We’ve done a lot of pivoting in the past year, from going to work and going to school to doing both from home. We’ve pivoted from large gatherings and public events to wearing masks and staying six feet apart and watching much of the world go by on television. Front-line workers had to pivot quickly to 24/7 crisis mode with no work-from-home option.
We are now pivoting again in the United States, from a scenario of vaccine demand exceeding supply to one of supply soon exceeding demand. Those who were frantically scrambling for vaccine appointments a couple of months ago can now find them with relative ease. Meanwhile, the CDC has relaxed its guidance on wearing masks outdoors, mostly for the fully vaccinated, while telling us all to keep masking up in indoor public places and outdoor events with big crowds.
The conversation is also pivoting, from a focus on conclusive and lasting achievement of herd immunity to something softer and less clear-cut — call it containment as opposed to eradication of disease.
What hasn’t changed is the need to vaccinate as many people as possible in order to protect as many people as possible. The degree of collective immunity we can achieve will help determine how successfully we will control or contain the virus and its rogue band of variants, this year and in years to come.
As of Tuesday, April 27, 54% of the U.S. adult population had received one shot, and 37% (3 in 8) were fully vaccinated. For vaccine communicators, this is now crunch time. The low-hanging fruit of avid vaccine-seekers is almost gone, and everything on the upper and outer branches requires a climb. As one public health scholar suggested, it’s time to stop talking about overcoming vaccine hesitancy and pivot — there’s that word again — to building vaccine confidence.
This edition of the Vaccine Project Newsletter is 3,249 words long and will take you 11 minutes to read.
The J&J vaccine is back in circulation, per the CDC and FDA, after 10 days on the shelf. It’s now accompanied by a warning related to blood clots and low platelets, a rare combination known as thrombosis with thrombocytopenia syndrome (TTS).
Based on data from 15 cases, the risk of TTS with the J&J vaccine was 7 cases per 1 million doses administered in women ages 18 to 49 and 0.9 cases per million for women older than 50. The risk was higher, 11.8 per million, in women 30 to 39 while none of the 15 reported cases occurred in women over 65 or in men of any age. See the slide presentation by Tom Shimabukuro, deputy director of CDC’s Immunization Safety Office, here. The numbers will change as vigilance continues, but the risk is expected to remain low.
The fact sheets for health care professionals and for caregivers and recipients of the J&J vaccine have been revised to include information about the rare chance of a blood clot complication and the signs and symptoms that should prompt a call to the doctor. An important reason for the pause was to give healthcare professionals a heads up on early recognition and treatment.
The pause may have reinforced reluctance among the already vaccine-skeptical, which means that an extra measure of education and persuasion will be needed. Chad Worz, chief executive of the American Society of Consultant Pharmacists, told McKnight’s Long-Term Care News that “We need to respond quickly, loudly and effectively to ensure we don’t lose some willing individuals to this blip in confidence.”
The communications effort
There’s a sports psychology book called Crunch Time: How to Be Your Best When It Matters Most. That’s the general idea here.
· Healthcare marketers are pooling their creative energies in an effort to win over the vaccine holdouts, Marc Iskowitz reports in MM+M. A consortium calling itself Face2FaceAmerica includes Convergence Point Media, Mint Collective, Dramatic Health, Fishawack Health and PhillyCooke Consulting and invites others to join. The education, delivered via Facebook, Twitter and other channels, shares video testimonials from individuals who “had questions, found answers and stepped up.”
· The New Mexico Department of Health is relying on a Trusted Voices campaign, delivered via YouTube videos, to build vaccine confidence. Tracie Collins, the state’s health secretary, told a Senate subcommittee, “We understand that persuasion is built on trust and that trust is often built on shared roots and experiences.” The department has hosted a series of virtual town halls and translated COVID-19 educational materials into a wide variety of languages at appropriate health literacy levels.
· Gordon Smith, President and CEO of the National Association of Broadcasters, told the same subcommittee that the NAB’s research on vaccine education finds the voices of local doctors, nurses and pharmacists to be the most influential. The National Association of Chain Drug Stores was quick to share that observation. Smith, a former two-term U.S. Senator from Oregon, noted that broadcasters have donated “hundreds of millions of dollars” of airtime for vaccine messaging.
