The nationwide COVID-19 vaccination campaign has taken a granular, gritty and downright ornery turn in recent days. After President Biden pledged a door-to-door effort to get out the vax, Missouri Governor Mike Parson tweeted: “Sending government employees or agents door-to-door to compel vaccination would NOT be an effective OR a welcome strategy in Missouri.” While acknowledging the importance of getting shots into people’s arms, Parson said we should not be “trying to force people to take it, not trying to scare them into it.”

The White House was swift to counter. Biden administration coronavirus response coordinator Jeffrey Zients and press secretary Jen Psaki said the door-to-door effort is spearheaded by “trusted local messengers” and not government agents. Individuals and organizations who are “feeding misinformation and trying to mischaracterize this type of work are doing a disservice to the country and to the doctors, the faith leaders, the community leaders and others who are working to get people vaccinated, to save lives and help to end this pandemic,” Zients added.

The post-July 4 fireworks come at a time when COVID-19 cases and hospitalizations are rising in most states, including Missouri—a state that has never had a mask mandate, where hospital officials are now sending their own urgent tweets in search of ventilators and respiratory therapists. Alicia Lasek has further details in McKnight’s Long-Term Care News.

As it happens, the Missouri health department, whose COVID-19 mantra is “Stronger Together,” has already asked for help from the federal “surge response teams” created to assist communities struggling with the double whammy of COVID-19 outbreaks and low vaccination rates. Missouri certainly fits that definition; It recently had the nation’s highest rate of cases caused by the rapidly spreading Delta variant – a.k.a. “COVID-19 on steroids” – and one of the lowest rates of COVID-19 vaccination.

The conflict is not limited to the Show-Me state. In South Carolina, Governor Henry McMaster asked his state health department to oppose targeted door-to-door tactics. “Enticing, coercing, intimidating, mandating or pressuring anyone to take the vaccine is a bad policy which will deteriorate the public’s trust and confidence in the state’s vaccination efforts,” McMaster said.

Once again, the Biden administration counterpunched. “The failure to provide accurate public health information, including the efficacy of vaccines and the accessibility of them to people across the country, including South Carolina, is literally killing people,” Psaki said.

Clearly, the concept of “meeting people where they are” in the vaccination push is subject to different interpretations. Fact is, local “trusted messengers” have been out and about at least since April, doing their work without much fanfare. In New York City, the Mount Sinai Visiting Doctors program has vaccinated 500 homebound patients, family caregivers and home health workers in collaboration with the state health department. The first step in the program was an outreach effort to provide education and gauge public interest in receiving COVID-19 vaccine.

An ad hoc volunteer group calling itself the Chicago Vaccine Brigade started with about a dozen nurses and public health activists. It has since grown to 160, assisting established community vaccination programs in the city with outreach, education and vaccine delivery.

Nationally, America’s Health Insurance Plans and the Blue Cross Blue Shield Association helped vaccinate more than 2 million seniors in 100 days through an outreach collaboration known as Vaccine Community Connectors. At least 50 payers joined in the effort, which included phone calls, PSAs, offers of free transportation to vaccination sites and other incentives. The organizers used CDC’s Social Vulnerability Index to identify populations at highest risk of COVID-19.

At least 115 cities in 33 states have signed up for the Mayor’s Challenge to Increase COVID-19 Vaccinations, a project of the United States Conference of Mayors in collaboration with the White House, Centers for Disease Control and Prevention and Bloomberg Philanthropies. The program’s toolkits outline strategies for overcoming racial and ethnic disparities and other obstacles to equitable vaccine distribution. The goal is to share ideas and approaches that work.

The debate over how to win hearts, minds and arms coincides with a significant slowdown in vaccination rates and the persistence of resistance. Polls show that the unvaccinated are not a monolithic block of immovable granite but rather a mix of some folks who might and some who absolutely won’t roll up their sleeves; some people who want to “wait and see” for a little while and some who want to wait and see for a good long while; and others who are interested in getting vaccinated but lack some combination of information, access and opportunity.

One school of thought suggests that people will be more inclined to say yes to vaccination once the Food and Drug Administration grants full approval to the three vaccines currently available under emergency use authorization. Others feel that such a decision could backfire if it appears to be hurried by political pressures.

For some, especially a growing number of workers in healthcare settings, COVID-19 vaccination is now part of the job description. Health systems joining the growing list of vaccine mandates include Trinity Health (117,000 employees in 22 states), the University of Chicago system and four major hospital networks in the St. Louis area. A group of seven national hospital and infectious diseases organizations has now endorsed mandatory vaccination for workers in healthcare settings.

The mandate movement is generating its own vigorous pushback from state legislatures that are considering – and in the case of Montana, enacting – laws that make it illegal to discriminate against people on the basis of their vaccination status. The bills vary and allow some exceptions, but generally seek to forbid government entities and businesses from requiring COVID-19 vaccination or making people disclose their vaccination status. Caitlin Owens of Axios says these actions “show how deep into the political psyche resistance to coronavirus vaccine requirements has become, and how vaccination status has rapidly become a marker of identity.”

