Over the past year, vaccine incentives have become a popular strategy among businesses and state and local governments. From free donuts to free Mets tickets, Americans have had opportunities to get bonus rewards along with protection from the coronavirus. And one particularly common incentive is cash, offered through small payments accompanying vaccinations and lotteries that only vaccinated people can enter.
While politicians at all levels have praised cash incentives, research has shown that this strategy has little impact on actually convincing Americans to get vaccinated. A recent investigation I worked on (at the Documenting COVID-19 project and the Missouri Independent) provides new evidence for this trend: the state of Missouri allocated $11 million for gift cards that residents could get upon receiving their first or second vaccine dose, but the vast majority of local health departments opted not to participate in the program—and a very small number of gift cards have been distributed thus far.
The Missouri program’s limited success fits into a national pattern. “It’s hard to tease out a causal effect of a program that’s not introduced with the purpose of a research experiment,” Dr. Allan Walkey, an epidemiologist at Boston University who’s studied vaccine incentives, told me. Still, Walkey said, the majority of research on these programs has found that cash incentives are not driving huge numbers of people to get their shots.
Walkey specifically studied a vaccine lottery in Ohio, the first state to set up such a program. While initial reports by state leaders suggested that a lot of people got vaccinated after the lottery was announced, Walkey found that, in fact, the new vaccinations were more likely caused by an expansion of vaccine eligibility. Two days before the lottery was announced, the Pfizer vaccine was authorized for children between the ages of 12 and 15.
For this story, I also spoke to Ashley Kirzinger, a polling expert at the Kaiser Family Foundation (KFF) who helps run KFF’s Vaccine Monitor surveys. In these surveys, KFF sorts unvaccinated Americans into categories based on their vaccine attitudes: “wait and see,” “only if required,” and “definitely not.” Kirzinger told me that cash incentives, vaccine requirements for events, and other social pressures are more likely to “motivate the ‘wait and see’ or ‘only if required’” groups.
But for those Americans who “definitely” don’t want to get vaccinated, these incentives aren’t likely to move the needle. In fact, the people in this group may be angered by incentives, because they could see such programs as unfair pressure from the health system.
This was true in some Missouri local public health departments. For example, in Carter County—where the local agency did opt in to the state gift card program—a planned vaccination drive with the gift cards was canceled due to local opposition.
“So many parents and community members were upset, we were not allowed to hold the vaccination event at the school,” said Michelle Walker, the county health center administrator.
Overall, out of 115 local public health agencies in Missouri that were eligible to participate in the incentive program, just 20 opted to get gift cards. Most departments purchased $50 gift cards, so that residents could get $50 at their first vaccine dose and $50 at their second dose.
Through surveying the local agencies that participated, my colleague Tessa Weinberg and I obtained data from 10. Out of 6,378 gift cards that the agencies were able to purchase with state funding, we found that just 1,712 had been distributed so far, as of late November.
!function(){“use strict”;window.addEventListener(“message”,(function(e){if(void 0!==e.data[“datawrapper-height”]){var t=document.querySelectorAll(“iframe”);for(var a in e.data[“datawrapper-height”])for(var r=0;r<t.length;r++){if(t[r].contentWindow===e.source)t[r].style.height=e.data["datawrapper-height"][a]+"px"}}}))}();
Read the full story for more on why many departments didn’t participate in this gift card program, and how it’s going for the departments that did opt in.
Directory of Local Health Departments: The National Association of County and City Health Officials maintains this database of all local public health departments in the U.S. You can navigate to health department lists for specific states by clicking on the map, or explore a 180-page PDF that includes the name, website link, and contact information (in some cases) for every single department.
Media and Misinformation update from the KFF Vaccine Monitor: The Kaiser Family Foundation typically updates its COVID-19 Vaccine Monitor project with reports once a month. This week, however, the Vaccine Monitor team released an additional report focusing on American adults’ experiences with misinformation. One key finding: about 78% of those surveyed “believe or are unsure about at least one common falsehood” about COVID-19 or the vaccines.
More data on vaccination for kids 5-11 is coming: About 900,000 children in the recently-eligible 5 to 11 age group were vaccinated in the first week since the CDC authorized shots for these kids, the White House announced on Wednesday. At the time, this estimate was higher than official numbers on the CDC’s dashboard due to data lags; but the agency is planning to publish more data on this age group by the end next week, according to Bloomberg editor Drew Armstrong.
💉👨👦The CDC will begin publishing data on how many kids ages 5-11 have gotten vaccinated late next week (three weeks after the shots were authorized), per the agency.
A lot of COVID-19 data sources caught my eye this week!
More booster data from the CDC: This week, the CDC added both booster shot trends by day and booster shots by primary series type to its COVID Data Tracker. For booster shot trends, click “People Receiving a Booster Dose” on the Trends page, and for primary series data, scroll down to “Covid-19 Booster Dose Type by Primary Series Type” on the Vaccination Totals page. So far, it looks like a lot of Johnson & Johnson recipients are opting for mRNA boosters.
KFF’s latest Vaccine Monitor update: The Kaiser Family Foundation has released the latest edition of its monthly vaccine poll, the COVID-19 Vaccine Monitor. This month’s edition focuses on vaccinations for children ages 5 to 11, in line with the recent discussions around shots for this age group, but it also includes other polling on general vaccination demographics, boosters, mandates, and more.
