“COVID’s US toll expected to drop sharply by end of July” was the headline following a CDC “weather” report on the future course of the pandemic. That is entirely plausible and possible, but read the full story and we discover that shifting patterns could make the difference between sunny skies or storm clouds ahead.
Teams of researchers used statistical modeling to create and analyze four COVID-19 scenarios from April through September:
· High vaccination rate with moderate use of nonpharmaceutical interventions (NPIs) such as masking and distancing
· High vaccine uptake with low use of NPIs
· Low vaccine uptake with moderate use of NPIs
· Low vaccine uptake with low use of NPIs.
As you might imagine, some of the scenarios had better outcomes than others, the projected differences measurable in thousands of cases, hospitalizations and deaths. “Some states could reach levels of disease similar to those observed in late 2020 in scenarios with lower use of NPIs,” the authors said. And some areas could achieve the Holy Grail of herd immunity, as Los Angeles County now expects.
These projections come at a time when the pace of vaccination is slowing and public health measures are loosening, with talk of relaxing indoor mask mandates. Add in variants as a wild card and the future is in flux.
The researchers took pains to say they were not making forecasts but simply reflecting a “range of realistic uncertainty.” In a way, it’s like predicting the weather without the benefit of radar. The difference is that we will not live a simulation or a model but in real life and in real time. The scenarios we construct day by day will determine what the world around us looks like. Good news: we have more control over creating a best-case coronavirus scenario than we do over the weather.
This edition of the Vaccine Project Newsletter is 3,357 words long and will take you 11 minutes to read.
Opening shot
COVID-19 shots are going into the arms of 12- to 15-year olds after the FDA on Monday okayed an emergency use authorization for the Pfizer/BioNTech vaccine. The CDC’s Advisory Committee on Immunization Practices is meeting today[FH1] to make its recommendation, but some vaccinators have already acted on the FDA nod. Acting FDA Commissioner Janet Woodcock called the decision “a significant step in the fight against the COVID-19 pandemic” and said that “parents and guardians can rest assured that the agency undertook a rigorous and thorough review of all available data.” The two-dose regimen will be the same as for older teens and adults.
Vaccinating 12-to-15-year-olds will be a climb, based on how their parents feel about it. According to the Kaiser Family Foundation, 30% of parents of children ages 12 to 15 say they will have their child vaccinated as soon as the product is available. Others want to wait and see how the vaccine is working (25%) or will have their child vaccinated if school requires it (18%). Nearly 1 in 4 say they will definitely not get their child vaccinated; they tend to be parents who don’t want the vaccine themselves.
The communications effort
Doctors are now on call.
· “From Concern to Confidence: How Physicians Can Build Trust in COVID-19 Vaccines” is a 4-page summary of practical tips developed by the de Beaumont Foundation and the Association of State and Territorial Health Officials. The guidance shares “messaging that works,” noting that doctors are regarded as the most trusted source of information on COVID-19 and vaccines. Further insights are available at the de Beaumont Foundation’s website on “Changing the COVID Conversation.”
· The de Beaumont Foundation, a partner in the Public Health Communications Collaborative, also shares the results of a focus group explaining how they overcame their doubts about getting vaccinated. You can see a 10-minute excerpt of the discussion here.
· Doctors’ offices are now getting the priority as vaccination sites they have been seeking all along, Politico reports. Let the conversations begin.
· Public relations agencies, networks and holding companies with offices in India are reaching out to help arrange medical and hospital services, mental health support and vaccination for employees and their families as the country suffers a devastating spike in COVID-19. PRWeek’s Aleda Stam reports that companies are encouraging their people to get vaccinated, with some firms providing on-site vaccination and others offering paid time off to get shots. The industry is also busy helping its clients redirect their communications to crisis-focused messaging.
· The U.S. Chamber of Commerce Foundation and the U.S.-India Business Council are offering guidance to companies on how to lend a hand to those suffering in India.
· Operation Jersey Summer is an initiative to reach the goal of vaccinating 4.7 million New Jerseyans (70% of the adult population) by June 30. The effort includes a campaign called Grateful for the Shot, which will allow people to go directly from church services to a vaccination site. Latest additions to a 6-month awareness campaign include a 30-second TV spot on the theme of “Let’s Get Back to It.”
