using the cellular immune system. IF you already have sufficient humoral response (circulating antibodies) to respond initially to an infection, you might reduce the viral innocullum to the point where your infection is mild and in hours or days, the cellular system can come to full speed and attack remaining virus, but if you don’t have circulating antibodies because the humoral response has waned over time, then you have to wait for the cellular system to have the T cells recognize the foreign antigen and trigger a B cell response releasing IgG (antibodies, in lay terms) specific for the antigen identified. Vaccines are designed to “train” the cellular immune system to recognize the base form of an antigen and be able to produce appropriate IgG quickly but if the T cells identify another variant, the B cells can learn the genetic sequence and create, with some additional delay, the right response.

But vaccines will not stop COVID-19, nor most respiratory-transmitted viruses. With few exceptions these viruses are unstable and will mutate in random or seemingly random fashion. The successful variations (variants) will allow the virus to spread but won’t kill the host, or at least not too quickly, so that this variant can propagate and “succeed”. Variants happen when areas of their genetic material are chemically altered, and at that point, there may be a sufficient change in the 3D structure of the virus to preclude an existing antibody from blocking entry to the cell by, in the case of COVID-19, acetylcholinesterase receptors on the cell membrane of the host cells. This conformational change is the result of substitutions and deletions of certain elements often of the Spike protein and is referred to as “immune evasion”.

Because the viruses do mutate and can evade existing (circulating) immune response, the Public Health community has a concept of a multi-layered defense strategy:

https://www.nytimes.com/2020/12/05/health/coronavirus-swiss-cheese-infection-mackay.html

(hat tip to NY Times)

What this means is you don’t depend on one element, e.g., masks, vaccinations, air circulation, HEPA filtration, etc., but combine several, or all of these mitigations to reduce the likelihood of acquiring a sufficient viral load to become infected. So to answer your question, masks are likely to be an important Non-Pharmaceutical Intervention (NPI) from now on. Note that some cultures around the globe already utilize masks routinely and no stigma is associated with that. Instead, they have fewer respiratory-spread illnesses and fewer lung problems from pollution than the US.

At this point, somewhere between 15–20% of the population eligible for the current booster (which is effective in protection from severe disease from JN.1, the current dominant strain in the US) have actually availed themselves of the booster. That means a lot of people are at risk for getting ill, and COVID-19’s a non-trivial disease. We’re still learning which organ systems are affected, and how. Between 3–20% of those who have a COVID infection will develop post-acute COVID symptoms (PASC or Long COVID) and since these change with different variants we don’t have a great handle on which biomarkers we can measure to determine when someone has the syndrome and how to determine its severity in individual cases. As someone with a loved one who does have PASC/Long-COVID, I sorta know it when I see it but many of her doctors were stymied as to whjat to call it or what to do. In other words, we’re still learning.

This pandemic has seen an explosion in terms of scholarly work on a new disease process. Using a very quick Google Scholar search for SARS-CoV-2, over 643,000 PEER REVIEWED articles, and hundreds of thousands more on preprint servers (not peer reviewed). Further, the science involved in pandemic response was openly visible to the public via the Internet which had some unintended consequences, most notably that when experts were trying to communicate with peers, they often engaged in jargon for clarity and brevity… that only works if both/all parties understand the jargon. IF you’re not up to date on said jargon and often, as well, in the discipline-specific science, the words used may look like Engligh and be strung together in a “standard” sentence format, but the meaning of the words/phrases/sentences isn’t what you might think. This was an attempt at efficient communication, rather than obfuscation, although it’s been misinterpreted repeatedly since 2020. Also, we engaged in public health research and communication fell into a trap where our communications often related Data but didn’t communicate the meaning of these data very well to the public. This led to people claiming we were changing what we told people without justification. In general, we HAD made a change but it was premised on new information which might arise and change at least daily or even more frequently. We also saw some political figures, and I suspect (without a trace of conspiracy theory but with a knowledge of the security and intelligence space) that we had malign foreign actors as well as some malign domestic actors intentionally spreading DISINFORMATION, for reasons not specified unless one looks at it as an attack.We alsohad a number of people who aligned with some fragment of information that aligned with their world-view and propagated this misinformation, which is an unintentional spreading of false information. Both misinformation and disinformation has done significant damage to our COVID-19 pandemic response.