The Vaccine Project Newsletter: So much hanging in the balance

This edition of the Vaccine Project Newsletter is 2,716 words long and will take eight minutes to read.

Source: Getty Images
Source: Getty Images

Checking our progress on the U.S. immunization odometer:

•  215.5 million people ages 12 and older have received at least one dose of COVID-19 vaccine (76% of the vaccine-eligible)

•  185.9 million people ages 12 and older are fully vaccinated (65.6% of the vaccine-eligible)

•  94% of seniors 65+ have received at least one dose of vaccine and 84% are fully vaccinated.

The Centers for Disease Control and Prevention added a new stat this past week: The percentage of the fully vaccinated who have received a booster dose. That number stands at 3.4% of adults 18 and older, 5.4% of people 50 and older and 8.4% of seniors.

Overall, 6 million people have received a booster since mid-August. That’s a reasonably brisk but not torrid pace, in keeping with the advice of CDC Director Dr. Rochelle Walensky to “walk, don’t run” to the nearest booster opportunity.

In search of balance and harmony

As signs of the zodiac go, we are in the time of Libra, the sign of justice, balance and harmony. The scales of Libra remind us to balance the bad news of the pandemic with the good, to be mindful of and grateful for incremental progress while acknowledging the unprecedented gravity of the situation surrounding us.

The sad news of reaching 700,000 COVID-19 deaths in this country (and 4.8 million in the world) is heartbreaking but must be counterbalanced by a collective determination to pursue the task at hand: saving lives through vaccination. As the CDC data show, there are 2 million people who are vaccinated today who were not vaccinated a week ago. There are also tens of millions of unvaccinated folks who continue to weigh the benefits and risks of vaccination.

Novant Health, a not-for-profit health system with 15 medical centers and 800 locations in the Carolinas and Georgia, made a conscientious effort to balance many considerations before implementing a vaccination mandate for its employees. Novant President and CEO Carl Armato said that, “Without a vaccine mandate for team members, we faced the strong possibility of having a third of our staff unable to work due to contracting, or exposure to, COVID-19. This possibility only increases heading into a fall season with the more contagious and deadly Delta variant.”

Novant announced its vaccination mandate in July. As of September 21, 98.6% of the company’s more than 35,000 team members had received either a single dose of the J&J vaccine or the first dose of Pfizer/BioNTech or Moderna vaccine. The compliant also included workers who applied for and received a medical or religious exemption.

Novant weighed its options once again and decided to give the 375 noncompliant employees a second chance during a five-day unpaid suspension period. During that time, about 200 rolled up their sleeves; the remaining 175 were terminated.

Novant employees who received Pfizer or Moderna vaccine have until October 15 to receive their second dose. Those who obtained a medical or religious exemption must undergo weekly COVID-19 testing and wear N95 masks or other appropriate PPE, including eyewear protection. “These added safety measures are in place to ensure patient and team member safety and preserve staffing levels,” Armato said. In the meantime, Novant has made 150 new hires.

For United Airlines CEO Scott Kirby, what tipped the balance in favor of a mandate was the death of a 57-year-old United pilot from COVID-19. “We concluded ‘enough is enough,’” Kirby told The New York Times. “People are dying and we can do something to stop that.”

Before implementing a mandate, the airline laid the groundwork for a strong base of voluntary buy-in by negotiating with unions, offering a variety of financial incentives, setting up vaccination clinics and providing vaccine education. The number of United employees facing termination is just 320, less than one half of 1% of the workforce of 67,000.

Recently, more than 20,000 people applied for 2,000 available flight attendant positions with United. American Airlines, JetBlue and Alaska Airlines are among the other airlines following suit with mandates of their own.

In New York, the looming deadline of a vaccination mandate did not produce a mass exodus of long-term care workers but rather a major surge in vaccinations, Danielle Brown reports in McKnight’s Long-Term Care News. Across the country, Brown notes, nursing home operators who are reluctant to terminate unvaccinated workers are giving them a 30-day leave to think things over.

In this season of Libra, businesses, government bodies and courts alike are weighing the merits of mandates.

Source: Getty Images.

Mandates in motion

•  Judges in Kentucky, California, Colorado and New Jersey have upheld vaccination mandates instituted by local health systems (Greater Cincinnati area), municipalities (Denver) and universities (Rutgers, University of California).

•  Fun factoid: In Kentucky, the federal judge who upheld the vaccine mandate for St. Elizabeth Healthcare and its 10,000 employees is David Bunning, son of the late Hall of Fame pitcher (and U.S. Senator from Kentucky) Jim Bunning. Judge Bunning said, “The Court recognizes that the COVID-19 pandemic has become unfortunately political and vitriolic, on all sides. But the Court expressly refuses to adjudicate the political assertions raised in this case.” The son can throw a perfect strike too.

