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 entered a new phase this week as American health care workers 

 — the first in what will be a massive effort. Science writer Ed Yong of The Atlantic says the coming months will usher in the most complicated immunization program the U.S. has ever attempted.

"It's going to be a slow process, and there are a lot of possible roadblocks in the way in terms of producing the vaccine, distributing it, allocating it," Yong says. "Don't think of the vaccine as a light switch — that the minute it starts going into people's arms, normalcy resumes. ... It's going to take awhile for things to get under control."

Yong has been covering the pandemic since it began, writing about nearly every aspect, including how the virus is spread; the 

 who have symptoms lasting for months; and the mental health of the doctors and nurses caring for patients.

 explains the science that led to the development of COVID-19 vaccines in record time — and the flawed thinking that has shaped misguided health policies.

Yong says that the U.S. vaccination program will depend upon a public health structure that has been severely overburdened and underfunded. He notes that the amount of money Congress allocated for vaccine distribution was "minuscule" compared with the sum devoted to creating the vaccine.

"I think there has been a certain amount of naïveté on the part of the government about what it actually takes to turn vaccines into vaccinations," he says. "Unless we actually put more funding into this particular area, it's going to be a bit tragic, because we're going to have vaccines, but we're going to fall at the last hurdle."

Nevertheless, Yong is optimistic about 2021: "Both [with] a combination of an administration that's taking things seriously and the rollout of the vaccines, I'm hoping that that will restore some of the cherished rituals that we lost this year."

On whether or not a vaccinated person could still transmit the disease 

We don't know. And the reason we don't know is that the clinical trials that assess the 

 vaccine looked really only at their ability to prevent symptomatic disease.

So we know that they stop people from developing symptoms very, very effectively, much more effectively than anyone had dared hope for. But we still don't know whether they stop infected people from transmitting. Now, two things there: If they don't, that is bad news because it means it's going to be much harder to achieve herd immunity, the level at which the virus struggles to find new hosts. And it means that there's a risk that vaccinated people lower their guard and could potentially spread the virus to others, which would be a pretty bad scenario.

That being said, I think it is reasonable to assume, based on how well these vaccines seem to prevent symptomatic disease, that they will have some effect, too, on reducing transmission. So a lot of the people I spoke to are variously hopeful or pretty confident that they will have an effect on transmission. ... But we'll just have to see when new data comes out. But our expectation, I think, should be that they do have at least some effect on reducing transmission.

On whether new messenger RNA vaccine technology is at all a health concern 

I don't think that they should [be concerned]. There has been a long process of development for mRNA vaccines that go well beyond this year, and that's partly why these vaccines could be made in such short order. I'm pretty confident, looking at the clinical trials that have already been done for the Pfizer and Moderna vaccines, that they didn't skimp on any of the necessary steps for testing things like safety and efficacy. Things were quick, but corners don't seem to have been cut.

And there's nothing about the biology of these vaccines that's concerning. So these vaccines use mRNA, which is the genetic material of the virus. They use a sliver of that genetic material and inject it into the body. The body then uses that material sort of as an instruction booklet to reconstruct a very small and noninfectious portion of the virus, a protein called a spike protein, which sits on its surface and which it uses to interact with our cells. That little fragment of the spike is then used by the immune system to prepare adequate defenses in case the actual virus should make its way into us.

None of that really is cause for concern. We're not dealing with anything infectious. We're not dealing with anything particularly dangerous. As I've said, this technology has been developed and refined for many years, and if anything, this year is the year in which mRNA vaccines have proved their worth — and that's a really good thing. That's a really encouraging thing, not just because of COVID-19. These vaccines are designed to be customizable. So most traditional vaccines have to be bespoke: Whenever you get a new pathogen, you have to design an entirely new vaccine to counter it. And this "one bug, one drug" approach is very laborious and very time-consuming. 

But mRNA vaccines should be very easy to tweak to whatever new virus emerges. You just take that virus's genetic material, slot it into these existing vaccines and you're off to the races. So the fact that they're working this time, the fact that we have one [vaccine] approved — possibly two [vaccines] in the near future — means it sort of heralds an age where we should be able to develop vaccines against new emerging diseases much more quickly than we have ever done in the past.

On how Congress didn't allocate enough money to study children and education in the pandemic

I think that the disruptive and discordant policies are reflective of America's very disparate attempts to deal with the virus and the fact that there was no single, coordinated and effective national strategy. ... There are just the basic aspects of how the virus moves between children — to what extent children and schools, more generally, contribute to the spread of the pandemic — that are still being argued over by very seasoned veteran experts in this space. I think partly that stems from a lack of clear, coordinated, large-scale research efforts.