Under-testing in U.S. prisons and jails: A new report from the UCLA Law COVID Behind Bars Data Project explores how insufficient COVID-19 testing of incarcerated people in the U.S. contributes to skewed case rates. Even in the states that have tested their incarcerated populations the most, this report shows, that testing is still far less frequent than testing for other congregate living facilities, like nursing homes.
Impact of School Opening on SARS-CoV-2 Transmission: A group of scientists (including school data expert Emily Oster) recently published a new paper in Nature examining how school reopening models—remote, hybrid, or in-person—contribute to community transmission. In most parts of the country, reopening model did not have a significant impact on transmission, they found; the South was an exception. The authors shared the data underlying their paper, with some information from Burbio and the CDC removed due to requirements from those organizations.
Reporting recipe for breakthrough case data: Dillon Bergin, my colleague at the Documenting COVID-19 project, wrote this reporting recipe, which guides local newsrooms through acquiring data on and covering breakthrough cases in their areas. The recipe accompanies a recent story that Dillon wrote, in collaboration with the Las Vegas Review-Journal, on breakthrough cases by occupation in Las Vegas. (Unsurprisingly, healthcare workers and casino workers were likely to have breakthrough cases, the Las Vegas data show.)
Polling on small businesses and vaccine mandates: Here’s another vaccine survey released this week, this one from the U.S. Chamber of Commerce. The agency asked small businesses about their positions on vaccine mandates, as well as hiring challenges and other issues. 64% of small business owners support “businesses in their area requiring vaccines for their employees,” the survey found.
The Pfizer vaccine will likely be available to children ages 5 to 11 next week, but many parents are hesitant about getting their kids vaccinated. Chart via the KFF COVID-19 Vaccine Monitor.
Last week, the Food and Drug Administration (FDA) recommended Pfizer’s COVID-19 vaccine for children ages 5 to 11, under an Emergency Use Authorization. The agency’s vaccine advisory committee met on Tuesday to discuss Pfizer’s application and voted overwhelmingly in favor; the FDA followed this up with an EUA announcement on Friday.
This coming week, the process continues: CDC’s own vaccine advisory committee will discuss and vote on vaccinating kids in the 5-11 age group, and then the agency will make an official decision. If all goes well—and all is expected to go well—younger kids will be able to get their vaccines in time for Thanksgiving.
Many of the parents I know have been eagerly awaiting this authorization, but the sentiment is far from universal. COVID-19 vaccinations for kids are incredibly controversial, more so than vaccinations for adults. The public comment section of the FDA advisory committee meeting—in which basically anyone can apply to share their thoughts—was full of anti-vaxxers, many of them sharing misinformation. Even some experts on the FDA advisory committee were not fully convinced that vaccines are needed for all young kids, though all but one eventually voted in favor.
Now, let me be clear: there are definite benefits to vaccinating younger children. While kids are less likely to have severe COVID-19 cases than adults, the disease has still been devastating for many children. Almost 100 kids in the 5 to 11 age range have died of COVID-19, making this disease one of the top 10 causes of death for this group over the past year and a half.
Plus, children who get infected with the coronavirus are at risk for Long COVID and MIS-C, two conditions with long-lasting ramifications. There have been about 5,200 MIS-C cases thus far—and the majority of these cases have occurred in Black and Hispanic/Latino children. Minority children are also at much higher risk for COVID-19 hospitalization.
This impt 🧵from today's FDA advisory meeting on Pfizer vaccine for 5-11s.
1) CDC seroprevalence studies show infections in kids are underreported. Kids are as likely as adults to be infected.
2) Black, Hispanic, and AI/AN children have the highest risk of hospitalization. https://t.co/BvwxIuO5g6
Vaccination can prevent children from severe ramifications of a potential COVID-19 case, as well as from the mild infections that lead to missed school and other disruptions. But the FDA committee had to carefully weigh this benefit against potential side effects from vaccination, namely myocarditis—a type of heart inflammation.
The U.S. system for tracking vaccine side effects has identified a small number of myocarditis cases in children ages 12 to 15 after their second shots of Pfizer or Moderna vaccines. For the meeting this past Tuesday, the FDA presented some models weighing potential myocarditis cases in young kids against vaccination benefits; the models showed that, in almost every scenario, the number of severe COVID-19 cases prevented by vaccination is higher than the myocarditis cases.
It’s worth noting: in Pfizer’s clinical trial for the 5 to 11 age group, no child had a severe adverse reaction to the vaccine. But the Pfizer researchers did observe five medical events that were unrelated to vaccination—including one kid who swallowed a penny.
Some of the FDA advisory committee members suggested that perhaps vaccines would be most beneficial for children with underlying medical conditions, who are more susceptible to severe COVID-19. But the committee ultimately voted in favor of vaccines for all kids in the 5 to 11 age group, allowing parents to consult their pediatricians and pursue vaccination if they deem it necessary.
Polling data suggest that many parents don’t currently deem it necessary, though. The latest survey from the Kaiser Family Foundation found that just 27% of parents with kids in the 5 to 11 age range plan to get their kids vaccinated immediately, once shots are available. 33% intend to “wait and see,” 5% will only pursue vaccination if it’s required by the child’s school, and 30% say “definitely not.”
Public health experts, pediatricians, and others in the science communication world have a lot of work ahead of us to convey the importance of vaccinating kids—and dispel misinformation.
