COVID-19 Data Dispatch

Tag: vaccine distribution

  • COVID-19 risk factors that should lead to Omicron booster priority

    COVID-19 risk factors that should lead to Omicron booster priority

    Parts of the South and Midwest have higher rates of chronic conditions (colored darker red on the map) that confer higher risk for severe COVID-19. Chart via the CDC.

    The U.S. has started a new booster shot campaign, this time using vaccines designed to specifically target super-contagious subvariants Omicron BA.4 and BA.5. (For more details on the shots themselves, see last week’s post.)

    Unlike previous vaccination campaigns, these boosters are available to all adults across the country who have been previously inoculated. There was no prioritization for seniors, healthcare workers, or other higher-risk adults. The official guidance from the federal government is actually pretty straightforward, for once: everyone should get the new booster. And get a flu shot soon, too, possibly even at the same time as your COVID-19 shot.

    But all previously-vaccinated Americans are not facing similar levels of COVID-19 risk. Many of the same qualifications that might have warranted you an earlier dose in spring 2021 should now lead you to prioritize your Omicron booster, even if you might have been infected recently. At the same time, people who fall in these groups (or who share their households) have a good reason to continue using other safety measures after their boosters.

    Here are the major qualifications for higher risk, with data to back them up:

    • Seniors, especially those over age 70: More than 90% of Americans over age 65 have received at least their primary vaccine series, according to the CDC, while over 70% have received at least one booster. Yet older Americans continue to have the highest rates of hospitalizations and deaths. For example, those older than 70 have consistently been hospitalized at several times the rate of younger adults (when adjusted for population). The same pattern is true for deaths among adults over age 75. Seniors who receive the new booster shots will face a lower risk of severe COVID-19 this fall and winter.
    • Black, Indigenous, and other Americans of color, especially seniors: Despite dedicated vaccination campaigns and other health equity efforts, Americans of color have continued to be hit harder by the pandemic than white Americans. Higher rates of chronic conditions in minority populations combined with other socioeconomic factors (POC are more likely to work essential jobs, to lack healthcare, etc.) have led to disproportionately high hospitalization and death rates. And the U.S.’s booster shot campaigns so far have been inequitable, as shown in a recent study by demography experts. Reaching these populations should be a priority for the new Omicron boosters.
    • Immunocompromised people: National estimates consider about 3% of Americans to be moderately or severely immunocompromised, meaning that their immune systems have limited capacity to respond to infections without medical assistance. This group includes cancer patients, organ transplant recipients, people with autoimmune diseases, and more. (This Yale Medicine article provides more information.)  Immunocompromised people might have already had multiple booster shots but are still eligible to receive an Omicron booster as soon as possible, the CDC recommends.
    • People with Long COVID and related conditions: While there isn’t as much established data in this area, I have seen a lot of anecdotal reports from Long COVID patients who work hard to avoid new coronavirus infections—concerned about reinfection’s possibility to worsen their symptoms. On the flip side, vaccination might lead to improvement in Long COVID patients, as the shot boosts a patient’s immune system in responding to lingering reservoirs of virus. The Atlantic covered this possibility when Long COVID patients were first eligible for vaccination in early 2021, and other studies since then have backed it up. More research is needed, but at the very least, Long COVID patients receiving a new booster will have lower risk of a new severe case.
    • People with other preexisting health conditions: The CDC has an extensive list of medical conditions that can confer additional risk for severe COVID-19, with plenty of links to other CDC pages and medical sites where you can learn more about relevant evidence. I won’t go through them all here (that’s a topic for another week’s issue), but I do recommend checking out the CDC’s information and linked sources if you have a condition on the list. You can also explore this map of chronic condition rates by county.

