Here’s hoping you and your family and friends had a fun, festive and unfettered Fourth. After the parades and fireworks, now imagine a thousand brush fires erupting in hot spots around the country. Imagine a national fire department sending teams into communities to quell the flames.

You don’t have to imagine. As the July 4 holiday approached, the federal government mobilizedsurge response” teams to go into counties vulnerable to COVID-19 outbreaks. These are counties with a tinderbox combination of low vaccination rates (less than 30% fully vaccinated) and potentially high exposure to the Delta coronavirus variant, the latest SARS-CoV-2 “variant of concern.” More transmissible and potentially more troublesome than its predecessors, Delta now accounts for more than half of new COVID-19 infections nationally.

The response teams have an assignment, and they choose to accept it: get people vaccinated, distribute medicines and help with contact tracing. In the vanguard of this effort, a team from the Centers for Disease Control and Prevention arrived in Mesa County, Colorado at the end of June to investigate how and why Delta is spreading in the western part of the state.

Although we did not meet the July 4 goal of getting at least one COVID-19 shot into the arms of 70% of American adults nationally—we made it to 67%—we are now going to double down on the mission and focus on trouble spots locally. President Biden is looking to community  pharmacies, doctors’ offices, worksites, mobile clinics and door-to-door shoe leather to recapture some momentum. If June was a National Month of Action on vaccination and public education, July and August will need to be versions 2.0 and 2.5.

On Independence Day, 16 months into a pandemic, the country was not about to lose track of a bigger, brighter picture: that we have fully vaccinated more than 157 million people, including 55.5% of the vaccine-eligible population age 12 and older, 58% of all adults, and 79% of seniors 65 and up. Anheuser-Busch made good on its promise to buy a beer for the vaccinated. Panera offered free bagels from July 2-4 and Chipotle had a buy-one- get-one-free deal for any burrito, taco or other entree on Tuesday from 3 pm to closing time.

By all indications, many Americans celebrated the holiday with a sense of newfound freedom from the virus and fear of the virus. On July 1 and again on July 2, more than 2 million passengers moved through US airports, nearly three times as many as in pandemic-stymied 2020 and slightly more than in pre-pandemic 2019. A year ago, 78% of those responding to an Axios-Ipsos poll regarded attending a July 4 event as a moderate- to high-risk experience; this year that number was down to 41%. Last year, just 6% saw no risk in going to Independence Day festivities; this year that was up to 23%.

We can’t lose track of a bigger and not-so-bright picture: Pandemic hot spots are burning around the world, and vaccination campaigns in all but the wealthiest countries are just beginning. By one recent estimate, the poorest won’t be vaccinated until 2023. For now, Delta is causing a new wave of lockdowns in countries that had started to open up. There’s now a higher-octane Delta plus as well as a regular Delta.

In the U.S., the variant is stirring fears that recent gains against the pandemic could evaporate in the summer sun. As COVID-19 cases and hospitalizations tick up again here and there, public health officials worry that warm-weather get-togethers and big-crowd events could prove to be superspreaders in areas where vaccination rates lag. More than 2,000 counties representing more than half of the country’s population failed to meet the 70% goal. Within the past week, states with lower vaccination rates reported 6.6 new cases per day per 100,000 population, CNN notes, almost triple the rate of 2.2 per 100,000 in states with higher vaccination rates. The rate of new cases in Arkansas, where just under 40% of the eligible population is fully vaccinated, was 16 per day per 100,000. Hospitalizations are now climbing in Arkansas after the July 4 holiday.

Nevada is reporting one of the nation’s highest rates of new COVID-19 infections at a time when Las Vegas is reopening with a flourish. Cirque du Soleil proclaimed that Intermission is Over. Headline acts glittered in a grand reopening over the holiday weekend, including Bruno Mars at Park MGM and Miley Cyrus at Resorts World Las Vegas.

Where COVID-19 is concerned, however, what happens in Vegas doesn’t necessarily stay in Vegas. Cassius Locket, director of disease surveillance and control for Clark County, where Vegas is located, says, “Some of our [vaccination] campaign is shifting to, if you are not doing it for you, do it for someone else, do it for a friend who may have an underlying health condition.”

Missouri is seeing a new surge of infections and hospitalizations. Steve Edwards, CEO of CoxHealth, a nonprofit health system based in Springfield, noted that his facility had at least 100 COVID-19 inpatients and is expecting more. “If you are hesitant to get a COVID vaccine,” he tweeted, “and don’t know who to trust, try to eliminate all the noise on both sides and ask the one person who won’t judge you, the one you entrust the most with your healthcare. Ask your personal doctor.” On July 1, he tweeted more pointedly:  “If you are making wildly disparaging comments about the vaccine, and have no public health expertise, you may be responsible for someone’s death. Shut up.”