· Physicians in the U.K. are getting much of the credit for a tripling of COVID-19 vaccination rates among minority ethnic groups from early February to early April, Luke Haynes reports in GP. The head of National Health Service England said that doctors’ understanding of their local communities was a key driver of the improvement, helping to dispel misinformation and build confidence.
· What are the pro-vaccine messages that people actually want to hear? The Washington Post reviews what resonates. Kelly Moore, deputy director of the Immunization Action Coalition, sums it up succinctly: “No national ad campaign is ever going to be as effective … as people who look like you and come from your community saying: ‘This is important. It’s the right thing for us.’”
· The Immunization Action Coalition offers a Facebook Frame that allows you to change your profile photo to show that “I’ve had my COVID-19 vaccine.”
· The Public Health Communication Collaborative has updated its “Tough Questions” FAQ feature to include information about the lifting of the J&J pause. The Collaborative has also made available, on demand, its recent webinar on vaccine messaging in rural communities, based on the successful experiences of health teams in West Virginia.
· What’s been missing from the messaging is the fact that the vaccine will change our lives for the better, Amesh Adalja said in a briefing presented by the Infectious Diseases Society of America. Adalja, senior scholar at the Johns Hopkins Center for Health Security, said the vaccines have done what we wanted them to do — essentially defang and tame the disease, virtually eliminating the risks of hospitalization and death and giving us an opportunity to reclaim our lives.
· Hip Hop Public Health, a national nonprofit founded in 2004, is all in on vaccine advocacy, most recently rolling out a five-part “animated rap anthology” titled Community Immunity. The videos feature the voice of Run DMC’s Darryl DMC McDaniels and are designed to position vaccination as a social norm and “an act of community service.” The organization’s founder is Olajide Williams, professor of neurology at Columbia University.
· In a survey of adults who attend religious services, 44% of the vaccine-hesitant and 14% of the vaccine resistant said that faith-based approaches would make them more likely to roll up their sleeves. Such approaches might include a religious leader encouraging vaccination, a religious community holding an information forum, a local congregation serving as a vaccination site or their religious community helping arrange vaccine appointments. The survey was conducted by the Public Religion Research Institute and Interfaith Youth Core.
The best communication strategies are often the simplest: Ask your doctor. Or your minister. Talk to friends and family you trust. Turn to each other.
Vaccination megasites may soon be giving way to minisites. Whatever works.
· State health officials are getting creative in reaching out to the unvaccinated, emphasizing a tone of respect rather than reproach. As MM+M’s Lecia Bushak notes, strategies include partnering with local businesses, distributing information from trusted sources on social media and providing vaccines through doctors’ offices so that folks can reach “their physician of comfort” in “their persuadable moments.” It’s about easing access as well, whether by taking walk-ins at vaccination sites, providing transportation to and from, or vaccinating people at home.
· A number of mass vaccination sites around the country are shutting down as long lines have disappeared and some places are turning down shipments of additional doses. Strategies are shifting to mobile vaccination clinics, vaccination in doctors’ offices and other smaller-scale efforts.
· The vast majority of people receiving the Pfizer or Moderna vaccine are getting both shots, but 5 million have skipped the second dose, the New York Times reports. Some folks are concerned about side effects while others believe that one shot is enough. (It isn’t.) In some cases, vaccination sites didn’t have the same product on hand for dose two. As of Tuesday, more than 96 million people in the U.S. were fully vaccinated, whether with the two-dose vaccines or the single-dose J&J vaccine.
· Employers are expected to play a key role in encouraging the next wave of vaccination, not necessarily mandating shots for their workers but providing education, tangible incentives, and in some cases vaccination on site.
· The U.K. is proposing a COVID-19 vaccine requirement for staff who work in older adult care homes, Nick Bostock notes in GP. However, the chair of the Royal College of General Practitioners is not in favor of a mandate for all health professionals, claiming that “informed and educated choice about health interventions would be more beneficial long-term than enforcing them, which risks leading to resentment and mistrust.”
