Even as medical scientists have detected a new, potentially more contagious variant of the coronavirus that also may pose greater risks to children, the high hopes for a faultless roll-out of Covid-19 vaccines are getting tempered with unhappy doses of reality.
Roughly 1 million Americans have been vaccinated already, most with a product from Pfizer and some with a vaccine from Moderna.
That is good news to start. It may, however, also start to raise concerns about the plans to inoculate more than 300 million Americans, many with a two-shot vaccine. That’s because Trump Administration officials had forecast with great confidence in recent days that 20 million Americans would be vaccinated before 2020’s end.
As Elisabeth Rosenthal reported for the nonpartisan, independent Kaiser Health News service:
“Even before there was a vaccine, some seasoned doctors and public health experts warned, Cassandra-like, that its distribution would be ‘a logistical nightmare.’ After Week 1 of the rollout, ‘nightmare’ sounds like an apt description. Dozens of states say they didn’t receive nearly the number of promised doses. Pfizer says millions of doses sat in its storerooms, because no one from President Donald Trump’s Operation Warp Speed task force told them where to ship them. A number of states have few sites that can handle the ultra-cold storage required for the Pfizer product, so, for example, front-line workers in Georgia have had to travel 40 minutes to get a shot. At some hospitals, residents treating COVID patients protested that they had not received the vaccine while administrators did, even though they work from home and don’t treat patients. The potential for more chaos is high.”
Part of the problem, according to various media reports, rests with the already shambolic federal response to the pandemic. The administration has refused from the start, and continues to do so, to take the central role in dealing with the disease coast-to-coast, pushing down responsibilities, instead, to states and local governments.
But this only worsens problems between have and have-not areas, as well as the familiar logistics nightmare of the “last mile.” Military experts, giant shipping companies, and major warehouse operations may be able to deal with the challenges posed by moving out hundreds of millions of doses of vaccines that require cold or super cold handling. Bigger headaches, though, may await those who must get the medical safeguard that seemingly short distance from product storage, into syringes, and into willing patients’ arms.
As Rosenthal reported:
“Throughout the Covid pandemic, the U.S. health care system has shown that it is not built for a coordinated pandemic response (among many other things). States took wildly different Covid prevention measures; individual hospitals varied in their ability to face this kind of national disaster; and there were huge regional disparities in test availability — with a slow ramp-up in availability due, at least in some part, because no payment or billing mechanism was established. Why should vaccine distribution be any different? … Instead of a central health-directed strategy, we have multiple companies competing to capture their financial piece of the pandemic health care pie, each with its patent-protected product as well as its own supply chain and shipping methods.”
Hospitals received much-deserved, heavy media coverage when they began to vaccinate front-line health workers. But even the good cheer here dissipated fast, as institutions full of smart, educated, skilled folks bungled what should have been common sense allocations of a much-desired health safeguard. Wait, now, hospitals keep careful records on their medical staff, and, large as the numbers may be at some academic centers, these institutions deal with complex staffing issues all the time, right?
Well, Stanford caught the first, ugly black eye, when its bumbling administrators at the university health complex blamed a mathematical formula, an algorithm that was supposed to ensure equity in vaccine administration, shut out front-line care givers (toiling residents) in favor of shots first for senior, home-bound doctors.
The New York Times, however, followed up with complaints from doctors and nurses and other medical staff at hospitals across the New York area about inequities and even back-stabbing behavior in institutions as workers threw figurative elbows to get in the vaccination line.
Nursing homes and other long-term care facilities were, with hospitals, at the front of the line to have staff and residents vaccinated, with the assistance of drug store chain giants CVS and Walgreens. Here, too, the process has been bumpy at best, with owners and operators of facilities struggling to ensure that residents or their loved ones give the necessary, legal, and appropriate consent for vaccination. Staff at the facilities, already over worked, under paid, and struggling with heavy duties and high stress, have balked in notable numbers, experts say, at receiving what they regard as a too little tested injection that may, with its sometimes harsh side effects, sideline from work they need to do to earn money.
The ’21 situation report may see more rocky times ahead for planned vaccinations. Schedules were always going to be variable. But after officials finish vaccinating front-line health workers and nursing home residents and staff the next groups get more complicated and difficult to reach and inoculate.
Federal expert advisors have met and recommended a plan, with “essential workers,” and Americans 74 and older next in line. The advisory panel said it thinks those who should be a priority for shots next should include, as the medical news site Stat reported, “frontline essential workers [such] as first responders, teachers and other education workers including day care workers, food and agriculture workers, correctional facility staff, postal workers, public transit workers, and people who work in manufacturing and in grocery stores.”
Sound right? Well, remember this is federal advice only. States and local governments may decide differently, for example, putting teachers higher in line, in hopes of getting youngsters back in re-opened schools.
Equally key will be the outreach and actual giving of shots to Americans in subsequent rounds: How will they be persuaded the vaccine is safe and effective? Where will they go to get their shots? Who will keep records as to whether they were vaccinated, including whether they got the required second dose weeks later? How will patients protect themselves, so they get the vaccine free, as it is supposed to be? How will they show they belong in a group in line for vaccination and that they are not cutting in line? Can employers require their workers to get vaccinated?
If there seem to be many questions with the second group in line, they likely will increase with the much larger priority group three — “adults [ages] 65 to 74, people 16 to 64 years old with high-risk medical conditions, and essential workers not included in the second phase of vaccination.” How does this recommended group cover some Americans hardest hit by the pandemic — African Americans, Latinos, and indigenous people? They may be younger as a group but less healthy and more vulnerable than, say, affluent older adults.
The incoming Biden Administration will have its hands full as it takes over the federal government and transitions the oversight of the crucial vaccination program. It is not helpful that President Trump has sidelined a big budget- and pandemic-relief compromise bill approved by the Congress, which includes billions of dollars in funding that states and local governments — already staggered by pandemic response spending — need to fund vaccination campaigns.
It is receiving, if it is possible, even greater attention as medical scientists globally track a new coronavirus variant, detected in significant fashion in Britain. Models of the virus, with its modifications, suggest that the variant is more easily transmitted and may pose heightened risks for increased transmission in children, who had seemed to be more resistant to the coronavirus. For now, vaccine makers say they believe their products, already rolled out and in development, will be effective against the variant, too. But public health measures have been taken, for example, requiring testing of travelers from the United Kingdom before they enter the U.S. and more stringent isolation of Britain by the European Union.
In my practice, I see the harms that patients suffer while seeking medical services, and I urge people I know to consult with their own doctors with care about preventing Covid-19 infection, especially by vaccination. Vaccines, like any medical intervention, pose risks. But these are far outweighed by the benefits of vaccines, which, in relatively recent order, have revolutionized health care around the globe. The coronavirus vaccine is the product of years of research and represents novels advances in development of infection protections.
Shots will be part of the way the world will defeat the coronavirus, along with public health measures like excellent hygiene (especially hand washing), face covering, distancing, and avoiding closed spaces for long periods, and staying home as much as possible.
As time passes and the numbers of Americans vaccinated increases — it already has gone from tens of thousands in clinical trials to hundreds of thousands nationwide — patients may be less hesitant about the coronavirus shots and more assured of their safety and effectiveness. Still, public figures, community leaders, medical experts, and others may wish to be as public as they feel comfortable in getting the vaccine and letting others know that it can be beneficial.
It will be vital that significant numbers of people get immunized so the country can achieve “herd immunity,” the group protection afforded when so many people have been sick and recovered from an infection or vaccinated against it that infections find it hard or impossible to continue to spread.
We have lots of work to do to put down this pandemic and get to a far better place than we were before.