I have lived in New Jersey and Pennsylvania most of my life, long enough to recognize a bottleneck when I see one. Let’s hope that the bumper-to-bumper delays we are experiencing on the Road to Vaccination are mostly just volume and not a five-car—or God forbid, a 133-car-and-truck—pile-up around the next bend.

We are being asked to stay in our lane until we can put on our turn signal for the next available vaccination slot. On the turnpike and in supermarkets, they open extra lanes when traffic builds up. Where is our E-Z Pass when we need it most?

As is true in any situation shrouded in the fog of uncertainty, we just want to know what’s going on. The vaccine-envious ask, “Mom and Dad, are we there yet?” The vaccine-hesitant want to know, “Is it safe?”

That’s why communications are in the driver’s seat of this vehicle. We need one of those overhead highway signs that says you are 20 miles but 39 minutes away from your destination; we need to manage expectations. And we need signs that say: When you get there, you’ll be okay.

This edition of the Vaccine Project Newsletter is 3,057 words long and will take you nine minutes to read.

The communications effort

The race is not only vaccines versus the virus and its mutant ninjas. It’s also straightforward, accurate information versus creeping crapola.

  • How did Oregon-based Marquis Companies manage to vaccinate 82% of its 2,700 long-term care employees when the national average was south of 40%? CEO Phil Fogg Jr., in an interview with James M. Berklan of McKnight’s Long-Term Care News, says the key was “inundating” staff with education, delivered by the right messengers. “Masterful” video messages blending personal and professional perspectives came from chief medical officer Kathryn Kolonic and VP of clinical services April Diaz. Another key: not engaging with anti-vaxxers, focusing instead on “people sincerely concerned or afraid, who didn’t have enough information.”
  • Also in McKnight’s LTC News: Health workers who are hesitant to be vaccinated say their concerns are often misconstrued, Danielle Brown notes. Staff with questions and anxieties should be looked upon as “slow yeses” rather than definite nos.
  • Public health messages explaining who can get vaccinated—and when—must stick to the facts and not make promises or set timelines that can’t be met, W2O advises in its report on vaccine confidence. Failure to deliver on those promises will only seed distrust. Other findings: Attempts to mandate vaccination will likely backfire, given strong sentiment for freedom of choice. Visible, vocal endorsement by doctors and nurses is “paramount to achieving broad immunity” and can help sway fence-sitters who are unsure of the science, concerned about side effects and inclined to watch and wait.
  • Leaders also need to be cautious about forecasting when we might achieve herd immunity. We’ve heard lots of projections, each one a couple of months later than the previous. Now we hear it might not be until Thanksgiving or early winter. Or possibly never.
  • The Ad Council has added “What the Black Community Should Know About COVID-19 Vaccines from Our Experts” to its library of short videos conveying vaccination messages. Those experts include Martha Dawson, president of the National Black Nurses Association; Leon McDougle, president of the National Medical Association; Valerie Montgomery Rice, president and dean of Morehouse School of Medicine; and Ernest Grant, president of the American Nurses Association.
  • Sixty Black members of the National Academy of Medicine are urging Black Americans to be vaccinated: “Do this for yourself. Do this for our community. We are asking you to trust our advice because we are a part of you. And together we can save lives.” That good advice needs to travel from the op-ed pages of The New York Times to the streets and neighborhoods of this country.
