The CDC’s Advisory Committee on Immunization Practices meets today to review the data that have led, “out of an abundance of caution,” to a recommended pause in the use of J&J’s COVID-19 vaccine in the U.S. The focus is on six cases of what appears to be a very rare but severe type of blood clot, all occurring in women ages 18 to 48, with symptoms developing six to 13 days after vaccination. One woman died and another is hospitalized in critical condition.
Nearly 7 million doses of the single-dose J&J vaccine have been given in this country. The concern is a clot known as cerebral venous sinus thrombosis, occurring in combination with low blood platelets. Traditional treatments for clots, such as heparin, may actually be dangerous in this situation. The CDC and FDA are advising that anyone who has received the J&J vaccine and develops severe headache, abdominal pain, leg pain or shortness of breath within three weeks of being vaccinated should contact their health care provider.
Today’s Vaccine Project Newsletter is 3181 words long and will take you 10 minutes to read.
Opening shot: Are we approaching a plateau?
The pulse takers and prognosticators are telling us that we will soon be reaching an inflection point in our response to the viral pandemic that has plagued this planet for more than a year.
One of the forecasters, Surgo Ventures, predicts that the pace of vaccination in the U.S. will plateau in late April, when the people who are most enthusiastic about getting vaccinated will have had their shots. The task will then turn to convincing those who want to wait, are uncertain, or have no intention at this moment of rolling up their sleeves.
Surgo, consulting its crystal ball of survey data, believes that 52% of Americans will be vaccinated by July, but then the pace will slow to a virtual crawl, reaching just 58% by April 2022. That’s well short of the 70%, 80% or more needed for herd immunity.
“Despite the general vaccine enthusiasm we are seeing now in the United States, things are going to get really difficult really soon,” says Sema K. Sgaier, Surgo’s co-founder and CEO and an adjunct professor at Harvard T.H. Chan School of Public Health. “Without significant investment in addressing people’s barriers and making vaccines available to those below 18, reaching herd immunity will be a real challenge.”
Surgo divides the U.S. population into five psychobehavioral segments: the Enthusiasts (22%), the Watchful (6%), the Cost-Anxious (9%), System Distrusters (7%) and Conspiracy Believers (16%). That adds up to 60%; the other 40% are the people who’ve already been vaccinated.
Surgo considers the Watchful, the Cost-Anxious and System Distrusters, a combined 22% of the total, to be The Persuadable and a group that needs to be prioritized. Messaging to each of those will need to be fine-tuned and ultimately individualized.
The calculus changes if you add in an X factor—people who are not yet vaccinated but have been sick with COVID-19 and thus have gained a measure of natural immunity. Taking that X factor into account, Surgo says we might reach a combined 65% immunity by this July.
Either way, we have miles to go, and millions more vaccinations, before we sleep.
The communication effort
They call it a campaign because people vote, we hope with their arms rather than their feet.
· A new PSA from Budweiser and the Anheuser Busch Foundation, in partnership with the Ad Council and Covid Collaborative, assures us that “Good Times Are Coming. Now we have a shot.” The 30-second spot, airing on national TV and social and digital channels throughout April, shows “special shared moments over a beer” to the tune of I’ll Be Seeing You, Jimmy Durante version. The PSA, part of the Ad Council’s “It’s Up to You” campaign, debuted on April 7, National Beer Day.
· Sam Adams has done its own uniquely Bostonian take on a vaccine ad and will buy a beer for the first 10,000 people who post a photo of their vaccination sticker or bandage on Instagram or Twitter.
· Another Ad Council PSA will premiere this Sunday during the live broadcast of the Academy of Country Music Awards. The ad is a collaboration with ACM Lifting Lives, the Academy’s philanthropic arm, and features music stars Eric Church, Ashley McBryde and Darius Rucker at Nashville’s Ryman Auditorium and Grand Ole Opry House.
· In a 60-second video, Baton Rouge Mayor Sharon Weston Broome urges everyone to get vaccinated to protect themselves, end the pandemic and return to normal. It’s the first in a series of messages from mayors, sponsored by the National Association of Chain Drug Stores, African American Mayors Association, and National Forum for Heart Disease & Stroke Prevention. The initiative focuses on reaching the underserved and vaccine-hesitant.
