COVID-19 Data Dispatch

Tag: vaccine equity

  • Sources and updates, March 6

    A couple of data sources, a couple of data-related updates:

    • State plans for utilizing COVID-19 relief funding: The federal Office of Elementary and Secondary Education has posted every state’s plan for utilizing ESSER funding, a $13-billion fund set aside to help schools address the impact of COVID-19. Money can be utilized for academic assistance, improving ventilation in schools, testing, and more. State plans were due to the federal government last June, though some materials are still pending on the website.
    • New GAO report on Long COVID: Between 8 and 23 million Americans may have developed Long COVID in the last two years—and an estimated one million are out of work because of this condition—according to a new report from the U.S. Government Accountability Office. The report discusses medical and economic impacts of Long COVID, including current efforts by the federal government to study the condition.
    • KFF COVID-19 Vaccine Monitor update: This week, the Kaiser Family Foundation published a new report detailing America’s sentiments on COVID-19 vaccines and other pandemic issues. Key findings include: COVID-19 vaccine uptake “remains relatively unchanged since January” for both adults and children; a majority of parents with children under five say they “don’t have enough information” about vaccines for that age group; and “most adults believe that the worst of the COVID-19 pandemic is over but there are disagreements about what returning to normal means and when it should happen.”
    • Vaccination disparities between urban and rural counties: Here’s a CDC MMWR study that caught my eye this week: researchers compared vaccination rates in urban and rural U.S. counties, finding that the rate of people in urban counties who have received at least one dose (75.4%) is much higher than the rate in rural counties (58.5%). Moreover, the gap between urban and rural counties has more than doubled between April 2021 and January 2022, the researchers found.
    • CDC updates seroprevalence data: The CDC recently updated a dashboard showing data from seroprevalence surveys, which use information from labs across the country to estimate how many Americans have resolving or recent coronavirus infections. (This does not include vaccinations, unlike other seroprevalence estimates.) According to this new update, about 43% of the country had antibodies from a recent infection as of late January. In some parts of the country that were harder-hit by Omicron, the esimate is over 50%.

    All featured sources
  • 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

  • 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

  • Omicron variant: What we know, what we don’t, and why not to panic (yet)

    Omicron variant: What we know, what we don’t, and why not to panic (yet)

    On Thanksgiving, my Twitter feed was dominated not by food photos, but by news of a novel coronavirus variant identified in South Africa earlier this week. While the variant—now called Omicron, or B.1.1.529—likely didn’t originate in South Africa, data from the country’s comprehensive surveillance system provided enough evidence to suggest that this variant could be more contagious than Delta, as well as potentially more able to evade human immune systems.

    Note that the words suggest and could be are doing a lot of work here. There’s plenty we don’t know yet about this variant, and scientists are already working hard to understand it.

    But the early evidence is substantial enough that the World Health Organization (WHO) designated Omicron as a Variant of Concern on Friday. And, that same day, the Biden administration announced new travel restrictions on South Africa and several neighboring countries. (More on that later.)

    In today’s issue, I’ll explain what we know about the Omicron variant so far, as well as the many questions that scientists around the world are already investigating. Along the way, I’ll link to plenty of articles and Twitter threads where you can learn more. As always, if you have more questions: comment below, email me, (betsy@coviddatadispatch.com), or hit me up on Twitter.

    Where did the Omicron variant come from?

    This is one major unknown at the moment. South Africa was the first country to detect Omicron this past Monday, according to STAT News. But the variant likely didn’t originate in South Africa; rather, this country was more likely to pick up its worrying signal because it has a comprehensive variant surveillance system.

    Per The Conversation, this system includes: “a central repository of public sector laboratory results at the National Health Laboratory Service, good linkages to private laboratories, the Provincial Health Data Centre of the Western Cape Province, and state-of-the-art modeling expertise.”

    Researchers from South Africa and the other countries that have detected Omicron this week are already sharing genetic sequences on public platforms, driving much of the scientific discussion about this variant. So far, one interesting aspect of this variant is that, even though Delta has dominated the coronavirus landscape globally for months, Omicron did not evolve out of Delta.

    Instead, it may have evolved over the course of a long infection in a single, immunocompromised individual. It also may have flown under the radar in a country or region with poor genomic surveillance—which, as computational biologist Trevor Bedford pointed out on Twitter, is “certainly not South Africa”—and then was detected once it landed in that country.

