There was a No. 1 song way back in the 1960s that went like this:

Walk right in/Sit right down/Daddy, let your mind roll on.

The 2021 version would be:

Walk right in/Sit right down/Daddy (and Mommy) let your sleeves roll up.

After a winter of discontent and vaccination-appointment disappointment, COVID-19 vaccines are suddenly available in abundance. Vaccination sites are taking walk-ins, mass vaccination sites are shutting down and local efforts are in motion to bring the vaccine to the people if the people can’t come to the vaccine.

The shape of things to come is evident in Massachusetts, where the state will be closing four of seven mega-vaccination clinics in June and shifting its emphasis to the harder-to-reach populations. The plan includes working through 22 regional collaboratives, increasing doses sent to primary-care doctors, and expanding mobile vaccination clinics in hard-hit areas.

That theme was also dominant in White House pronouncements on Tuesday, calling on tens of thousands of pharmacies to offer walk-in appointments and redirecting resources to pop-up clinics, small vaccination sites (including doctors’ offices) and itinerant vaccine vans. The goal for July 4 is to fully vaccinate 160 million adults (currently 105 million) and give at least one dose to 70% (now 56%) of them. Communities will step up efforts to reach and recruit the unvaccinated.

By the way, the original version of Walk Right In dates to 1929 when Gus Cannon’s Jug Stompers did the honors. The 1963 variation by The Rooftop Singers hit the rooftop of the charts and was one of the first folk songs to feature a 12-string guitar. The tune is a brisk two and a half minutes, just long enough for you to walk right in, sit right down, and get your shot.

Pretty soon the kids will be able to get their shots too. Read on.

This edition of the Vaccine Project Newsletter is 3,204 words long and will take you 11 minutes to read.

Opening shot

Getting the next 100 million shots into arms will be harder than the first 230 million, notes Stefanie Friedhoff, a professor of health services, policy and practice at Brown University. However, she takes umbrage when the unvaccinated are depicted as a stubborn bloc of hesitancy and resistance. In an opinion piece for STAT, Friedhoff says “it’s time to talk about what motivates people to get vaccinated and identify the ongoing barriers to vaccination.”

Friedhoff offers several suggestions: (1) Let’s stop talking about vaccine hesitancy. “Repeating the term over and over again unwittingly communicates that there may be something to be hesitant about” and it becomes a self-fulfilling prophecy. (2) Remember that vaccine confidence is not a fixed mindset but a reflection of attitudes at a given point in time. People who told pollsters they don’t plan to get vaccinated may have important questions or concerns that need to be answered and could be resolved. (3)  Consider not only individual behavior and attitudes but also systemic barriers to vaccination, including a shortage of access and an abundance of misinformation.  

Friedhoff ends on a positive note: “For most Americans who are given the chance to discuss vaccination on their own terms and timelines and for whom vaccination is easy, nearby and supported by employers, the question shifts from if they will get vaccinated to when and how.”

The communication effort

“Meeting people where they are” can mean just about anywhere. In a bar, for example.

·  Giving new meaning to a shot and a beer, New Jersey health officials and a dozen breweries are offering a pint  on the house for anyone who gets their first shot in May. You’ll get carded, but it’s the vaccination card you’ll need.

·  Bars and restaurants in New Orleans have teamed up with local health officials to offer “Shots for Shots.

·  Google’s website doodle on May 1 was “Get vaccinated. Wear a mask. Save lives.” Also included: a link to “Find a vaccination site near you.”

·  In communicating vaccination and health messages to employees, businesses can take their cue from CDC guidance but also need to customize policies that put “the best interests of the entire staff at heart,” Chris Daniels reports in PRWeek. Chowning Aguilera, healthcare practice lead at Jackson Spalding, tells us that not everyone on staff will have the same appetite for loosening restrictions, no matter what the CDC says. Aguilera recommends that employers take the pulse of their workers, through surveys and other outreach, when developing policies based on CDC guidelines and crafting language to communicate those decisions.

·  The Black Coalition Against COVID has launched a series called Black Doctors Read COVID Tweets, responding to real Twitter questions about COVID with real answers and dispelling myths with a strong dose of science and a touch of humor. Among those providing the answers is Reed Tuckson, cofounder of BCAC, former DC Commissioner of Public Health and former president of Charles R. Drew University of Medicine and Science in Los Angeles. The BCAC is a coalition of more than 40 organizations.

