Disneyland, the “Happiest Place on Earth,” is closed until further notice. However, Disneyland the mega-vaccination site is very much open, except on days when high Santa Ana winds shut down this immunization tent city.

A compelling case can be made that the happiest place on earth these days is your neighborhood COVID vaccination clinic, where vaccinators are finding joy, jubilation and rejuvenation in the experience of giving shots to the tearfully grateful. Corie Robinson, a Kaiser nurse in the nation’s capital, told the Washington Post, “This is probably the most important thing I’ll ever do in my career… You can see their smiles through their masks.”

Happy stories abound. An 89-year-old Black woman receives the first vaccination of her life. A couple show up in their matching homemade vaccine t-shirts, get their shots and head off for celebratory margaritas. A nurse, who has held iPads so that dying patients can say goodbye to loved ones, calls a Colorado vaccination clinic “one of the top three days of my 16-year nursing career… I’m super-excited to be a part of something so positive.”

Meanwhile, the $50 million national vaccine education campaign spearheaded by the Ad Council and COVID Collaborative, titled “It’s Up to You,” is off to the races, enlisting some 300 partners in the public and private sectors. The campaign’s goal is to “shift the public mindset from vaccine hesitancy to vaccine confidence,” targeting the 40% who are either skeptical about COVID-19 vaccine or “open but uncertain.” As Mariah Cooper reports in Campaign, the effort is taking “an empathetic tone by sending the message that vaccines are the way we can get back to having the moments we all miss.”

Another ray of hope is the greenlight granted to Johnson & Johnson’s single-dose COVID-19 vaccine, going into arms as we speak. Wouldn’t it be nice, after a full year on this rocky road, to finally turn a corner onto a smoother highway?

This week’s Vaccine Project newsletter is 3,062 words long and will take you nine minutes to read.

The communications effort

It’s a circle of trust: We’re counting on trusted messengers to inspire vaccine confidence. And we’re hoping that the uncertain among us, once fully informed, will trust the science, the system and the messenger enough to roll up their sleeves. And tell a friend.

  • The Ad Council campaign says it’s okay, even good, to have questions about vaccines and that answers are available. The questions and answers are posted at getvaccineanswers.org and in Spanish at detidepende.org. The Centers for Disease Control and Prevention is vetting all scientific content.
  • For a deep dive into the research shaping the campaign’s core messages, listen to the webinar featuring Charysse Nunez, insights lead for the initiative, and Anne Schuchat, the CDC’s principal deputy director. If you’re in a hurry, the slides shown in minutes 21 through 30 capture key points. The program is hosted by the Public Health Communication Collaborative.
  • Faith leaders figure prominently in efforts to tap into “social capital” and quench the public’s thirst for accurate information. A national town hall addressing Black and Hispanic faith communities is taking place March 9. In the same spirit, the Ohio Department of Health just finished a series of four virtual town halls for Black, Hispanic, Asian and rural audiences.
  • The themes of trust and personal choice are front and center in a number of state COVID-19 vaccination initiatives. Massachusetts, for example, is asking people to Trust the Facts: Get the Vax.
  • Missouri, the Show-Me State, vows to be Stronger Together, emphasizing that “Choice is a powerful thing… You have the choice to help our society shape our new path forward beyond COVID-19. Here, we put the facts in front of you so you can make an informed choice.”
  • In Colorado, the Champions for Vaccine Equity Initiative says its goal “is not to ‘convince’ people to take the vaccine but rather meet people where they are and share accurate information to empower individuals to make decisions that are best for them and their families.” The state has forged more than 20 partnerships with community groups.
  • The most trusted voices are not national or state leaders, but community-based clinicians who have been caring for people in their neighborhoods for decades. That’s the view of David Chokshi, New York City Health Commissioner, who weighed in during the CDC’s National Forum on COVID-19 Vaccine. Conversations with the vaccine-hesitant cannot be one-offs, he added. “It’s an iterative process. You need to listen well, revisit, and build on what was said in your first conversation.” 
  • A London physician is tackling vaccine hesitancy head-on by personally telephoning patients who have not had their jabs. Farzana Hussain has called 50 of the 90 people on her list, many of them from Black, Asian or minority ethnic communities, and has changed about one mind in five. “In the vast majority of cases, there is a hesitancy rather than outright rejection,” she told GP’s Luke Haynes. She has corrected erroneous beliefs that the vaccine contains animal products and causes infertility.
  • In Campaign, Brittaney Kiefer explains how minority groups in the U.K., appalled that official communication efforts were missing the mark or not even aiming, developed a grassroots educational campaign, #TakeThe Vaccine, and put it on national television.
  • Remember Ted Koppel? He’s still at it at age 81. In “A Matter of Trust,” a recent 12-minute CBS Sunday Morning segment, he addressed the root causes of vaccine hesitancy in the Black and Latino communities.
  • In addition to acting as scientific fact-checker for the Ad Council campaign, the CDC is directly funding, to the tune of $17 million, the educational efforts of 15 advocacy groups. Recipients include the National Urban League and UniDosUS, an organization serving the Hispanic community.
  • Good news: vaccine hesitancy is waning sufficiently to put herd immunity within reach. The “wait and see” group has declined from 39% in December to 22% in February, per the Kaiser Family Foundation. Axios compares the wait-and-see folks to “persuadable swing voters.”
  • After orthopedic surgeon Steven Arsht lost his 58-year-old brother-in-law to COVID-19, he wanted to promote vaccination while honoring the stricken. The result is a social media campaign, This Jab’s for You. You tag your vaccination photo on Facebook or Instagram and make a dedication. Rachel Nuwer has the story in Medical Bag.
  • In encouraging vaccination, “it is important to be respectful and empathize with patients’ concerns and perspectives,” says health ethicist David Alfandre in Renal & Urology News. For those who emphasize freedom of choice, he suggests framing vaccination as a way to help “take personal control of their life and allow them to be free to live a healthy life.”