    Why are scientists worried about Omicron?

    Omicron seems to be spreading very quickly in South Africa—potentially faster than the Delta variant. Based on publicly available sequence data, Bedford estimated that it’s doubling exponentially every 4.8 days.

    An important caveat here, however, is that South Africa had incredibly low case numbers before Omicron was detected—its lowest case numbers since spring 2020, in fact. So, we cannot currently say that Omicron is “outcompeting” Delta, since there wasn’t much Delta present for Omicron to compete with. The current rise in cases may be caused by Omicron, or it may be the product of a few superspreading events that happen to include Omicron; we need more data to say for sure.

    Still, as Financial Times data reporter John Burn-Murdoch pointed out: “There’s a clear upward trend. This may be a blip, but this is how waves start.”

    Another major cause for concern is that Omicron has over 30 mutations on its spike protein, an important piece of the coronavirus that our immune systems learn to recognize through vaccination. Some of these mutations may correlate to increased transmission—meaning, they help the virus spread more quickly—while other mutations may correlate to evading the immune system.

    Notably, a lot of the mutations on Omicron are mutations that we simply haven’t seen yet in other variants. On this diagram from genomics expert Jeffrey Barrett, the purple, yellow, and blue mutations are all those we haven’t seen on previous variants of concern, while the red mutations (there are nine) have been seen in previous variants of concern and are known to be bad. 

    Some of these new mutations could be terrible news, or they could be harmless. We need more study to figure that out. This recent article in Science provides more information on why scientists are worried about Omicron’s mutations, as well as what they’re doing to investigate.

    How many Omicron cases have been detected so far?

    As of Sunday morning, genetic sequences from 127 confirmed Omicron cases have been shared to GISAID, the international genome sharing platform. The majority of these cases (99) were identified in South Africa, while 19 were identified in nearby Botswana, two in Hong Kong, two in Australia, two in the U.K., one in Israel, one in Belgium, and one in Italy.

    According to BNO News, over 1,000 probable cases of the variant have already been identified in these countries. Cases have also been identified in the Netherlands, Germany, Denmark, the Czech Republic, and Austria. Many of the cases in the Netherlands are connected to a single flight from South Africa; the travelers on this flight were all tested upon their arrival, and 61 tested positive—though authorities are still working to determine how many of those cases are Omicron. 

    The U.K. Health Security Agency announced on Saturday that it had confirmed two Omicron cases in the country. Both of these cases, like those in Israel and Belgium, have been linked to travel—though the Belgium case had no travel history in South Africa. “This means that the virus is already circulating in communities,” Dr. Katelyn Jetelina writes in a Your Local Epidemiologist post about Omicron. 

    After South African scientists sounded the alarm about Omicron, cases were detected in Botswana, Australia, Hong Kong, Israel, the U.K., and other countries. Chart via GISAID, screenshot taken about 11:30 AM NYC time on November 28.

    Omicron hasn’t been detected in the U.S. yet. But the CDC is closely monitoring this variant, the agency announced in a rather sparse Friday press release.

    Luckily, Omicron is easy to identify because one of its spike protein mutations enables detection on a PCR test—no genomic sequencing necessary. Alpha, the variant that originated in the U.K. last winter, has a similar quality.

    How does Omicron compare to Delta?

    This is another major unknown right now. As I mentioned earlier, Omicron is spreading quickly in South Africa, at a rate faster than Delta spread when it arrived in the country a few months ago. But South Africa was seeing a very low COVID-19 case rate before Omicron arrived, making it difficult to evaluate whether this new variant is directly outcompeting Delta—or whether something else is going on.

    (Note that a couple of the tweets below refer to this variant as “Nu,” as they were posted prior to the WHO designating it Omicron.)

    We also don’t know if Omicron could potentially evade the human immune system, whether that means bypassing immunity from a past coronavirus infection or from vaccination. However, vaccine experts say that a variant that would entirely evade vaccines is pretty improbable.

    Every single coronavirus variant of concern that we’ve encountered so far has responded to the vaccines in some capacity. And the variants that have posed more of a danger to vaccine-induced immunity (Beta, Gamma) have not become dominant on a global scale, since they’ve been less transmissible than Delta. Our vaccines are very good—not only do they drive production of anti-COVID antibodies, they also push the immune system to remember the coronavirus for a long time.

