If we’re painting this landscape by the numbers, the bigger picture is now taking shape.

•  More than 220 million people ages 12 and older have received at least one dose of COVID-19 vaccine (77.7% of the vaccine-eligible)

•  More than 190 million people 12 and older are fully vaccinated (67.2% of the eligible).

•  96.5% of seniors 65+ have received at least one dose of vaccine and 84.7% are fully vaccinated.

•  Nearly 14 million people have had a booster shot—7.7% of the adult population and 18.3% of seniors.

Please listen closely, however, as our menu options are changing:

•  The pool of vaccine-eligible in the U.S. will expand by some 28 million youngsters the moment a vaccine is authorized for kids aged 5 to 11.

•  The arrival of boosters may lead to a new definition of “fully vaccinated.” Do stay tuned.

Youth movement, phase two

The Food and Drug Administration’s vaccine advisory committee on Tuesday recommended COVID-19 vaccination of 5- to 11-year-olds. The vaccine advisory group of the Centers for Disease Control and Prevention meets next week with the same item on its agenda.

In a document prepared for the FDA committee meeting, Pfizer said its vaccine for ages 5 to 11—formulated at one third the dose of the original vaccine, and using a smaller needle—was 90.7% effective in preventing symptomatic COVID-19 in a clinical trial.

The White House has laid out its plans for a pediatric vaccine rollout in advance of the formal FDA and CDC go-aheads, in an effort to ensure that the vaccine is “quickly distributed and made conveniently and equitably available to families across the country.” The goal is to establish vaccination clinics at more than 25,000 pediatric and other primary care offices, 100 children’s hospitals, tens of thousands of local pharmacies and hundreds of school-based clinics, community health centers, and rural health clinics.

The pediatric initiative will also include a national public education campaign for parents and guardians based on “accurate and culturally responsive information about the vaccine and the risks that COVID-19 poses to children.” The campaign will create forums that allow parents to pose questions to pediatricians. It will also communicate directly with parents via social media postings and personal visits by vaccine advocates to high-risk and hard-hit communities.

Building parents’ confidence in COVID-19 vaccines is critical to the effort, Kristin Della Volpe writes in The Clinical Advisor. To that end, the National Academies of Sciences, Engineering and Medicine have released a concise guide to communicating with parents.

The guide emphasizes the importance of understanding and addressing the beliefs that drive vaccine hesitancy “without derogating the parents and making them feel bad for their choices,” said co-author Dr. K. “Vish” Viswanath, professor of health communication at Harvard’s T.H. Chan School of Public Health. “The important point is to validate parents’ emotions but gently guide them to science and data. Scientific rationale without empathy may make them more resistant.”

We already have a track record of pediatric vaccination among adolescents ages 12 to 17. COVID-19 vaccine has been available to 16- and 17-year-olds since last December and to 12- to 15-year-olds since May. The Pfizer/BioNTech COVID-19 vaccine is the only one currently authorized in the U.S. for youngsters 12 to 17, although Moderna and J&J are in pursuit.

So far, uptake among teens hasn’t kept pace with adults. As of October 20, 58% of youngsters ages 12 to 17 had received at least one dose of COVID-19 vaccine and 48% were fully immunized, the American Academy of Pediatrics reports (versus latest figures of 79.6% and 69% for adults, respectively). The initial momentum of vaccinating minors has faded: The weekly total of new vaccinations peaked at 1.6 million at the end of May (just after 12- to 15-year-olds first became eligible), dipped to 586,000 in mid-August and has now fallen below 150,000.

The good news is that the vaccine works in young and old alike. Two doses of the Pfizer/BioNTech vaccine were 93% effective in preventing COVID-19 hospitalizations in adolescents and young adults 12 to 18 years of age, a CDC study reports. The data come from 19 pediatric hospitals in 16 states from June through September. Of adolescents hospitalized with COVID-19, 97% were unvaccinated and 3% were fully vaccinated. All 77 patients needing care in the ICU were unvaccinated.