And this just in: More than 125 people who attended a five-day church camp in Texas tested positive for SARS-CoV-2. Hundreds more may have been exposed.

A couple of pertinent facts to mention here: (1) The World Health Organization stresses that all COVID-19 vaccines approved for emergency use help to protect against severe disease, hospitalization and death caused by SARS-CoV-2, including its Delta offshoot. (2) In June, as in May, 99% of COVID-19 deaths in the US occurred in the unvaccinated. Breakthrough infections among the vaccinated are rare and tend to be mild.

Keep on pushing

·  As the vaccination campaign becomes ultra-local, the education campaign will follow suit. The Public Health Communications Collaborative has developed COVID-19 vaccine messaging tailored to the level of local vaccination rates. The PHCC has also posted its recent webinar on answering parents’ questions about COVID-19 vaccination of children.

·  The latest video from the Ad Council/COVID Collaborative is a short-form documentary (five and a half minutes) in which descendants of the men involved in the Tuskegee syphilis study talk about the importance of having confidence in public health today. 

·  Lillie Tyson Head, President of the Voices For Our Fathers Legacy Foundation said, “We should not allow anyone who needs and wants a COVID-19 vaccine to not have their questions answered – or be denied the opportunity to get it, like the men in the U.S. Public Health Service Syphilis Study at Tuskegee. We must protect ourselves and each other.” The film’s closing screen shot says, “They were denied treatment. Let their legacy be our motivation.”

·  Young adults are a key focus of the next educational push, for good reason. People ages 18 to 49 not only account for a sizable portion of the unvaccinated, they represent an increasing share of COVID-19 hospitalizations—just under one third in May but 43% in preliminary data for June, the Washington Post reports. 

·  Meanwhile, Dr. Anthony Fauci chatted up TikTok influencers in an effort to boost vaccinations among the young. The White House is hoping that teens will get vaccinated in their doctor’s office before going back to school.

·  Most employers are still encouraging rather than requiring vaccination, with notable exceptions in the healthcare sector. The Association for Professionals in Infection Control and Epidemiology (APIC) has declared its support for COVID-19 vaccination mandates in hospitals and health systems, Alicia Lasek notes in McKnight’s Long-Term Care News. APIC President Ann Marie Pettis describes mandates as a “bold patient safety step” and says that “as healthcare professionals, we have an ethical responsibility to protect those individuals entrusted to our care.”  

·  Legacy Lifecare, one of the largest senior living providers in Massachusetts, has decided to require COVID-19 vaccine for staff, Danielle Brown reports in McKnight’s LTC News.

·  Federal data shows, however, that only four states—Hawaii, Vermont, Alaska, and California—have vaccinated 75% or more of long-term care staff, a benchmark that industry leaders had hoped to reach by the end of June, Lasek notes. Puerto Rico leads the pack at 93%. The lowest rates (41%-44%) are in Florida, Missouri, Mississippi and Louisiana.

·  The number of college campuses with some type of vaccine mandate is up to 571, according to the Chronicle of Higher Education. 

·  The mask debate continues. While the World Health Organization is urging all to mask up again in the face of Delta, the CDC recommends that state and local jurisdictions adopt their own guidance.

Source: Getty Images.

The challenges

·  COVID-19 vaccination is a family matter. The Kaiser Family Foundation reports that 77% of vaccinated Americans live in fully vaccinated households while 75% of the unvaccinated live in fully unvaccinated households. It’s also a political matter. According to the survey, two thirds of Democrats live in all-vaccinated households and four in ten Republicans live in homes where no one is vaccinated.

·  Republican Governors in Arkansas, Utah, and West Virginia are urging their residents to get vaccinated.

·  CDC has updated its web page countering myths about COVID-19 vaccine, clarifying, among other matters, that shots do not make you magnetic or infertile.

·  A new national collaborative of community-based health organizations, the Vaccine Equity Cooperative, is working to reduce persistent disparities in vaccination rates among communities of color and to facilitate one-to-one conversations with trusted local messengers. The coalition’s resource hub offers curated toolkits tailored to specific populations. The cooperative receives support from the Rockefeller Foundation, JPB Foundation, W.K. Kellogg Foundation and Kresge Foundation.