    It’s also worth noting here that, so far, Omicron does not appear to be more likely to cause severe COVID-19 symptoms. Angelique Coetzee, chairwoman of the South African Medical Association, announced on Saturday that cases of the variant have been mild overall. Hospitals in South Africa are not (yet) facing a major burden from Omicron patients.

    What can scientists do to better understand Omicron?

    One thing I cannot overstate here is that scientists are learning about Omicron in real time, just as the rest of us are. Look at all the “We don’t know yet.”s in this thread from NYU epidemiologist Céline Gounder:

    Gounder wrote that we may have answers to some pressing questions within two weeks, while others may take months of investigation. To examine the vaccines’ ability to protect against Omicron, scientists are doing antibody studies: essentially testing antibodies that were produced from past vaccination or infection to see how well they can fight off the variant.

    At the same time, scientists are closely watching to see how fast the variant spreads in South Africa and in other countries. The variant’s performance in the U.K., where it was first identified on Saturday, may be a particularly useful source of information. This country is currently facing a Delta-induced COVID-19 wave (so we can see how well Omicron competes); and the U.K. has the world’s best genomic surveillance system, enabling epidemiologists to track the variant in detail.

    How does Omicron impact vaccine effectiveness?

    We don’t know this yet, as scientists are just starting to evaluate how well human antibodies from vaccination and past infection size up against the new variant. The scientists doing these antibody studies include those working at Pfizer, Moderna, and other major vaccine manufacturers. Pfizer’s partner BioNTech has said it expects to share lab data within two weeks, according to CNBC reporter Meg Tirrell:

    If BioNTech finds that Omicron is able to escape immunity from a Pfizer vaccination, the company will be able to update that vaccine within weeks. Moderna is similarly able to adjust its vaccine quickly, if lab studies show that an Omicron-specific vaccine is necessary.

    Even if we need an updated vaccine for this variant, though, people who are already vaccinated are not going back to zero protection. As microbiologist Florian Krammer put it in a Twitter thread: “And even if a variant vaccine becomes necessary, we would not start from scratch… since it is likely that one ‘variant-booster’ would do the job. Our B-cells can be retrained to recognize both, the old version and the variant, and it doesn’t take much to do that.”

    What can the U.S. do about Omicron?

    On Friday, the Biden administration announced travel restrictions from South Africa and neighboring countries. The restrictions take effect on Monday, but virus and public health experts alike are already criticizing the move—suggesting that banning travel from Africa is unlikely to significantly slow Omicron’s spread, as the variant is very likely already spreading in the U.S. and plenty of other countries.

    At the same time, travel restrictions stigmatize South Africa instead of thanking the country’s scientists for alerting the world to this variant. Such stigma may make other countries less likely to share similar variant news in the future, ultimately hurting the world’s ability to fight the pandemic.

    So what should the U.S. actually be doing? First of all, we need to step up our testing and genomic surveillance. As I mentioned above, Omicron can be identified from a PCR test; an uptick in PCR testing, especially as people return home from Thanksgiving travel, could help identify potential cases that are already here.

    We also need to increase genomic surveillance, which could help identify Omicron as well as other variants that may emerge from Delta. In a post about the Delta AY.4.2 variant last month, I wrote that the U.S. is really not prepared to face surges driven by coronavirus mutation:

    We’re doing more genomic sequencing than we were at the start of 2021, which helps with identifying potentially concerning variants, but sequencing still tends to be clustered in particular areas with high research budgets (NYC, Seattle, etc.). And even when our sequencing system picks up signals of a new variant, we do not have a clear playbook—or easily utilized resources—to act on the warning.

    We also need to get more people vaccinated, in the U.S. and—more importantly—in the low-income nations where the majority of people remain unprotected. In South Africa, under one-quarter of the population is fully vaccinated, according to Our World in Data.

    What can I do to protect myself, my family, and my community?

    In general, do all of the same things that you’ve already been doing. Most importantly, get vaccinated (including a booster shot, if you’re eligible).

    Also: Wear a mask in indoor spaces, ideally a good quality mask (N95, KN95, or double up on surgical and cloth masks). Avoid crowds if you’re able to do so. Monitor yourself for COVID-19 symptoms, including those that are less common. Utilize tests, including PCR and rapid tests—especially if you’re traveling, or if you work in a crowded in-person setting. 