The Delta surge is waning. Will this be the last big surge in the U.S., or will we see more? This question and more, answered below; chart from the CDC.
Last week, I asked readers to fill out a survey designed to help me reflect on the COVID-19 Data Dispatch’s future. Though the Delta surge—and the pandemic as a whole—is far from over, I’m considering how this publication may evolve in a “post-COVID” era. Specifically, I’m thinking about how to continue serving readers and other journalists as we prepare for future public health crises.
Thank you to everyone who’s filled out the survey so far! I really appreciate all of your feedback. If you haven’t filled it out yet, you can do so here.
Besides some broader questions about the CDD’s format and topics we may explore in the future, the survey asked readers to submit questions that they have about COVID-19 in the U.S. right now. In the absence of other major headlines this week, I’m devoting this week’s issue to answering a few of those questions.
Should I get a booster shot? If so, should it be a different one from the first vaccine I got? When will my kids (5-11) likely be eligible?
I am not a doctor, and I’m definitely not qualified to give medical advice. So, the main thing I will say here is: identify a doctor that you trust, and talk to them about booster shots. I understand that a lot of Americans don’t have a primary care provider or other ways to easily access medical advice, though, so I will offer some more thoughts here.
As I wrote last week, we do not have a lot of data on who’s most vulnerable to breakthrough COVID-19 cases. We do know that seniors are more vulnerable—this is one point where most experts agree. We know that adults with the same health conditions that make them more likely to have a severe COVID-19 case without a vaccine (autoimmune conditions, diabetes, kidney disease, etc.) are also more vulnerable to breakthrough cases, though we don’t have as much data here. And we know that vaccinated adults working in higher-risk locations like hospitals, nursing homes, and prisons are more likely to encounter the coronavirus, even if they may not necessarily be more likely to have a severe breakthrough case.
The FDA and CDC’s booster shot guidance is intentionally broad, allowing many Americans to receive a booster even if it is not necessarily needed. So, consider: what benefits would a booster shot bring you? Are you a senior or someone with a health condition that makes you more likely to have a severe COVID-19 case? Do you want to protect the people you work or live with from potentially encountering the coronavirus?
If you answered “yes” to one of those questions, a booster shot may make sense for you. And, while you may be angry about global vaccine inequity, one individual refusal of a booster shot would not have a significant impact on the situation. Rather, many vaccine doses in the U.S. may go to waste if not used for boosters. But again: talk to your doctor, if you’re able to, about this decision.
Currently, Pfizer booster shots are available for people who previously got vaccinated with Pfizer. The FDA’s vaccine advisory committee is meeting soon to discuss Moderna and Johnson & Johnson boosters: they’ll discuss Moderna on October 14 and J&J on October 15. Vaccine approval in the U.S. depends upon data submission from vaccine manufacturers—and vaccine manufacturers have not been studying mix-and-match booster regimens—so coming approvals will likely require Americans to get a booster of the same vaccine that they received initially. We will likely see more discussion of mix-and-match vaccinations in the future, though, as more outside studies are completed.
As for when your kids will likely be eligible: FDA’s advisory committee is meeting to discuss Pfizer shots for kids ages 5 through 11 on October 26. If that meeting—and a subsequent CDC meeting—goes well, kids may be able to get vaccinated within a week of that meeting. (Potentially even on Halloween!)
Why don’t people get vaccinated and how can we make them?
I got a couple of questions along these lines, asking about vaccination motivations. To answer, I’m turning to KFF’s COVID-19 Vaccine Monitor, a source of survey data on vaccination that I (and many other journalists) have relied on since early 2021.
KFF released the latest round of data from its vaccine monitor this week. Here are a few key takeaways:
The racial gap in vaccinations appears to be closing. KFF found that 71% of white adults have been vaccinated, compared to 70% of Black adults and 73% of Hispanic adults. Data from the CDC and Bloomberg (compiling data from states) similarly show this gap closing, though some parts of the country are more equitably vaccinated than others.
A massive partisan gap in vaccinations remains. According to KFF, 90% of Democrats are vaccinated compared to just 58% of Republicans. This demonstrates the pervasiveness of anti-vaccine misinformation and political rhetoric among conservatives.
Rural and younger uninsured Americans also have low vaccination rates (62% and 54%, respectively). Both rural and uninsured people have been neglected by the U.S. healthcare system and face access barriers; for more on this topic, I recommend this Undark article by Timothy Delizza.
Delta was a big vaccination motivator. KFF specifically asked people who had gotten their shots after June 1 why they chose to get vaccinated. The most popular reasons were, in order: the increase in cases due to Delta (39%), concern about reports of local hospitals and ICUs filling with COVID-19 patients (38%), and knowing someone who got seriously ill or died from COVID-19 (36%).
Mandates and social pressures were also vaccination motivators. 35% of KFF’s recently vaccinated survey respondents said that a big reason for their choice was a desire to participate in activities that require vaccination, like going to the gym, a big event, or traveling. 19% cited an employer requirement and 19% cited social pressure from family and friends.
The second part of this question, “how can we make them?”, reflects a dangerous attitude that has permeated vaccine conversations in recent months. Yes, it’s understandable to be frustrated with the Americans who have refused vaccination. But we can’t “make” the unvaccinated do anything, and such a forceful attitude may put off people who still have questions about the vaccines or who have faced discrimination in the healthcare system. To increase vaccinations among people who are still hesitant, it’s important to remain open-minded, not condescending. For more: read Ed Yong’s interview with Dr. Rhea Boyd.
