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How new COVID-19 vaccine rules can help pandemic end faster

LOS ANGELES, CA - JANUARY 07: Nurse Cherry Costales prepares the Pfizer-BioNTech COVID-19 vaccine at St. Louis Children's and Family Center.  John's Well on Thursday, January 7, 2021 in Los Angeles, California.  (Irfan Khan / Los Angeles Times)
Nurse Cherry Costales prepares a dose of COVID-19 vaccine at the St. Louis Center for Children and Families. John’s Well in Los Angeles. The new vaccination rules would allow more doses to be administered more quickly, but there are risks. (Irfan Khan / Los Angeles Times)

In a pandemic marked by surprise, improvisation, and unstable introduction, decisions about priority access to COVID-19 vaccines had to be different. Even moving at a distorted rate, the development and testing of vaccine applicants has given public health experts, medical ethicists, and public health agencies months to consider the order in which scarce doses should be distributed.

Then all their careful planning was set aside.

Amid growing criticism that so few shots hit US weapons, the US Department of Health and Human Services suddenly announced changes to the rules this week. Federal officials said they would stop withholding the second dose of vaccine for anyone who received the first shot. They extended the right to participate to all senior citizens aged 65 and over, as well as to younger people with medical conditions that increase the risk of a serious case of COVID-19. And they said that the more doses of vaccine they give, the more new doses they are likely to receive.

Meanwhile, researchers at the Centers for Disease Control and Prevention warned on Friday that a highly transmitted strain of coronavirus, which arrived from the UK just a few weeks ago, could cause a new outbreak of infections by March. But that tide can be suppressed or even reversed by an aggressive vaccination campaign that reaches 1 million Americans a day.

This goal could be more achievable according to the plan of newly elected President Joe Biden, who supported the decision to open vaccine gateways. The Biden administration will involve the Federal Emergency Management Agency and the National Guard to step up immunizations and make sure people receive all the recommended doses. Retail pharmacies would help you get started.

All this leaves state and local health services struggling to deliver vaccines as quickly as possible. Which raises some questions.

Does this mean that there are more vaccines?

Not exactly.

With 38 million doses produced so far and 12 million already in use, about 26 million doses are ready for grabs, with several million more coming off the production line next week.

Most of them have either already been sent or the states agree with them. Production has not increased. But the freezers in the 14,000 locations to which these doses were sent will no longer be supplied with vials set aside for a second intake.

Nor will doses be retained for people in priority groups who need to receive them but have not shown up – say, a nursing home attendant who is not convinced that rapidly developed vaccines are safe.

Instead, all of these doses will now be released for general use. That’s safe, as the federal government has delivered 31 million doses of the vaccine “essentially without problems,” Health Minister Alex Hazard said this week. And “with the number of cases we are facing now, there is absolutely no time to lose. We need doses that go where they will be applied quickly and where they will protect the most vulnerable. “

So, the goal is still to give all two doses of vaccine?

Yes. When US officials began hearing about British plans to provide the first doses without promising a second dose, three to four weeks later, they took swift action to cancel the adoption of such an idea here.

The federal government is committed to 100% providing a second dose for every American who receives a first dose, Hazard said. “Based on the science and the evidence we have, it’s imperative that people get their second doses on time. That’s what science says, and ignoring that would be reckless.”

Dr. Peter Marx, who oversees the evaluation of new vaccines and drugs in the Food and Drug Administration, warned that there is no data to show how well or for how long a shot will be protected either by the Pfizer-BioNTech vaccine or by Moderna. from the development of COVID-19. People who receive a single dose may “assume that they are fully protected when they are not, and change their behavior accordingly to take unnecessary risks.” The uneven effectiveness of vaccines given under such conditions could undermine public confidence in vaccination efforts, he said.

Who will be vaccinated next?

Azar effectively opened the line to approximately 261 million people. He invited all 47 million Americans aged 65 and over who are not in long-term care facilities to step forward for their photos. And he told states they need to vaccinate more than 100 million adults with one or more of the chronic diseases that make them more vulnerable to a severe case of COVID-19. (These conditions include obesity, diabetes, coronary artery disease, and cancer.)

This was a dramatic departure from the CDC’s recommendations as to which groups should first receive meager doses of vaccine. After 10 public meetings, an expert advisory commission concluded that the country’s 21 million health workers and 6 million residents of nursing homes and other groups should go first, followed by 87 million key first-line workers – category , which includes teachers and bus drivers, first aid, employees in food and postal services, correctional staff and people employed in production and food services.

Frontline workers have priority over adults because they are less able to protect themselves from infection by staying at home. But it was also an explicit attempt to deviate from the long-held reality of health care in the United States: that scarce resources go first to the rich, educated, and socially connected, and last to people with less money, less education, and less access to doctor.

