COLUMBUS, Ohio — At a recent COVID-19 vaccination clinic, a woman about to get her shot asked the nurse, "Are we going to have to do this every year?"
"We don't know yet," the nurse answered.
She was right. The vaccines are too new to determine things like how long they provide immunity, and another crucial variable is how many people end up getting the vaccine.
Ultimately, only time and more research will provide the answers.
"That's definitely one of the questions of the hour," said Dr. Iahn Gonsenhauser, chief quality and patient safety officer for Ohio State University's Wexner Medical Center. "Everyone wants to know what this will look like moving forward. Among the medical community, the prevailing sentiment is moving toward the idea that COVID likely will have some footprint in the community for the foreseeable future."
The consensus of several experts interviewed last week, though, was that perhaps as soon as next year, dealing with COVID-19 will become more like dealing with the flu: It may require a booster shot, but the disease will no longer be a raging pandemic, and we won't have to have such a large-scale, urgent vaccine campaign.
"We anticipate that this is not going to go away, but we envision it becoming endemic," said Dr. L.J. Tan, chief strategy officer for the Immunization Action Coalition, a nonprofit organization based in St. Paul, Minnesota, that helps educate health care providers on vaccines.
So what does endemic mean, exactly? And what's the difference between that and a pandemic?
In short, a pandemic is a disease that is spreading out of control and to different parts of the world. A disease is considered endemic when it is seasonal and/or more predictable, such as malaria in tropical parts of the world or the flu in the United States.
Some of the difference can be attributed to whether the disease is caused by a new (or novel) virus to which a population has no immunity. This factor is why diseases such as smallpox or measles devastated indigenous Americans when Europeans settlers first arrived, and why COVID-19 has hit us so hard.
One can achieve immunity either naturally — the body is exposed to the disease and develops antibodies — or by vaccination, which prompts the body to develop antibodies and other defenses.
For a large population to combat a virus such as COVID-19 through natural immunity alone, however, would come at an incredible cost of lives. And that's why getting vaccines into as many arms as possible is crucial to de-escalating a pandemic.
The longer the virus circulates through a population, the more it has a chance to mutate and create some of the variants that have been popping up recently.
"How well we stop the variants goes hand-in-hand with how well we continue to vaccinate," Tan said. "If we can stop the virus from replicating, then they can't mutate. If we can reduce mutation by vaccination, we could see an immediate impact as soon as next year."
Experts say COVID-19 likely will not be a case like the measles, in which a vaccine was created that eventually eradicated the disease in America. That's because the measles virus did not mutate.
Instead, a better comparison for what COVID-19 will look like in the future is the flu, a disease that occasionally produces worrisome variants that cause outbreaks. Millions of people routinely get a flu shot each year, and those vaccinations are formulated to combat the latest mutations to the virus.
Virginia Ruef, a regional pharmacy officer for Mount Carmel Health System, said those boosters are important, even if they are not 100% effective.
"You hear from year to year, `Oh, the flu shots aren't that effective this year,'" Ruef said. "But you still are getting an exposure to a variant, and your body remembers that. So years later, if you had four or five years of flu shots, a variant may emerge that is similar and you already have some immunity built up."
Ruef and Gonsenhauser both predicted that a COVID-19 vaccine will quickly become a routine part of annual health care, one shot you get alongside a flu shot or other periodic boosters.
"I'll be shocked if we don't end up with a combination flu-COVID vaccine," Gonsenhauser said. "There won't be large-scale vaccination sites, it will just be part of what you do every year."