That said, we’re now getting a sense of which strategies can increase vaccination: employer mandates, vaccination requirements for public life, and personal experience with the coronavirus. As the Delta surge wanes, it will take more vaccination requirements and careful, open-minded conversations to continue motivating people to get their shots.
What are some things I might say to convince people of Delta’s severity and the need to not relax on masking, distancing, etc?
To answer this, I’ll refer you to the article I wrote about Delta on August 1, as the findings that I discuss there have been backed up by further research.
Personally, there are two statistics that I use to express Delta’s dangers to people:
Delta causes a viral load 1,000 times higher than the original coronavirus strain. This number comes from a study in Guangzhou, China, posted as a preprint in late July. While viral load does not correspond precisely to infectiousness (there are other viral and immune system factors at play), I find that this “1,000 times higher” statistic is a good way to convey just how contagious Delta is, compared to past variants.
An interaction of one second is enough time for Delta to spread from one person to another. Remember the 15-minute rule? In spring 2020, being indoors with someone, unmasked, for 15 minutes or more was considered “close contact.” Delta’s increased transmissibility means that an interaction of one second is now enough to be a “close contact.” The risk is lower if you’re vaccinated, but still—Delta is capable of spreading very quickly in enclosed spaces.
You may also find it helpful to discuss rising numbers of breakthrough cases in the U.S. While vaccinated people continue to be incredibly well protected against severe disease and death caused by Delta, the vaccines are not as protective against coronavirus infection and transmission. (They are protective to some degree, though! Notably, coronavirus infections in vaccinated people tend to be significantly shorter than they are in the unvaccinated, since immune systems can quickly respond to the threat.)
It’s true that rising breakthrough case numbers are, in a way, expected—as more people get vaccinated, breakthrough cases will naturally become more common, because the virus has fewer and fewer unvaccinated people to infect. But considering the risks of spreading the coronavirus to others, plus the risks of Long COVID from a breakthrough case… I personally don’t want a breakthrough case, and so I continue masking up and following other safety protocols.
What monitoring do we have in place for COVID “longhaulers” and their symptoms/health implications?
This is a great question, and one I wish I could answer in more detail. Unlike COVID-19 cases, hospitalizations, and other major metrics, we do not have a comprehensive national monitoring system to tell us how many people are facing long-term symptoms from a coronavirus infection, much less how they’re faring. I consider this one of the country’s biggest COVID-19 data gaps, leaving us relatively unprepared to help the thousands, if not millions, of people left newly disabled by the pandemic.
In February, the National Institutes of Health (NIH) announced a major research initiative to study Long COVID. Congress has provided over $1 billion in funding for the research. This initiative will likely be our best source for Long COVID information in the future, but it’s still in early stages right now. Just two weeks ago, the NIH awarded a large share of its funding to New York University’s Langone Medical Center; NYU is now setting up long-term studies and distributing funding to other research institutions.
As I wrote in the September 19 issue, the NIH’s RECOVER website currently reports that between 10% and 30% of people infected with the coronavirus will go on to develop Long COVID; hopefully research at NYU and elsewhere will lead to some more precise numbers.
While we wait for the NIH research to progress, I personally find the Patient-Led Research Collaborative (PLRC) to be a great source for Long COVID research and data. The PLRC consists of Long COVID patients who research their own condition; it was founded out of Body Politic’s Long COVID support group. This group produced one of the most comprehensive papers on Long COVID to date, based on an international survey including thousands of patients, and has more research currently ongoing.
If you have the means to support Long COVID patients—many of whom are unable to work and facing homelessness—please see the responses to this tweet by PLRC researcher Hannah Davis:
As others have mentioned, people with Long COVID are unable to work & are becoming homeless.
If you have #LongCovid & are struggling, drop your venmo/cashapp/paypal/etc in this thread & I'll retweet.
If you have $ to spare, please support patients in this thread.
Why is the CDC not doing comprehensive high volumes of sequencing on all breakthrough cases at the very least?
I wish I knew! As I wrote last week (and in several other past issues), the lack of comprehensive breakthrough case data in the U.S. has contributed to a lack of clarity on booster shots, as well as a lack of preparedness for the next variants that may become threats after Delta. The CDC’s inability to track and sequence all breakthrough cases—not just the severe ones—is dangerous.
That said, it is very difficult to track breakthrough cases in a country like the U.S. Consider: the U.S. does not have a comprehensive, national electronic records system for patients admitted to hospitals, much less those who receive COVID-19 tests and other care at outpatient clinics. This lack of comprehensive records makes it difficult to match people who’ve been vaccinated with those who have received a positive COVID-19 test. Thousands, if not millions of Americans are now relying on rapid tests for their personal COVID-19 information—and most rapid tests don’t get entered into the public health records system at all.
Plus, local public health departments are chronically underfunded, understaffed, and burned out after almost two years of working in a pandemic; they have little bandwidth to track breakthrough cases. Many Americans refuse to participate in contact tracing, which hinders the public health system’s ability to collect key information about their cases. And there are other logistical challenges around genomic sequencing; despite new investments in this area, many parts of the country don’t have sequencing capacity, or the information infrastructure needed to send sequencing results to the CDC.