·  Crowds gathering in stadiums, pubs and bars to watch the Euro 2020 soccer championships may be driving a new wave of COVID-19 infections across Europe. Concerns run high in London, which is hosting the semifinals and finals this week and next.

·  Essential workers in a variety of industries and services—from meatpacking plants and agricultural worksites to funeral homes and day care centers—are at higher risk of COVID-19 sickness and death but have lower vaccination rates than people working from home. In STAT, public health researchers from Boston University and George Washington University say these folks should be central to the next vaccination push. Improving access will help: offering paid leave to get vaccinated, providing vaccinations at transportation hubs, and giving vaccinations to people in their homes.

·  Although most pandemic restrictions in the U.K. are scheduled to be lifted on July 19, the British Medical Association is urging the government to keep some safety measures in place, Luke Haynes reports in GP. Pointing to a worrisome rise in COVID-19 cases and hospitalizations, the BMA suggests that the government require masks in public indoor places and provide more detailed guidance to businesses on safe re-opening. Prime Minister Boris Johnson says the country will have to “learn to live with this virus.”

Getting back to where we once belonged

·  Keep working remotely? Come back to the office? Healthcare marketing agencies hope to capture the best of both worlds, Lecia Bushak reports in MM+M. A survey of 288 employees at four agencies, conducted by Filament Inc., finds tradeoffs: Getting household chores done during the week makes it possible to reclaim some semblance of a weekend. On the other hand, people working from home miss out on the institutional learning provided in person by managers and peers. “We have not proven that hybrid works,” said Filament president Mark Schnurman. “We have to make it work, but the idea that magically 60% of the people are going to be in the office and everything’s going to be perfect is not practical.”

·  Passengers are ready to return to travel, airlines not so much, Sabrina Sanchez writes in PRWeek. “Airlines need to communicate as clearly and candidly as they can during this time,” said Dave Duschene, crisis and issues team lead for Golin Chicago. “They should honestly say that they will need time to get back to standards that were set before the pandemic.”

·  Many people in the job market are passively searching but not actively looking for work, reports a survey by Indeed. One reason for a lack of urgency: concerns about COVID-19 and a desire to wait until more people—one’s prospective co-workers, clients and customers—are vaccinated.

·  In Campaign, Pippa Glucklich calls for an end to sexual harassment in the advertising industry as people return to the office. Glucklich, chief executive of Electric Glue, notes that harassment takes place remotely as well.

Source: Getty Images.

The vaccine dashboard

·  J&J says its single-dose COVID-19 vaccine offers “strong, persistent activity” against Delta and other highly prevalent variants and that “the durability of the immune response lasted through at least eight months.”

·  Moderna released results from in vitro studies demonstrating that the company’s vaccine produced neutralizing titers against a number of SARS-CoV-2 variants, including Delta and some you may not have heard of, such as Eta, first identified in Nigeria, and Kappa, first reported in India. The latter two are “variants of interest” in CDC parlance but not yet “variants of concern” like Delta.

·  Sanofi has launched a Center of Excellence for research and development of the next generation of mRNA vaccines for routine use against infectious diseases “with high unmet need.” The company expects to have at least six clinical candidates by 2025.

Parting shot

“People will continue to die until we vaccinate everybody,” Jonathan Reiner, professor of medicine and surgery at George Washington University, told CNN. He added: “What I would say to young people is that COVID-19 doesn’t have to kill you to wreck your life.”

The task won’t get any easier. Per the Kaiser Family Foundation, half of unvaccinated adults feel that cases are so low that there is no need to vaccinate more people. In an ABC News/Washington Post poll, 73% of those who say they probably or definitely won’t get vaccinated believe that the dangers of Delta are exaggerated and 79% feel they have little or no risk of getting sick.

A helpful perspective comes from Pulitzer prize winner Ed Yong of the Atlantic in “The three simple rules that underscore the danger of Delta”: (1) The vaccines are still beating the variants. (2) The variants are pummeling the unvaccinated. (3) The longer the variants spread among the unvaccinated, the more likely it is that new variants and mutations will infect the vaccinated. Public health experts tell Yong that other measures to control COVID-19 are effective but underused, including  improved ventilation, widespread rapid testing, systematic contact tracing, better masks, more effective isolation of the sick, and policies such as paid sick leave to give folks time and opportunity to get their shots.

… and some songs

Delta Dawn, Helen Reddy

It’s Now or Never, Elvis Presley

Not Too Late, Norah Jones

It’s My Life, Bon Jovi

Right Now, Van Halen

Thanks so much for tuning in. See you back here next Wednesday with a new edition of the Vaccine Project Newsletter. Take good care.