·  A three-tiered approach to increasing vaccination uptake in Black and Brown communities is getting good results in San Bernardino County, California, Jessica Nye reports in Infectious Disease Advisor. Loma Linda University hosted a vaccine summit for local faith leaders; called on community health professionals, including a Black pharmacist, to provide vaccine education; and sent mobile vaccination units into church parking lots, with the pharmacist managing that effort as well. 

·  In Colorado, Get Out the Vote tactics are being put to good use to Get Out the Vaccine, Axios reports. The advocacy group Healthier Colorado is partnering with Governor Jared Polis and the political data firm Winning Connections. In true political campaign style, volunteers are making phone calls, sending text messages and staffing hotlines to answer questions, correct misinformation, help people make vaccination appointments (1,500 so far) and provide transportation to and from. 

·  Vaccination works. In a study involving 24 hospitals in 14 states, being fully vaccinated with either Pfizer or Moderna vaccines was 94% effective in preventing COVID-19 related hospitalization in seniors 65+. Partial vaccination was 64% effective (emphasizing the importance of the second dose). Half of the 417 patients in this study were 75 or older. By reducing the risk of primary infection, vaccination may also reduce the risk of “long” COVID and COVID-related death, the CDC concludes. Brian Park shares further details in MPR.

·  Get the Vaccine to Save Lives is the message conveyed in full-page newspaper ads from Ourshot2savelives.org, a partnership of more than 60 health systems. A video spot on the website says, “Not since World War II have all people been called to come together to protect humanity’s future.” The site, designed by Ethos Creative Group, also provides messaging to share on Instagram, Facebook, LinkedIn and other social media.

·  The Ad Council reports that 77% of Americans have seen at least one of its COVID-19 vaccine PSAs.

·  “Language choice about COVID-19 vaccines can save lives,” says an article in the Journal of Healthcare Communication. Mark Miller, VP of communication for the de Beaumont Foundation, summarizes the group’s research and identifies words that work (“getting the vaccine will keep you safe” vs “it’s the right thing to do”). Apart from getting vaccinated for their own benefit, a majority of those surveyed said they would be most willing to roll up their sleeves for family (53%). Others would do it for their country (20%), the economy (13%), the community (6%) or their friends (6%). 

The Takeaway:

When vaccination rates wind down, it’s time for the communication effort to rev up.

Source: Getty Images

The rollout

We reached a milestone at the end of April: 100 million fully vaccinated Americans, including more than 40% of all adults and nearly 70% of seniors. The pace is slowing, however.

·  Mass vaccination sites are shutting down, as state officials say people can now get the vaccine closer to home, at a local pharmacy or doctor’s office. The site at LA’s Dodger Stadium, which has delivered more than 400,000 shots since January, will wrap things up by the end of May. Mayor Eric Garcetti says the city and its partners are now “prepared to bring doses to Angelenos and move us closer to the end of this pandemic.”

·  Bechara Choucair, White House vaccinations coordinator, says it’s all about “the ground game” now, county by county, zip code by zip code, census tract by census tract. In Detroit, local health workers will be knocking on doors.

·  In the U.K., more than 25% of the adult population is fully vaccinated, and 64% have had their first shot, Nick Bostock reports in GP. The second shot of AstraZeneca vaccine may be given as late as 12 weeks after the first, hence the gap. Physician-led vaccination sites have delivered more than three fourths of the jabs. Health officials estimate that vaccination saved more than 10,000 lives in the 60-and-older population by the end of March.

·  Florida has scrapped a rule requiring proof of residency for COVID-19 vaccination, opening the doors to migrant workers who were previously turned away. The new system will allow verbal verification from folks who are either residents of Florida or are in the state for business purposes. Snowbirds can continue to flock to the Sunshine State for a healthy dose or two of immunization.

·  The borough of Edgewater, NJ sends a bus that picks people up at their homes and takes them to a local medical center where they get their COVID-19 vaccination without having to leave their seats. Nurses with shots in hand come on board and put shots in arms. More than 300 residents, mostly seniors, have ridden the bus to wellness, now available to all residents 16 and older. 

