What started as a tidal wave of COVID-19 vaccination in the first quarter of this year—remember those long lines of cars queued up at the mega-sites?—began to ebb as March turned to April and April turned to May. To re-energize the effort, President Biden on May 4 announced the goal of getting one shot into the arms of 70% of American adults by July 4.
It has proved to be a laudable but elusive goal. Yesterday the White House admitted that we will fall short of the 70% threshold by the time we fire up the holiday BBQs. Yes, we have managed to vaccinate 70% of adults over age 30 (and 65.5% of all adults), but have yet to persuade the younger set to roll up their sleeves en masse.
As of May 22 just 38% of adults ages 18 to 29 have had at least one shot, the Centers for Disease Control and Prevention reports, versus 57% of all adults and 80% of seniors 65 and older. At current rates of vaccination, coverage by the end of August would reach 78% for all adults but with wide swings: a whopping 95% for seniors, 86% for adults ages 50 to 64, 71% for the 30- and 40-somethings, but just 58% for those 18 to 29.
The reasons why people don’t get vaccinated are the ones you likely have heard: concerns about side effects, general distrust of COVID-19 vaccines, a desire to “wait and see” more evidence of safety and effectiveness, a feeling that others are more in need of a vaccine, or a belief that the vaccine itself is not needed at all.
To improve vaccination rates in younger adults, the CDC suggests turning to trusted sources, such as health authorities and primary care providers, “to explain the community and individual value of vaccination and to address concerns about vaccine safety.” If younger adults don’t feel particularly vulnerable to serious illness themselves, it helps to emphasize that vaccines are important in preventing the spread of COVID-19 to family and friends and resuming social activities. Also suggested: offering vaccinations at work and at strategically located mobile and walk-in clinics with flexible hours.
Let’s take some measure of pride in the fact that we have fully vaccinated 150 million Americans since mid-December, no small feat, and that what President Biden describes as a “summer of joy” is still within reach of a pandemic-weary country.
Will vaccine perks and privileges be enough?
Quite apart from the million-dollar lotteries and sweepstakes, with their long shots of winning big bucks or college scholarships, any number of perks and benefits are within easy reach of the COVID-19 vaccinated.
· On Father’s Day, the Foo Fighters played to a fully vaccinated crowd at Madison Square Garden, the first concert at the World’s Most Famous Arena since March 2020. Anti-vax protestors waved signs outside.
· The first cruise ship available to North Americans since March 2020 set sail from St. Maarten earlier this month with 95% of passengers and 100% of crew fully vaccinated. Carnival Cruise Line will depart with a load of fully vaccinated passengers on its first ship out of Galveston, Texas in July. Many—but not all—cruise lines are requiring COVID-19 vaccination as a condition of stepping on board. Such requirements are currently a matter of contention in the courts, but when all is sorted out, the vaccinated are likely to enjoy smoother sailing.
· In its guidance covering all types of travel, at home and abroad, the CDC draws a bright line between the vaccinated and unvaccinated when it comes to testing and quarantining as well as the trifecta of masking, distancing, and washing hands.
· The CDC also has an infographic on “Choosing Safer Activities,” showing the faces of happy, maskless and vaccinated people along one side of a list of activities and the faces of less happy, mostly masked and unvaccinated people along the other side. The CDC considers it “least safe” for the unvaccinated to go to an indoor movie theater, attend a full-capacity worship service, eat at an indoor restaurant or bar or participate in an indoor, high-intensity exercise class. In all such situations, the agency recommends the mask/distance/wash trifecta for the unvaccinated only.
· The Occupational Safety and Health Administration has updated its guidelines for employers—and its rules for healthcare settings—that allow different sets of standards for the vaccinated and unvaccinated in the interests of mitigating the risk of COVID-19 transmission in the workplace.
· California celebrated the full-blown re-opening of its economy on June 15, lifting restrictions here and there and almost everywhere while not abandoning all caution. For example, people who go to indoor concerts, sports events or other large gatherings of more than 5,000 people will have to provide proof of vaccination or a negative COVID-19 test. At outdoor events with more than 10,000 people, folks are “strongly encouraged” to do the same. California is offering 50,000 free passes to Six Flags amusement parks to the vaccinated.
· New York also marked its re-opening on June 15. Fairs and festivals may eliminate six feet of social distancing and thus increase capacity “if all attendees within the event space—or a separate designated area in the event space—present proof of full vaccination status.”