    More vaccination data

  • Sources and updates, July 31

    • KFF poll shows low vaccine uptake for young kids: This week, the Kaiser Family Foundation released an update from their COVID-19 Vaccine Monitor, an ongoing project tracking U.S. attitudes towards vaccines. This latest update focuses on children under age five, and the results are worrying: about 43% of parents with kids in this age group say they will “definitely not” get their child vaccinated, citing concerns about vaccine safety. Conservative parents and those who are unvaccinated themselves were particularly likely to be against vaccinating their young kids, KFF found.
    • Vaccine side effects less common for second boosters: A new CDC study, published in this week’s Morbidity and Mortality Weekly Report, tracked reactions to COVID-19 boosters among Americans over age 50 using CDC monitoring systems. Among over 200,000 people who received third and fourth doses from the same vaccine manufacturer, side effects like a sore arm and fatigue were less common after the fourth dose compared to the third dose. Still, uptake for second boosters has been slow and potentially inequitable; the CDC recently published data on second boosters by race/ethnicity, showing that white Americans over age 50 are more likely to get this extra protection than non-white people in this age group.
    • White House summit on next-generation COVID-19 vaccines: And one more piece of vaccine news for this week: the White House brought together federal officials, scientists, and pharmaceutical executives for a summit discussing next-generation COVID-19 vaccines. The summit highlighted vaccine candidates designed to work against many potential coronavirus variants, as well as those that would be delivered through the nose—potentially producing more protection against coronavirus infection and transmission. Either option would require a lot of funding from a Congress that has been hesitant to support COVID-19 efforts.
    • States are letting health emergency declarations expire: While the federal declaration of COVID-19 as a public health emergency will remain in place at least through this fall, many states have let their declarations expire in recent months. These expirations impact the resources states are able to allocate for tracking and responding to COVID-19—ranging from data collection to telehealth access. The ending emergencies are certainly contributing to less frequent COVID-19 data updates in many states.
    • New studies on COVID-19’s origins: Two major studies have conclusively linked the coronavirus’ early spread to the Huanan Seafood Market in Wuhan, China. These studies, both published in Science, were produced by an international group of virologists and evolutionary biologists at the Scripps Research Institute, the University of Arizona, the University of Sydney, the University of Edinburgh, and many other institutions. The experts traced early cases in the seafood market, finding evidence of spillover from animals to humans. The precise origins of COVID-19 are still unknown, but these studies go a long way in demonstrating early spread tied to animals, not a lab leak.

    All featured sources
  • We need more data for fall booster decisions

    We need more data for fall booster decisions

    At the FDA advisory committee meeting this week, Pfizer presented data from different options of Omicron-specific booster shots.

    This week, the FDA’s vaccine advisory committee met to discuss fall booster shots, in anticipation of another COVID-19 surge next winter. The discussion demonstrated the U.S.’s continued failure to provide the data that are really needed to make these decisions.

    I have written a lot about this topic in the past, so to avoid being too repetitive, I’ll link to a couple of past articles:

    But here’s the TL;DR: due to the fractured nature of America’s public health system, it’s difficult for researchers to connect data on different health metrics. For example, a state might have one database with vaccination records and another database with case records, and the databases might not easily link to answer questions about breakthrough cases.

    Some state health departments have figured out how to make these links, but the process is not uniform. And the breakthrough case data we do have generally aren’t linked to information on variants, or demographic data, or outcomes like Long COVID.

    The more specific the vaccine effectiveness question, the more complicated it becomes to answer. This is a bigger problem now as the FDA considers fall boosters, because the agency needs to determine the best vaccine candidate and identify priority populations for shots—while operating in a politcal climate where vaccine funding is less popular than it was a year ago.

    Here are a few questions that the FDA is trying to answer, drawing from the STAT News meeting recap:

    • Should the fall booster be a monovalent vaccine, meaning it only includes Omicron-specific genetic material? Or should it be bivalent, meaning it includes both Omicron and the original, Wuhan strain? Pfizer and Moderna presented different options; some experts say a bivalent vaccine may provide more long-term protection.
    • Should the booster shot be specific to BA.4 and BA.5? The panel agreed that it should, as these strains are now dominant in the U.S., but there’s a timing trade-off as vaccine companies have yet to do clinical trials (or provide substantial data) for a subvariant-specific vaccine.
    • Should the booster shot be another type of vaccine entirely? In addition to Pfizer and Moderna, the FDA panel also heard from Novavax. This company has developed a protein-based vaccine that hasn’t yet received FDA authorization, but panelists were impressed by its potential for long-term protection.
    • How well do the vaccines provide non-antibody-based protection? As in past advisory committee meetings, the vaccine companies primarily presented data based on antibodies generated from their shots. Experts wanted to see more data about T cells and other aspects of immunity which are harder to measure, but may be more important in the long term.
    • Who would most benefit from another booster? If the federal government isn’t able to buy enough shots for everyone, priortization will need to happen. Will Omicron-specific boosters be most useful for seniors, or for people with certain health conditions? These groups will likely get priority again, though we could still be collecting more data on how the vaccines fare for them.