· Vaccine access, not vaccine hesitancy, is the core issue in Black and Brown communities, says a report from Verywell Health. Shamard Charles, a public health physician who lives and works in Harlem, notes that people working in essential jobs find it difficult to make daytime vaccination appointments. Others must find a caregiver to watch a child or elderly parent. Some mistakenly think they have to pay for the vaccine, while others don’t have a primary care provider who could notify them of their eligibility and help in setting up an appointment.
· AstraZeneca’s comms effort has taken a beating in the press of late, but Campaign’s Fiona Fox says it’s not that simple. While the data are “messy,” company officials and scientists have made themselves accessible to the press and answered questions all along the vaccine’s sometimes rocky road. Fox says press folks at AZ and Oxford “deserve a break” and shares the hope that “open science communication from big pharma will emerge as a positive dividend of this crisis.”
· Most people (59%) believe employers should talk to their workforce about COVID-19 vaccine and encourage them to get vaccinated, according to surveys by Civis Analytics and the US Chamber of Commerce Foundation. That attitude increases with increasing age, education and income. Only 43%, however, believe that employers should mandate vaccination.
· Short of a mandate, vaccinating staff at long-term care centers remains a challenge. The Patient-Centered Outcomes Research Institute, a government-sponsored nonprofit, is now offering up to $28 million in grants to explore interventions that increase vaccine confidence and uptake in the LTC workforce. Danielle Brown has details in McKnight’s Long-Term Care News.
· Research is needed. In Florida, as of April 9 there were more long-term staff testing positive for the virus (344) than long-term care residents (276), according to the South Florida Sun-Sentinel. Overall, cases are just a tenth of what they were in January, but more than half of long-term care employees—and nearly 20% of residents—in the state remain unvaccinated.
· In the nationwide vaccination push, “no one is speaking Gen Z’s language,” STAT reports. A STAT-Harris poll found that 21% of Gen Zers (defined as people ages 18 to 24) would not get vaccinated and 34% would “wait awhile and see.” A 22-year-old who did get her shot said, “All the messaging online … isn’t targeted toward our age group, it doesn’t explain why, if you’re a healthy 19-year-old, you should get this vaccine.”
· Meanwhile, some GenZers are taking matters into their own hands, and arms. A student at Cornell University started the Covid Campus Coalition, sharing straightforward vaccine information (“Get the fax. Get the vax”) on Instagram, TikTok and other channels. Students on more than 20 other campuses, including Ohio State and Notre Dame, have followed suit.
The Takeaway:
To avoid hitting the wall at mile 24 of this marathon, we can do what runners do: maintain a steady pace, avoid sudden surges, stay well hydrated (with facts), grab a few carbs (reassurance), burn some fat (excess rhetoric).
The rollout
More than 29% of U.S. adults (about 75 million of us) are fully vaccinated, as are 62.5% of seniors. The number of course is changing rapidly as we speak—we’ve been averaging 3 million shots a day of late and topped 4 million over this past weekend.
· The role of local pharmacies in the vaccine campaign continues to grow, Lecia Bushak writes in MM+M. The federal program that began in February with 6,500 retail pharmacies will soon have blossomed to 40,000 sites. Some, like CVS Health, are extending their reach by using vaccination vans and setting up community-based clinics in partnership with local nonprofits.
· A similar expansion is taking place in federally funded community health centers. A program that started out with 250 centers in February and grew to 950 in March is now open to all 1,470 centers nationwide. About 70% of those vaccinated at the centers are racial or ethnic minorities.
· On yet another front, the CDC is funneling $3 billion to local and state health departments and community-based organizations to expand access to COVID-19 vaccination by putting more feet on the street. The CDC says the money could be used to train “trusted members of the community” to conduct door-to-door outreach or hire community health workers to provide bilingual, culturally competent health advocacy. The money is coming from the American Rescue Plan and other deep pockets.