Apart from mandates and the legal battles they may stir up, good old-fashioned incentives remain in plentiful supply. In Vero Beach, Florida, Harbor Retirement Associates held a raffle for vaccinated staffers that included $100,000 in cash prizes and a 2021 Nissan Versa. As Kimberly Bonvissuto reports in McKnight’s Senior Living, the drawing for the car took place via Zoom, reaching an audience of 38 senior communities in 13 states. Harbor leaders say their 82% staff vaccination rate is also the result of a concerted effort to educate and build camaraderie. COO Kim Lewis said, “We have reached the goals we’ve reached by coaching people and helping them understand that, as a mission-driven business, we have a higher calling to keep our residents safe.”

Spreading the word

·  July 4 has come and gone but we’re still counting vaccinations. A quick check of the numbers shows that we have fully vaccinated 48% of the total U.S. population, 56% of the vaccine-eligible (age 12 and older), 59% of all adults and 79% of seniors. That’s 159.7 million people in all.

·  Other pertinent numbers come to us from The Commonwealth Fund. By the end of June 2021, the U.S. vaccination program had prevented an estimated 279,000 COVID-19 deaths and up to 1.25 million hospitalizations. The current reality is that virtually all new hospitalizations and deaths are among the unvaccinated.

·  The education and immunization campaign marches on to a slightly different tune as cases and hospitalizations ramp up again across the country with hot spots in the South and Midwest. The Delta variant accounts for more than 50% of new infections and up to 80% in some areas.

·  More than 40% of hospitalizations now occur in adults ages 18 to 49. In Utah, leaders of four hospital systems are urging residents to get vaccinated amid a surge of hospitalizations among the shotless.

·  A “fun, uplifting and positive” campaign for the Mayor of London’s office shows young people celebrating their COVID-19 vaccinations on digital billboards and movie screens at familiar locations around the city, Jonathan Owen reports in PRWeek. Ketchum developed the ads, aimed at persuading young adults ages 18 to 35 to get their shots. The message, says Kat Dare, Ketchum’s practice director, is that “we’re all in it together and if we all play our part and get the vaccine, we’re one step closer to celebrating a return to freedom and life returning to normal.”

·  A new Heineken ad by Publicis Italy and Le Pub shows shining happy seniors drinking, flirting and otherwise cavorting at the bar scene, providing evidence that “the night belongs to the vaccinated. Time to join them.” See pertinent details in Campaign.

·  MM+M reports that New Orleans rapper Juvenile has released “Vax That Thang Up,” a new version of his 1999 hit Back That Thang Up. Check out his video with Mannie Fresh and Mia X, produced by the Atlanta creative agency Majority (co-founded by NBA Hall of Famer Shaquille O’Neal) and supported by BLK, Match Group’s dating app for Black singles.

·  North Dakota state legislator Keith Kempenich was a COVID-19 skeptic until he got sick and almost died. Now he is a vaccine advocate, and the state health department is looking for other converts who can share similar testimonials in a public education campaign. Kempenich, a 61-year-old rancher, said, “I’m kicking myself. Truthfully, once you go through this, it’s not something you want to repeat. There is a remedy and it’s better than going through it.”

·  In advance of a possible partnership with the CDC to provide vaccination at some of its 17,400 stores – many in rural areas unpopulated by other grocery stores or pharmacy chains – Dollar General has appointed its first chief medical officer. Dr. Albert Wu joins the retailer from McKinsey & Co.

Source: Getty Images.

The challenges

·  The vaccination gap is not just a matter of blue states versus red states but also red counties versus blue counties.

·  CDC investigators have linked 47 cases of COVID-19 to a gymnastics facility in Oklahoma. The infected include 23 gymnasts, three staffers and 21 household contacts. Of 21 specimens submitted for lab testing, all tested positive for the Delta variant. Two adult patients (both unvaccinated) were hospitalized and one required intensive care.

·  State health officials in Mississippi are asking seniors and immunocompromised persons, regardless of their vaccination status, to avoid indoor mass gatherings until July 26. Mississippi ranks last in key measures of COVID-19 vaccination rates.

·  The pandemic is taking a mental as well as physical toll on public health workers. In a March-April survey of more than 26,000 state and local health employees, 53% reported symptoms of at least one mental health condition in the prior two weeks, including depression (32%), anxiety (30.3%), PTSD (36.8%) and suicidal ideation (8.4%). The highest prevalence of mental health symptoms was among people under 30 and transgender or nonbinary persons of all ages. The severity of symptoms increased with increasing work hours and percentage of time devoted to COVID-19 response. Heather R. Johnson has more in Psychiatry Advisor.