    Of course, despite the dearth of data and cautions from some members of the FDA advisory committee, the U.S. government seems to be going full-speed ahead with fall boosters. The Biden administration has placed a $3.2 billion order from Pfizer for 105 million doses of whichever Omicron-specific vaccine the FDA chooses to authorize.

    More vaccine reporting

  • Sources and updates, June 26

    Sources and updates, June 26

    A new chart from the CDC shows booster shot eligibility and uptake by age. Retrieved on June 26.
    • CDC report on Paxlovid distribution: A major study from the CDC’s Morbidity and Mortality Weekly Report this week: researchers at the CDC and collaborators studied the distributions of antiviral COVID-19 drugs Paxlovid and Lagevrio (also called Molnupiravir) by ZIP code, comparing ZIP codes with the CDC’s Social Vulnerability Index. More than one million prescriptions were dispensed between late December 2021 and late May 2022, the study found. But, by the end of that period, prescription rates were twice as high in low- and medium-vulnerability ZIP codes as in high-vulnerabilty ZIP codes—indicating that these antivirals are not reaching the people who most need them.
    • CDC booster shot data update: The CDC has added a new chart to its “COVID-19 Vaccinations in the United States” page, showing booster shot eligibility and uptake by age. The chart includes two rounds of boosters for seniors; according to the data, 64% of eligible seniors have received their first booster, but only 21% have received their second booster. The data are also available for download.
    • COVID-19 vaccinations among children: I also recently learned about this CDC page focused on kids’ vaccinations, including vaccination coverage by demographic factors such as poverty status, parents’ education level, and insurance. The data come from a national survey previously used to monitor flu vaccinations among children. Data are updated monthly, and don’t yet include figures for children under 5; but existing data for children ages 5-17 affirm that vaccine uptake for kids has been low so far.
    • Guide to finding government COVID-19 documents: The Digital Public Library of America has released a free ebook with an archive of over 3,000 government documents related to the pandemic response. These documents were collected by the COVID Tracking Project during its year of work, and have been meticulously categorized and indexed in true CTP fashion. CTP alum Jennifer Clyde was the project’s editor.
    • Commonwealth Fund report on improving our public health system: A new report from healthcare-focused foundation The Commonwealth Fund provides recommendations for improving the country’s public health system. It focuses on organizing local agencies, providing more funding, improving trust, and other key topics.
    • History of exposure notification apps: Jenny Wanger, whom I interviewed about COVID-19 exposure notification apps back in spring 2021, sent me this paper she wrote about the technology, which was published earlier in June. The paper provides a report of how exposure notification protocols were developed, how states used the technology, and how limited data made it difficult to assess the technology’s success.

  • COVID source callout: Still no state-by-state data on vaccinations by race/ethnicity

    COVID source callout: Still no state-by-state data on vaccinations by race/ethnicity

    This week, the CDC added a new feature to the vaccination section of its COVID-19 dashboard: you can now look at demographic vaccination trends at the state level, not just nationally and regionally.

    But there’s a catch: the state-by-state demographic trends only include age and sex data. Vaccination trends by race and ethnicity are still only available at the national level; in fact, when you click on “Race/Ethnicity” on the booster shots section of this dashboard, the CDC directs you to “please visit the relevant health department website” for more local data.

    For state-level race and ethnicity data, the CDC directs users to state public health agencies. Screenshot taken on March 20.

    It is now over a year into the U.S.’s vaccine rollout, and the CDC is still failing to publicly share data on vaccinations by state and race/ethnicity. I actually wrote a callout post about this in March 2021, and nothing has changed since then!

    This is a major issue because such data are needed to examine equity in the vaccine rollout. While it’s possible to compile data from the states that report vaccinations by race and ethnicity themselves, major inconsistencies in state reporting practices make these data hard to standardize. Why isn’t the CDC doing this? Or, if the CDC is doing this, why aren’t the data public?

    more source spotlights
  • As COVID-19 precautions are lifted, who remains vulnerable?

    As COVID-19 precautions are lifted, who remains vulnerable?