· Speaking of feet on the street, a program run by the Archdiocese of New York has given COVID-19 shots to 300 homebound seniors in the past two weeks. Diane Eastabrook tells the story in McKnight’s Home Care Daily. One incentive: The sooner they get vaccinated, the sooner they can return to one of the program’s four day centers for some long-lost activities, including Seeing Other People.
· Nearly 80% of pre-K to 12th grade teachers, staff and childcare workers received at least one dose of COVID-19 vaccine by the end of March, the CDC reports. President Biden’s goal was to reach 100% (as my high school biology teacher wrote in my yearbook, “Aim high”). An estimated 2 million in this group got their shots through the Federal Retail Pharmacy Program and 5 to 6 million through their state’s vaccination efforts.
· In long-term care, the vaccination focus is shifting to short-stay residents—people who come for rehab for a month or less and could easily be missed, Danielle Brown notes in McKnight’s Long-Term Care News. In Connecticut, for example, Operation Matchmaker pairs nursing homes with a pharmacy or other provider to continue the vaccination push, which also includes “catch-up” clinics for longer-stay residents who did not get their shots the first time around.
· The list of colleges requiring COVID-19 vaccination has grown to at least a dozen, CNBC reports.
· The federal government is spending $100 million to increase COVID-19 vaccination among older adults and people with disabilities, Kimberly Bonvissuto reports in McKnight’s Senior Living. Grants to state aging and disability networks will help folks schedule vaccine appointments, get to the vaccination sites, or receive their shots at home. The funds also support education on the importance of getting vaccinated.
· No jab, no job? In People Management, Elizabeth Howlett explores the pros and cons of employer-mandated COVID-19 vaccination. One boss in the U.K. quipped, “If it’s good enough for the Queen, it’s good enough for Pimlico Plumbers.” He assures that his workers are “delighted” by the policy.
· CVS Health has administered more than 10 million COVID-19 shots at nearly 2,000 locations in 44 states and says it has the capacity to give up to 25 million shots a month.
The Takeaway:
The magnitude of what we’re doing here stretches the mind. A year ago at this time, some headlines were declaring that “the worst is over.”
The challenges
It took a year for the worldwide death toll of COVID-19 to reach 2 million. It took just three months to add another million.
· Just when we thought things were slowing down: COVID-19 cases and hospitalizations in the U.S. are up for the third straight week.
· Hot spots are flaming. Five states that represent 22% of the U.S. population recently accounted for 44% of all new COVID-19 cases, the AP reports. The five are Michigan, Florida, New York, Pennsylvania and New Jersey.
· Michigan Governor Gretchen Whitmer is asking her constituents for a voluntary two-week suspension of in-person school classes, youth sports, and dining out. The CDC has suggested that Michigan “close things down” and accept that they can’t quickly vaccinate their way out of this situation.
· COVID-19 cases in Michigan nursing homes ballooned from 48 to 353 between March 28 and April 5, and deaths increased from 5 to 77, Danielle Brown reports in McKnight’s Long-Term Care News. Officials point to community spread—”employees come and go into buildings every day”—and to gaps in vaccination, with 30% of residents and at least 50% of staff still not vaccinated.
· A recent CDC report from Montana highlights the urgency of vaccinating communities at highest risk for COVID-19 illness and death. From March through November 2020, COVID-19 incidence and mortality among American Indian/Alaska Natives were 2.2 and 3.8 times higher, respectively, than rates among whites. Factors include living in multigenerational households, lack of access to healthcare, limited opportunity to telework, and high prevalence of heart disease, diabetes and smoking.
· The emergence of variants will define the next phase of the pandemic, emphasizing the importance of widespread vaccination, say experts interviewed by the Washington Post. “The sooner we vaccinate everyone, the faster we will contain the viral spread and reduce the chance for new variants to emerge,” said Columbia University’s David Ho.
· The federal government’s decision to provide COVID-19 vaccine at kidney dialysis centers may help overcome hesitancy in that group, Natasha Persaud reports in Renal & Urology News. In a survey of more than 900 patients, 22% were not likely to seek vaccination, but that resistance dropped to 18% if vaccines were provided at a dialysis center. Similarly, among patients ages 18 to 44, vaccine reluctance softened from 34% to 26%. The pandemic has taken a particularly high toll among patients with end-stage kidney disease.
