BACK

COVID vaccinations of the most vulnerable needed to be faster

COVID vaccinations of the most vulnerable needed to be faster

It’s not too late to require corrective measures to urge the vaccines to the people that need them most

The US has stumbled out of the COVID-19 vaccination starting stalls. Over three weeks after the Food and Drug Administration issued an emergency use authorization for the primary vaccine, we still have most of our supply sitting unused — as thousands of US citizens die daily from the coronavirus. 

According to Bloomberg News, as of Tuesday night, just over 17 million doses of the Pfizer-BioNTech vaccine and therefore the Moderna vaccine for COVID-19 had been distributed within the U.S., but only a touch over 5 million shots had been given.
So what’s going on? Here are the main problems with America’s vaccine rollout, with some suggestions on the way to vaccinate the foremost vulnerable among us more quickly.

CDC guidance was late
Like a university student handing during a composition fortnight after the deadline, albeit he had nine months to figure thereon, the Centers for Disease Control and Prevention career staff released their guidance after the primary vaccine was authorized and being administered to Americans.

States and hospitals were sitting on their vaccine supplies waiting on the CDC. Even worse, when the CDC did release its guidance, it had been flawed.

First, the guidance didn't stratify America’s 23 million health care workers. Instead, it placed someone sort of a healthy 32-year-old dermatologist specializing in Botox injections within the same priority group as a 63-year-old medical care unit nurse with diabetes and asthma.

COVID-vaccinations-of-the-most-vulnerable-needed-to-be-faster-1

Covid-19 vaccine testing.

Second, the guidance didn't start with the oldest Americans, an easy-to-implement allocation strategy that maximizes the preservation of human life. Some 80% of COVID-19 deaths are in people over age 65. The disease has killed quite 357,000 people within the U.S. so far.

The CDC director urged the allocation committee to use the essential approach of vaccinating older Americans early — a technique that has been adopted by other countries with great success. Israel, for instance, has already vaccinated approximately half its citizens who are over age 60.

Fortunately, Florida has rejected the complex CDC guidance for an easy age-based strategy, which avoids confusion and streamlines messaging sort of a boarding process. Florida Gov. Ron DeSantis, seeing long lines of high-risk seniors, appropriately concluded: "It makes no sense for somebody that’s 42 to leap before somebody that’s 70-years-old."

We are vaccinating people that are already immune
Tragically, due to poor CDC guidance, we are using precious vaccines to vaccinate people that are already resistant to COVID-19.

The overwhelming majority of individuals who have already been infected with the coronavirus have built up the antibodies and memory B and T cells to fight it off themselves. 

Natural immunity may last as long or nearly as long as vaccinated immunity — an issue that will be answered over time. But thus far, after one year of the pandemic, reinfections are rare, and once they do occur they're mild.

Keep in mind that the vaccines aren't perfect. COVID-19 infection occurs in approximately 5% of vaccinated individuals. Right now, while our vaccine supply is restricted, those that have had the infection should be stepping aside within the vaccine line.

The government held back quite half the vaccine
 Director of the National Institute of Allergy and Infectious Diseases Dr. Anthony Fauci and therefore the faction medical establishment decided to order a second vaccine dose for each one that receives an initial dose, plus a 5% buffer supply.

It may sound smart to order those second doses, but it ignores the info that partial immunity after the primary dose is often 80-90% effective.

Given the high rate of carnage from this pandemic and therefore the scarcity of the vaccine supply, more American lives would be saved if we use the whole current vaccine supply on first doses, then follow up with second doses after every high-risk American has been offered an initial dose. This is often highly achievable during a short period of your time as evidenced by our diary giving the flu shot to half Americans some years.

People at low risk are cutting within the vaccine line
After a summer of corporate and political statements about Black Lives Matter, Americans with power and access are cutting within the vaccine line.

Because the CDC guidance was late and unclear, vaccine administration centers have scrambled to develop tiered allocation systems for who gets the vaccine. Some have done it well while some have done poorly, magnifying inequities in our healthcare system.

Some facilities also received more vaccine doses than they need patients and staff, fostering cronyism in who gets the excess.

In the first fortnight after the FDA authorized the life-saving vaccine, hospital board members, young members of Congress, spouses of physicians, receptionists in facelift offices, and young firefighters are getting the vaccine, while society’s most vulnerable wait around like sitting ducks in our pandemic war. 

Low-risk Americans who cut within the vaccine line using their access and power are essentially telling our society’s most vulnerable members "your life matters less."

Just because you'll get the vaccine now doesn’t mean you ought to. Those with access should pause and assess their risk as our short supply forces vulnerable Americans to attend.

Failure to use dialysis centers
Kidney disease is the commonest risk factor for COVID-19 deaths. per annum, U.S. dialysis centers give kidney patients the flu vaccine early and efficiently. Yet the nation’s vaccine plan didn't ship the vaccine to any of America’s 7,500 dialysis centers.

Sending the vaccine to dialysis centers would have enabled them to swiftly protect those most vulnerable. Similarly, pharmacies, which are integrated into communities and therefore the routines of seniors, should be better utilized as vaccination partners instead of those that specialize in hospitals as vaccination hubs.

Hospitals sitting on vaccine surpluses should immediately offer them to older members of the community.

On a private note, I can’t justify taking the vaccine myself before my 74-year-old friend in Baltimore, who is Black and high-risk because he has renal disease. My case death rate is extremely low. And while I add health care, I don't work on the frontlines of treating patients with COVID-19.

My surgical patients are tested before their operations. We even have impeccable protocols. I’m not criticizing clinicians who get the vaccine. My personal decision could be different if I spent longer within the medical care unit and took more emergency calls. But that’s not me.

Given my low personal risk of mortality and my low risk of getting the virus in my limited clinical work, I even have joined a growing chorus of health care professionals who have taken a pledge to not get the vaccine until every high-risk American has been offered it first.

Authorize the Oxford-AstraZeneca vaccine
Finally, the FDA must stop playing games and authorize the Oxford-AstraZeneca vaccine. It’s safe, cheap ($2-$3 a dose), and is the easiest vaccine to distribute. It doesn't require freezing and is already apprved and being administered within the UK.

COVID-vaccinations-of-the-most-vulnerable-needed-to-be-faster-2

 Oxford-AstraZeneca vaccine.


Sadly, the FDA is months faraway from authorizing this vaccine because FDA career staff members insisted on another clinical test to be completed and are punishing the corporate for inadvertently giving a half-dose of the vaccine to some people within the trial.

The FDA is holding out, pontificating existing excellent data and being vindictive against a corporation for creating an error while thousands of US citizens die every day.

Ironically, those within the Oxford-AstraZeneca trial who inadvertently received half the initial vaccine dose had lower infection rates. And in the week Dr. Moncef Slaoui, the chief adviser to Operation Warp Speed, acknowledged that using half a dose could be an honest broader strategy for the U.S. to double our supply as long our supply is severely constrained. That’s an honest strategy that creates sense. Along with vaccine supply; medical masks, disposable gloves, and protective suits are demanded in the coronavirus battle.

It’s not too late to require corrective measures to urge the vaccines to the people that need them most. Let’s think through our priorities and pivot so those that are within the greatest danger are often rescued from this deadly plague.