The takeaway: “Lead with empathy” is the new mantra.  

Source: Getty

The rollout

We celebrate! My wife got her first shot last week in Teaneck, epicenter of the early outbreak in north Jersey. I just got my own appointment for tomorrow. Good things come to those who wait, yes?

  • As vaccination sites crop up across the country, many organizers do two things before the first shot goes in the first arm: Say a prayer and conduct a brief blessing ceremony for the vaccine and the people on both the giving and receiving ends. In a Native American community in Arizona, tribal leaders met the truck delivering the first batch of vaccine and held the blessing right then and there.
  • Eleven new federal/state vaccination megasites are opening within the next two weeks, with a combination of active military, National Guard and FEMA folks on hand to assist the local health corps. There are four in Florida, four in upstate New York and one each in Pennsylvania, Illinois and North Carolina. That will bring the total of these pilot sites to 18—at college campuses, stadiums, community centers, even a dog track—capable of delivering up to 61,000 shots a day.
  • Two national nursing home associations have set a goal of vaccinating 75% of staff by the end of June, Danielle Brown reports in McKnight’s Long-Term Care News. “It’s critical to acknowledge that the reasons for vaccine hesitancy are real and varied. Staff concerns must be understood and thoughtfully addressed,” said LeadingAge President/CEO Katie Smith Sloan.
  • LeadingAge is holding a national town hall Thursday evening in partnership with the Black Coalition Against COVID to address the questions and concerns of people who work in “aging services.” The program will be streamed by blackdoctor.org on Facebook Live and YouTube.
  • Vaccination as a tough sell to long-term care employees is neither surprising nor new. In the 2019-2020 flu season, 69% of workers in long-term care got a flu shot, notches below the 79% for staff in doctors’ offices and 93% in hospitals. The pattern has persisted for at least the past decade.
  • To understand the checkerboard nature of vaccination priority, look no farther than the population ages 16 to 64 with a high-risk medical condition. They’re currently eligible for COVID-19 vaccine in fewer than half the states, and in some it’s a county-by-county decision. Actually, checkerboards are much more organized.
  • Independent pharmacies want a bigger piece of the vaccination action. They say they’re more likely than big chains to have personal relationships with customers and can put friendly persuasion to work as an Rx for vaccine hesitancy.
  • In an effort to simplify, Connecticut is taking an age-based approach to vaccination because other scenarios “proved overly complex and confusing, would potentially exacerbate inequities in vaccine distribution and slow down the process.” The new schedule expands eligibility to people ages 55 to 64 as of March 1, followed in three-week intervals by ages 45 to 54, 35 to 44 and 16 to 34. Dedicated clinics are also scheduled for school teachers, educational staff and professional childcare providers.
  • The Department of Homeland Security promises that federal immigration and customs officials will not conduct enforcement activities at or near vaccination distribution sites or clinics. The next step is to deliver that message convincingly to the affected individuals and families themselves.
  • Little things can go a long way in filling the potholes of the vaccine rollout. They include getting more doses out of each vial, storing vaccine in regular freezers instead of scarce ultra-deep-freeze units (as Brian Park notes in MPR) and having a standby list so that expiring doses don’t have to be tossed. 
  • If you look at this globally—a reasonable thing to do in a global pandemic—the U.S. is doing pretty darn well, ranking in the top five countries in vaccine doses administered per population. We trail Israel, United Arab Emirates, the U.K. and the Seychelles.
  • The Seychelles? Well, yes, of course we had to look it up. It’s an archipelago of 115 granite and coral islands in the Indian Ocean northeast of Madagascar (population about 100K),  lush with mountains, rainforests, nature preserves and beaches. It’s also home to the rare giant Aldabra tortoise, which can tip the scales at 550 pounds and live for up to 150 years. Remember, you heard it here first.
  • What’s in your wallet? It could be a global vaccine passport, validating your status as a COVID vaccinee and theoretically smoothing your travels and getting you in the restaurant door. Not everyone thinks this is a good idea, either scientifically or ethically.

