A vaccine is not necessary. That, for months now, has been the position of the International Olympic Committee and its Japanese partners with respect to the rescheduled Tokyo Olympics. The Games, they have said, will go on “with or without COVID.” In recent months, in public and private, even amid coronavirus surges, optimism throughout Olympic circles has surged as well.
Nonetheless, organizers reacted with “relief” on Monday to news from the vaccine world. Pfizer, an American pharmaceutical company, announced that its trials have been 90% effective. Leading scientists called the figure “remarkable” and “a huge step.” Tokyo’s Games delivery officer Hidemasa Nakamura digested all of this and said Tuesday morning: “The organizing committee is feeling the same as you probably felt — positive sentiment.”
Jonathan Finnoff, the U.S. Olympic and Paralympic Committee’s chief medical officer, agreed. “It's very exciting that there's such positive preliminary results,” Finnoff told Yahoo Sports on Tuesday.
And yet, Finnoff said, “It does not change any of our planning. … The most likely scenario is that there will be one or more vaccines available probably before the Olympics. But its availability to the public, and around the world, is going to be variable. And therefore we have to move forward with planning for the Olympic and Paralympic Games as if there is not a widely available, effective vaccine.”
Tokyo organizers are taking a similar stance. For sports, as for almost every segment of society, vaccine progress is a welcome development. Thousands of vaccinated Olympians would make the rescheduled Games a significantly more manageable undertaking. And the IOC, president Thomas Bach said Wednesday, has indeed been speaking with various authorities to figure out how it might get its hands on a vaccine. But many questions remain — about how impactful vaccines will be, about how they’ll be distributed, and about when athletes will have access to them.
Vaccine leads to questions
Experts celebrated Monday’s news because it proved, definitively, that 10 months of vaccine work will bear fruit — for Pfizer, and for other pharmaceutical giants whose trials are only slightly behind. “We know that if this vaccine works … several others are also likely to work,” says John Moore, a virologist at Cornell. “Which is a good thing. So we can reasonably anticipate that multiple vaccines are going to be useful in the next few months.”
Monday’s news was also, however, what those same experts call “science-by-press-release.” In the scientific community, it’s generally taboo. During a pandemic, it’s acceptable and necessary. The world can’t wait for detailed peer reviews. “It's understandable,” Moore says. “But it's also frustrating.” Because 10 paragraphs, incomplete results and optimistic quotes leave dozens of questions unanswered.
Paul Offit, chair of vaccinology at the University of Pennsylvania, and a member of the FDA’s COVID-19 vaccine advisory committee, asks one of the dozens: “Is the 90% efficacy long-lasting?” Or short-lived?
And does it apply to all demographics?
And what, exactly, does effectiveness mean? Does the vaccine merely prevent sickness? Or does it prevent a person from contracting the virus and spreading it as well?
A vaccine that stems spread would allow for much quicker progress toward vaccine-induced herd immunity. According to expert estimates, only around 60 percent of a population would need to be vaccinated to eradicate the virus. On the other hand, Offit says, “If the vaccine is good at protecting against illness, but less good at protecting against asymptomatic shedding, that matters. … When you’re exposed, and you still shed the virus, you're still contagious to others.” That would be bad news for everybody, including Olympians.
Then there’s the question of availability. Pfizer’s vaccine must be “distributed and stored under specialized conditions,” Moore explains, at negative-80 degrees Celsius. It won’t be available at your local Walmart.
“This could create major logistical challenges for mass treatment outside major urban areas and in low- or middle-income countries,” Andrew Hill, a pharmacology fellow at the University of Liverpool, told Reuters.
“To immunize hundreds of millions of people in America,” Moore says, “and billions of people worldwide, is a monumental effort.”
All of which means that when athletes converge on Tokyo in July, a vaccine won’t have ended the pandemic. Significant segments of the global population, likely a majority, won’t yet be immune. The big question, then, is what experts call “prioritization.” Who’ll be first in line for a vaccine? And second? How far back will athletes be, and how long will they have to wait?
How distribution will work
Vaccine strategy is remarkably complex. In the U.S., as in most countries, one central actor will be the federal government. It has already pre-purchased hundreds of millions of doses from Pfizer. Once Pfizer’s vaccine is approved, the CDC will decide whom to prioritize. The CDC and Department of Defense will coordinate distribution to all 50 states, where healthcare workers, other essential workers and vulnerable populations, including the elderly, are expected to get first dibs on whatever becomes available. Those groups constitute tens of millions of people, and each will require two doses.