· The University of California and California State University, which together enroll and employ more than 1 million people, will require COVID-19 vaccination after one or more vaccines are fully approved by the FDA. The vaccines are currently available under an emergency use authorization, but full approval is expected in the coming months. The mandate will apply to faculty, staff, and students on 33 campuses and allow for medical and religious exemptions.
· An assisted living provider in Florida is trying to increase vaccination of staff—now at an anemic 30%–by offering pop-up vaccination clinics to family members of unvaccinated workers. The idea is to reduce employees’ possible exposure to COVID-19 at home and to generate some pro-vaccine buzz.
· COVID-19 cases and deaths in long-term care have dropped dramatically since vaccination began in December, by nearly 92% and 89% respectively, according to an analysis by Kaiser Family Foundation. Kimberly Bonvissuto has further details in McKnight’s Senior Living, noting that cases and deaths in long-term care are at an all-time low.
Some judicious combination of carrot and stick may actually work. West Virginia Governor Jim Justice has offered the carrot of a $100 savings bond to all people ages 16 to 35 who get vaccinated.
No one said it would be easy to get from Maybe/Maybe not to Maybe yes/Yes. We’re going to need a piece de resistance.
· In a Washington Post-ABC poll taken a few days before the J&J pause was lifted, just 22% of the unvaccinated said they would be willing to get the J&J vaccine. While 50% to 53% of the unvaccinated consider the Pfizer and Moderna vaccines to be very safe or somewhat safe, only 28% felt that way about the J&J vaccine. To date, 8 million doses of J&J vaccine have been administered in the U.S, and another 9 million have been delivered and are on call.
· In the same Washington Post-ABC poll, 56% of all adults surveyed said they had already been vaccinated. Others said they would definitely (7%) or probably (11%) get vaccinated or probably (8%) or definitely (16%) would not.
· Latinos are three times more likely to be hospitalized with COVID-19 and twice as likely to die from the infection, but 27% of the unvaccinated say they won’t take the vaccine and another 24% are not sure, according to a poll by Change Research for the grassroots group Voto Latino. They don’t trust the safety and they don’t trust vaccine manufacturers, attitudes fed in part by misinformation on social media. Logistical barriers arise as well—lack of online access, English-only vaccination websites and lack of transportation to vaccination sites.
· The National Hispanic Medical Association has launched a campaign, #Vaccinate4All, to increase vaccination education and uptake in the Latino community. The effort, which provides health professionals and other vaccine advocates with educational materials, is supported by the CDC, J&J, and Biotechnology Innovation Organization (BIO). BIO has also produced a podcast on Voices of Vaccine Hesitancy.
· In the 1918 flu pandemic, 50% of infected pregnant women died. In the 2009 H1N1 flu pandemic, pregnancy carried a high risk of severe illness, hospitalization and death. COVID-19 is proving to be high-risk as well. A study in JAMA Pediatrics, drawing data from 18 countries, reports poorer outcomes for pregnant women with COVID-19, ranging from pre-eclampsia or eclampsia to ICU admission, preterm birth, and maternal or neonatal death. It’s the latest of numerous reports of dire outcomes from COVID-19 during pregnancy.
· Pregnant women should get vaccinated, CDC Director Rochelle Walensky noted, citing a recent study in The New England Journal of Medicine that did not find any “obvious safety signals” among pregnant women who received either of the two mRNA COVID-19 vaccines (Pfizer/BioNTech and Moderna).
This news should help allay concerns about safety of the vaccine in pregnancy, which has been a key contributor to hesitancy among nursing home workers, Alivia Lasek reports in McKnight’s Long-Term Care News.
· Among 627 cases of SARS-CoV-2 infection in Chicago nursing homes, 22 were breakthrough infections, occurring in 12 residents and 10 employees who were fully vaccinated. The CDC reports that nearly two thirds of the breakthrough infections (64%) were asymptomatic, and no secondary transmission took place. In 15 nursing homes with breakthrough cases, attack rates in residents were 15% for the unvaccinated and 0.8% for the vaccinated. Attack rates in staff were 6% and 1%, respectively.