There simply wasn't, certainly in this country, a study of the size and scope that would offer really solid answers to these questions. A lot of the ones that were done were small and piecemeal. I think that reflects our biases, as a society and biases among the research enterprise. ...

We want drugs and vaccines, and a lot of biomedical researchers focus on sickness as an acute event — just a battle between a person and a virus that leads to perhaps death or recovery. 

But a lot of social scientists think about long-term consequences. They understand that if you take children out of school for a year, maybe longer, you're really going to set them up for problems much further down in their lives and in their careers. So it should have been obvious to everyone, even in March, that without a vaccine ready by the fall, we would need to face questions about whether schools would reopen. And this was a major area of research that needed investment. 

But when Congress awarded billions of research to the [National Institutes of Health] to study COVID-19, none of that went down to the National Institute of Child Health and Human Development, which focuses on these kinds of issues. That institute did do some studies, but it didn't benefit from that massive congressional bolus of money, and that's a tragedy. I think it reflects where our priorities lie and areas that are being neglected.

On how surviving a severe case of COVID-19 depends on the health care workers, who are overburdened and burned out 

COVID-19 patients who end up in an ICU are

some of the sickest patients that a lot of health care workers have ever treated. They might have eight to 12 intravenous lines going into their heart and other blood vessels, pumping in pain meds, sedatives, all kinds of other things, none of which are specifically designed to treat COVID. They're just about keeping that patient alive. And so a lot of that savvy of how to deal with a patient whose body is just crashing — that's the thing that makes a difference. ...

This third surge, which is pummeling health care facilities across the country, is stretching nurses and doctors and respiratory therapists to the very limit. And the more that happens, the less they are able to make use of all that knowledge that they've learned over the year and the higher death rates are going to become. And I worry that we're still only just starting to see the tip of that happening now.

On how the virus has exposed vast inequity in the U.S. 

This disease has widened every possible inequity that it could find in this society, and it has found plenty. Just in terms of preventing yourself from infection, a lot of people have been able to stay at home and work from home. Many people had to do so-called essential work. They had to go out and about, exposing themselves and their loved ones and colleagues because they earned low hourly wages that they couldn't afford to skip.

And then a lot of Americans don't have access to health care at all, or receive [a] poorer quality of health care. A lot of people from Black, Latino and other minority groups have long received poorer quality, discriminatory health care, that has led to worse outcomes even before COVID-19. So it's no surprise that a lot of these folks have also been disproportionately hit by this virus.

On what he expects from the Biden administration 

I'm expecting good things. I'm expecting them to actually try to control the pandemic, which is almost an astonishing thing to say, but we've not had that this year. We've had an administration that has been woefully negligent and that in some ways has actually just tried to let this thing rip through the community unchecked. I expect the Biden administration to actually try to control it.

A lot of the measures they've talked about in their plans — testing, supporting public health, all of these things — are things that experts have been calling for for the entire year, often in vain. I'm really, really glad to see a lot of seasoned experts on the task force in the administration.

 has been picked to lead the CDC. She is a phenomenal scientist and a great communicator. A lot of the people who've been appointed to the COVID-19 task force have a strong focus on health equity, and that's really important. We need people who can maintain a focus on the most vulnerable and the most hard-hit populations. What I would love to see more of are more social scientists on the panel. We know that issues of trust, of communication have been so vital and so missing this year, and we're going to need that going forward in 2021.

Obviously, the vaccine rollout is going to be a very complicated process with a lot of potential pitfalls. And I think we need to remember that even if it goes really well, there will be a lot of lingering scars from this year that will take a long time to heal. The stresses upon the health care system, the numbers of health care workers who will leave or who will have burned out, the long-haulers who will still be struggling with symptoms, the widened inequities for communities of color, for women who dropped out of the job market, for people from poorer communities who were financially hit by the economic fallout of the pandemic. All of these things will continue to be problems even as vaccination brings the pandemic to its endgame.

Amy Salit and Kayla Lattimore produced and edited this interview for broadcast. Bridget Bentz, Molly Seavy-Nesper and Deborah Franklin adapted it for the Web.

Health

COVID-19

Terry Gross

Author

Atlantic writer Ed Yong says the COVID-19 vaccination program will be the most complicated the U.S. has ever attempted: "It's going to be a slow process, and there are a lot of possible roadblocks."

Without resources, vaccine rollout could 'fall at the last hurdle,' journalist warns

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