  • Leaders are helpful but TLMs—trusted local messengers—are essential. Pediatric surgeon Ala Stanford, president of the Black Doctors COVID Coalition and a MM+M Health Influencer 50 honoree, put it this way: “The vice president getting [the shot] matters. But it matters more that your barber got it.”
  • Speaking of haircuts and vaccines, community health workers in Nevada who deliver flu shots in barber shops and churches are building on the trust they’ve developed and applying it to COVID-19 vaccination. The project is a partnership between Immunize Nevada and the Southern Nevada Health District.
  • In rural North Carolina, community health advocates are delivering a message before delivering the vaccine, Kaiser Health News reports. Instead of saying “We’re from the medical system and we’re to help you,” the advocates frame vaccination as an opportunity for the individual to “be a community hero.” “Giving people that ownership and sense that they can help in this small way is empowering,” said Adrienne Sigmon, a lead street medic with the nonprofit BeLoved Asheville.
  • Friends and family have clout. In a biweekly “sentiment tracker” run by Verywell Health, people who know someone who has been vaccinated for COVID-19 are more likely to want vaccination themselves. Those who’ve heard about someone refusing the vaccine are more likely to worry about side effects and effectiveness. Complicating matters, COVID fatigue is making people tune out the news, letting misinformation chime in.
  • At Bartle’s Pharmacy in the historic riverside town of Oxford, NY, the newly vaccinated celebrate by ringing a COVID cowbell. “It’s pretty amazing to see the relief on people’s faces,” pharmacist Heather Bartle-Ferrarese told STAT.
  • There are no cowbells for Hallie Forstner but a handheld sign saying “I’m doing my part to #wipeoutCOVID.” As a child, she traveled by wagon in Tennessee to receive an experimental flu vaccine in the pandemic of 1918. A month ago, at age 109, she moved into a Chattanooga assisted living center and got her COVID-19 shot. Kimberly Bonvissuto has the story in McKnight’s Senior Living. The Twitter hashtag, by the way, was created in 2007, when Ms. Forstner was a mere child of 96 years.
  • Mardi Gras parades were missing in New Orleans this year, given how last year’s parades turned out to be unwitting superspreaders. In NOLA, they still know how to party, from their front porches if nowhere else. In Alabama, the Mobile Area Mardi Gras Association, a Black organization founded 82 years ago, converted its parade-planning energy to fueling vaccine awareness. Let the good times roll up their sleeves.
  • Managing expectations helps us understand “why COVID vaccines are taking so long to reach you.” Scientific American points to bottlenecks in supply chains and “difficult” (to say the least) appointment registration systems. Meanwhile, Axios weighs in with “why vaccine production is taking so long.” Isn’t it ironic, after all the kvetching that Operation Warp Speed was such a rush job? 
  • Fear and mistrust of vaccine lurk in the Amazon. We’re talking about the river and region in Brazil and not the delivery trucks ubiquitously roaming your local streets. President Jair Bolsonaro has not helped matters by refusing vaccination and delivering stridently anti-science messages. Social media has been more effective than traditional media in reaching—and not always teaching—Indigenous and riverine people in remote areas.
  • The CDC is hosting a three-day National Forum on COVID-19 Vaccine next Monday through Wednesday. Online plenary and town hall sessions will share best practices for (1) building trust and confidence in COVID-19 vaccines; (2) using data to drive vaccination delivery; and (3) optimizing equitable access to immunization. The forum will explore the role of healthcare providers as trusted messengers of vaccine information and will highlight innovative approaches to combating misinformation, engaging with local communities and creating effective public education campaigns.