Only after they’ve been immunized will the federal government allocate vaccine doses to the general public. Scott Gottlieb, a former FDA commissioner and Pfizer board member, has said that this could be mid-2021 if a vaccine is authorized by December 2020. Spring and summer of 2021 have long been pegged, by Anthony Fauci and others, as the timeline for mass rollouts. The Olympics are scheduled to begin in that window, on July 23.
But Olympians, American or otherwise, are not necessarily beholden to the U.S. government. While “America has clearly, under the Trump administration, taken an America-first [approach to vaccine development],” Moore says, other countries are sharing. International consortiums — which the U.S. chose not to join — are involved. Private companies like Pfizer and its German partner, BioNTech, are free to sell doses to whomever they want. The Australian government, for example, has also signed an agreement with Pfizer; and another with a second American company, Novavax; and a third with a domestic manufacturer.
“So countries — developed, Western, relatively rich countries — are putting into place their own plans,” Moore says.
The problem, he says: “I very much doubt that the Burkina Faso government, or Mongolia, has an advanced vaccine program. It depends on resources, as it always does. The developing world always gets the thin end of the wedge.”
And the developing world participates in the Olympics. There is, therefore, almost no chance that all 10,000-some Olympians are vaccinated by July. Unless, that is, the IOC cuts the line, by striking its own agreement with a private manufacturer or government. It could, in theory, buy tens of thousands of doses on its own. Bach said Wednesday that the IOC is already in contact with the World Health Organization, other governmental and non-government organizations, health authorities and manufacturers.
“There are different options under consideration,” he said. “But first of all, the first wave of vaccination — and this is what we are supporting very much — must be for people in need, for the high-risk groups, for the nurses, for the medical doctors, and for everybody who is keeping our societies alive.”
Finnoff, the USOPC medical chief, says he and his colleagues stateside have had their own “early discussions” about “when the vaccine's available, how we will get the vaccine.” But he echoed Bach, saying: “I think that essential workers and vulnerable populations, such as the elderly, in nursing homes and assisted living, need to be vaccinated first. They need to be highest priority.”
Even if an Olympic organization were to purchase its own vaccine supply, however, not every Olympian would want one. “We certainly have athletes who currently don't want to be vaccinated with standard vaccines,” Finnoff says. “There will likely be a mix of people who want to be vaccinated, and a small percentage of the population who does not.”
It’s also unclear whether the IOC would or could mandate vaccination. Dick Pound, the IOC’s longest-serving member, told Yahoo Sports last month: “It's more likely to take the form of a very strong recommendation.”
Plus, 90% efficacy isn’t 100%. Other vaccines could be less effective than Pfizer’s. Vaccination mitigates risk, but doesn’t eliminate it. COVID-19 will still be alive and kicking next summer — which is why organizers are devising other mitigation measures.
Olympic planning continues
Final decisions on the rescheduled Tokyo Games remain months away. Planning, however, has been ongoing since they were postponed back in March. Officials are expected to reveal detailed contingencies next month.
Halfway across the world, the USOPC doesn’t yet know what they’ll look like. But some information filters through. Some countermeasures are reasonably foreseeable.
Athletes, Finnoff says, will be subject to some sort of quarantine period before or after arrival in Tokyo. But athletes, of course, can’t be confined to hotel rooms for two weeks as they ramp up to competition. That period, instead, will be what Finnoff terms “a mobile quarantine type of environment, that is separate and safe from the public,” but that allows athletes to train. “The organizing committee recognizes the importance of ongoing training,” he says, and “also the potential for much higher injury rates, changes in performance ability” if quarantines were restrictive.
Testing will also be part of the strategy. “I think it's very likely that there will be a baseline amount of testing that will be performed by the organizing committee,” Finnoff says. “They haven't said the frequency or type of testing, but they've specifically said that testing and surveillance are part of their COVID mitigation plan.”
Other aspects of the plan, such as distancing measures in the Athletes Village, remain to be determined.
A vaccine, if available, would be a very strong part of that plan — but not a replacement. It would help keep athletes safe — but so will everything else. “I think they're gonna keep these measures in place until there can be such a high prevalence of vaccination, and with an incredibly effective vaccine,” Finnoff says.
Until then, he is operating on a simple motto: “Plan for the worst, hope for the best.”
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