· Vaccination was also protective in a nursing home outbreak of COVID-19 in Kentucky that was traced to a coronavirus variant, Lasek reports. Unvaccinated residents and staff had 3.0 and 4.1 times the risk of infection, respectively, compared to their vaccinated counterparts. Vaccination was 86.5% protective against symptomatic illness for residents and 87.1% protective for staff.
· Senior care facilities in Kansas and North Dakota have reported a few breakthrough cases of COVID-19 that were asymptomatic and discovered only on routine testing, Bonvissuto notes in McKnight’s Senior Living.
· Vaccine mandates promise to remain a focus of discussion, controversy and most likely legal action, as the momentum of early vaccination activity fades. In Infectious Disease Advisor, Tori Rodriguez interviews medical and legal experts to explore the feasibility and acceptance of government or employer mandates. Lawrence Gostin a professor at Georgetown and Johns Hopkins, notes that “We need to build community trust in the COVID-19 vaccine before we mandate it.”
Can the mantra “Vaccination saves lives” become as instantly familiar as Nike’s “Just do it”?
The vaccine dashboard
It’s World Immunization Week, with the theme “Vaccines bring us closer.”
· The British government is ramping up a campaign to give booster shots of COVID-19 vaccine in the fall “to make sure our vaccines stay ahead of the virus,” Luke Haynes reports in GP. The booster could be given at the same time as the annual flu shot, suggested health and social care secretary Matt Hancock, and regular immunizations could become part of ongoing COVID-19 management.
· In addition to returning to the U.S. market, the J&J vaccine is now rolling out in the 27 nations of the European Union as well as non-EU countries Norway and Iceland. The safety committee of the European Medicines Agency conducted its own investigation of TTS and concluded, as did the FDA and CDC, that the benefits of the vaccine outweigh the risks.
· The EMA reached a similar conclusion in summarizing the “benefits and risks in context” of the AstraZeneca vaccine, also linked to rare instances of blood clot-low platelet combinations.
· In the U.K., where 21 million doses of the AstraZeneca vaccine have been given, regulators continue to emphasize the rarity of the adverse effect (7.9 cases per million) and to recommend the vaccine, noting that people 18 to 29 years old with no underlying conditions should be offered an alternative vaccine if available.
· Canadian Prime Minister Justin Trudeau, 49, and his wife, Sophie Gregoire-Trudeau, 46, issued a vote of confidence and received their first dose of AstraZeneca vaccine last Friday at a Rexall pharmacy in Ottawa. It was the day before her birthday.
· An FDA inspection turned up a number of quality and safety issues at the Baltimore subcontractor plant that was manufacturing the J&J vaccine, Brian Park reports in MPR. That’s the plant where 15 million doses of vaccine were ruined by a mix-up of ingredients. Failure to investigate the mix-up is one of the problems cited.
· One year after its formation, a global health coalition warns that the pandemic is still a rising tide worldwide and that tests, treatments and vaccines are inequitably distributed. “COVID-19 knows no borders,” said Carl Bildt, a World Health Organization special envoy and former prime minister of Sweden. “A new variant from anywhere could unravel progress everywhere, even in a country that has achieved 100% vaccination.”
· For its part, the U.S announced it will send up to 60 million doses of AstraZeneca vaccine, now sitting in storage, to countries in need, pending an FDA safety review. AstraZeneca has not yet applied for emergency use authorization in the U.S.
· We’re also sending vaccine raw materials to pandemic-ravaged India along with therapeutics, rapid diagnostic test kits, ventilators, and PPE. India’s health system has been overwhelmed, with more than a million new cases in a three-day period in a situation the World Health Organization describes as “beyond heartbreaking.”
The lens of history may focus less on whether we were able to fire up the grill for our July 4 barbecues and more on what all of us as a global community did to keep the world from burning.
… and some songs, all Academy Award winners
Thanks once again for joining us, always appreciated. Tune in tomorrow for a Haymarket Coronavirus Briefing on life and living in pandemic times. Stay well.