The Vaccine Project Newsletter: In the vaccine election, the voting continues

This week’s Vaccine Project Newsletter is 2,154 words and will take you seven minutes to read.

Source: Getty Images
Source: Getty Images

To borrow a familiar election-year refrain, are we better off now than we were a year ago? When it comes to COVID-19, the answer in many respects is a resounding yes. In other respects, not so much.

•  A year ago, we had no vaccines in hand, or in arms. Today:

•  More than 221 million people ages 12 and older in the U.S. have received at least one dose of COVID-19 vaccine (78.2% of the vaccine-eligible).

•  More than 192 million people 12 and older are fully vaccinated (67.9% of the eligible).

•  97.5% of seniors 65+ have received at least one dose of vaccine, and 85.4% are fully vaccinated.

•  19.8 million people have had a booster shot—more than one in 10 adults and one in four seniors.

•  Globally, some 7 billion vaccine doses have been administered.

• Not all the news is promising. Nearly 750,000 people in this country have died of COVID-19, and now 5 million worldwide.

Here come the kids

•  The Food and Drug Administration, acting on the recommendation of its vaccines advisory committee, has authorized emergency use of the Pfizer/BioNTech vaccine in children ages 5 to 11. “Vaccinating younger children against COVID-19 will bring us closer to returning to a sense of normalcy,” said acting FDA Commissioner Janet Woodcock.

•  On Tuesday, the Centers for Disease Control and Prevention followed suit and issued its own green light, noting that COVID-19 hospitalizations among children and adolescents increased fivefold from late June to mid-August. .

•  A national pediatric rollout is poised for action. The question is: As they build it, who will come?

•  Parents of 5- to 11-year-olds are not of one mind when it comes to vaccinating their children, according to the Kaiser Family Foundation’s October Vaccine Monitor. Feelings are divided almost equally among parents who are eager to have their child vaccinated as soon as possible (27%), those who want to wait a while to see how the vaccine is working (33%) and others who say their child will definitely not get the vaccine (30%).

•  MM+M examines the challenges facing the pediatric campaign and notes that it could be more of a slow and steady drip than a rapid current. The most common parental worry is vaccine safety and the possibility of unknown long-term side effects. Two-thirds of all parents surveyed by Kaiser are very or somewhat concerned that the vaccine could impair their child’s future fertility. One in three think they might need to take time away from work to get their kids vaccinated or care for them if they have side effects from the shots. More than half worry about possible vaccine mandates for school kids – so there’s your next potential battleground.

•  The Kaiser data also reveal an enduring hard core of resistance to vaccination among adults, with 16% saying they will definitely not get vaccinated—a number that has held relatively steady since December 2020. Another 4% of adults will roll up their sleeves only if required to do so.

•  Extending the campaign to younger children will bring into play the pivotal role of pediatricians, family physicians, pharmacists, school nurses and others in talking to parents about the risks and benefits of vaccination. The CDC and American Academy of Pediatrics have each developed talking points and toolkits to use in conversations, which emphasize listening with empathy, asking open-ended questions and avoiding fear tactics.

•  The children’s campaign will also try to reach those most at risk. Black, Hispanic and American Indian/Native Alaskan children are three times as likely as white or Asian children to be hospitalized with COVID-19.

•  As it happens, COVID-19 infections among school-age children are driving the latest surge of disease in the U.K., the New York Times reports. Just 21% of 12- to 15-year-olds in England are vaccinated, compared to 80% of adults.

• Citing “soaring rates of mental health challenges” throughout the course of the pandemic, the AAP, American Academy of Child and Adolescent Psychiatry and Children’s Hospital Association have declared a national state of emergency in children’s mental health. The organizations are calling on advocates and policy makers to ensure access to mental health screening, diagnosis and treatment “with particular emphasis on under-resourced populations.”

Then and now

If the daily onslaught of COVID-19 numbers is giving you a sense of deja vu, you are not alone. We have passed this way before.

