In a pandemic marked by surprise, improvisation and unstable launches, decisions on priority access to COVID-19 vaccines should be different. Despite advancing at a high speed, the development and testing of vaccine candidates has given public health specialists, medical ethics specialists and state health agencies months to ponder the order in which low doses should be distributed.
So, all your careful planning was put aside.
Amid growing criticism that so few shots hit American weapons, the United States Department of Health and Human Services this week abruptly announced changes to the rules. Federal officials said they will stop retaining the second dose of the vaccine for each person who gets the first injection. They expanded eligibility for all elderly people aged 65 and over, as well as for younger adults with medical conditions that increase the risk of a serious case of COVID-19. And they told states that the more doses of vaccine they administer, the more new doses they are likely to receive.
Meanwhile, scientists at the Centers for Disease Control and Prevention warned on Friday that the highly transmissible coronavirus strain that arrived from the UK just a few weeks ago may be causing a new outbreak of infections in March. But that increase could be suppressed, or even reversed, by an aggressive vaccination campaign that reached 1 million Americans a day.
That goal could be more attainable with a plan by President-elect Joe Biden, who endorsed the decision to open the floodgates of the vaccine. The Biden administration will call on the Federal Emergency Management Administration and the National Guard to step up immunizations and ensure that people receive all recommended doses. Retail pharmacies would help drive the effort.
All of this leaves local and state health departments struggling to deliver vaccines as quickly as possible. Which raises some questions.
Does this mean that more vaccine is available?
Not really.
With 38 million doses produced so far and 12 million already administered, about 26 million doses are at stake, with several million coming off the production lines next week.
Most of them have already been sent or are spoken by states. Production has not increased. But freezers in the 14,000 locations to which these doses were sent will no longer be stocked with vials reserved for second doses.
Nor will doses be withheld for people in priority groups who should receive them, but they did not show up to do so – say, a health care worker who is not convinced that rapidly developed vaccines are safe.
Instead, all of these doses will now be released for general use. It is safe to do so because the federal government distributed 31 million doses of the vaccine “essentially without problems,” said Health Secretary Alex Azar this week. And “with the count of cases that we face now, there is absolutely no time to lose. We need doses that go where they will be administered quickly and where they will protect the most vulnerable. “
So, the goal is still to give everyone two doses of the vaccine?
Yes. When the American authorities started hearing about British plans to make the first doses available without promising a second dose, three to four weeks later, they acted quickly to cancel the adoption of such an idea here.
The federal government is “100% committed to ensuring that a second dose is available to every American who receives the first dose,” said Azar. “Based on the science and the evidence we have, it is imperative that people receive the second dose at the right time. That’s what science says, and to ignore it would be unwise. “
Dr. Peter Marks, who oversees the evaluation of new vaccines and drugs at the Food and Drug Administration, warned that there is no data to suggest how well or for how long a single injection of the Pfizer-BioNTech or Moderna vaccine would protect someone from developing the COVID-19. People who receive a single dose can “assume that they are fully protected when they are not and, consequently, change their behavior to take unnecessary risks”. The unequal effectiveness of vaccines administered under such conditions can undermine public confidence in vaccination efforts, he said.
Who will be vaccinated next?
Chance effectively opened the line to about 261 million people. He invited all 47 million Americans aged 65 and over who are not in long-term care institutions to report for vaccines. And he told states that they should vaccinate more than 100 million adults with one or more of the chronic health conditions that make them more vulnerable to a serious case of COVID-19. (These conditions include obesity, diabetes, coronary artery disease and cancer.)
This was a dramatic departure from the CDC’s recommendations for groups that should receive low doses of the vaccine first. After 10 public meetings, an expert advisory panel concluded that the country’s 21 million health workers and 6 million residents of nursing homes and other group settings should go first, followed by 87 million essential frontline workers – a category that includes teachers and bus drivers, first responders, grocery and postal workers, prison officers and people employed in industry and food services.
Frontline workers were prioritized over the elderly because they are less able to protect themselves from infections by staying at home. But it was also an explicit attempt to move away from a longstanding health reality in the United States: that scarce resources go first to the wealthy, educated and socially connected and, finally, to people with less money, less education and less access. to a doctor.
What is wrong with it?