The Vax and the Vax-Not
The National Football League demonstrated just how far the distinctions can go. Unvaccinated players must undergo daily testing for COVID-19; the fully vaccinated are exempt. The vaccinated have unrestricted use of the team cafeteria, weight room, steam room and sauna; the unvaccinated do not. Vaccinated players can eat with vaccinated family members and friends while traveling; the unvaccinated must stay in the team hotel for meals, cannot dine in restaurants and are not allowed to interact with non-team members while traveling. All of these guidelines are part of a joint agreement between the NFL and the players’ union for the 2021 season.
For the vast majority who do not play professional football, some form of preferential treatment awaits those of us who have had our COVID-19 shots. Did we mention the most pertinent perk of all: Gaining a healthy measure of protection against a disease that can be debilitating or fatal?
These developments come at a time when everything seems to be dropping. Nationally, COVID-19 cases, hospitalizations and deaths are down precipitously compared to where we were a year ago. At the same time, COVID-19 vaccination rates are falling off after a strong push in Q1 of 2021.
One thing that should not drop, public health officials caution, is our guard, especially in parts of the country where vaccination rates are low and segments of the population remain vulnerable to the virus. Hot spots keep cropping up on the COVID-19 weather map—in southern Missouri, for example, where a surge in cases and hospitalizations occurred in counties with vaccination rates below 30%, counties that are home to tourist attractions such as Branson and Lake of the Ozarks.
· The virus itself keeps shape-shifting, the latest rogue being the highly transmissible Delta variant, first identified in India and now rampant in the U.K. and delaying a return to normal activities. Delta is quickly gaining a foothold in the U.S., responsible for about 20% of infections, and on a pathway to becoming globally dominant, according to the World Health Organization. The good news is that the vaccinated are generally well protected against this and other variants. The bad news is that the unvaccinated, who number in the tens of millions and represent half of the U.S. population, are not.
· We have essentially answered the question of, if we build a vaccination mega-site, will they come? The answer was yes, about half of them. The vaccination campaign is now rolling out in smaller community-based settings: doctors’ offices, pharmacies, neighborhood health centers and pop-up clinics. Door-to-door canvassing of the homebound is an option, as Diane Eastabrook reports in McKnight’s Home Care Daily. The Mayors Challenge to Increase COVID-19 Vaccinations, looking to employ any and all strategies, has 114 participating cities.
· Now that everyone 12 and older is vaccine-eligible, children and adolescents remain key pieces of the puzzle. A Harris Poll finds that 54% of parents intend to have their 12- to 17-year-olds fully vaccinated, while 9% have already done so. Nearly two-thirds (62%) plan to have their children under 12 vaccinated when that becomes an option. Some parents (11%-12%) want their kids to have just one instead of two doses of vaccine, which is not a recipe for optimal protection against emerging variants. One in four parents do not intend to have their children vaccinated as they await more data on safety (51%) and effectiveness (37%). Nearly two thirds of parents (64%) support required vaccination of eligible children in grades K-12 and 72% support mandatory vaccination of teachers and school staff.
· Most employers are still choosing to encourage rather than mandate vaccination, with notable exceptions among hospitals, health systems, senior care networks and universities. IntegraCare, based in Pittsburgh with 13 senior living facilities in Pennsylvania, Maryland and Virginia, has achieved a 100% vaccination rate among staff, Kimberly Bonvissuto reports in McKnight’s Senior Living. Enlivant, a Chicago-based company with 216 senior communities in 26 states, has vaccinated 90% of staff and residents and is working toward 100% in a campaign called “Together We Can Do It.” Other senior living centers have achieved staff vaccination rates of 97% and 98% with mandates.
· Despite these signature successes, the long-term care industry concedes that it will not reach its national goal of vaccinating 75% of staff by June 30. Danielle Brown has details in McKnight’s Long-Term Care News.
· Anyone working in a nursing home or personal care facility in England will need to be vaccinated against COVID-19, Nick Bostock reports in GP. The policy, which requires approval by Parliament, applies to physicians paying visits to residents as well as hairdressers, tradespeople and others who provide services on site. Some employers are concerned that the mandate could hamper recruitment and retention in a sector that is already experiencing a staff shortage. Jessica Brown has details in People Management.
· The CDC’s Advisory Committee on Immunization Practices is meeting today to examine data on reported cases of heart inflammation in teen and young adult recipients of COVID-19 vaccine. The item was on the agenda for a meeting last Friday but the session was postponed by the newly designated Juneteenth holiday.