What’s wrong with that?

Many of these workers are difficult to access. They have trouble finding the time, transportation and access to the doctor they need to get the COVID-19 vaccine. And they’re not so sure they want it. Because of the medical facility’s long history of abuse, many black Americans are wary that early access to vaccines is simply a ploy to use them as guinea pigs.

Overcoming these obstacles will require mass vaccination, promotion campaigns, advertising and other assistance. And that takes money and labor that most countries just didn’t have.

But they have it now (and Biden’s transition team has vowed to provide them with more funds). After months of guerrilla warfare, President Trump signed a bill on Dec. 27 allocating $ 87.5 billion to vaccine distribution states, including $ 300 million for “targeted efforts to distribute and administer vaccines to high-risk and low-maintenance populations, including racial and ethnic minorities and rural communities. “

Not surprisingly, these efforts have hardly begun.

Is that why things are so chaotic?

Hmm. With 261 million Americans eligible for vaccines, but only about 31 million available, it’s free for all.

Hazard said this week that efforts to prioritize key workers “have prevented vaccines from reaching a wider range of vulnerable populations more quickly.”

“It’s time to move on to the next phase of the vaccination campaign,” he added, likening it to boarding a plane. If groups 1 and 2 had their chance to get on board, but some of these passengers did not get in line, it is a good idea to go to group 3.

Many Americans are perfectly fine with this. In a Harris survey, 31% of respondents said they would prefer a first-come, first-served approach to an approach that prioritizes certain groups.

But doesn’t that make any sense?

It makes more sense in light of a new development: the rise of this more transmissible strain of coronavirus. As the strain grows in the UK, the number of new infections is expected to be higher than ever – and with them hospitalizations and deaths.

Apart from more draconian public health measures, for which there is declining public patience or political will, vaccines are the only way to blunt these leaks. The more Americans receive some kind of protection measure, even if it is partial, the more downward pressure the country can put on new infections.

Three studies published last week in the Annals of Internal Medicine offer evidence that pushing out the first doses can quickly prevent new infections and slow the incidence of disease.

One of these modeling exercises explores the trade-off between speed and the more limited effectiveness of a single dose. Researchers at Stanford have concluded that it makes sense not to bind second doses in refrigerators, but to push them out instead.

The Stanford team estimates that in eight weeks, about 24 million people will receive at least the first dose of the vaccine. And based on the scarce available data, the team hypothesized that a single dose would reduce the recipient’s risk of developing COVID-19 by just over 50%.

Under these conditions, the number of people developing COVID-19 could be reduced by between 23% and 29% compared to the strategy of keeping half of all doses now to be kept on hand as second doses, the researchers estimate.

“It’s not a magic decision,” said co-author Joshua A. Salomon, a senior fellow at the Stanford Center for Health Policy. Among other problems, if the supply of vaccines collapses in the coming months, Americans may become more vulnerable, as immunity to single-dose inoculation may not last very long.

But for now, he said it was clear that the shots should go into arms: “We need to get an aggressive supply to the states. And countries need to speed up delivery. Indeed, both must happen. “

What’s wrong with giving vaccines to the elderly and healthy people?

Good question. After all, these are the people who most often get sick and die. And they are more likely to look for the vaccine, show up to get it, and return for their second dose than many of the front-line workers who had to come before them. In fact, their impatience is why so many planning websites are collapsing right now.

If vaccinated in large numbers, the likelihood of hospitalization and mortality is likely to decrease rapidly. And not only will they protect themselves, but they can also prevent secondary infections – those transmitted to the people they come in contact with and those who in turn come into contact with those people.

So the new plan may be less fair, but more effective in slowing the pandemic?

In general yes. Black and brown communities will now compete for meager doses of vaccines with highly motivated communities with better resources for older white people. These are hardly equal conditions.

At this stage, we may never know whether the reluctance of black Americans to receive the vaccine earlier could be overcome or whether the absorption of the vaccine could be increased by focusing its efforts on dissemination on colored communities. Such efforts did not come off the ground fast enough.

At the same time, if people who are more likely to take hospital beds or die are vaccinated in large numbers, medical resources can be freed up to take care of everyone else.

“People will be unhappy no matter what you do,” said Dr. Paul Ofit, a pediatrician at Children’s Hospital of Philadelphia who served on the CDC’s vaccine advisory committee. “There is a limited amount of vaccine and many will die. This is the situation on the Titanic: Everyone must get off the ship as soon as possible and there are not enough lifeboats.”

This story originally appeared in the Los Angeles Times.

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