    Hispanic, Black, and Native Americans are less likely to have received their booster shots than white Americans, according to CDC data.

    As more states and other institutions lift COVID-19 safety measures, the shift has sparked a conversation about who remains most vulnerable to COVID-19 during this period. I wanted to highlight a few of these vulnerable groups:

    • Seniors who remain unvaccinated or unboosted: “No other basic fact of life matters as dramatically as age for COVID,” writes Sarah Zhang in The Atlantic this week. Zhang’s story argues that the U.S. has not actually pushed to vaccinate elderly Americans with the same focus that other wealthy nations have. More than 10% of Americans over age 65 are not fully vaccinated and about one-third of those seniors who are fully vaccinated have not received their booster shots, according to CDC data. These seniors face higher COVID-19 risk than younger adults who are entirely unvaccinated, Zhang writes.
    • People of color who remain unvaccinated or unboosted: Zhang’s article inspired me to also look at recent vaccination trends by race and ethnicity. Black, Hispanic, and Native Americans have been at higher risk for COVID-19 throughout the pandemic, as their minority identities often coincide with lower socioeconomic status. According to CDC data, booster shot trends are similar to the vaccination trends we saw in early 2021: while 55% of eligible white Americans have received their booster shots, that number is below 50% for Black, Hispanic, and Native Americans. It’s lowest for Hispanic or Latino Americans: only 39% of those eligible have received a booster shot, as of February 19.
    • Immunocompromised people: If you haven’t yet read Ed Yong’s latest feature, about how America’s pandemic response has left immunocompromised people behind, drop everything and read it today. About 3% of U.S. adults take immunosuppressive drugs, while others live with diseases like AIDS that impact their immune systems. “In the past, immunocompromised people lived with their higher risk of infection, but COVID represents a new threat that, for many, has further jeopardized their ability to be part of the world,” Yong writes. Several other articles this week have also highlighted the challenges immunocompromised Americans face at this point in the pandemic.
    • Pregnant people: According to CDC data, about 68% of pregnant people ages 18 to 49 are fully vaccinated, as of February 12. That leaves almost one-third of pregnant Americans who are not fully vaccinated. Studies have found that pregnant people infected with the coronavirus are at higher risk for complications during their pregnancies and other severe outcomes. Plus, a new CDC study released this week found that a parent’s vaccination while pregnant greatly reduces an infant’s risk of being hospitalized for COVID-19, as antibodies produced by vaccination may be transferred from parent to child.
    • Children under age five: Of course, I have to mention the one group of Americans that is still not yet eligible for vaccination: children under age five. As parents of these kids have dealt with a confusing back-and-forth from Pfizer and the FDA on when vaccines might be available, many are facing high stress levels and remaining cautious even while schools and other institutions reduce safety measures.

    More vaccination data

  • Featured sources, January 30

    • KFF updates COVID-19 vaccine monitor: The Kaiser Family Foundation released a new report in its COVID-19 vaccine polling project this week, marking over a year since the U.S.’s vaccine rollout began. Notable updates from this report include: people are worried about Omicron’s impact on the economy and healthcare system, less worried about its impact on them personally; vaccine uptake “inched up in January” with more people getting their first doses; and gaps in booster shot uptake echo early gaps in vaccine uptake, with white Americans getting boosted at higher rates than Black and Hispanic Americans.
    • New version of the COVID-19 circuit breaker dashboard: A few weeks ago, I shared a dashboard from emergency physician Dr. Jeremy Faust and colleagues that estimates which U.S. states and counties are facing hospitals operating at unsustainable levels. The dashboard has now been updated, with help from Kristen Panthagani, Benjy Renton, Bill Hanage, and others; this new version includes hospital capacity and related metrics over time for states and counties, estimates of open beds, ICU-specific data, and more.
    • Biobot’s Nationwide Wastewater Monitoring Network: If you’re looking to monitor COVID-19 levels in U.S. wastewater, Biobot’s dashboard is a great source. The wastewater epidemiology company collects samples from water treatment facilities across the country; their dashboard includes both estimates of coronavirus levels in the U.S. overall and estimates for specific counties in which data are collected. The data are available for download on Github. (H/t Data Is Plural.)
    • Prisoners released in 2020, DOJ: A new report from the U.S. Department of Justice includes data on state and federal prisons during the COVID-19 pandemic. The number of inmates in these facilities declined about 15% from the end of 2019 to the end of 2020, according to this report. A large cause for this decline was overall disruption in the court system, not compassionate releases due to the pandemic: there was a 40% decrease in prison admissions from 2019 to 2020.
    • Companies requiring COVID-19 vaccinations: ChannelE2E, a news site covering the IT industry, has compiled this comprehensive list of major companies requiring their employees to get vaccinated. The list includes about 50 companies, and is regularly updated with links to news sources discussing policy changes. (H/t Al Tompkins’ COVID-19 newsletter.)