So, if the CDC were tracking non-severe breakthrough cases, they’d likely miss a lot of the cases. But that doesn’t mean they shouldn’t be trying, in my opinion.
How safe is it to visit my family for the holidays?
This is another place where I don’t feel qualified to give advice, but I can offer some thoughts. If I were you, I would think about the different ways in which holiday travel might pose risk to me and to the people at the other end of my trip. I would consider:
Quarantining beforehand. Do your occupation and living circumstances allow you to quarantine for a week, or at least limit your exposure to settings where you might be at risk of catching the coronavirus, before you travel? Can you get a test before traveling?
Types of travel. Can you make the trip in a car or on public transportation, or do you need to fly? If you need to fly, can you select an airline that has stricter COVID-19 safety requirements? (United recently reported that over 96% of its employees are now vaccinated, for example.) Can you wear a high-quality mask for the flight?
Quarantining and/or testing upon arrival. Can you spend a couple of days in quarantine once you get to your destination? Would you have access to testing (with results in under 24 hours) upon your arrival, or would you be able to bring rapid tests with you?
Who you’re spending time with. Among the family you’d be visiting, is everyone vaccinated (besides young children)? If anyone is not vaccinated, could your potential travel be a motivator to help convince them to get vaccinated? Does the group include seniors or people with health conditions that put them at high risk for COVID-19, and if so, can they get booster shots?
Activities that you do at your destination. Would you be able to have large gatherings outside, or in a well-ventilated space? What else can you do to reduce the risk of these activities?
Like other activities, travel can be relatively safe or fairly dangerous depending on the precautions that you’re able to take, and depending on COVID-19 case rates where you live and at your destination. And, like other activities, your choice to travel or not travel depends a lot on your personal risk tolerance. Nothing is zero-risk right now; each person has a threshold that determines what level of COVID-19 risk they are and are not comfortable taking. Through some self-reflection, you can determine if travel is above or below your risk threshold.
Why are policies so different now than they were at this time last year?
Public health tends to go through cycles of “panic” and “neglect.” Ed Yong’s latest feature goes into the history of this phenomenon:
Almost 20 years ago, the historians of medicine Elizabeth Fee and Theodore Brown lamented that the U.S. had “failed to sustain progress in any coherent manner” in its capacity to handle infectious diseases. With every new pathogen—cholera in the 1830s, HIV in the 1980s—Americans rediscover the weaknesses in the country’s health system, briefly attempt to address the problem, and then “let our interest lapse when the immediate crisis seems to be over,” Fee and Brown wrote. The result is a Sisyphean cycle of panic and neglect that is now spinning in its third century. Progress is always undone; promise, always unfulfilled. Fee died in 2018, two years before SARS-CoV-2 arose. But in documenting America’s past, she foresaw its pandemic present—and its likely future.
During the COVID-19 pandemic, the U.S. took a nosedive into the “neglect” cycle before we were even finished with the “panic” cycle. Congress has already slashed its funding for future pandemic preparedness, while state and local governments across the country restrict the powers of public health officials. As a result, we’re seeing an “everyone for themselves” attitude at a time when we should be seeing new mask mandates, restrictions on public activities, and other safety measures.
Basically, America decided the pandemic was over and acted accordingly—and if you get COVID-19 now, it’s “your fault for not being vaccinated.” This phenomenon has been especially pronounced in rural areas, which struggled a lot (but saw few cases) during spring 2020 lockdowns and are extremely hesitant to do anything approaching a “lockdown” again.
We need an attitude shift—and more investment in public health—to actually end this pandemic and prepare for the next health crisis. Yong’s feature goes into this in more detail; definitely give that a read if you haven’t yet.
When is this going to be over?!?
Unfortunately, this is very hard to predict—even for the expert epidemiologists and computational biologists who make the models. Check out the CDC’s compilation of COVID-19 case models: most of them agree that cases will keep going down in the coming weeks, but they’re kind of all over the place.
Last week, I summarized two stories—from The Atlantic and STAT News—that discuss the coming winter, and kind of get at this question. It’s possible that cases keep declining from their present numbers, and that the Delta surge we just faced is the last major surge in the U.S. It’s also possible that a new variant arises out of Delta and sends us into yet another new surge. If that happens, more people will be protected by vaccination and prior infection, but healthcare systems could come under strain once again.
As long as the coronavirus continues spreading somewhere in the world, it will continue to pose risk to everyone—able to cause new outbreaks and mutate into new variants. This will continue until the vast majority of the world is vaccinated. And then, at some point, the coronavirus will probably become endemic, meaning it persists in the population at some kind of “acceptable” threshold. Just like the flu.
Dr. Ellie Murray, epidemiologist at Boston University’s School of Public Health, explained how a pandemic becomes endemic in a recent Twitter thread:
Everyone keeps talking about covid becoming endemic, but as I listen to the conversation, it’s becoming more & more clear to me that very few of you know what “endemic” means.
Dr. Murray points out that, even when a disease reaches endemic status, tons of scientists and public health workers will still continue to monitor it. This is the case for the flu—think about all of the effort that goes into a given year’s flu shot!—and it will likely be the case for COVID-19.
In short, public health leaders need to figure out what level of COVID-19 transmission is “acceptable” and how we will continue to monitor it. This needs to happen at both U.S. and global levels. And, thanks to our vaccine-rich status, it’ll likely happen in the U.S. long before it happens globally.