· Atria Senior Living has vaccinated 98% of its 10,000 employees in more than 200 facilities, Kimberly Bonvissuto reports in McKnight’s Senior Living. The company mandated vaccination but also had a communication plan that helped smooth the way. Sleeve Up Atria was a concerted effort to educate, support, and encourage staff and residents. “We believe our residents deserve to live, and our employees deserve to work, in a vaccinated environment,” said CEO and Chairman John Moore. “For every person vaccinated, a link in the possible chain of transmission is broken, and vaccinated individuals can start to say ‘the disease stops with me.’”
· Two nursing home operators took very different routes to vaccinating staff with similar success, Danielle Brown notes in McKnight’s Long-Term Care News. Jewish Senior Services in Connecticut achieved 95% staff compliance with a mandate. “It is the only way to deliver the message to our current and future clients that their safety comes first,” said president and CEO Andrew Banoff. At the Gardens at DePugh Nursing Center in Winter Park, Florida, staff received $100 to get the first shot and another $900 if 75% of them got the second. The result: 92% uptake. “Cash talks,” said board chairman Rick Baldwin.
· The Seattle Mariners want you to know that they were the first Major League Baseball team to offer COVID-19 vaccinations at the ballpark. Vaccinations are given by the Seattle Fire Department EMS, and you have your choice of the J&J single-dose vaccine or the first dose of Moderna (follow-up provided for Dose 2). On May 4, 190 fans got their shots. It’s a partnership with the city of Seattle and the soccer team FC Sounders, which is also giving shots and happy to share the news that the team is fully vaccinated.
· Tix for vax: New York Mets and Yankees fans who get vaccinated at their stadiums will receive ticket vouchers for future games. As of May 19, both teams will divide their stadiums into separate sections for the vaccinated (sitting close to each other at up to 100% capacity) and unvaccinated (6 feet apart in sections with no more than 33% of capacity). The Atlanta Braves offered free vaccination and two free tickets to Braves games at the park last weekend.
The Takeaway:
It’s reassuring to know that doctors are getting their turn to pitch in the later innings. A complete game needs starters, middle relief, set-up specialists and closers.
The rollout
Across the country, the trend is clear. Mass vaccination sites are shutting down as neighborhood sites are opening up. States are cutting back their orders of vaccines as demand wanes, while community coalitions are pounding the pavement to help it wax again.
· 44% of U.S. adults and 71% of seniors are fully vaccinated, per the CDC’s dashboard. People who have received at least one dose include 84% of seniors, 58.5% of all adults (goal is 70% by July 4) but just 33% of those ages 18 to 29.
· In the Cincinnati area, healthcare organizations, community groups and private businesses are collaborating on a Get Out the Vax Campaign to increase the vaccination rate from 49% to 80% of all vaccine-eligible people by July 4. Free public transit is available to and from vaccination sites, where walk-ins are welcome.
· Los Angeles is making appointment-free vaccinations available at all locations and opening two new night clinics. The city has 10 vaccination vans fanning out to neighborhoods hardest hit by the pandemic in its Mobile Outreach for Vaccine Equity (MOVE) program. Meanwhile, a coalition of local leaders, the Community Organized Relief Effort (CORE), has launched a vaccine awareness and acceptance campaign, “It’s Time Los Angeles,” reaching out to Black, Latino and AAPI populations. The campaign was developed by the multicultural firm American Entertainment Marketing.
· The decline in COVID-19 cases and deaths in nursing homes can be tied to vaccination, independent of other contributing factors, a study of 2,501 facilities in 17 states has concluded. Alicia Lasek has details in McKnight’s Long-Term Care News. The evidence provides support for the federal government’s early decision to put LTC residents and workers in the top priority tier for vaccination and its more recent decision to relax rules for visitation and congregation.
· At Tennessee-based Brookdale Senior Living, which operates more than 700 senior living and retirement communities in the U.S., cases among residents are down 97% since peaking in December, and 93% of residents have been vaccinated, Kimberly Bonvissuto reports in McKnight’s Senior Living.