Meanwhile, Moderna has released topline data from its Phase 2/3 study among children ages 6 to 11, showing a “robust” antibody response to two doses of vaccine—at half the adult dose—and a favorable safety profile. The data will be submitted “in the near term” to regulatory authorities globally. Brian Park has details in MPR.

Source: Getty Images.

Getting it done

•  Despite pockets of strong pushback in several states, legal experts expect vaccination mandates to survive challenges in court, Lecia Bushak writes in MM+M. “By and large, judges aren’t going to second-guess the science,” said Dorit Reiss, professor at UC Hastings College of the Law in San Francisco.

•  A statewide vaccination mandate in Maine for hospital and nursing home workers will go into effect on Friday unless a second round of appeals to the U.S. Supreme Court is successful.

•  A growing number of PR agencies are mandating COVID-19 vaccination or preparing for a policy of “get vaccinated or get tested,“ Chris Daniels reports in PRWeek. Many firms are taking their cues from vaccinated staff members who, according to PR Council President Kim Sample, “are letting it be known that they feel nervous about being around employees who are not vaccinated.”

•  Every day, more than twice as many people are getting booster shots (340,000) as first shots (158,000). We can expect this trend to continue as both the CDC and FDA have endorsed boosters for some 70 million people previously vaccinated with the Pfizer/BioNTech, Moderna or J&J vaccines.

•  Just to recap the basics, the two agencies recommend boosters for:

   – All recipients of J&J vaccine who are 18 and older, two months or more after the first dose.

   – Recipients of Pfizer/BioNTech or Moderna vaccine, six months or more after the second dose, for all people 65 and older and for adults 18 and older who have underlying medical conditions, live in long-term care or are at high risk for COVID-19 because of where they live or work.

•  It is okay to mix and match vaccines for booster doses, mix and match being a more user-friendly term than “heterologous.” FYI, the Moderna booster is, by design, half the dose of the primary series. STAT peels away the newest layers of the COVID vaccine onion and explores the complexities within.

•  As of Sunday, four states had fully vaccinated 70% or more of their population: Vermont, Connecticut, Rhode Island and Maine, with Massachusetts close behind at 69% and New York, New Jersey, Maryland and New Mexico all around 66%. Lagging the field were North Dakota, Alabama, Mississippi, Wyoming, Idaho and West Virginia, with rates ranging from 46% down to 41%.

•  Alabama’s poor performance (44.4% vaccinated) notwithstanding, Governor Kay Ivey issued an executive order defying the Biden administration’s proposed vaccination requirements mandate for private employers, saying it would “threaten to increase vaccine skepticism.”

•  Notwithstanding Governor Ivey, Auburn University intends to proceed with its vaccine mandate with a December 8 deadline.

•  Business leaders are asking the Biden administration to delay the vaccination requirements for private employers until after the holidays, CNBC reports.

The communications effort

•  In a new set of PSAs from the Ad Council, rural Americans explain their personal decisions to get vaccinated. Testimonials come from family pharmacists in Texas, a football coach in North Carolina, newlyweds in Mississippi, family farmers in Kansas and Georgia, a sports mom in Georgia and a young rancher who lost his wife to COVID-19 at the age of 38. Rural areas have higher rates of COVID-19 disease and lower rates of vaccination.

•  The Ad Council’s “It’s Up to You” COVID-19 vaccination campaign has now received $200 million in media support and related publicity across all channels. At least 75% of vaccine-eligible Americans have seen a campaign ad. The effort has generated more than 9 million sessions at the Q&A website, GetVaccineAnswers.org; nearly 60% of visitors with concerns left feeling more confident about getting vaccinated.