·  The Transportation Security Administration is extending its face mask requirement until September 13. The rule had been due to expire on May 11. Instead, it will continue to be “masks on” for everyone, vaccinated or not, at airports, aboard commercial planes and on over-the-road buses as well as commuter bus and rail systems. Your carry-on bags can include one hand sanitizer of up to 12 ounces per person, otherwise the good old rules about liquids, aerosols and gels still apply. 

The Takeaway:

We’re going from mega-sites to micro-plans with a smaller lineup of vaccination sites closer to home, reaching those outlying precincts that have yet to vote. 

Source: Getty Images

The challenges

The tragedy in India defies description in mere words. The worst pandemic fears realized. Heartbreak and horror. A system overwhelmed.

·  The numbers in India are chilling, appalling, frightful: a 7-day average of more than 370,000 new cases and 3,400 deaths a day at a time when less than 2% of adults are fully vaccinated. 

·  Lest we forget: cases and deaths in India continue to trail the U.S. by a wide margin (32 million cases and 578,000 deaths here vs 20 million cases and 222,000 deaths in India). The U.S. began limiting travelers from India as of Tuesday.

·  The Biden administration is considering mandating COVID-19 vaccination in the military once the status of vaccines moves from emergency use authorization to full FDA approval, Politico reports. About one third of U.S. troops, and up to 40% of Marines, are unvaccinated.

·  Many people remain confused about the need for two doses of vaccine. In a national survey of adults, including the vaccinated and unvaccinated, 20% believed the vaccines provide strong protection after just one dose and 36% were not sure. Black and Latinx adults were significantly less likely than Whites to believe that the best protection comes 1 to 2 weeks after the second dose. “Failing to combat second-dose attrition among members of minority groups risks magnifying existing racial disparities in the virus’s human toll,” the authors cautioned.

·  In the same survey, published in The New England Journal of Medicine, 85% of adults who received a first dose of vaccine remembered being told they would need a second, but only 54% recall being advised that two doses are needed to provide strong protection.

·  The needle is moving slowly in long-term care but it is moving. Vaccination rates of LTC staff improved from 55% in March to 64% in April, Danielle Brown reports in McKnight’s Long-Term Care News. About 25% of home healthcare staff remain shotless, Diane Eastabrook notes in McKnight’s Home Care Daily.

·  The nonprofit Trust for America’s Health is sending an urgent call for better coordination among governments, healthcare agencies and community groups to identify homebound seniors and people with disabilities and get them vaccinated, Eastabrook reports.

·  A special report from the American Heart Association/American Stroke Association points out that the risk of developing a blood clot in the brain’s veins—central venous sinus thrombosis (CVST)—is 8 to 10 times higher with COVID-19 infection than it is with COVID-19 vaccination. The report emphasizes that most patients with CVST, alone or in combination with low platelets, can recover fully with prompt diagnosis and proper treatment with non-heparin anticoagulants. The report recommends immediate screening of all patients who present in the ER with symptoms of CVST or blood clots to determine if they recently received COVID-19 vaccine. Bottom line: Clots are very rare and “we urge all adults to receive any of the approved COVID-19 vaccines.”

·  In early April, five mass vaccination sites reported 64 anxiety-related events in folks receiving the J&J COVID-19 vaccine, including 17 who fainted. None of the events were considered serious. Four of the five sites were drive-through, the CDC reports, and four were giving J&J vaccine for the first time. Half the cases involved people ages 18-29, a group with higher rates of fainting after vaccination. Needle phobia could have been a factor, and seeing others faint nearby might have had an unfortunate domino effect. All this took place before reports of blood clots went public.

·  Nearly two thirds (64%) of U.S. infectious disease physicians surveyed during the J&J pause still expressed confidence in adenovirus vector vaccines, according to Apollo Intelligence. That was a drop from an 82% confidence level in March. Confidence in prescribing any of the authorized COVID-19 vaccines was 89%. The ID doctors don’t envision herd immunity occurring until March 2022 and believe that it will require vaccinating 75% of the population. 

