• PublicHealthRising

Vaccines are slowly rolling out. Now … what to do while you wait?

We predict you’re having one of the following reactions to our topic this week: (1) This is chaos; (2) I actually got my vaccine, why do I still have to wear a mask?; or (3) Who’s that in the photo? In reverse order, that’s half of Public Health Rising getting her phase 1A shot here in Colorado. For those of you who have also received a vaccine, congratulations on getting immunized but yes you still need to take COVID precautions until the rest of your friends, family, and neighbors catch up and new COVID infections are rare in your community. This is because vaccination may not provide significant protection from asymptomatic infection and ongoing transmission to those who are not vaccine protected. After you get your vaccine, you could still acquire and transmit COVID, without knowing it. What we do know is that vaccination provides strong protection against COVID disease (illness with symptoms), hospitalizations, and deaths. We recommend you continue with the other prevention measures you've been doing, such as wearing a mask, staying six feet apart, and limiting gatherings. Protection against COVID disease takes full effect two weeks after your second vaccine dose. At that time, some limited changes in your safety practices may be possible, including expansion of your bubble to include other fully vaccinated individuals.

Finally, yes rollout is chaotic, more so in some states than others and in general attributable to the long neglect of public health infrastructure that we’ve discussed before. There are some straightforward and feasible steps that could, however, be taken immediately. There is little visibility into vaccine supply, for example, with information obscured at the federal level. This means your state government and local health department really don’t have information to share with you -- although those groups could be more transparent as well, providing data about inventory on hand. Limited supply might be bad news, but transparency is key. Sharing basic information can help slow the downward spiral as people continue to lose trust and start to believe vaccines will not be available by the time their appointment slot rolls around, or that a second dose will not be provided. This spiral is so far leading to a frenzy, with people jumping the queue and even vaccine providers mis-using their allocated doses. The confusing patchwork of state and local approaches is degrading the situation further. In some states, family members of health care workers can get a shot. In other states, health system administrators working remotely from home are getting a shot before people 75 years and older. This will scar our overall pandemic response further, and we fear that a familiar pattern is playing out: when pressure mounts, the first sacrifice is equity. We’ll explore this in more detail in an upcoming post, hopefully when we have a data point to better see who has actually been receiving vaccines beyond phase 1A so far. We also believe more of us will be receiving a vaccine soon as the pace of getting shots in arms speeds up, and it’s possible that within coming weeks -- not months -- additional vaccines will receive emergency use authorization.

A key message to close for today: we need to accelerate vaccine rollout at almost any cost. Not only can this be rapidly lifesaving for many, it can also start to unburden overwhelmed health care facilities. We also believe that vaccine efficacy is stable, so far, in the face of COVID variants currently circulating in the U.S. There may be a self-reinforcing cycle in play here, and time is the key variable if the vaccine proves to at least reduce infections (in addition to preventing disease, as explained above). The more widely infection spreads, the greater chance of resistant variants emerging; the more quickly we get vaccine rolled out now, the greater chance we can curb the spread of infection and the risk of resistant variants emerging. Is it possible that the vaccine could increase evolutionary pressure on the virus, causing emergence of resistant strains? That’s a consideration too, but we have to fight the fire that’s burning our house right now.

Efforts to address the well-earned mistrust in key communities need to continue and expand to address how we reach the most disproportionately impacted, who may also be most likely to refuse the vaccine, at least at this relatively early stage. It remains critically important that when your turn comes, you receive your vaccination, and after you do -- keep up your COVID precautions until we’re all protected.

P.S. You may be seeing news reports today about a single production lot of vaccine being held back from administration in California, following a report from "one community vaccination clinic [where] fewer than 10 individuals required medical attention over the span of 24 hours." We look forward to more details emerging, and our initial thinking is that with all occurrences coming from a single clinic, and understanding that doses from this lot have been administered extensively in other clinics (including in other states) where no such reports have emerged, this is not a systemic issue of concern and should not dissuade people from keeping their vaccine appointments.

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