· Rowan University in Glassboro, NJ is offering a $500 credit on registration fees to students who show proof of COVID-19 vaccination before July 31. Students who live on campus will get another $500 credit on their housing bill. Rowan is mandating vaccination but allows medical and religious exemptions as well as an opt-out for anyone who submits a formal declination statement. Unvaccinated students will need to be tested weekly for COVD-19.
· Mayor R. Rex Parris of Lancaster, CA has created a raffle for 16- to 18-year-olds. If you get fully vaccinated, post a selfie on social media, and tag five friends, you could win a grand prize of a $10,000 scholarship, second prize of a $5,000 scholarship or a $50 gift card, to be awarded to 20 third prize winners. Teens can help their chances by persuading unvaccinated friends to get the shot. Mayor Parris told ABC News that he created the raffle “so our community’s youth feel that much more excited and motivated to be part of ending the COVID-19 pandemic.”
· The American Museum of Natural History in New York City is a vaccination site. Get your shot and you’ll receive a voucher, redeemable online, covering general admission for a future visit for up to a group of four. The museum has also received a grant from the National Science Foundation to address the disruptions caused by the pandemic in students pursuing careers in STEM (science, technology, engineering and math).
· Not to be outdone by New Jersey’s shot and a beer program, the Connecticut Restaurant Association and the Governor’s office are partnering in CT Drinks on Us, offering a free libation in return for proof of inoculation. The offer runs from May 19 to 31. Connecticut is the first state to fully vaccinate 50% of its adult population.
· The NFL has told all 32 teams they should offer COVID-19 vaccines to players coming to this month’s mini-camps for rookies. The league does not mandate vaccination but wants teams to let all players know that vaccinations may help them avoid missed practices and games, “and therefore may have a competitive impact for the club.” All teams must return to in-season COVID-19 protocols by May 17. Unvaccinated players will be tested every day, vaccinated players once a week.
The Takeaway:
The longest line I have seen lately is at the new Krispy Kreme drive-in located, as it happens, less than 2 miles from my house. They got this whole incentive thing started with a donut.
The challenges
There is light at the end of the tunnel. However, we’re still in the tunnel.
· Now that the federally run vaccination program in nursing homes has run its course, sustaining the momentum is a challenge for states and the facilities themselves. In McKnight’s Long-Term Care News, Kimberly Marselas explains what Ohio has done to reach and sustain resident vaccination rates at 90%. Nearly 1,600 of Ohio’s 1,745 long-term care facilities are enrolled in a program that helps structure partnerships with pharmacies. Vaccinating the LTC staff remains a separate challenge, as just 52% of workers in Ohio have had their shots.
· Civis Analytics tested six different messages to explore what might change the minds of vaccine skeptics. The most effective were “Getting Back to Normal,” emphasizing the daily activities that the vaccinated can enjoy, and “Personal Decision,” stating that it’s normal to have questions and encouraging people to learn more. Not as effective: messages focusing on vaccine safety, “scary COVID statistics,” and appeals to patriotism. The findings come from a randomized controlled trial of 4,215 adults “most likely to be uncertain about vaccination.”
· What might seem like a negative attitude toward vaccination is, in many cases, a lack of information. In the Kaiser Family Foundation surveys, 29% of all adults and 42% of Hispanic adults say they are not sure whether they are eligible to get a vaccine in their state, even though all adults now qualify. For those not eager to be vaccinated, 30% would be more likely to step forward if the vaccine were offered at the same place they go for healthcare.
· Patients with rheumatic and musculoskeletal diseases (RMDs) who are taking immune-modifying drugs may have a blunted response to COVID-19 vaccines. The American College of Rheumatology has updated its guidance, Meghna Rao notes in Rheumatology Advisor, recommending adjustments in medications such as methotrexate and mycophenolate, as well as acetaminophen and NSAIDs, before and after vaccination. The ACR also recommends that household members and close contacts of patients be vaccinated to help provide a protective “cocooning” effect.