The takeaway: Here’s an aphorism for these challenging times: The truth is paywalled but the lies are free.

Source: Getty

The rollout

We’re gaining on it: Almost 40 million first doses and 15 million second doses have been given as of Tuesday, per the CDC. Maybe slow and steady really does win the race.

  • We’ve heard the promising new math—200 million more vaccine doses to be purchased. That will equate to a total stockpile of 600 million in the U.S., enough to vaccinate 300 million people, as reported by Diana Ernst in MPR with additional details from the White House and Department of Health and Human Services.
  • The boost in supply–starting now–should help us pick up the pace of vaccination, says top presidential advisor Anthony Fauci, in time to have “open season” (interesting choice of words) by April. Most Americans could be vaccinated by mid to late summer if we can hang on through a winter of discontent and a spring of slowly receding angst.   
  • The Biden administration is partnering with state governments in New York, Texas and California to open mass vaccination sites. In New York City, the sites are York College in Queens and Medgar Evers College in Brooklyn, each capable of giving 3,000 shots a day. In Texas, of course, it will be bigger—up to 10,000 shots a day each at three locations, including the homes of the Dallas Cowboys and Houston Texans. The California mega-sites in Los Angeles and Oakland, which opened this week, are also sending mobile vaccination clinics into surrounding areas.
  • “Equity is our North Star here.” That’s the mantra from Marcella Nunez-Smith, head of the Biden health equity task force, in announcing plans to ship vaccine directly to 250 federally qualified health centers. Two thirds of the people served by these community centers live at or below the poverty level, and 60% represent racial and/or ethnic minorities. The eventual goal is to offer vaccine through all 1,300 community health centers.
  • Achieving vaccine equity—reaching populations underserved by the healthcare system and overrepresented in the COVID casualty toll—is a long and arduous road. Lecia Bushak navigates the journey in MM+M.
  • Global health officials will point out that the North Star shines over the entire planet, and that disparities in vaccination between the haves and have-nots reflect poorly on us as a civilization. As UNICEF reminds us, 130 countries have not put a single vaccination into a single arm.
  • COVID-19 vaccination is an ethics course in itself. In Infectious Disease Advisor, Chen Fang covers the landscape in an interview with Mildred Solomon, president of The Hastings Center.
  • The U.K. is aiming to complete the first doses of COVID-19 vaccination for all folks over 50 years of age by May 1, Nick Bostock reports in GP.  The Brits have walked the walk in the rollout, now claiming the third highest vaccination rate in the world, after Israel and United Arab Emirates.
  • The Centers for Disease Control and Prevention has issued a road map for the safe opening of schools, saying decision makers should consider giving high priority to vaccinating teachers but adding that “access to vaccination should nevertheless not be considered a condition for reopening schools for in-person instruction.” Even after teachers and staff are vaccinated, schools will need to continue masking, distancing and other mitigation measures “for the foreseeable future.”
  • Let’s not forget the kids, who are at the end of the long line for shots as we await results of pediatric and adolescent clinical trials. Dr. Fauci says that kids as young as first-graders could be lining up for vaccinations by the fall. Though not the first to climb into the vaccination lifeboat, the youngest can certainly help us row to the shores of herd immunity.
  • We not only have drive-through vaccination clinics; we now have a drive-through eye clinic, screening for high intraocular pressure. In Ophthalmology Advisor, Jodi McCaffrey explains that office visits for routine eye care are down drastically, and that IOP cannot readily be measured in a telehealth visit. So researchers in California have improvised. In a pandemic, necessity is the prolific mother of invention.

The takeaway: How a vaccine becomes a vaccination is now more complicated than how a bill becomes a law. This needn’t be a Darwinian free-for-all or a dystopian Hunger Games.

Source: Getty

The challenges

When it comes to getting vaccinated, up to one in three adults are leaning out rather than leaning in. Is the glass one third empty or two thirds full?  

  • In Florida, some evangelical pastors in Hispanic churches are telling their congregations not to get vaccinated, one of them calling it the “mark of the devil,” the Miami Herald reports. It’s part of a broader pattern of bad information, including conspiracy theories, coming from a different kind of “bully” pulpit.
  • The COVID Collaborative and Langer Research Associates, in the first of six monthly pulse surveys of COVID-19 vaccine attitudes and acceptance, reports that 71% of adults are either favorably inclined or have already been vaccinated. A wait-and-see attitude, where much of the attention on increasing uptake will be focused, is most pronounced among Black Americans, Republicans, rural Americans and those whose formal education ended after high school.
  • Fewer than half (45%) of employees surveyed by The Conference Board say their companies have communicated a COVID-19 vaccination policy. One-third report that their employers are strongly encouraging vaccination but not making it a condition of return to the workplace. Only 32% of men and 17% of women feel very comfortable about going back into the office.
  • CEOs—who tend to be more trusted than the government—want a larger say and a bigger role in the vaccination push, Axios reports. Target is offering employees two hours’ pay for each vaccine dose and up to $15 each way for a Lyft to and from vaccination sites.
  • Although nursing homes have had some success in vaccinating residents and staff, Medicare and Medicaid officials say it’s too soon to lift the curtain on visitation restrictions, Danielle Brown reports in McKnight’s LTC News.
  • Part of the challenge, Brown adds, is finessing the coming transition from a federal-pharmacy partnership to a homegrown vaccination effort. Ohio, for example, has plans to vaccinate newly admitted long-term care residents and newly hired staff in advance while offering vaccination to anyone who didn’t choose it the first time around. Kimberly Bonvissuto and Alicia Lasek explore additional avenues for handling what comes next.
  • Lasek also addresses the question of whether COVID-19 vaccine is recommended for patients with Parkinson’s disease—because people are asking. The answer is yes, with caution advised in the frail and elderly.
  • Lots of patients with chronic illness want to know if the vaccine is safe for them. The American College of Rheumatology says its members have been “inundated” with such questions. The ACR has issued guidance for vaccinating patients with musculoskeletal, inflammatory and autoimmune conditions, with some caveats and advice to adjust immunosuppressant medications when needed.
  • New growth industries spawned by the pandemic include masks, Plexiglas, restaurant tents and op-ed pieces. Among the more thought-provoking we’ve seen lately:  “If You’ve Been Working from Home, Please Wait for Your Vaccine”; “I Work in a Nursing Home. Here’s Why My Colleagues Are Skipping the Vaccine”; and Do the Math; Vaccines Alone Won’t Get Us Out of This Pandemic.”