The takeaway: Meaningful metrics for the beginning of March: 20% of U.S. adults and more than 50% of folks over 65 have received at least one dose of vaccine. ‘M’ stands for Momentum. And possibly end of May–President Biden’s new target date for having enough vaccine supply for every adult.

Source: Getty

The challenges

“We may be done with the virus, but clearly the virus is not done with us,” cautions CDC Director Rochelle Walensky. “People are tired and they want to get back to life, to normal, but we’re not there yet.” She adds that now is not the time to reopen by lifting public health restrictions. “At this level of cases with variants spreading, we stand to completely lose the hard-earned ground we have gained.”

  • In the desperate daily hunt for vaccinations, the tech-savvy are using bots to scan websites and send alerts to the tech-naive when appointments open up. There is a Good Samaritan aspect to this cybersurfing, but a downside as well—as when 95% of slots at a rural clinic in Massachusetts were quickly snapped up by folks outside the county. The clinic canceled all appointments and networked with senior centers to find more than enough willing takers locally.
  • My colleague Larry Dobrow was spot on in spotlighting the vaccine hunters, who have gathered in Facebook groups attracting thousands of hopefuls. Vaccinehunter.org tracks down doses that are set to expire and can be claimed by the nimble.
  • “Regrettable” doesn’t begin to describe it. Kaiser Health News finds that many vaccine registration websites pose insurmountable obstacles for blind people.
  • Pockets of resistance are still to be found among family caregivers who are not only reluctant to get the shot themselves but are not inclined to favor vaccination of the seniors in their care. A survey by Wakefield Research for SCAN Health Plan points to safety as the main concern.
  • Other groups not sold on the vaccine who haven’t gotten that much ink: Republicans and young members of the military.
  • Long-term care facilities are telling the government that it’s time to ease up on visitation regulations. They admit that ongoing vigilance will be needed to maintain infection control even after vaccination is a fait accompli. “Return to normal” will not be immediate and will require a measured, stepwise approach. Danielle Brown and Alicia Lasek lay out the details in McKnight’s Long-Term Care News.
  • Stay tuned for what promises to be “relaxed guidance” on what we safely can and can’t do after getting vaccinated. There’s not much, if anything, that is relaxed about this pandemic.
  • In Rheumatology Advisor, Inga Back shares the American College of Rheumatology’s guidance for vaccinating patients with musculoskeletal and rheumatic diseases—one of many constituencies out there in COVID-land with focused questions and concerns.
  • Saturday Night Live nailed the absurdities of the rollout by presenting a game show, “So You Think You Can Get the Vaccine?”, hosted by a faux Anthony Fauci. Contestants competing for their shot included a fake smoker from New Jersey and a hopeful 85-year-old who was otherwise qualified but needed a PhD in perpetual website refreshment.