•  Supreme Court Justice Sonia Sotomayor allowed the vaccination mandate for New York City teachers and school staff to remain in place. About 95% of public school employees have received at least one shot and more than 18,000 did so in the past 10 days.

•  California Governor Gavin Newsom has announced a statewide vaccination mandate for all eligible schoolchildren, with the timing based on full Food and Drug Administration approval of vaccines for each age group. The mandate would most likely take effect for middle and high school students in July of 2022. The Governor encouraged individual school districts to adopt mandates sooner depending on local circumstances, and several in the Los Angeles and San Francisco areas have already done so.

•  AT&T has extended its vaccination mandate to employees who are members of the Communications Workers of America. The union members have until February 1 to get their shots or receive an approved job accommodation. Those not vaccinated by February 1 will have a 60-day unpaid “reconsideration period,” a union official told The Hill. AT&T management must be vaccinated by October 11.

The communications effort

•  The CDC issued an “urgent health advisory” in an effort to increase COVID-19 vaccination rates among people who are pregnant, were recently pregnant, are trying to become pregnant or might become pregnant in the future. Noting that only 31% of pregnant individuals are vaccinated against COVID-19, the CDC emphasized that vaccination is vital in preventing serious illness, death, and adverse pregnancy outcomes.

•  YouTube’s decision to ban vaccine misinformation about all types of vaccines, not just COVID-19, will put additional pressure on tech companies to step up their vigilance, Lecia Bushak reports in MM+M. “Factual and trusted healthcare information has never been more important,” said Real Chemistry president Elyse Margolis. “Active targeting of audiences, especially young people, with misinformation is a real and urgent threat to public health. Online platforms, health companies, healthcare providers and governments all have a responsibility to join together to solve this growing challenge.”

• Let’s face it: The vaccinated and unvaccinated see the world through different lenses. In the Kaiser Family Foundation’s September polling, the vaccinated viewed the summertime surge in COVID-19 cases as evidence that too many people are refusing the vaccine. The unvaccinated tended to see it as evidence that the vaccines aren’t working as well as expected. Similarly, the vaccinated regard breakthrough infections as evidence that overall the vaccines are effective, while the unvaccinated reach the opposite conclusion.

Source: Getty Images.

The challenges

•  The Mississippi chapter of the American Academy of Pediatrics sent an urgent message to local school leaders, cautioning against the relaxation of mask mandates in the classroom. Although case rates have started to decline, the doctors noted that six pediatric COVID-19 deaths have occurred since the end of July and that 31% of admissions to the University of Mississippi Children’s Hospital were of children with COVID-19 under age 12. Mississippi ranks 47th among the states in percentage of population fully vaccinated against COVID-19 — and first in case fatality rate.

•  The National School Boards Association wrote to President Biden asking the federal government to “investigate, intercept and prevent threats and acts of violence” against students, educators and school board members trying to ensure safe school reopening in the time of COVID. The letter cites more than 20 instances of “threats, harassment, disruption and acts of intimidation” that have taken place during school board meetings.

•  More than half (56%) of parents surveyed by CivicScience said they were very (30%) or somewhat (26%) satisfied with the COVID safety measures taken by their child’s school. Just 26% were somewhat (11%) or very (15%) dissatisfied. The rest (19%) were neutral.

•  The owner of a pharmacy in Puerto Rico has pleaded guilty to administering COVID-19 vaccination to children ages 7 to 11, for whom no vaccine is currently authorized. The charges are a felony, according to the U.S. Attorney’s office for Puerto Rico, involving illegal conversion of federal property (vaccine) and conspiracy to commit fraud by submitting Medicaid claims for shots given to 24 youngsters. The maximum penalty is five years in prison and fines of up to $250,000.

•  The Louisiana Department of Health identified 28 outbreaks of COVID-19 at summer youth camps in June and July, half of them at day camps and half at overnight camps. The 321 cases included 47 staff members, none of whom were vaccinated, the CDC reports. Of the 274 campers infected, two were fully vaccinated, 133 were age-eligible but not vaccinated, and 139 were too young to be vaccinated.

•  The return to Broadway was a brief magic carpet ride for Aladdin, now on a 10-day hiatus after a number of breakthrough COVID-19 cases among cast and crew. The plan is to reopen next Tuesday. For all performances until at least January 2, all guests 12 and older must be fully vaccinated. Children ages 4 to 12 must have a recent negative test and children under 4 are not allowed in the theater. Everyone in the audience must wear a mask.

The vaccine dashboard

•  The FDA’s vaccine advisory committee will meet October 14 to discuss booster doses of Moderna and on October 15 to tackle the same subject for the J&J vaccine. The committee will also look into the feasibility of mixing and matching COVID-19 vaccines for primary and booster doses. J&J submitted its application for emergency use authorization to the FDA on Tuesday; Moderna submitted initial booster data a month ago.