    All featured sources
  • We failed to vaccinate the world in 2021; will 2022 be more successful?

    We failed to vaccinate the world in 2021; will 2022 be more successful?

    According to Bloomberg, the 52 least wealthy places in the world have 5.6% of the vaccinations. Chart from Bloomberg’s vaccine tracker, screenshot taken on December 19.

    In January, COVAX set a goal that many global health advocates considered modest: delivering 2.3 billion vaccine doses to low- and middle-income countries by the end of 2021. COVAX (or COVID-19 Vaccines Global Access) is an initiative to provide equitable access to vaccines; its leadership includes the United Nations, the World Health Organization (WHO), and other organizations.

    Despite COVAX’s broad support, the initiative has revised its vaccine delivery projections down again and again this year. Now, the initiative is saying it’ll deliver just 800 million vaccine doses by the end of 2021, according to the Washington Post, and only about 600 million had been delivered by early December.

    Considering that most COVID-19 vaccines are two-dose series—and boosters will likely be necessary to combat Omicron—those doses are just a drop in the bucket. According to Bloomberg’s vaccine tracker: “The least wealthy 52 places have 5.6% of the vaccinations, but 20.5% of the world’s population.”

    Why this access gap? Many scientists and advocates in low- and middle-income nations blame vaccine manufacturers and rich countries like the U.S., I found when I reported a story on this topic for Popular Science.

    “We basically have artificial scarcity of vaccine doses,” says Robbie Silverman, a vaccine advocate at Oxfam America. The pharmaceutical companies control “where doses are produced, where they’re sold, and at what price.” The world’s vaccine supply is thus limited by contracts signed by a small number of big companies; and many of those contracts, [Fatima Hassan, health advocate from South Africa] says, are kept secret behind non-disclosure agreements.

    While rich countries claimed to support COVAX, the Washington Post reports, “they also placed advance orders with vaccine manufacturers before COVAX could raise enough money to do so.” This practice pushed COVAX to the back of the vaccine line—and then, when rich countries decided they needed booster shots, that pushed COVAX to the back of the line again. India’s spring 2021 surge didn’t help either, as the country blocked vaccine supplies produced at the Serum Institute of India from being exported to other nations.

    According to Our World in Data, low-income nations have administered about 60 million doses total, while high-income nations have administered more than 300 million booster shots. At times this winter, there were more booster shots administered daily than first and second doses in low-income countries.

    Even taking booster shots into consideration, there should be enough vaccine supplies produced by the end of this year to vaccinate 40% of the world’s population by the end of this year, meeting WHO targets, according to STAT News’ Olivia Goldhill. The world is on track to manufacture about 11 billion vaccines in total this year, Goldhill reports, while about 850 million doses are needed to get all countries to a 40% vaccination benchmark.

    But again, rich countries pose a problem: the countries currently focused on administering booster shots have stockpiled hundreds of millions of doses, and are unwilling to send their stockpiles abroad. From STAT News:

    “That number can be redistributed from what high-income countries expect to have by the end of this year. So it’s not an overall supply challenge,” said [Krishna Udayakumar, founding director of Duke’s Global Health Innovation Center]. “It’s very much an allocation challenge, as well as getting high income countries more and more comfortable that they don’t need to hold on to hundreds of millions of doses, for contingencies.”

    The vaccine shortage for low-income countries is less than the surplus vaccines within the G7 countries and the European Union, according to separate analyses from both Duke and Airfinity, a life sciences analytics firm that is tracking vaccine distribution.