The takeaway: Questions are never in short supply. Answers need to follow.

Source: Getty

The vaccine dashboard

Not the best-case but not the worst-case scenario: COVID becomes the new flu, a disease we can control if not eliminate with vaccination and commonsense public health measures. Meanwhile, the old flu has flickered out, at least for this season, and the “twindemic” didn’t happen.

  • Alex Gorsky, CEO of Johnson & Johnson, believes that we may need to be vaccinated every year against COVID-19 for several years to come, in order to keep virus variants at bay.
  • A similar prediction comes from British vaccines minister Nadhim Zahawi, Nick Bostock reports in GP. Zahawi foresees the need for a booster vaccination this fall with an annual shot afterward, not unlike “the way we do with flu.”
  • Infectious disease experts in the U.S. and European Union second that emotion, suggesting that COVID-19 will be with us and that a pan-viral vaccine against evolving variants may be needed. Alicia Lasek offers insight in McKnight’s LTC News.
  • The World Health Organization has approved the AstraZeneca/Oxford vaccine for emergency use. This will help, among others, the 130 countries that have yet to pass the starting line on their vaccination campaigns.
  • You may not have heard of Valneva, but you will. The U.K. has pre-ordered 100 million doses of a Valneva COVID-19 vaccine now being evaluated in clinical trials, a vaccine already being pre-manufactured, if you will, in Scotland. Valneva, headquartered in France with offices in the U.S. and elsewhere, manufactures two vaccines for travelers, one for Japanese encephalitis and another for cholera.
  • It’s hard to improve on 95% efficacy, but researchers are looking for new ways to make mRNA vaccines more practical and affordable. Four things on their to-do lists: make the vaccines more stable at higher temperatures, reduce the amount needed for each dose, switch from two doses to one and keep ahead of viral variants by having boosters at the ready.

The takeaway: There’s a movie in this—2021: An Immunization Odyssey.

Source: Getty

The resources

As Homer Simpson says, “Every time I learn something new it pushes some old stuff out of my brain.”

  • We’re not going to understand the spread of disease and outrace the virus variants unless we step up our woefully inadequate pace of genomic testing. To that end, the CDC has put together a Genomic Epidemiology Toolkit for those who are capable of doing this new stuff. There’s an excellent illustrated piece on genomic epidemiology in the Washington Post and another accessible-to-the-layperson explanation in Science.
  • A Covid-19 Vaccine Training Program is free for medical professionals, courtesy of The New England Journal of Medicine. Up to two hours of CME credit is available in a curriculum covering SARS-CoV-2 virology, vaccine development, and both mRNA and non-mRNA vaccines.
  • The American Public Health Association has curated a concise and regularly updated compendium of data, policy, and tips and tools for decision makers.
  • Get Smart is an Axios short course on vaccines, how they work and why they matter. Especially now.

…and some songs

Let’s Hang On, Frankie Valli and the Four Seasons

Let the Good Times Roll, B.B. King

Give Me One Reason, Tracy Chapman

When You Say Nothing at All, Alison Krauss

See You Again, Wiz Khalifa featuring Charlie Puth

Thanks for joining us. It’s always nice to see you here. Stay warm, be well, keep in touch. Tune in tomorrow for a most excellent Haymarket Media Coronavirus Briefing… and on Friday for NASA’s livestreamed Mars landing of the Perseverance Rover.