· North of the border, the wheels of the rollout are turning slowly. As of April 9 Canada had vaccinated 20% of its population with at least one dose, lagging several steps behind the U.S. at 34%. A variant is wreaking havoc out west, with a record 1,300 new cases in British Columbia in one day; 25 cases among the National Hockey League’s Vancouver Canucks put their season on ice for a week.
· “Stop taking shots at those who fear them.” Robert Kaplan, a faculty member at Stanford School of Medicine, suggests that people who are afraid of needles need comfort, not criticism. In an op-ed for the Wall Street Journal, Kaplan notes that needle phobia is common among young adults and kids, who are next up in the vaccination queue.
· Immigrants are being turned away at vaccination sites after being asked for documentation that isn’t needed to get a shot, including driver’s licenses, Social Security numbers, or health insurance cards, the Washington Post reports.
· The Florida Governor’s ban on vaccine passports is likely headed to court, observes Law360, as a major cruise line has developed a policy requiring proof of vaccination for passengers and crew. And NBA’s Miami Heat has set up “vaccinated only” sections in American Airlines Arena where socially distanced basketball fans still need to cheer through masks.
The Takeaway:
They say that science is messy. So is working your way through a pandemic—not just scientifically but socially, politically, economically, emotionally. Hang on.
The vaccine dashboard
While thoroughly investigating any and all safety issues, we can’t lose track of the hundreds of millions of vaccine doses that have been given without ill effects.
· In the first step toward vaccination of youngsters, Pfizer and BioNTech have formally applied to the FDA for emergency use authorization of their COVID-19 vaccine in adolescents ages 12 to 15. They’ll be making similar requests of regulatory bodies overseas.
· Several European countries and Australia have put some curbs on the use of the AstraZeneca vaccine after the European Medicines Agency (EMA) declared that “unusual blood clots with low blood platelets should be listed as very rare side effects.” Most reported cases of blood clots have occurred in women under age 60 within two weeks of the first dose, the EMA says. Like the FDA, the EMA is also looking into similar blood clot and low platelet reports with the J&J vaccine, which was approved for use in the EU in March but has not yet been deployed.
· In the U.K, the Joint Committee on Vaccination and Immunisation recommends that adults under 30 with no underlying conditions be offered an alternative to the AstraZeneca vaccine if available. People who have already received the first dose of AZ vaccine should receive the second.
· The COVAX global vaccine initiative, after delivering its first shipment to Ghana in late February, has now sent 38 million doses to more than 100 countries. The vaccines come from Pfizer/BioNTech, AstraZeneca/Oxford, and the Serum Institute of India. COVAX expects to deliver 2 billion doses this year from an ever-widening portfolio of vaccines.
· Leaders of two dozen countries plus the head of the World Health Organization are calling for an end to “vaccine nationalism” and a mutual commitment to “ensuring universal and equitable access to safe, efficacious and affordable vaccines, medicines and diagnostics for this and future pandemics.” Russia, China, and the U.S. are not among the signees, but Secretary of State Anthony Blinken has pledged to work with other countries to “ensure there will be enough vaccine for everyone, everywhere.”
· Lest we forget, the WHO issued another reminder that the vaccine rich get richer: 87% of the 700 million doses worldwide have gone to people in middle- and high-income countries; 1 in 4 have been vaccinated in high-income countries vs 1 in 500 in the poorest countries.
The Takeaway:
Vaccines will remain under a microscope employing ultra-high magnification.
Parting shot
Vaccine hesitancy isn’t always about safety and efficacy. Logistics get in the way as well: No time to get to a vaccination site when it is open, no way to get there, unfounded worries about cost. Community health doctor Shamard Charles says that low-income communities in particular need free internet access, round-the-clock vaccination availability, and transportation to and from sites.
… and some songs
· I Believe That We Will Win, Pitbull
· We’re All in This Together, High School Musical
· We’re All in This Together, John Paul White featuring Rosanne Cash
Thanks so much for being here. See you tomorrow with a Haymarket Coronavirus Briefing. Stay safe, be well, get vaccinated when you can.