So, yes, our only viable choice left is covid becoming endemic. It didn’t have to be this way, but our leaders MADE a choice.
And now they need to make another choice: They need to choose an “acceptable” level of COVID death & disease.
This past Thursday, an advisory committee to the CDC recommended that booster doses of the Pfizer vaccine be authorized for seniors and individuals with high-risk health conditions. The committee’s recommendation, notably, did not include individuals who worked in high-risk settings, such as healthcare workers—whom the FDA had included in its own Emergency Use Authorization, following an FDA advisory committee meeting last week.
Then, very early on Friday morning, CDC Director Rochelle Walensky announced that she was overruling the advisory committee—but agreeing with the FDA. Americans who work in high-risk settings can get booster shots. (At least, they can get booster shots if they previously received two doses of Pfizer’s vaccine.)
This week’s developments have been just the latest in a rather confusing booster shot timeline:
The US timeline for boosters. You'd have to work really hard to mess this up this badly and engender this much confusion. 😬 pic.twitter.com/KHNWEQJyLg
Why has this process been so confusing? Why don’t the experts agree on whether booster shots are necessary, or on who should get these extra shots? Part of the problem, of course, is that the Biden administration announced booster shots were coming in August, before the scientific agencies had a chance to review all the relevant evidence.
But from my (data journalist’s) perspective, the booster shot confusion largely stems from a lack of data on breakthrough cases.
Let’s go back in time—back four months, or about four years in pandemic time. In May, the CDC announced a major change in its tracking of breakthrough cases. The agency had previously investigated and published data on all breakthrough cases, including those that were mild. But starting in May, the CDC was only investigating and publishing data on those severe breakthrough cases, i.e. those which led to hospitalization or death.
At the time, I called this a lazy choice that would hinder the U.S.’s ability to track how well the vaccines are working. I continued to criticize this move, when researchers and journalists attempted to do the CDC’s job—but were unable to provide data as comprehensive as what the CDC might make available.
Think about what might have been possible if the CDC had continued tracking all breakthrough cases, or had even stepped up its investigation of these cases through increased testing and genomic sequencing. Imagine if we had data showing breakthrough cases by age group, by high-risk health condition, or by occupational setting—all broken out by their severity. What if we could compare the risk of someone with diabetes getting a breakthrough case, to the risk of someone who works in an elementary school?
If we had this kind of data, the FDA and CDC advisory committees would have information that they could use to determine the potential benefits of booster shots for specific subsets of the U.S. population. Instead, these committees had to make guesses. Their guesses didn’t come out of nowhere; they had scientific studies to review, data from Pfizer, and information from Israel and the U.K., two countries with better public health data systems than the U.S. But still, these guesses were much less informed than they might have been if the CDC had tracked breakthrough cases and outbreaks in a more comprehensive manner.
From that perspective, I can’t really fault the CDC and the FDA for casting their guesses with a fairly wide net—including the majority of Americans who received Pfizer shots in their authorization. There’s also a logistical component here; the U.S. has a lot of doses that are currently going unused (thanks to vaccine hesitancy), and may be wasted if they aren’t used as boosters.
But it is worth emphasizing how a lack of data on breakthrough cases has driven a booster shot decision based on fear of who might be at risk, rather than on hard evidence about who is actually at risk. Other than seniors; the risk for that group is fairly clear.
The booster shot decision casts a wide net. But at the same time, it creates a narrow band of booster eligibility: only people who got two doses of Pfizer earlier in 2021 are now eligible for a Pfizer booster. Recipients of the Moderna and Johnson & Johnson vaccines are still left in the dark, even though some of those people may need a booster more than many people who are now eligible for additional Pfizer shots. (Compare, say, a 25-year-old teacher who got Pfizer to a 80-year-old, living in a nursing home, with multiple health conditions who got Moderna.)
That Pfizer-only restriction also stems from a data issue. The federal government’s current model for approving vaccines is very specific: first a pharmaceutical company submits its data to the FDA, then the FDA reviews these data, then the FDA makes a decision, then the CDC reviews the data, then the CDC makes a decision.
By starting with the pharmaceutical company, the decision-making process is restricted to options presented by that company. As a result, we aren’t seeing much data on mixing-and-matching different vaccines, which likely wouldn’t be profitable for vaccine manufacturers. (Even though immunological evidence suggests that this could be a useful strategy, especially for Johnson & Johnson recipients.)
In short, the FDA and CDC’s booster shot decision is essentially both ahead of evidence on who may benefit most from a booster, but behind evidence for non-Pfizer vaccine recipients. It’s kind-of a mess.
I also can’t end this post without acknowledging that we need to vaccinate the whole world, not just the U.S. Global vaccination went largely undiscussed at the FDA and CDC meetings, even though it is a top concern for many public health experts outside these agencies.
48. An observation: There was zero discussion today about the global vaccine supply situation or how use of boosters in the United States might affect getting first doses to billions around the world. Not. One. Word. #ACIP
At an international summit this week, President Biden announced more U.S. donations to the global vaccine effort. His administration seems convinced that the U.S. can manage both boosters at home and donations abroad. But the White House only has so much political capital to spend. And right now, it’s pretty clearly getting spent on boosters, rather than, say, incentivizing the vaccine manufacturers to share their technology with the Global South.