Opening up

·  The CDC issued its guidance for school reopening, emphasizing that a return to in-person instruction this fall is a priority. Fully vaccinated students and teachers need not wear masks. California has decided to keep a mask mandate in schools for all. Texas and Florida, on the other hand, have adopted laws forbidding mask mandates.

·  Josh Earnest, global chief communications officer of United Airlines, tells PRWeek’s Diana Bradley that “we did not want to be defined by the crisis; we wanted to be defined by our response to it.” That response included a comprehensive cleanliness and safety initiative, in collaboration with Clorox and the Cleveland Clinic, along with vaccination incentives for staff and passengers. Earnest, who served as President Obama’s press secretary, says United has “enhanced our brand and leadership team’s credibility by telling people the truth about the difficult circumstances we faced and leveling with them about the strategy we were pursuing to try to deal with it.”

·  England came up just a penalty kick short of victory in the Euro 2020 soccer tournament but, as Emma Bower reports in GP, the country still has a celebration in the works: the easing of most pandemic restrictions on July 19. The government is asking people to be cautious and consider wearing masks in crowded locations, such as public transport. Doctors are concerned that opening up the economy will lead to a spike in cases and impose further burdens on an already hefty workload.

·  A group of 15 scientists wrote to the Lancet urging a delay in the July 19 date, saying “we believe the government is embarking on a dangerous and unethical experiment.” The group added that “we consider any strategy that tolerates high levels of infection to be both unethical and illogical.”

Source: Getty Images.

The vaccine dashboard

·  The FDA has added a warning to the fact sheet for the J&J COVID-19 vaccine, noting that Guillain-Barre syndrome may occur in rare instances within six weeks after vaccination. Data suggest an association but not a causal relationship – so far, 100 cases among 12.8 million vaccinations.

·  Stay tuned for further developments on the question of COVID-19 booster shots. This is most likely not an “if” question but a “when” and “for whom” one. Pfizer and federal health officials are in discussions this week as to what the data say and what it all means. For now, the CDC and FDA maintain that “Americans who have been fully vaccinated do not need a booster shot at this time… We are prepared for booster doses if and when the science demonstrates that they are needed.”

·  Israel this week began giving third doses of Pfizer vaccine to immunocompromised adults, including cancer patients and recipients of liver transplants. It’s a possible first step toward boosters for other high-risk groups.

·  In most of the rest of the world, the challenge is simply finding that first dose of vaccine. According to Axios Latino, fewer than 10% of people in Latin America and the Caribbean are fully vaccinated against COVID-19. That part of the world represents less than 9% of the global population but accounts for more than one third of COVID-19 deaths. Crowded urban centers contribute to rapid disease transmission.

·  While the US is facing a surge of Delta variant, Peru is struggling with Lambda and Brazil is beset by Gamma. We’ll hear more about all of them, eventually.

·  Africa just had its worst pandemic week, with more than 251,000 new cases in the period ending July 4. That’s 12% higher than the peak in January. Vaccinations have reached less than 2% of people on the continent.

·  World Health Organization officials are sharply critical of a move to boosters in high-income countries at a time when low-income countries are starved for vaccine. “What part of ‘This is a global crisis’ are we not getting?” asked Mike Ryan, executive director of WHO’s health emergencies program.

·  Cancer patients should be included in COVID-19 vaccine trials, says a joint statement from the American Society of Clinical Oncology and a patient advocacy group, Friends of Cancer Research. Leah Lawrence has details in Cancer Therapy Advisor.

·  A COVID-19 vaccine delivered via intranasal spray fully protects against lethal infection in mice, report researchers from the University of Iowa and University of Georgia. The single-dose vaccine also prevented mouse-to-mouse transmission and worked well in ferrets, too. The vaccine uses a harmless parainfluenza virus (PIV5), similar to common cold viruses, to deliver the SARS-CoV-2 spike protein into cells, triggering an immune response.

Parting shot

Seoul, South Korea is banning fast music (more than 120 beats per minute) in gyms in order to curb transmission of COVID-19, CNN reports, suggesting that Katy Perry’s “Teenage Dream” and Miley Cyrus’ “Wrecking Ball” would make the cut. The music need not be “Can’t Help Falling in Love”-slow but can’t be frantic. As the health ministry noted, “harsh breathing from intense activities can spatter a lot of saliva.”

Well, we can’t possibly end on that note. Here are 80 good news stories from a pandemic year. And today, 18-year-old pop star Olivia Rodrigo is meeting at the White House with President Biden and Dr. Anthony Fauci to promote vaccination of young people.

…and some songs

Go Your Own Way, Fleetwood Mac

Knockin’ on Heaven’s Door, Bob Dylan

This Is It, Kenny Loggins

Vax That Thang Up, Juvenile with Mannie Fresh and Mia X

Can’t Help Falling in Love, Elvis Presley

Stay well, stay tuned, stay connected and we’ll see you in this space next week for a new edition of the Vaccine Project Newsletter.