Vaccines -- Now More Than Ever

Covid-19 has NOT disappeared. The trend for cases, hospitalizations, and deaths from Covid has been downward but today’s New York Times tracking page shows (as of 17 September 2022) a 7-day average for the U.S. of 62,037 cases (down 29% over 14 days), 32,168 hospitalizations (down 12% over 14 days), and 465 deaths (down 6% over 14 days). The cases have been declining since late May. Sadly, vaccination rates have not materially improved. For all ages in the U.S., 68% have been fully vaccinated (2 doses) but only 33% have received a booster. The numbers for those older than 65 are somewhat better: 92% are fully vaccinated and 65% have been boosted. 

The head of WHO said on 14 September “We have never been in a better position to end the pandemic. We are not there, but the end is in sight.” As an infectious disease physician and epidemiologist, I will simply say I am hopeful but prefer to keep my powder dry. At the moment, there do not appear to be new variants emerging that would cause concern. Of course, as I type here in Altadena, who knows what Covid is doing as it infects people across the globe. Our knowledge on emerging variants depends on a thin distant early warning system and we have been rudely surprised before. Nevertheless, let’s try to be optimistic. 

Globally, over 5.35 billion people have received at least one dose of Covid vaccine (~70% of the total global population). Still, full vaccination status is rarer in the lesser developed world and Africa has barely been touched with Covid vaccines. The opportunities for viral replication and mutation remain high.

Cuba leads the world in vaccine distribution with 368 doses given per 100 people. That is twice the rate of vaccine distribution in the United States. I will refrain from a rant but the advantages of a medical system not dependent on profit that includes everyone in a nation are plainly evident in this statistic.

But there is much more than Covid to worry about on the vaccine front. In the United States for a quarter of a century or more, the spread of misinformation and disinformation about vaccines has created a substantial (and vocal) minority of opponents to vaccination. In an excellent article in the New York Times on 31 May 2022, Moises Velasquez-Manoff gave a good summary of the people who are vaccine opponents and how the Covid pandemic became a focal point for their disinformation regarding vaccines. He identified an erosion in confidence in medical expertise (read Tom Nichol's book The Death of Expertise) and discusses how antiscience beliefs have now become incorporated into someone’s political identity. The numerous protests regarding vaccine mandates are a “don’t tell me what to do freedom movement.” Some anti-vaxxer leaders profit financially while others are conspiracy theorists. Velasquez-Manoff quotes many pediatricians and public health people who worry that opposition to other vaccines, which were expanding before Covid, will increase. We have already seen outbreaks of vaccine-preventable infections with such diseases as measles and whooping cough. The CDC confirmed that the United States has now joined a list of 30 countries, mostly in Africa and the Middle East, where circulating vaccine-derived poliovirus exists. This follows a case of paralytic polio in an unvaccinated man in July 2022. Subsequent analysis of sewage has detected poliovirus in several New York counties, an ominous sign that there are many more infected with it (inapparent infections outnumber those with symptoms). And guess what? In New York State, the statewide vaccination rate for polio is 79%, but it is substantially lower than the three counties that have found the virus in their wastewater.

Vaccination works. It is perhaps the single most effective advance in public health and medicine since 1900. Rationality and sanity dictate that our use of vaccines should increase and that those who oppose vaccines are at best misguided and at worst a threat to human health. The bivalent booster for Covid-19 is available – please get it. Childhood vaccines are critical – vaccinate children. The time for witchcraft is long past.