Among the top vaccine donors: -13% of vaccines donated by US have been delivered – 49% of China's donations delivered – 34% of Japan's donations delivered – 4% of Germany's delivered – 8% of UK's delivered
State Guidance on School Reopenings, CRPE: The Center on Reinventing Public Education (CRPE) is an education research organization focused on improving student outcomes. The organization has compiled and analyzed state guidance for school reopening in fall 2020, focusing on mask mandates and vaccination requirements. Read about their findings here.
Will Students Come Back?: July 2021 Parent Survey: The RAND Corporation, a survey company, has a new report out this week displaying parent attitudes towards fall reopening. According to the survey, as of July 2021, 89% of U.S. parents are planning to send their kids back to school in person. This number is higher for white (94%) and Asian (88%) parents than Black (82%) and Hispanic (83%) parents.
COVID Stimulus Watch: The policy resource center Good Jobs First has put together this extensive database of CARES Act funding recipients. You can search the database by federal agency, CARES Act program, business sector, company type, location, amount received, and whether the money has been refunded.
Update on Bloomberg’s Vaccine Tracker: After nine months of manual data updates, the team behind Bloomberg’s COVID-19 vaccine tracker is switching to automated data capture from the World Health Organization, Johns Hopkins, and other sources. Or, as health editor Drew Armstrong put it on Twitter: “We’re finally ready to let the robots take over.” Thank you, Bloomberg team, for your months of hard work!
Last week, a COVID-19 outbreak in Cape Code, Massachusetts was revealed to be the subject of a major CDC study providing evidence of the Delta variant’s ability to spread through vaccinated individuals. The outbreak quickly became the subject of national headlines, many of them sensationalizing Delta’s breakthrough potential—while failing to provide much context on the people who actually got sick.
Here’s one big piece of context. Provincetown, the center of this outbreak, is one of America’s best-known gay communities, and the outbreak took place during Bear Week. Bear Week, for the uninitiated, is a week of parties for gay, bisexual, and otherwise men-loving men who identify as bears—a slang term implying a more masculine appearance, often facial and body hair.
This week, I had the opportunity to talk to Mike, a Bear Week attendee from Pittsburgh who caught COVID-19 in Provincetown. (Mike asked me to use only his first name to protect his privacy.) He told me about his experience attending parties, getting sick, and learning about the scale of the outbreak.
We also discussed how Provincetown and the Bear Week community were uniquely poised to identify this outbreak, thanks to a better-than-average local public health department and a group of men who were willing to share their health information with officials.
The interview below has been lightly edited and condensed for clarity.
Betsy Ladyzhets: My first question is just like, how are you doing? How have you been after being involved in this outbreak?
Mike: I’m good… I live in Pittsburgh, I drove back on that Saturday [after the week of Provincetown events] and on Sunday, I started coughing really bad as I was driving home. This just came out of nowhere. I had to pull over, I’m like, yeah, I’m not good. This cough was a lot worse than I had anticipated. So, that was my first symptom. I went into the office Monday after getting home… My first test was negative, on like Monday or Tuesday. But like, I’m still coughing. I didn’t fully trust it. So I got another one Friday, a PCR test.
BL: So, you got tested twice? Did you experience contact tracing, or how did you get identified as part of the outbreak?
M: I mean, I just knew I’d been there. Um, no one reached out but… There was a Facebook group, probably ten or fifteen thousand people in it. Lots of people posted about their test results. Like, people after they were leaving [Provincetown], started quarantining.
The thing about Provincetown is, there were events that happened in the first week [of July, for July 4] that no one really had time to process… Then Bear Week, the week I went, I went at the busiest week of the year for the town. And it had to be, from a planning perspective, I don’t know that was necessarily the best time to have two huge events back to back.
All the official events for the week that I went were canceled, though there were some of the regular bars and stuff doing events. There was, at the time, I think one venue that has a mostly outdoor party every day from like three to seven, that was very heavily attended with one or two thousand people every day, mostly outside and it’s possible to distance at. I only ended up going once or twice just because it wasn’t really where I wanted to be regardless of COVID risks, it wasn’t particularly a scene that I was craving at the time.
I only went to, maybe, three or four indoor things the whole time, and it was without a mask for two or three of them. There’s a bunch of nightclubs in Provincetown that were still having events. And I don’t think that any of the bars themselves that were having events were requiring vaccination cards or anything. One venue that I saw a show at, they announced the next day that they were making either masks or proof of vaccination required. One of the venues that has outdoor events, they just moved all their shows outside instead of inside.
BL: I see. And you mentioned the Facebook group, was that how you found out that a lot of people were getting tested and things like that?
M: Yeah, there were somewhere between ten and fifteen thousand people in the group, planning this whole week. People usually come to Provincetown from all over, sometimes from abroad, though I don’t think there were many people coming from abroad this year because of the restrictions.
BL: How did you learn about the big CDC study getting written about this?
ML: I didn’t really have any idea until afterwards. There were lots of people in the group saying that Barnstable County, or the Massachusetts Department of Health, wanted to know—they wanted people to call if they’d gotten a positive test so they could keep better track of it. I mean, I think part of why the report was able to happen was that it was in a place with better respect for public health than, like, the state of Florida would have, if this kind of outbreak would’ve happened there.
B: Yeah, I mean, it definitely seems like they responded quickly. Because I know they had, like, a 15% positivity rate one week, and then within a pretty short time it was back down.