    While leaders in the U.S., the U.K., and other nations with large stockpiles maintain that they can both administer booster shots at home and send doses for primary series shots abroad, their true priorities are clear. The U.S., for example, has pledged to donate 1.2 billion doses to other countries, but about 320 million—under one-third—of those doses have been shipped out so far.

    Another challenge is the type of vaccines being used in wealthy nations, as opposed to low- and middle-income nations. Wealthy nations have been particularly eager to horde Pfizer and Moderna’s vaccines, which are more effective against Omicron and other variants of concern. On the other hand, many low-income nations have relied on Sputnik, CoronaVac, and other vaccines which are less effective.

    “We’re now entering an era of second-class vaccines for second-class people,” Peter Maybarduk, director at the DC-based nonprofit Public Citizen, told me in October, discussing these differences in vaccine effectiveness. As Omicron spreads around the world, this concern is only growing.

    The more the coronavirus spreads across the world, particularly in regions with less immunity from vaccines, the more it can mutate and create new variants. Delta and Omicron provide clear examples, demonstrating the need to vaccinate the world in 2022.

    And there are some reasons to hope that this goal may be feasible. COVAX’s global supply forecast shows major jumps in vaccine supplies in the first three months of 2022. At the same time, vaccine companies are increasing their production capacity, and donations from the U.S. and other countries are expected to kick in. In South Africa, an mRNA vaccine hub is working to train African companies to manufacture COVID-19 vaccines similar to Pfizer and Moderna’s, without violating patents.

    Still, additional variants—and the need for additional booster shots—could be a major hurdle, as vaccine companies continue to prioritize wealthy nations. These companies continue to refuse to share their intellectual property with other manufacturers, even as they make patents for COVID-19 antiviral drugs widely available. And, once vaccines are delivered, getting them from shipments into arms will be a challenge.

    More international data

  • One month into vaccinations for kids 5-11, uptake varies wildly by state

    One month into vaccinations for kids 5-11, uptake varies wildly by state

    It’s been about a month since the FDA and CDC authorized a version of Pfizer’s vaccine for children ages five to 11. Those kids whose parents immediately took them to get vaccinated are now eligible for their second doses, and will be considered fully vaccinated by Christmas.

    Despite widespread availability of the shots, vaccine uptake has varied wildly: the share of children ages five to 11 who have received at least one dose ranges from almost 50% in Vermont—to under 4% in West Virginia. In Idaho, so few children in this age range have received a vaccine dose that the CDC has yet to report a number of children vaccinated.

    As you can see from the map (which uses data as of December 9), vaccination rates for kids are falling pretty much along partisan lines, with states in the Northeast and West Coast vaccinating more than those in the South and Midwest. This is unsurprising yet troubling, as the states with lower vaccination rates among kids are also those states with more lax COVID-19 safety measures in schools—suggesting that they’re exactly the kids who could use that protection.

    A new report from the Kaiser Family Foundation’s COVID-19 Vaccine Monitor provides context on slowing vaccination rates among children. According to KFF’s polling, three in ten American parents—both of teenagers and younger kids—say they will “definitely not” get their children vaccinated. Concerns about safety and potential long-term side effects abound, even though all data so far have suggested that the vaccines are very safe for children.

    https://twitter.com/DataDrivenMD/status/1469035785374420993

    While the overall data are troubling, we lack information in one key area: demographic data. Without breakdowns of child vaccination rates by race and ethnicity, it’s difficult to say whether the racial gap in vaccinations that we saw for adults earlier in 2021 has persisted for younger Americans. This data absence makes it difficult for policymakers and health advocates to address the potential need for vaccine messaging tailored to families of color.

    More vaccination data

  • Sources and updates, December 5

    • State approaches to contact tracing: This report from the National Academy for State Health Policy, updated on December 2, explores how every U.S. state is approaching contact tracing for COVID-19 cases. The report includes state partnerships with research institutions, adjustments for case surges, workforce sizes and training, digital contact tracing apps, and more. (H/t Al Tompkins’ COVID-19 newsletter.)
    • KFF COVID-19 Vaccine Monitor (December update): The newest polling report from the Kaiser Family Foundation’s Vaccine Monitor project is out this week, detailing public opinion on vaccinations, including booster shots, mandates, and more. Two notable findings: four in ten Republican adults are unvaccinated, and Republicans are less likely to report receiving a booster dose than Democrats.

    All featured sources