Daily counts of cases and deaths, as well as their moving seven-day averages, are comparable to where they were a year ago, in the middle ground between extreme highs and lows.

The difference between then and now? In 2020, we were heading toward a precipitous climb as fall turned into winter, peaking at more than 295,000 cases and 4,000 deaths in January. In late 2021, we are in the midst of a steady decline that we hope will continue.

Source: Getty Images.

“Vaccination” rhymes with “litigation”

Nineteen states are suing to block the Biden administration’s vaccination mandate for entities doing business as federal contractors, the AP reports. There are four separate lawsuits, all essentially claiming that the mandate, which is scheduled to take effect December 8, is a case of federal overreach.

•  The Biden administration announced on Monday that federal contractors would have broad leeway in enforcing vaccination requirements. December 8, senior officials say, is not a hard deadline but a date by which contractors must demonstrate good-faith efforts to have their employees vaccinated.

•  We can also expect legal challenges to the administration’s proposal to implement vaccination and testing requirements for businesses with 100 or more employees. Formal rules from the Occupational Safety and Health Administration are due to be published this week.

•  The U.S. Supreme Court rejected a challenge to Maine’s vaccination mandate for workers in hospitals and nursing homes. Maine allows medical but not religious exemptions to vaccination.

•  A federal appeals court has upheld a similar New York state vaccination mandate for healthcare workers, James M. Berklan reports in McKnight’s Long-Term Care News.

•  A federal judge turned back a challenge, navigated by a pilots’ union, to a Southwest Airlines vaccination mandate.

Within the world of work

•  Atria Senior Living and its recent acquisition, Holiday Retirement, have achieved a staff vaccination rate of nearly 100% across 430 communities in the U.S. and Canada, Kathleen Steele Gaivin reports in McKnight’s Senior Living. Atria announced its vaccination mandate in January and was one of the first companies to do so. Holiday’s mandate came in August, one day after the FDA’s full approval of the Pfizer/BioNTech vaccine.

•  5% of unvaccinated adults in the U.S. have quit their job over a vaccination mandate, according to the Kaiser Family Foundation. 25% of all workers surveyed say their employer has mandated vaccination, up from 9% in June.

•  More than 2,000 of New York City’s 11,000 firefighters have called in sick within the past week in apparent protest over a vaccination mandate that took effect Monday. Fire Commissioner Daniel Nigro called it “bogus sick leave” and suggested that absent firefighters were neglecting their oath. The vaccination rate for all NYC municipal workers jumped from 83% to 91% over the Halloween weekend as the witching hour approached.

•  More than 96% of active members of the Air Force have received the vaccine in advance of a Tuesday deadline. That means 12,000 members are refusing or seeking to opt out. The Air Force’s response to the holdouts may set the tone for other service branches with deadlines coming this month and next.

•  Which industries lead and which ones lag when it comes to a vaccinated workforce? According to a study by The Harris Poll and Fortune, top performers are the legal profession with just 6% unvaccinated, along with the hospitality sector (12%), healthcare (15%), education (17%) and banking (17%). Industries with the worst performance are food service (41% unvaccinated), business services (37%), manufacturing/construction (36%) and public safety (33%).

•  The British Medical Association is worried that mandating vaccination for healthcare workers could worsen severe labor shortages in a way that “could be devastating for patient services as we face a record backlog of care and winter pressures.” The BMA wants the government to explore alternatives for the unvaccinated, including remote working, redeployment, greater PPE protection and more frequent testing. Luke Haynes has more in GP.

•  University Hospital in Newark is mandating a COVID-19 booster shot by December 24 for all employees who received the J&J vaccine.

•  Iowa has enacted a law providing unemployment benefits for people who lose their jobs because of a vaccination mandate.

• COVID-19 cases and deaths at meatpacking plants were far higher than previously thought, Successful Farming reports.

Source: Getty Images.