M: The town itself is a mostly gay, retirement-somewhat community. They can spend lots of money on other things [like public health]. They’re not necessarily spending money on schools because of how many people don’t have any kids around that they need to spend money on. And I mean, there are a lot of residents who live there year-round who tend to be older and are at more risk.
So the week [Bear Week] itself is unique, and then there was a huge community presence about it, everyone wanted to be—for the most part, we’re comfortable about reporting afterwards. I don’t think anyone knew, walking into this, what it would lead to, but… there’s a feeling of community, and that ten thousand-ish Facebook group, I don’t think we otherwise would have necessary talked to each other or told each other about Massachusetts [public health department] asking people to call if they were positive.
BL: And did you do that? Did you call them?
M: Um, I personally didn’t, since I didn’t even find out I was positive until a few days later.
BL: Now, as you know, this outbreak has gotten a lot of national coverage, it’s been kind of sensationalized, with a lot of people focusing on the vaccine breakthrough cases and stuff like that. I know you were not personally one of the people whose test measurements are included there. But what is that experience like of being part of this thing that has gotten so much national attention?
M: I posted about it on social media and there were lots of people who were surprised or whatnot. I think, at least in my head, I went in with a calculated risk, of like 10, 20, 30, or more in the ten thousand-ish people coming, a lot of them are traveling on planes. I drove, thinking I’ll come into this place and I think I’ll make okay decisions…
And there were people in this one place for a whole week, that I guess you were able to test from the CDC’s perspective. I don’t think there are many other places that are as remote as Provincetown where people are staying for the entire week, and everyone generally leaves on the same day, and everyone was in conversation with one another, talking about what happened.
After vaccine incentives largely failed to drive up vaccination numbers, government agencies and corporations alike are now opting for requirements. Hundreds of thousands of Americans learned this week that, in order to keep their jobs, they need to get their shots—or go through a more arduous process like weekly COVID-19 testing.
Here are the major mandates I saw announced this week, and how many people are impacted by each one.
All city workers in NYC: 340,000 municipal workers in the city will need to get vaccinated or tested weekly. This includes teachers, police, and firefighters; a previous NYC guidance (announced last week) focused on public health workers. Staffers in nursing homes and other congregate care settings need to be vaccinated by August 16, while other workers need to do it by September 13—the first day of school in NYC this fall.
All state workers in California: A few hours after the NYC requirement was announced, California governor Gavin Newsom said that all CA state employees will similarly need to get vaccinated or opt into weekly testing. This applies to about 246,000 state employees and an undetermined number of healthcare workers, according to the New York Times.
All frontline workers in the Department of Veterans Affairs (VA): Also on Monday, the VA announced that all healthcare workers in VA facilities need to get vaccinated, along with facilities staff and others on the frontlines of patient care. Employees have eight weeks to get fully vaccinated, or may face consequences including potential firing. This applies to about 115,000 workers.
All Disney employees: Disney is requiring vaccinations for all salaried and non-union employees. Those who haven’t gotten their shots yet have 60 days to do so, and new hires need to be fully vaccinated before starting work. It’s unclear from the company’s announcement if Disney workers will get a testing option or what the consequences for remaining unvaccinated may be. Disney employs over 200,000 people.
All Walmart employees: Walmart, the largest retailer in the U.S., is requiring all U.S.-based corporate employees to be vaccinated by October 4. This doesn’t include workers in Walmart stores, but those workers are strongly encouraged to get their shots as well—and will get a $150 bonus upon vaccination. Walmart employs about 1.5 million people in the U.S., in total.
All Google employees: Alphabet CEO Sundar Pichai announced Google’s new policy on Wednesday: anyone coming back to work at a Google campus must be vaccinated. The policy is starting in the U.S., but will be expanded to the rest of the world as well; Google employs over 100,000 people globally.
Netflix actors and crew: Netflix is requiring all actors and crew in close contact with those actors to get vaccinated in order to come on set. Some have called for the requirement to be expanded to everyone at the company. The company employed about 9,400 full-time workers in 2020; it’s unclear how many will be impacted by the requirement.
Shake Shack workers and customers: The franchise’s founder and CEO announced Shake Shack’s requirement on Thursday, saying it would apply to full-service restaurants in NYC and Washington, D.C. While this requirement impacts far fewer workers than others in this list, it’s unique in that workers aren’t the only ones who need to be vaccinated: any customer hoping to dine in a Shake Shack needs proof of vaccination, too.
It’s unclear how much of a dent these mandates will make in overall vaccination numbers over the next few weeks. But surveys from KFF and others have suggested that, for many Americans, a vaccination requirement may be the last push they need to get their shots.
Screenshot of the now-downsized vaccine incentives page.
In the June 6 issue, one of our featured sources was a page from the federal government’s vaccine.gov site, providing an extensive list of rewards for Americans who got their shots—ranging from free Krispy Kreme donuts to a United Airlines sweepstakes.
Now, however, that same page only offers a small list of support options for Americans who may need assistance in making their appointments. These include childcare support and free rides from Uber and Lyft; still valuable information, but a huge change from the previous page.
What happened to the big list? A new note at the bottom of the page offers a clue: “This list is for informational purposes only and should not be inferred as an endorsement by CDC/HHS of the products, services or companies listed.”
COVID-19 Data Dispatch 
.jpg){kind=link}