The takeaway: We miss Alex Trebek. He could have efficiently handled the whole matter of vaccination Q&A (or A&Q) on Jeopardy! I’ll take “Side Effects” for $600, Alex.

Source: Getty

The vaccine dashboard

The near horizon is brighter with the arrival of a third COVID-19 vaccine in the U.S. Around the world, nine vaccines are in use, with more on the way. Confusing? We don’t seem to mind—or have noticed—that we have nine different flu vaccines in this country alone.

  • Virtually everything you might want to know about the Johnson & Johnson vaccine is in this 62-page briefing document. Or you can simply trust the FDA’s word that it’s safe and effective.The CDC’s Advisory Committee on Immunization Practices has given its nod as well.
  • Experts—including the real Dr. Fauci— are actively discouraging any notion that one COVID-19 vaccine is better or worse than another. Take the one that’s available. If you can’t be with the one you love, love the one you’re with.
  • In Israel, more than 84% of the 70+ population has received two doses of vaccine. Early data show a notable reduction in severe disease, hospitalizations and deaths in this age group, a sign that the glowing results of clinical trials might not be out of reach in the real world.
  • You can’t peruse the news these days without hearing the word “variant.” In MPR, Diana Ernst outlines Moderna’s strategy to cover the varmints, noting that the company has sent its booster vaccine candidate to the National Institutes of Health for evaluation. Moderna hopes the data will support lower dosage levels for boosters.
  • Vaccine trials continue to ramp up in children and adolescents. Latest word is that kids might start getting vaccinated in 2022.
  • The pandemic has reshaped the landscape in a way that “will forever alter vaccine research, development and deployment,” says Patrick Bergstedt, SVP of Commercial Vaccines for Moderna. In a podcast with MM+M’s Marc Iskowitz, Bergstedt also shares how the company is addressing vaccine hesitancy and using Uber to overcome obstacles to access.
  • The AstraZeneca/Oxford vaccine, approved in the U.K., European Union, and Canada and in many other localities through the global COVAX initiative, could become the fourth COVID-19 vaccine in the U.S. In Infectious Disease Advisor, Jessica Nye offers a helpful take on the clinical trials data.

The takeaway: What we are looking for, in a suite of available vaccines, is an effective surge protector.

Source: Getty

The resources

Ralph Waldo Emerson said, “Knowledge is when you learn something new every day.” With COVID, that’s not hard to do. Emerson also said, “Wisdom is when you let something go every day.” Yeah, we gotta work on that one.

  • The CDC’s National Forum on COVID-19 Vaccine may have ended, but it isn’t over. Participants were asked to share “promising practices” for building vaccine confidence, making effective use of data, and optimizing access—and share they have. Follow this link to an extensive, coast-to-coast listing.
  • The CDC has its own web page on Building Confidence in COVID-19 Vaccines.
  • The Ad Council/COVID Collaborative website includes a public health toolkit filled with core insights and messaging that resonates.
  • One of the nation’s foremost vaccine advocates is Paul Offit, director of the Vaccine Education Center at Children’s Hospital of Philadelphia. He offers his own COVID-19 Q&A in a series of short videos.
  • The National Resource Center for Refugees, Immigrants, and Migrants has vaccine information specific to those populations in more than 100 languages.
  • In Cancer Therapy Advisor, Andrea S. Blevins Primeau offers pertinent advice for cancer patients on whether and when to get COVID-19 vaccination. The “whether” is a thumbs-up, the “when” is a roll of the dice.

The takeaway: Emerson, once more with feeling: “What lies behind us and what lies ahead of us are tiny matters compared to what lies within us.”

… and some songs

 A Matter of Trust, Billy Joel

Trust in Me, Etta James

Trust in You, Lauren Daigle

Ode to Joy, Andre Rieu and His Johann Strauss Orchestra

Thank You (Falettin Me Be Mice Elf Agin), Sly and the Family Stone
Thank you for letting us into your screens and, we hope, your hearts and minds. Feedback is always welcome. Come back tomorrow for the Haymarket Media Coronavirus Briefing, a panoramic view of the pandemic from the redoubtable Mr. Dobrow.