•  Also scheduled: an FDA advisory committee meeting on October 26 to review Pfizer/BioNTech data on COVID-19 vaccination of children 5 to 11 years of age.

•  We haven’t heard a whole lot about the AstraZeneca COVID-19 vaccine. Though not yet approved for use in the U.S., hundreds of millions of doses have been administered in more than 100 countries across six continents. Now, in The New England Journal of Medicine, come Phase 3 results of a trial conducted among more than 32,000 participants in the U.S., Chile and Peru. They show estimated vaccine efficacy of 74% overall and 83.5% in people 65 and older.

•  As U.S. health authorities ponder what advice to offer for the coming holidays, South Korea experienced a daily high of more than 3,000 COVID-19 cases in late September, fueled in part by family get-togethers during Chuseok, the Korean equivalent of Thanksgiving. The government aims to fully vaccinate 80% of the eligible population by the end of this month. They must be doing something right: In a country of 52 million, just 2,500 COVID-19 deaths have been recorded.

•  Fifteen doctors, dentists and pharmacists who serve as Republican members of Congress have written to CDC Director Walensky asking for greater recognition of natural COVID-19 immunity – immunity acquired by infection rather than vaccination – in making policy. The letter suggests that vaccination may not be medically necessary or that sufficient protection can come from a single dose of vaccine.

• The CDC has previously expressed the view that people who have had COVID-19 infection still need to be vaccinated. In August, the agency published a report noting that among people previously infected, the unvaccinated were more than twice as likely as the fully vaccinated to be re-infected. Just last week, a California judge rejected a university professor’s argument that a vaccination mandate did not apply to him because he had natural immunity through infection.

Source: Getty Images.

The rest

•  Right now, people just don’t want to come back to the office, Steve Barrett writes in PRWeek. He foresees the need for “a new, more flexible contract between employers and employees.” PR professionals, Barrett says, “are going to be at the heart of constructing that new contract for the whole of their organizations – not just the PR departments and agencies. Office-based businesses must provide attractive working conditions for reluctant workers and show the positives of being together in a productive physical environment.”

•  Merck plans to apply “as soon as possible” to the FDA for emergency use authorization of an antiviral pill. In a Phase 3 trial, molnupiravir reduced the risk of hospitalization and death by 50% (versus placebo) in adults who had mild to moderate COVID-19 and at least one risk factor for more severe disease. Molnupiravir, developed in collaboration with Miami-based biotech Ridgeback Biotherapeutics, is also being studied for post-exposure prevention of COVID-19 in a Phase 3 trial aimed at curbing transmission within households.

•  For the second pandemic year in a row, the Maui invitational college basketball tournament won’t be played in Maui – or anywhere else in Hawaii – due to COVID-19 restrictions. The 2020 tournament took place in Asheville, North Carolina. This year they’re going to Las Vegas from November 22 to 24.

•  They don’t shed, are completely house-trained and cuddle nicely. What’s not to like about robotic pets that respond to human touch and bring comfort to elderly living in pandemic isolation? The Council on Aging-Southern California used coronavirus relief money to buy 200 furry friends for people in assisted living facilities, focusing on memory care units. Kimberly Bonvissuto has details in McKnight’s Senior Living.

•  The Clinical Advisor is publishing an eight-part series on cardiovascular complications associated with COVID-19. The latest installment reviews heart failure and includes links to previous articles on venous thromboembolism, atrial fibrillation and heart inflammation.

Parting shot

In upholding a local health system’s vaccine mandate in Northern Kentucky and Greater Cincinnati, U.S. District Court Judge David Bunning cited a 1905 Supreme Court case (Jacobson v. Massachusetts) involving a challenge to mandatory smallpox vaccination.

The court back then ruled in favor of the mandate, noting that the exercise of individual liberties must take into account the harm that can come to others in the community.

Justice John Marshall Harlan noted that “in every well-ordered society charged with the duty of conserving the safety of its members the rights of the individual in respect of his liberty may at times, under the pressure of great dangers, be subjected to such restraint, to be enforced by reasonable regulations, as the safety of the general public may demand.”

In 2021, Judge Bunning put it this way: “Liberty for all of us cannot exist where individual liberties override potential injury done to others…. If an employee believes his or her individual liberties are more important than legally permissible conditions on his or her employment, that employee can and should choose to exercise another individual liberty, no less significant — the right to seek other employment.”

… and some songs

Walk Don’t Run, The Ventures

A Whole New World, Peabo Bryson and Regina Belle

Magic Carpet Ride, Steppenwolf

On Broadway, George Benson

The Weight, The Band

He Ain’t Heavy, He’s My Brother, The Hollies

Whatever your sign, thanks for joining us. Enjoy the balance of the week and long weekend, and we’ll see you back here next Wednesday.

“I am hanging in the balance of a perfect finished plan/Like every sparrow falling/Like every grain of sand.” – Bob Dylan

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