· Some patients with kidney and other solid organ transplants may be at risk for COVID-19 even after receiving two doses of mRNA vaccine, Natasha Persaud reports in Renal & Urology News. Among 658 participants in a recent study, 15% of transplant recipients mounted an antibody response after both vaccine doses, 39% had a response after Dose 2 only and 46% did not respond to either dose. The lack of response was especially notable in patients taking antimetabolites to prevent organ rejection. Booster doses of vaccine may be needed along with adjustments in medication.
The Takeaway:
The devil is in the details. There will always be details.
The vaccine dashboard
The dashboard is lighting up as we begin the transition from emergency use to full-fledged FDA approval, and as the pediatric population, well acquainted with other vaccinations, gets a chance to try something new and different.
· Pfizer and BioNTech have applied to the FDA for full approval for their COVID-19 vaccine for people 16 and older. This is a step up from the emergency use authorization granted last December. The Biologics License Application can now include 6 months of real-world data on the use of the vaccine; more than 170 million doses have been delivered across the U.S. Having just received emergency use authorization for the vaccine in 12- to 15-year-olds, the companies could be submitting a similar request for 2- to 11-year-olds by September.
· Canada is proud to say it was the first country to approve COVID-19 vaccine for 12- to 15-year-olds, giving the go-ahead to Pfizer/BioNTech. Some shots might be given in schools.
· In MM+M, Lecia Bushak explores the Biden administration’s attention-getting and controversial decision to temporarily waive patent protection for COVID-19 vaccines. One observer calls it a “game of political chess” that has just begun to play itself out on the world stage. The endgame: finding the best way to ensure more equitable global access to life-saving technology.
· Moderna has shared data demonstrating that a booster dose of its COVID-19 vaccine is effective against the SARS-CoV-2 variants first identified in South Africa (B.1.351) and Brazil (P.1). Is it possible to give these variants names, the way we do hurricanes?
· The World Health Organization has expanded its emergency use listing of COVID-19 vaccines to include one produced by Sinopharm, a state-owned network in China. The two-dose vaccine has been given to millions in Asia, Africa and Latin America. Another vaccine from China, Sinovac, is undergoing review by the European Medicines Agency.
· If booster shots are needed, and there’s a good chance they will be, we’ll likely go through another exercise in triage, giving priority to older folks and people with underlying medical conditions.
The Takeaway:
By the end of the year, COVID-19 shots will be available and authorized for virtually all ages. This is starting to look more and more like Flu 2.0.
Parting shot
“The next 4 to 6 weeks are absolutely critical for the nation’s vaccination campaign,” says Reed Tuckson, co-founder of the Black Coalition Against COVID. The Coalition has been active on numerous fronts since its formation in April 2020, hosting a number of national town halls online and sharing a “Love Letter to Black America” from Black doctors and nurses. More recently, they have gone social as well, with a series called “Black Doctors Read COVID Tweets,” produced in collaboration with Real Chemistry.
“We’ve used every tool available to provide necessary information and to engage people who legitimately have questions and legitimately need answers,” Dr. Tuckson said in a conversation with this newsletter. “Twitter offers glimpses into what is on people’s minds. So we decided to dive into that conversation and literally meet people where they are.”
Dr. Tuckson’s responses to the tweets have the flavor of a kind father’s heart-to-heart talk, a healthy dose of science accompanied by an equally healthy dose of support and encouragement, as well as a dollop of humor. He empathizes with folks who are eager to return to backyard barbecues and says “I’m hungry too. I’m hungry to get my life back.” He’ll close with a note like, “In all seriousness, black doctors and health advocates are working as hard as we can to prioritize and save black lives from this pandemic.”
Dr. Tuckson says “It’s important for people to understand that it’s okay to have questions. There’s been a lot of finger pointing. We need to come at it with a lot more empathy and an understanding that different people have different opinions. At the same time, we are unabashedly carrying forth the message that getting vaccinated is a good thing to do. Our message is that we love you and care about you and come from the same community that you do.”
Sabrina Sanchez offers additional perspectives on BCAC initiatives in Campaign.
… and some songs, from Broadway shows returning this fall
· Welcome to the Rock, from Come From Away
· Defying Gravity, from Wicked
· Circle of Life, The Lion King
Thank you for your time and kind attention. Please return tomorrow for a Haymarket Coronavirus Briefing, offering glimpses into This Pandemic Life. Stay well.