•  Union County, New Jersey, with a population of more than 550,000, has one of the lowest rates of community transmission of COVID-19 in the Northeast. Local officials credit not just widespread vaccination and mandates for county employees but also aggressive testing and “vigorous guidelines on use of masks,” USA Today reports. Just as important, they say, is fostering an attitude that the job isn’t done. “COVID-19 will continue to be a matter of life and death until all eligible residents step up and get vaccinated,” said County Commissioner Sergio Granados.

Source: Getty Images.

The challenges

•  The long-term care industry is asking the Federal Trade Commission to take action against staffing agencies that are charging “exorbitant prices” to nursing homes and assisted living centers desperate for workers, Kathleen Steele Gaivin reports in McKnight’s Senior Living. Gaivin also cites a recent survey by ShiftMed in which 49% of nurses said they are “at least somewhat likely to leave nursing in the next two years.”

•  Despite widespread reports that people are happy working from home and don’t want to go back to the office, there’s a flip side to this coin, Peter Crush writes in Management Today. Among 200 heads of HR surveyed by Benefex, 87% say that increasing numbers of workers have disclosed to their employers issues related to poor mental health and 82% say more staffers are reporting feelings of loneliness.

•  The Equal Employment Opportunity Commission has issued guidance to employers for granting religious exemptions to COVID-19 vaccination. Objections to vaccination based on “social, political or personal preferences or on nonreligious concerns about the possible effects of the vaccine” do not qualify as religious beliefs. Employers can make a “limited factual inquiry” if they have an objective basis for doubting the religious nature or sincerity of an employee’s stated beliefs. Danielle Brown and James M. Berklan offer further insights in McKnight’s Long-Term Care News.

•  The political divide continues. According to the Kaiser Family Foundation, 90% of Democrats have been vaccinated, compared to 68% of Independents and 58% of Republicans.

•  Health officials here and abroad are keeping an eye on a coronavirus subvariant dubbed Delta-plus. Right now, they say it is not a cause for concern.

•  Variants won’t go away and neither will COVID-19, says Dr. Saskia Popescu, an infection preventionist at George Mason University. The most likely scenario is “little bursts” of disease in unvaccinated populations, rather than uncontrolled spread. Brown has more on this in McKnight’s.

The vaccine dashboard

•  Booster shots work, according to the first efficacy results for a randomized controlled trial of a COVID-19 booster. A booster dose of the Pfizer/BioNTech vaccine was 95.6% effective.

•  The U.S. has donated 200 million doses of COVID-19 vaccine to more than 100 countries, a down payment on a promise of 1 billion doses.

•  The CDC now has a web page tracking COVID-19 cases and deaths according to vaccination status. Another web page tracks hospitalizations in the same manner.

Source: Getty Images.

Parting shot

Zoos across the country, from Oakland and San Diego to Denver, St. Louis and Washington, D.C., are vaccinating tigers, chimps, gorillas and other mammals against COVID-19, the Washington Post reports. The Jersey-based animal health company Zoetis has donated more than 11,000 doses of its experimental veterinary COVID-19 vaccine to more than 70 zoos, animal sanctuaries and other institutions in a program overseen by the U.S. Department of Agriculture.

Closer to home, the CDC notes that “a small number of pets worldwide, including cats and dogs, have been reported to be infected with the virus that causes COVID-19… we know that most pets get infected after close contact with their owner or another household member.” Accordingly, the CDC recommends that “pet owners and every eligible person in the household should get vaccinated.” In addition, “people who have COVID-19 should not have contact with pets, and pets should not have contact with unvaccinated people outside the household.”

Maybe this could be the game-changer, the most convincing public health message of all: If you won’t get vaccinated to protect yourself, your family or your community, do it to protect your furry best friends.

…and some songs

Ghostbusters, Ray Parker Jr.

Black Magic Woman, Santana

Werewolves of London, Warren Zevon

Superstition, Stevie Wonder

Monster Mash, Bobby “Boris” Pickett and the Crypt-Kickers

Spooky, Classics IV

Have a happy and safe Halloween and an equally safe and happy Election Day. See you back here next week. Thanks, as always, for joining us.