On Variants and Vaccines
Your article helped clarify a little mental push and pull I've been having about the question of feeling optimistic or pessimistic about the near and moderate future. Perhaps this seems obvious, but after reading your article I was better able to separate the roles of my own personal optimism - being excited about the vaccine, discussing the many positive research studies, helping people find shots, etc. And of course just giving my brain a much needed boost of "it's not all bad!" I can also use my words and actions to show what healthy balance of excited optimism for the future is, while still maintaining responsible habits that help us keep this thing on track as a society.
And the pessimism (not really the appropriate word) is really more a role for government, both state and local. I can be as optimistic or pessimistic as I want, but neither of those attitudes are going to help get a vaccine ring in place. I think I see some of my peers holding onto pessimism and fear like perhaps that's going to help the gov't make the necessary changes to get shots in arms in the right zip codes with the right methods. This makes me come back to what I can do...take all those actions above and what - tweet at Andy Slavitt to read your articles?! I mean that probably can't hurt, but I hope he's doing something other than reading advice off of Twitter.
So I come back to - personal optimism, enthusiasm about science and what a gift we have and partnering that with the sort of behaviors that keep me, my family and my community safe.
I really appreciate your writing Zeynep that you're giving us the tools to expand our vision of both our own personal roles and those of other entities, government, etc.
My perspective from Seattle is that we're sleepwalking into a full reopening, barring a much much *much* more vicious variant. Economically it's clear that there's simply not adequate support at the city/state/federal level to adequately handle lockdowns. The city and state seem to be roughly tapped out; the feds are deadlocked. The state is playing it cautious, but there's not really anything to be done but to move to as reopened as possible without incurring catastrophic heath failures.
Vaccine strategy seems to be conditioned, right now, on the *willingness* of the states and those resident in them to get vaccinated. There's a very sharp distinction between E and W Washington State right now in that willingness on the part of individuals, which mirrors political views, as well as masking, etc.
In my rather jaded imagination, it's probable that to finish the business, the Federal government will need to fully operate the distribution and delivery process and fully sideline the state DoHs, to the point where by the fall, Army troop carriers go down Alabama roads and knock on each door to give vaccines. ( https://www.eatthis.com/news-covid-vaccine-state-rollout-cdc/ ). Since that will probably not happen, it is probable that Covid will be endemic in AL and other states until it becomes depoliticized. Sigh.
It looks to me that the CDC report on sterilizing immunity was studying the mRNA vaccines specifically. Should we take it to indicate that we can also expect sterilizing immunity from, say, J&J or AZ? (I'd been assuming not at least for J&J, perhaps naively, on the grounds that a vaccine which isn't as effective at preventing mild symptoms can't really be as effective at preventing infection altogether. But hey, this stuff is complicated...)
Hey Zeynep! As one of the recently-vaccinated and soon to be fully vaccinated, I'm not celebrating as you suggest I might be. Although I will soon be able to have in-home visits with people again, the world around me isn't reopening. Many restaurants aren't doing indoor dining here, even though they're allowed.
I thought about travel. Hey DC! I'll go to the Smithsonian! But they're closed with no reopening date. I thought about a road trip (from N.Cal), hey I'll go to Hearst Castle! Also closed with no reopening date. Maybe I can go to an Asian nation that hasn't suffered from the pandemic like we have? Except none have any plans to let us in, even with vaccine. And Europe is much further behind than we are in reopening and return to normalcy.
Of course, you might suggest that these are coming soon. But if the variants out and about today still lead to infection in the vaccinated, even if lesser, will we really continue reopening? How do you view the odds that the variants we have now, and newer ones that are likely just beginning to spread, will spoil the celebrations of the vaccinated?
I know we have the boosters coming, but I suspect that by the time they're being injected into arms, they'll always be a year behind whatever variant is doing the most damage.
P.S. I would like to celebrate. Really. 8-)
From the article in The Atlantic -
"I can’t read her mind, but if I were Walensky, I’d be scared because those who are not protected through vaccination or past infection are still at grave risk ..."