    I’ve seen some questions on social media about whether people should consider canceling holiday plans, or other travel plans, because of Omicron. This is a very personal choice, I think, and I’m no medical expert, but I will offer a few thoughts.

    As I said in the title of this post, we don’t yet know enough about this variant for it to be worth seriously panicking over. All of the evidence—based on every single other variant of concern that has emerged—suggests that the vaccines will continue to work well against this variant, at least protecting against severe disease. And all of the other precautions that work well against other variants will work against this one, too.

    So, if you are vaccinated and capable of taking all the other standard COVID-19 precautions, Omicron is most likely not a huge risk to your personal safety right now. But keep an eye on the case numbers in your community, and on what we learn about this variant in the weeks to come. 

    What does Omicron mean for the pandemic’s trajectory?

    This variant could potentially lead to an adjustment in our vaccines, as well as to new surges in the U.S. and other parts of the world. It’s too early to say how likely either scenario may be; we’ll learn a lot more in the next couple of weeks.

    But one thing we can say right now, for sure, is that this variant provides a tangible argument for global vaccine equity. If the country where Omicron originated had a vaccination rate as high as that of the U.S. and other high-income nations, it may not have gained enough purchase to spread—into South Africa, and on the global path that it’s now taking. 

    As physician, virologist, and global health expert Boghuma Kabisen Titanji put it in a recent interview with The Atlantic:

    If we had ensured that everyone had equal access to vaccination and really pushed the agenda on getting global vaccination to a high level, then maybe we could have possibly delayed the emergence of new variants, such as the ones that we’re witnessing.

    I will end the post with this tweet from Amy Maxmen, global health reporter at Nature. The Omicron variant was a choice.

    More variant reporting

  • Booster shots exacerbate global vaccine inequity

    At the end of last week’s post on booster shots, I wrote that these additional doses take up airtime in expert discussions and in the media, distracting from discussions of what it will take to vaccinate the world.

    But these shots do more harm than just taking over the media cycle. When the U.S. and other wealthy nations decide to give many residents third doses, they jump the vaccine supply line again—leaving low-income nations to wait even longer for first doses.

    I explained how this process works in a new article for Popular Science. Essentially, the big vaccine manufacturers (Pfizer, Moderna, Johnson & Johnson, etc.) have created artificial scarcity of vaccine doses, by insisting on controlling every single dose of their products—rather than sharing the vaccine technology with other manufacturers around the world.

    Then, out of this limited supply of doses, the big companies sell to wealthy nations first. The wealthy nations are “easier markets to service,” WHO spokesperson Margaret Harris told me, since they can pay more money and have logistical systems in place already to deliver the vaccine doses.

    If a wealthy nation wants boosters, it’s in the vaccine companies’ best interests to sell them boosters—before sending primary series doses to other parts of the world. Or, as South Africa-based vaccine advocate Fatima Hassan put it: “Supplies that are currently available are diverted” for boosters. “Just to serve preferred customers in the richer North.”

    The FDA and CDC authorized booster shots for Moderna, Johnson & Johnson, and mix-and-match regimens this week. Advisory committee discussions did not mention that, worldwide, three in five healthcare workers are not fully vaccinated.

    More international data

    • Three more COVID-19 data points, August 15

      Three more COVID-19 data points, August 15

      The number of children hospitalized with COVID-19 has shot up in recent weeks. Chart from the CDC COVID Data Tracker.

      A couple of additional items from this week’s COVID-19 headlines:

      • 1,900 children now hospitalized with COVID-19 in the U.S.: More kids are now seriously ill with COVID-19 than at any other time in the pandemic. The national total hit 1,902 on Saturday, according to HHS data. Asked about this trend at a press briefing on Thursday, Dr. Anthony Fauci explained that, thanks to Delta’s highly contagious properties, we’re now seeing more children get sick with COVID-19 just as we are seeing more adults get it. The vast majority of kids who contract the virus have mild cases, but this is still a worrying trend as schools reopen with, in many cases, limited safety measures. For more on this issue, I recommend Katherine J. Wu’s recent article in The Atlantic.
      • 2.7% of Americans now eligible for a third vaccine dose: Both the FDA and the CDC have now given the go-ahead for cancer patients, organ transplant recipients, and other immunocompromised Americans to get additional vaccine doses. There are about 7 million Americans eligible, comprising 2.7% of the population. Studies have shown that two Pfizer or Moderna doses do not provide these patients with sufficient COVID-19 antibodies to protect against the virus, while three doses bring the patients up to the same immune system readiness that a non-immunocompromised person would get out of two dioses. Still, this move goes against the World Health Organization’s push for wealthy nations to stop giving out boosters until the rest of the world has received more shots.
      • 203 cases so far linked to Lollapalooza, out of 385,000 attendees: Chicago residents and public health experts worried that Lollapalooza, a massive music festival held in the city in late July, would become a superspreader event. Two weeks out from the festival, however, local public health officials are seeing no evidence of superspreading, with a low number of cases identified in attendees. Lollapalooza may thus be an indicator that large events can still be held safely during the Delta surge—if events are held outdoors and the vast majority of attendees are vaccinated. (Officials estimated that 90% of the Lollapalooza crowd had gotten their shots.)

    • Yes, we still need better data on COVID-19 and race: An interview with Dr. Debra Furr-Holden

      Yes, we still need better data on COVID-19 and race: An interview with Dr. Debra Furr-Holden

      Dr. Debra Furr-Holden, photo via Michigan State University

      I recently had the opportunity to discuss data equity with Dr. Debra Furr-Holden, a public health expert at Michigan State University. Dr. Furr-Holden is the university’s Associate Dean for Public Health Integration and Director of the Flint Center for Health Equity Solutions, a health research center focused on Flint, Michigan, where she is based.

      At one of my National Science-Health-Environment Reporting Fellowship training sessions, Dr. Furr-Holden spoke about the Flint water crisis and other health equity issues. Her comments made me think about continued issues in COVID-19 data collection and reporting, so I asked her to discuss COVID-19 data further in an interview for the CDD.

      We talked about the ongoing challenges of collecting and reporting COVID-19 race data, how data gaps fuel vaccine hesitancy, the equity challenges inherent in vaccine mandates, and more.

      The interview below has been lightly edited and condensed for clarity.

      Betsy Ladyzhets: First, I’m curious about your backstory, how you got involved in doing this kind of [health equity] work.

      Dr. Debra Furr-Holden: I think it probably was born out of my own lived experience. My dad died at 37, of a complication from hypertension. My mom died at 56 of an asthma attack.

      It wasn’t until I went to college that I realized that my peers had very different experiences. I went to college with no living grandparents and one living parent, and I just assumed everybody had relatives with, you know, amputated limbs and with diabetes and heart disease. And I realized that’s not the case.

      As I networked with the very small cohort of African-American students in my class, I noticed despite our socioeconomic backgrounds—because I came from sort of more humble beginnings than some of my Black and brown peers—I was like, Oh, [these health conditions are] over-represented in black and brown people.

      BL: How has that informed the work that you’ve been doing with COVID? I saw that you’ve been advocating for better vaccine access and stuff like that?.

      DFH: What I’ve realized is, a lot of what we do around disparities, we do to people, and for people, and on their behalf. But the populations most affected very rarely have a voice, and the solutions that get created and implemented and employed—and we saw it with COVID, we’re seeing it now.

      The President has made a national declaration, give everybody $100 for the newly vaccinated. And that doesn’t make sense to a lot of people. People who are having trouble paying for their hypertension medication or their other things are now being told, we’ll give you $100 to get this COVID vaccine. When earlier in the pandemic, those same people couldn’t get access to a COVID test.

      BL: And in some cases, probably still can’t get access to a COVID test.

      DFH: Yeah. And I’ve just realized, like, my own lived experience that is ongoing still informs my work, but it elevated my authentic and deep appreciation for how important the voice of community and affected populations is in the work. It’s not just about the data. It’s not just about the science… You can only glean but so much from a data table. You need more wind underneath that. And that wind is the voice of community, and the voice of the people that you’re trying to impact and serve.

      So, the big gap to me in our work around how to bridge this gap among the unvaccinated is: we are quantifying who is unvaccinated, but we’re not asking the question of, what is needed to bridge that gap for you to get the vaccine? Instead, I think we’ve got a lot of well-meaning people who are coming up with solutions, but those solutions are not mapping onto people’s concerns. And it’s not moving the needle.