Many of these workers are difficult to reach. They have difficulty finding the time, transportation and access to a doctor they need to receive the COVID-19 vaccine. And they’re not so sure they want to. Because of a long history of abuse at the hands of the medical institution, many black Americans fear that early access to vaccines is simply a ruse to use as medical guinea pigs.
Overcoming these obstacles will require mass vaccination initiatives, outreach campaigns, advertising and other forms of assistance. And that requires money and manpower that most states simply did not have.
But they do now (and Biden’s transition team has promised to get even more funds for them). After months of party disputes, President Trump signed a bill on December 27 that distributed $ 87.5 billion to states for vaccine distribution, including $ 300 million for a “targeted effort to distribute and administer vaccines to populations needy and high-risk, including racial and ethnic minority populations and rural communities. ”
Not surprisingly, these efforts are barely off paper.
Is that why things are so chaotic?
Yes. With 261 million Americans eligible for vaccines, but only about 31 million available, it is a MMA.
Azar said this week that efforts to prioritize essential workers “prevent vaccines from reaching a wider range of the vulnerable population more quickly”.
“It’s time to move on to the next phase of the vaccination campaign,” he added, comparing that to boarding a plane. If groups 1 and 2 had the chance to board, but some of these passengers did not get in line, it is OK to move on to group 3.
Many Americans agree perfectly with this. In a Harris survey, 31% of respondents said they would prefer a first-come, first-hand approach to one that prioritizes certain groups.
But doesn’t that make any sense?
It makes more sense in light of a new development: the emergence of this more transmissible coronavirus strain. As the UK strain progresses, the number of new infections is expected to be greater than ever – and with them, hospitalizations and deaths.
With the exception of more draconian public health measures, for which public patience or political will are diminishing, vaccines are the only way to contain this increase. The more Americans get some measure of protection, even if partial, the more negative pressure the country can exert on new infections.
Three studies published last week in the Annals of Internal Medicine offered evidence that, by injecting the first doses more quickly, new infections could be prevented and case rates decreased.
One of these modeling exercises explored the balance between speed and the more limited effectiveness of a single dose. Stanford researchers concluded that it made sense not to tie the second doses to refrigerators, but to put them out.
The Stanford team assumed that, over eight weeks, about 24 million people would receive at least the first dose of the vaccine. And based on the scarce data available, the team assumed that a single dose would reduce a recipient’s risk of developing COVID-19 by just over 50%.
Under these conditions, the number of people developing COVID-19 could be reduced by between 23% and 29% compared to a strategy of retaining half of all doses now to keep them close at hand for use as a second dose, the researchers estimate.
“This is not a magic solution,” said co-author Joshua A. Salomon, a senior research fellow at the Stanford Health Policy Center. Among other issues, if the vaccine supply drops in the coming months, Americans may be more vulnerable because immunity from a single dose inoculation may not last long.
But for the time being, he said it is clear that shots need to go to guns: “We need to bring aggressive supplies to the states. And states need to speed up delivery. Both really need to happen. “
What’s wrong with giving vaccines to the elderly and people with underlying health problems?
Good question. After all, these are the people most likely to get very sick and die. And they are more willing to fetch the vaccine, show up to get it and return for their second dose than many of the essential frontline workers who should have come before them. In fact, your anxiety is the reason why so many scheduling sites are failing now.
If they are vaccinated in large numbers, hospitalization and mortality rates are likely to decline rapidly. And not only will they protect themselves, but they can also prevent secondary infections – those transmitted to the people they come into contact with and the people who, in turn, come in contact with those people.
So, the new plan may be less fair, but more effective in slowing down the pandemic?
At first yes. Black and brown communities will now compete for low doses of vaccine with communities of older, highly motivated and better-resourced white people. This is hardly a level playing field.
At this point, we may never know if black Americans’ reluctance to get the vaccine early could have been overcome, or if vaccine absorption could have been increased by focusing distribution efforts on communities of color. These efforts have not taken off quickly enough.
At the same time, if the people most likely to occupy hospital beds or die are vaccinated in large numbers, medical resources can be released to care for everyone else.
“People will be unhappy, no matter what you do,” said Dr. Paul Offit, a pediatrician at Children’s Hospital in Philadelphia who served on the CDC vaccine advisory committee. “The amount of vaccine is limited and many will die. This is a Titanic situation: everyone needs to get off the ship as soon as possible and there are not enough lifeboats. “