The vaccine dashboard

•  The FDA needs more time to review Moderna’s application for use of its COVID-19 vaccine in 12- to 17-year-olds. Specifically, the FDA wants to take a closer look at international data on the risk of myocarditis post-vaccination. The FDA’s review may take until January.

•  The CDC is sticking to its recommendation that people who have had COVID-19 infection still need to be vaccinated. In a study of more than 7,000 patients hospitalized with COVID-like symptoms, unvaccinated adults with a prior COVID-19 infection were 5.49 times more likely to test positive than fully vaccinated people with no previous history of COVID-19. 

•  The CDC now recommends up to four shots for moderately to severely immunocompromised adults who received the Pfizer/BioNTech or Moderna vaccines. The four shots include two primary doses, an additional dose needed because the immune response to the first two was suboptimal and a booster dose six or more months later.

•  Kidney dialysis patients might benefit by receiving the second dose of COVID-19 vaccine shortly after the first, researchers suggest. A meta-analysis of 32 studies encompassing 4,917 patients found that immune response averaged 41% after the first dose and 89% after the second. Jody Charnow has details in Renal & Urology News.

•  U.S.-based Novavax is seeking authorization of its protein-based COVID-19 vaccine in the U.K. and has also filed paperwork for provisional approval in Australia. The company expects to submit an application to the FDA by the end of the year.

•  Meeting in Rome last weekend, the G20 group of world leaders set a goal of vaccinating 40% of the world’s population by the end of this year and 70% by mid-2022, Reuters reports.

The rest

•  The antidepressant fluvoxamine, approved in the U.S. in 1994 and now used in treating obsessive-compulsive disorder, is showing promise as a treatment for early COVID-19, Alicia Lasek reports in McKnight’s Long-Term Care News. A study, conducted in Brazil and published in The Lancet, found that a 10-day regimen reduced the need for hospitalization among symptomatic high-risk adults.

•  Will fluvoxamine, which is much less expensive than current treatment alternatives, be a true game-changer? MM+M’s Marc Iskowitz explores that question with the experts, who await more data and, in the meantime, emphasize that the first option will continue to be vaccination.

•  A single injection of GlaxoSmithKline’s monoclonal antibody sotrovimab reduced the risk of COVID-19 hospitalization or death by 85% in a study where more than 60% of subjects identified as Hispanic or Latinx, a group generally underrepresented in trials but overrepresented in COVID-19 morbidity. Sotrovimab is currently authorized for emergency use by the FDA.

•  Companies wishing to retain employees post-pandemic will need to offer opportunities for lifelong learning, Nicola Amiss notes in People Management. The next generation of employees “has grown up in an ultra-fast-paced, ever-changing world, and will arrive in the workplace with the expectation of having to adapt quickly and continually… They also increasingly expect their chosen workplace to be as serious about their personal and professional growth as they are.”

•  Lexicographers at the Oxford English Dictionary have cast their ballots. The word of the year is “vax.”

Parting shot

Christmas and Hanukkah cards appeared on store shelves in October. We similarly have a tendency to get ahead of ourselves when anticipating the next curve COVID will throw at us.

We can take heart from any downturn in cases, hospitalizations and deaths, but must remember that we turned an optimistic corner once before only to see the roller coaster take a scary climb. As winter approaches, community transmission of COVID-19 remains high (73.7%) or substantial (16.3%) in many U.S. counties, moderate in 8% and low in just 2%.

“COVID’s not over. We need to be vigilant,” said John Moore, Chairman and CEO of Louisville-based Atria Senior Living.

…and some songs

Stand Up, Cynthia Erivo

Stand by You, Rachel Platten

Stand by Me, Ben E. King

You’ve Got to Stand for Something, John Mellencamp

I’ll Stand by You, The Pretenders

Stand, R.E.M

Stand, Rascal Flatts

Daylight Saving Time ends this weekend, so turn back your clocks and savor that extra hour. Stay well and see you back here next Wednesday. Many thanks!

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