At "grave risk"?
Wanted to get your opinion (you may have already given it elsewhere) to the efficacy of "vaccine passports" or some other sort of compulsory mandate to help compel acceptance in any ring vaccination areas. How effective do you think that would be / what's the best strategy to help drive vaccine acceptance? In the US at least, where vaccine access will likely become a non-issue in the next month or so, even a modestly high rejection rate seems like it could continue to drive outbreaks.
I doubt that a ring/surge strategy can be implemented in time to matter or, even if implemented, work better than the current approach.
Ring/Surge will require currently overstretched and under resourced Health Departments to:
- train a multi-lingual staff how to approach vaccine hesitant folks and convince them to stop what they are doing and come down to the street to get a shot.
- train and assemble enough medics to inoculate and monitor for bad reactions
- acquire enough vehicles and freezers to deliver the staff and vaccines
- develop the data systems to insure that folks get the correct number of shots, not more, not less
Once this is done, how many folks will be inside their apartments or homes instead of being at work?
How many folks will even open the door to strangers?
It is likely that if poorly implemented (=quickly implemented) this approach will convert vaccine hesitancy to vaccine paranoia.
I think that there are two better approaches.
First, continue to make the vaccines widely available in trusted locations and support community groups and leaders in their efforts to reduce hesitancy.
Second, provide incentives for vaccination and disincentives for refusal e.g. require proof of vaccination to attend high school and college, sports events, theatre and other dense indoor activities.
Zeynep, I wish that there is a more tactful way of saying this but the best I can do is - you cannot achieve a moral goal (not allow the "unvaccinated [to] continue to suffer, a fate increasingly confined to those without wealth or power") with impractical methods.
Zeynep - what do you think about the moral hazard surrounding your ring/surge vaccination proposal? One worry, I think, would be that states who are already itching to open up will then pull the trigger, knowing that if things go south they'll get a vaccination campaign to clean up. The proposal may be a net benefit anyways but I would think then that we would want to be careful about the details of implementing such a system.
Loving the ring vaccination proposal. Today, with so many more vaccine doses available it seems that this proposal could be carried out at the same time as we work through priority groups to get to majority of people being vaccinated. There must surely be an analogy somewhere in public health or medical care thinking. The area with an outbreak is like a skin wound. We treat the wound with topical antibiotics- hoping that this treatment will prevent spread to the rest of the body- as a first step in wound management.
I really respect your work and hesitate to challenge given your greater expertise. But...it seems to me from here in the UK that you're overdoing the impact of B117. I'm not denying there's clear data on it being more infectious (though I would point out that the original estimate of 70% got huge publicity and the subsequent revision to 30-50% none at all). But there are counterfactuals that everyone seems to ignore, which challenge the notion that it's this terrifying gamechanger of a variant. First, the way in which the UK January lockdown was instantly and massively effective - cases peaked Jan 1 and fell like a stone from then on despite lots of businesses still open and plenty of "key worker children" still going to schools for childcare (not education really). Second, despite B117 circulating for months on the Continent, France Italy etc got through December and Jan with light restrictions and no boom in cases. Yes now it's bad, but why did it take so long? Hard to see how those two square with the idea of B117 being game-changingly more infectious and lethal. Third, I don't think it's a settled finding yet that it's more lethal. Fourth, I know that "seasonality" is tainted by association with lunatics, but it's clearly relevant, since we in the UK saw Covid basically disappear over last summer despite no vaccines and no lockdown, and given that these last few months are the first time we had Covid in wintertime, it seems to me just as plausible that the deaths we saw in the UK were more because of that rather than because of B117.
Does ring vaccination work in a society where we are unwilling to prevent people from leaving a certain area? Sure we can immediately attack a ring around a surge with vaccinations and protocols but vehicle travel makes the efforts a bit tricky no? I can see it greatly dampening a potential regional surge, but I’m unsure. What do you think?