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Opinion | Are We Looking for the Wrong Coronavirus Vaccines?

Focusing on how to block the coronavirus’s transmission is a much more efficient approach.

This is why randomized controlled trials of the vaccines currently under consideration should include regular monitoring for the presence of SARS-CoV-2 in study subjects. The goal should be to evaluate whether the subjects acquire the infection at all, and for how long, as well as how abundantly they shed and spread the virus, when and how.

Studying these issues could also help cast a light on the role of so-called superspreading events in this pandemic.

More and more research suggests that a very small number of instances — gatherings at restaurants or bars, choir rehearsal, funerals, church services — might account for a vast majority of the cases of infection overall.

But the discussion about those instances has tended to focus on their settings and circumstances, such as the presence of crowds in confined spaces for extended periods of time.

Yet the question of whether some infected individuals, perhaps especially at certain stages of infection, are particularly infectious — whether they, themselves, are superspreaders — also needs to be studied head-on: When does contagiousness peak in whom and why? And can vaccines modify any of that?

The best vaccines don’t just protect the inoculated from getting sick from a disease. They also protect everyone else from even contracting the pathogen that causes that disease.

Preventing the very transmission of SARS-CoV-2, no less than stopping it from turning into Covid-19, should be a main priority of current efforts to develop the vaccines to end this pandemic.

Adam Finn (@adamhfinn) is a senior clinician in the pediatric immunology and infectious diseases clinical service at Bristol Royal Hospital for Children and a professor of pediatrics at the University of Bristol. Richard Malley (@rickmalley) is a physician specializing in infectious diseases at Boston Children’s Hospital and a professor of pediatrics at Harvard Medical School.

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