COVID 19: Normalcy by spring, herd immunity by fall

More than eight months and 900,000 deaths into the COVID-19 pandemic, people around the world are longing for an end. 

A latest McKinsey report said there are two important definitions of “end,” each with a separate timeline:

 An epidemiological endpoint when herd immunity is achieved. One endpoint will occur when the proportion of society immune to COVID-19 is sufficient to prevent widespread, ongoing transmission. Many countries are hoping that a vaccine will do the bulk of the work needed to achieve herd immunity. When this endpoint is reached, the public-health-emergency interventions deployed in 2020 will no longer be needed. While regular revaccinations may be needed, perhaps similar to annual flu shots, the threat of widespread transmission will be gone.

A second (and likely, earlier) endpoint will occur when almost all aspects of social and economic life can resume without fear of ongoing mortality (when a mortality rate is no longer higher than a country’s historical average) or long-term health consequences related to COVID-19. The process will be enabled by tools such as vaccination of the highest-risk populations; rapid, accurate testing; improved therapeutics; and continued strengthening of public-health responses. The next normal won’t look exactly like the old—it might be different in surprising ways, with unexpected contours, and getting there will be gradual—but the transition will enable many familiar scenes, such as air travel, bustling shops, humming factories, full restaurants, and gyms operating at capacity, to resume.

The two ends are related, of course, but not linearly. At the latest, the transition to normal will come when herd immunity is reached. But in regions with strong public-health responses, normalcy can likely come significantly before the epidemiological end of the pandemic.

The epidemiological endpoint

Most countries have deferred the hope of achieving herd immunity until the arrival of a vaccine. When herd immunity is reached, ongoing public-health interventions for COVID-19 can stop without fear of resurgence. The timing of the endpoint will vary by country and will be affected by a number of factors:

Consider the first and most crucial variables: the arrival of vaccines, their efficacy, and their adoption. We see four plausible scenarios for vaccine efficacy and adoption illustrated in Exhibit 1.6 Different combinations of those two factors will drive varying levels of conferred immunity, implying the extent of natural immunity that will be required to reach herd immunity under each scenario. Combinations of efficacy and adoption beyond those shown are possible.

Based on our reading of the current state of the variables and their likely progress in the coming months, we estimate that the most likely time for the United States to achieve herd immunity is the third or the fourth quarter of 2021. As we wrote in July 2020, one or more vaccines may receive US Food and Drug Administration Emergency Use Authorization before the end of 2020 (or early in 2021) and the granting of a Biologics License Application (also known as approval) during the first quarter of 2021.

Vaccine distribution to a sufficient portion of a population to induce herd immunity could take place in as few as six months. That will call for the rapid availability of hundreds of millions of doses, functioning vaccine supply chains, and peoples’ willingness to be vaccinated during the first half of 2021. We believe that those are all reasonable expectations, based on public statements from vaccine manufacturers and the results of surveys on consumer sentiment about vaccines.7

Herd immunity could be reached as soon as the second quarter of 2021 if vaccines are highly effective and launched smoothly or if significant cross-immunity is discovered in a population (For more on the potential for a faster resolution of the COVID-19 crisis in the United States, see “Searching for optimism in the US response to COVID-19,” forthcoming on McKinsey.com.)

On the other hand, the epidemiological end of the pandemic might not be reached until 2022 or later if the early vaccine candidates have efficacy or safety issues—or if their distribution and adoption are slow. At worst, we see a long-tail possibility that the United States could be still battling COVID-19 into 2023 and beyond if a constellation of factors (such as low efficacy of vaccines and a short duration of natural immunity) align against us.

The paths to herd immunity in other high-income countries are likely to be broadly similar to the one in the United States. The timelines will vary based on differences in vaccine access and rollout and in levels of natural immunity—and potentially, in levels of cross-immunity and previous coverage of other vaccines, such as the BCG vaccine.

Even as some locations reach herd immunity, pockets of endemic COVID-19 disease are likely to remain around the world, for example in areas affected by war or in communities with persistently low adoption of vaccines. In such places, until herd immunity is reached, COVID-19 might be analogous to measles—not a day-to-day threat to most people, but a persistent risk. If immunity wanes—for example, if booster vaccines are not fully adopted—then COVID-19 could become more widely endemic.

The arrival of herd immunity won’t mean a complete end to all public-health interventions. It’s possible that regular revaccinations would be required to maintain immunity and ongoing surveillance for COVID-19 will be required. But herd immunity would mean that the emergency measures currently in place in many countries could be lifted.

The pace at which governments relax public-health measures will be critical. Some of those measures (such as full lockdowns and restrictions on certain industries) have significant social and economic consequences, and others (such as testing and tracing), while expensive, don’t. Many governments are employing packages of measures that aim to minimize the number of COVID-19 cases and excess mortality while maximizing social and economic degrees of freedom.

The transition to normal

The second endpoint of the pandemic may be reached earlier than the first. We estimate that the most likely time for this to occur is the first or second quarter of 2021 in the United States and other advanced economies. The key factor is diminished mortality.

Society has grown used to tracking the number of COVID-19 infections (the case count). But case counts matter primarily because people are dying from the disease and because those who survive it may suffer long-term health consequences after infection. The latter is an area of scientific uncertainty, but there is concern that some recovered patients will face long-term effects.8

Most countries have made significant progress in reducing the number of deaths and hospitalizations associated with COVID-19. Some are close to eliminating excess mortality. Those results have generally been achieved through a combination of moderately effective interventions rather than a single “big bang”.

A transition to the next normal, in whatever form that takes, will come gradually when people have confidence that they can do what they used to do without endangering themselves or others. Gaining that confidence will require a continuation of the progress made to reduce mortality and complications, as well as further scientific study regarding long-term health consequences for recovered patients. When confidence is restored, people will again fill bars, restaurants, theaters, and sports venues to full capacity; fly overseas (except for the highest-risk populations); and receive routine medical care at levels similar to those seen prior to the pandemic.

The timing of such a transition will depend on the progress toward herd immunity, as previously detailed (since more people with immunity means fewer deaths and long-term health consequences), and on the effectiveness of a country’s public health response. Transitions will be gradual. They have already begun in some locations and could be well advanced in most countries by the first or second quarter of 2021. Given the interconnectedness of the global economy, country timelines to normalcy are not fully independent of one another.

To achieve that, we will need to see significant progress on the epidemiological endpoint, including an effective vaccine receiving Emergency Use Authorization approval during the fourth quarter of 2020 or the first quarter of 2021, followed by a smooth rollout and adoption by high-risk populations. Favorable findings on natural and cross-immunity would help accelerate timelines. Five additional criteria will also contribute to the transition to a form of normalcy—the more of these that are achieved, the faster the milestone is likely to be reached:

Both the epidemiological and normalcy ends to the COVID-19 pandemic are important. The transition to the next normal will mark an important social and economic milestone, and herd immunity will be a more definitive end to the pandemic. In the United States, while the transition to normal might be accomplished sooner, the epidemiological endpoint looks most likely to be reached in the second half of 2021. Other advanced economies are probably on similar timetables. (https://www.mckinsey.com)