·  60% of employers in the U.S. and U.K. plan to require proof of COVID-19 vaccination from their employees, and 59% will be offering incentives, according to a poll by Arizona State University supported by the Rockefeller Foundation. Overall, 88% said they would either require or encourage vaccination, and 84% are willing to provide vaccinations at the workplace if supplies are available. The survey of 1,339 mid- to large-size businesses (more than 70% of them from the U.S.) was conducted in March.

The Takeaway:

Building knowledge helps build confidence.

Source: Getty Images

The vaccine dashboard

Here come the youngest among us.

·  Vaccination of adolescents and children is moving ever closer. Emergency use authorization of the Pfizer/BioNTech vaccine for youngsters ages 12 to 15 is expected within the next week, and the companies hope to have data in hand for kids 5 to 11 years of age as early as the end of summer. The White House plans include sending vaccine directly to doctors’ offices to help accelerate the pediatric rollout.

·  Will parents choose to have their children vaccinated? Civis Analytics asked 2,739 parents of kids in grades K to 12. More than half (58.4%) said Yes, 24.5% said No, and 17.1% were unsure. More likely to say Yes: parents previously diagnosed with COVID-19 (76.7%), men (65.5%), and the fully vaccinated (84.5%). More likely to say No: parents younger than 35 (31%), Trump voters (35.3%) and the unvaccinated (38.7%). The survey was conducted from March 26 to April 26.  

·  “Without digital, we wouldn’t be here” Pfizer CEO Albert Bourla said at the recent Adobe Summit. Bourla recalled that on the day he was named CEO—January 1, 2019—Pfizer also appointed a Chief Digital Officer. In Campaign, Raahil Chopra notes that the CDO’s first assignment was to digitize the discovery and development process. By using advanced analytics and a supercomputing platform, Pfizer shortened vaccine formulation processes from 4 weeks to 18 hours. Creating data tables that once consumed 5 to 6 months of work took just  2 to 3 days.  

·  The World Health Organization has granted an emergency use listing for the Moderna COVID-19 vaccine, making it the fifth vaccine so designated by the WHO. The others are Pfizer/BioNTech, J&J, and two versions of the AstraZeneca vaccine. The listing will help speed the regulatory process abroad and will also make Moderna’s vaccine eligible for use in the global COVAX program, which sends vaccines to low and middle-income countries.

·  Politico calls it “the most promising coronavirus vaccine you’ve never heard of.” You know it well, actually, as the Novavax vaccine, which has been quietly in clinical trials while the high rollers took center stage. A company that has never brought a product to market intends to make a splash this year both in the U.S. (100 million doses promised) and worldwide, shaping up as a key player in the COVAX initiative.

The Takeaway:

Here’s an early vote for coronavirus vaccine as TIME magazine’s “Person” of the Year for 2021. 

Parting shot

“The end of the pandemic will probably look like this: A steep drop in cases followed by a longer period of low numbers of cases, though cases will rise again if people ease up on precautions too soon.” That forecast comes from Zoe M. McLaren, an associate professor in the School of Public Policy at the University of Maryland-Baltimore County, in an analysis for The New York Times. 

If that sounds as fuzzily inconclusive as the final episode of The Sopranos, so be it. We could do much worse. Without getting into the weeds of terms like “exponential growth” and “exponential decay,” cases will decline quickly if every person with COVID-19 infects fewer than one other person, on average. When it comes to slowing transmission to that level, everything counts—getting vaccinated, wearing masks, getting tested and avoiding crowded indoor spaces. In fact, synchronizing the efforts of vaccination on the one hand and public health precautions on the other “magnifies their impact,” McLaren says, “by making it nearly impossible for the virus to spread and breaking many transmission chains at once.”

That’s not only synchrony, it’s also a symphony playing the music we want and need to hear.

… and some songs with 12-string guitar

·  Hotel California, The Eagles

·  Stairway to Heaven, Led Zeppelin

·  Rude Mood, Stevie Ray Vaughan

·  Early Morning Rain, Gordon Lightfoot

·  Dog and Butterfly, Heart

·  Hear My Train A Comin’, Jimi Hendrix

         Seasons, Chris Cornell

That’s a wrap for today. See you back here tomorrow for a Haymarket Coronavirus Briefing. Be well. Happy Cinco de Mayo!