LMS President’s Message, February 2021: COVID-19 Vaccines: We Need to Educate, Model Acceptance, and Promote
By James Borders, MD
The New Year offers the promise of a decline in COVID-19 cases if the newly available vaccines become widely available. At the current pace, it is estimated that the U.S. death toll due to COVID-19 by February 2021 will be well over 400,000. With reported effectiveness rates of approximately 95% for the Pfizer and Moderna vaccines, an answer to the pandemic appears at hand.
Unfortunately, 40-50% of Americans say they will not get the vaccine, and we need nearly 70% to receive it to achieve herd immunity. A perplexing reality is that nearly 1/3 of polled healthcare workers are among those refusing vaccination. There are many reported reasons. Some who have in recent years maintained a stance against vaccines in general have benefitted from herd immunity for the diseases those vaccines prevent. In the 1950’s, the public needed little encouragement to take advantage of an opportunity to prevent polio with its very visible and undeniable consequences. The herd immunity available for so many vaccine-preventable viral illnesses will not protect the “anti-vaxer” for COVID-19, and this reality must be emphasized.
As related in the January article, the general public has been subject to an ever-changing standard of care for COVID-19, both in treatment and prevention. Political overtones and internet misinformation have led to widespread distrust in government and, for some, the scientists. Market forces prompting pharmaceutical companies to fiercely compete for lucrative government contracts have convinced many that good science was not conducted, especially given President Trump’s promises for a vaccine “by the end of the year”, a statement strongly criticized by the scientific community when it was first made. Much of the unprecedented speed of vaccine development is attributed to the tremendous federal government investment (estimated at nearly $10 billion) allowing pharmaceutical companies to move to phase 3 studies before phases 1 and 2 were completed. Without this financial support, companies involved in vaccine development are typically forced to prove early trial success before devoting the resources for higher phase research.
Our task will be first to educate ourselves about the vaccines, to model acceptance of them, and to promote them to our colleagues and patients as supplies allow. There are currently 12 more vaccine candidates, five of whom are in phase three trials. AstraZenica’s vaccine will likely be next in line, followed closely by those developed by Novavax and Janssen. Improvements in refrigeration requirements and the need for booster doses are expected. For the present time, receipt of one of the vaccines will not allow the recipient to forego public health measures for COVID-19. Questions remain as to the durability of the vaccine’s effectiveness and the potential of harboring and spreading the virus to others even if one is personally immune to it.
As of this writing, the supply of effective vaccines does not meet demand. Much work is underway to develop the infrastructure for vaccine administration. There has not been a coordinated federal vaccine distribution plan, forcing each state to work out one. Dr. Steven Stack, Kentucky’s Public Health Commissioner, is currently working with hospital leaders, pharmacies, and public health departments to work out these details. The first COVID-19 vaccine available was the Pfizer vaccine in allotments of 975 doses requiring refrigeration at -80 degrees C, a condition met by only 11 Kentucky hospitals. The Moderna vaccine is available in allotments of 100 and does not require such stringent refrigeration requirements. Both require booster injections-3 weeks for Pfizer and 4 weeks for Moderna.
“Phases” have been devised to provide guidance in prioritizing vaccine administration. The initial focus is on individuals in phase 1A, defined as healthcare workers and patients in long term care facilities. Phase 1B consists of first responders, K-12 school personnel, and individuals over 70 y/o. Phase 1C consists of people over age 60, those over 16 with CDC-defined higher risk conditions, and all “essential workers”. Phase 2 will be all those over 40, phase 3 for those over 16, and phase 4 for those under 16, estimated to be approximately 18% of Kentucky’s population.
At the present time, there are 33 state-wide vaccination sites. The general public should be directed to access these for online appointments through Kentucky’s public health website kycovid19.ky.gov. On the website, they should click on “healthcare/labs” for scheduling site options. Both locations require online appointment scheduling. Those walking in without an appointment will be turned away.
Veterans registered with the Lexington VA Health Care System are reportedly being contacted by the VA health care team to schedule vaccinations.
As other vaccination sites open, they will be included on the state’s website. Bear in mind that the supplies of available vaccine are extremely limited, and we do not know a timeline of future vaccine availability to publish. Advise those asking you for information to check the state’s website daily for updates.
All vaccination sites are working to assure that vaccine recipients are vaccinated in order of phase prioritization subject to vaccine availability.
As to waiting for one particular type of vaccine over another, the best advice, say the experts, is to take the first one available to you.
James Borders, M.D.