· While vaccination is the front end of the COVID-19 solution, the back end is providing successful treatment for those who get sick. Good news: Regeneron’s monoclonal antibody cocktail of casirivimab and imdevimab reduced the risk of death by 20% in hospitalized COVID-19 patients who were not able to mount an immune response.
· The Food and Drug Administration has issued an emergency use authorization for another monoclonal antibody, GlaxoSmithKline’s sotrovimab, for treating adults and children (12 and up) with mild-to-moderate COVID-19 that is at risk for progressing to severe disease
· To explore the evolving field of monoclonal therapy for COVID-19, MPR’s Batya Swift Yasgur interviews Jason Gallagher, a clinical professor at Temple University and co-author of the Infectious Diseases Society of America treatment guidelines for COVID-19.
· Meanwhile, Merck has agreed to sell 1.7 million courses of the antiviral molnupiravir to the U.S. government for $1.2 billion as soon as the drug, now in Phase 3 trials for treatment of COVID-19, receives an EUA from the FDA (the ticket to ride).
· The Biden administration is placing an additional $3.2 billion bet on the development of “easily administered” oral antivirals (i.e., pills) for COVID-19. The money for the Antiviral Program for Pandemics is coming from the American Rescue Plan.
· There is also a front end and back end of COVID-19 treatment. The front end is focused on keeping people out of the hospital, off respirators and alive, while the back end is all about seeking answers for the lingering, long-term consequences of the disease. The CDC has issued clinical guidance for these post-COVID conditions, Alicia Lasek reports in McKnight’s Long-Term Care News, noting that one in four COVID-19 survivors has at least one persistent post-acute symptom.
· Disputes over wearing masks have led to at least eight fatalities in the U.S., the most recent the shooting of a supermarket cashier by a 30-year-old customer near Atlanta.
· As we emerge from the COVID-19 tunnel into a brighter day, consumers will demand that businesses actively demonstrate community spirit, Amy Cashman writes in Management Today. Cashman, CEO of the UK Insights division at Kantar, says, “The pandemic has shifted the emphasis around purpose, refocusing attention on the impact businesses have at a human level over and above things like corporate investment in good causes or activity to mitigate environmental damage.” Kantar’s Global Barometer, she noted, showed that “three out of four people thought the number one thing companies should be prioritizing was employees’ health.”
The vaccine dashboard
· CureVac, a German company, reported disappointing results for its first-generation COVID-19 vaccine in a Phase 2b/3 trial: 47% efficacy against disease of any severity. Researchers identified at least 13 variants of SARS-CoV-2 within the study population in Latin America and Europe; the original virus was virtually nowhere to be found. CureVac is continuing the trial and also partnering with GSK on a second-generation vaccine with more robust activity against variants.
· Two doses of the Pfizer or Moderna COVID-19 vaccine did not affect sperm counts in a small group of healthy male volunteers (n = 45) at the University of Miami Miller School of Medicine. The CDC says that COVID-19 vaccines do not impair male or female fertility, an oft-cited concern of the vaccine hesitant.
· The U.S. is buying another 200 million doses of Moderna COVID-19 vaccine, looking ahead to vaccination of younger children and perhaps the need for booster shots. That brings Moderna’s total U.S. commitment to 500 million doses, 217 million of which have been delivered.
· In India, with 30 million COVID-19 cases and close to 400,000 deaths, everyone will be eligible for a free vaccine paid for by the government, AP reports, although patients who get their vaccine through a private hospital will still have to pay. Less than 5% of the population is fully vaccinated.
· The American College of Physicians is calling for greater equity in distributing vaccines globally, Britt Gambino reports in Pulmonology Advisor. The COVAX effort to vaccinate the world needs 2 billion doses in 2021 and is struggling to reach that goal. In the poorest countries, only 1% have had at least one dose of COVID-19 vaccine, and just 10% of the world’s population is fully vaccinated.
The Ad Council and CDC, with support from the Rockefeller Foundation, have launched a series of PSAs encouraging people to continue masking up until they are vaccinated. The 30-second spots, titled “Book Club,” “Concert” and “Swim,” are the work of creative agencies Colle McVoy and SKDK. The ongoing Mask Up America campaign, launched a year ago, has generated more than a billion impressions across $17.8 million in donated, earned and shared media.
…and some songs for the first days of summer
Thanks for joining us and welcome to Summer! May it truly be a season of joy. See you here next Wednesday. Be well.