      In Ohio, they offered this big lottery, it did not cause a big boom in vaccination. Same thing is happening in Michigan right now. It did not rapidly accelerate the pace of newly vaccinated people. And because my work is so community engaged, when I talk to people and they tell me the reasons underneath [their vaccination choice], it’s not about the money.

      I call the money the carrot. We’ve tried to dangle the carrot in front of people. That didn’t produce much. Now we’re using the stick.

      BL: The mandates.

      DFH: The mandates, yeah. That will likely produce more [vaccination] than the carrot did, because people will have their hands forced. But that will likely elevate resentment and give way to—any negative consequences or outcomes that come from people being forced into vaccination will likely only further fuel their mistrust of the healthcare system, and our government overall. I just feel like the solutions are not being informed by the people that we’re trying to get on board.

      BL: Yeah. What kind of information do we need to actually inform better solutions, do you think? 

      DFH: We need to hear from the very large and diverse pool of unvaccinated people. Because there’s no one solution here.

      Now, I do believe fundamentally, as a public health professional, I think of public health big population-level interventions that make health choices easy. So things like fluoride in drinking water. We don’t [remember] the time when the cavities and dental cavities were contributing to all of this excess death and morbidity. Why, because we got fluoride in drinking water. So it’s just a non-starter for us now. Same thing for standardized childhood immunizations, which were transformative for eradicating diseases that took millions of lives before we not only developed those vaccines, but made them a part of the standard immunization protocol for children.

      We’ve now got to do the work to figure out how to implement and integrate these COVID protections into our system of care, and have them be more normative. I think all of the mistakes around how the whole pandemic has been handled in the US—how the resources, not just the vaccine, but other resources, like payroll protection, enhanced unemployment, support for essential workers.

      You know, we weren’t providing PPE to essential workers in the beginning. We had national leaders saying you don’t have to wear a mask. All of these things now conflict with, “Oh, we care so much, and everybody has to get vaccinated. Everybody needs to take one for the team.” People just aren’t buying into that.

      BL: They think there’s something else going on, I guess. So, I know, when we were closer to the start of the vaccine rollout, like earlier in 2021, I saw a lot of press attention on the lack of demographic data on vaccinations. A couple of my colleagues at the COVID Tracking Project wrote an article in The Atlantic and there was other kind-of big name publication stuff. But now we still don’t have good data. And it seems like no one is really drawing attention to that. I’m wondering if you have any thoughts on this, and if there’s anything we can do to continue that pressure, because we still do need this information.

      DFH: Yeah, it’s unfortunate, because I always say a lack of data continues to fuel the debate. And the lack of quality data around COVID resources is only fueling the problem. It is an unnecessary and unacceptable omission for providers to administer COVID tests and not collect basic demographic data on the people that they’re testing. It dampens our ability to quantify who is most impacted and what should be the targets of our outreach, engagement, and intervention efforts. And it’s unnecessary and unacceptable.

      In Michigan, the system that we use is called MICR… It would take a programmer about eight seconds to make race, and ZIP code, and gender, and age category a required field to be entered. And we just simply haven’t done it. And so as a result, it’s hard for us to quantify the extent of a problem.

      Because, remember, COVID cases are only a function of COVID testing. You can only get identified as a COVID case as a function of having a COVID test. If you’re in a household, and there’s a known case in the household, and all of the other [household] members display classic COVID symptoms, if they don’t get a test, they don’t get counted anywhere. So we know that we’ve greatly underestimated the extent of the problem.

      BL: When I asked you about this at the SHERF session, you mentioned that there’s a provision in the CARES Act that requires providers to do this [data collection]. Can you talk more about that? And what we can do to actually have some accountability there?

      DFH: Yes. There is a provision in the CARES Act that all COVID testing providers have to collect these core demographic variables. And then there was follow up guidance that was issued. And when the new administration took office, they haven’t enforced that [guidance].

      So COVID testing providers continue to receive these resources to provide COVID testing, with no quality assurance or quality control, to ensure that they’re actually collecting and entering that demographic data. It then shifts the responsibility to backfill that information to local health departments and other providers, to try to link insurance records or electronic health records. Or even worse to do outreach and contact tracing and actually contact cases, by phone or by email to try to backfill that information. When there are so many other competing demands, it’s an unfair and undue burden to place on an already overstressed segment of our healthcare system. 

      What it’s akin to is gums without teeth. We have the law, but there’s no enforcement or compliance checks to ensure that that law is being honored. And I think a simple solution is compliance checks. We need compliance checks, and we need enforcement.

      BL: Do you have any thoughts on other stories that we should be telling? Like, what should I tell my journalist friends to cover around COVID and health equity?

      DFH: One thing is probably already on your radar, which is the fact that we’re not doing systematic genetic sequencing on current strains of COVID. So it’s hard to estimate, you know—people keep talking about the Delta variant, but we have thousands of variants of SARS-CoV-2 now. And we just don’t have a good system for genomic surveillance to understand them.

      And the CDC a few weeks ago said, we’re just going to stop doing the genomic sequencing on any kind of systematic level and reporting. It’s a problem, because with breakthrough cases, and

      the vaccinated now showing up in hospitals and emerging data saying that even if you’re vaccinated, you can still spread and transmit… I just had a conversation with somebody who works in our building who said, I don’t want to get vaccinated, because if I get COVID, I want to have symptoms, so I’ll know, so I can protect my nine-year-old who’s got asthma. Like, I want to know. A lot of people now feel like the vaccine increases the chances of them being an asymptomatic carrier.

      We just really have to collect data. Instead of mandating shots in arms, we should be mandating the data so that we have better information and can do more credible and transparent information dissemination to communities.

      BL: Yeah, so that we can actually answer people’s questions on these things.

      DFH: Yeah.

      BL: I was also wondering if you had any recommendations, either of good stories that do a good job of covering these issues we’ve been talking about, or data sources or resources that myself and other journalists in this space should be paying attention to.

      DFH: We should be putting the press on the CDC to collect and compile the data. Like, the data on cases, all of that data should be disaggregated by race. And the percentage of cases with unknown race or unknown gender or unknown geography should also be reported. Because I don’t know if people notice this, but a lot of times [the CDC is] presenting data only on cases with complete information. But the missing information points to something important as well.

      BL: I think it’s something like they have maybe 50% or 60% of cases with known race. But where’s that other share of cases? [Editor’s note: It’s 63%, as of August 14.]

      DFH: The assumption is that the distribution of these variables in the unknown is similar to that of the known. But it is a major assumption. And it’s not an assumption that we should be making.

      BL: I see. Yeah. Anything else [you’d recommend as a story idea]?

      DFH: I do like this carrot stick analogy. The carrot is not working, the dangling the big incentive is not working. The stick will likely work. If you tell people, “You can’t get on a plane, if you’re unvaccinated,” there will be a lot of people who are unvaccinated right now who will get vaccinated because they’ll not want to lose the opportunity to travel.

      Think about the media. If you are chasing a story, or if you’ve got to be on site for something… If you’re in New York and you’ve got a story in California, you’re not going to drive to California, you will likely get off the fence and get vaccinated.

      I feel like a larger problem is, we have to engage experts in the work to make sure that we’re not furthering inequity [with mandates]. Because if we use, now, the stick, and start to mandate it…. [Michigan State University] has now mandated vaccination for all faculty, staff and students who want to return to campus by September 7. I know that that will likely produce greater increases in vaccination than did the incentives of cash payments, or lotteries or other things.

      But we have to keep an eye toward equity, and make sure—what if there’s disproportionality and then who does that impact? Are we going to see an increase in Black and brown people, or people with disabilities, or people with chronic health conditions, losing their jobs, or dropping out of school, or some of these other things? There just needs to be more thoughtfulness to how we apply these policy interventions to make sure that it’s not furthering inequity.

      BL: Have you seen any examples of where that’s been done successfully?

      DFH: No, because it’s all just coming out now.

      BL: I know there are some places, like in New York, they’re giving you an option, saying, “You can get vaccinated or you have to be tested once a week.” Is that effective? Or does that still fit into what you’re talking about?

      DFH: I think we’re gonna figure that out. And if that’s the case, then again, we gotta deal with the access issue, and people need to have fair and equitable access—and affordable access—to COVID testing.

      BL: Yeah, totally. And the last kind of big question I had for you: one thing I think a lot about as a journalist who is still rather early-career and has been covering COVID very intensely is that this is probably just the beginning of us dealing with major public health crises. You know, continued climate disasters and all that stuff.

      And I’m wondering how you think about preparing for the next COVID, or the next whatever it’s going to be. What lessons do we take from these past couple of years?

      DFH: Well, I think we’ve learned there is a business case for preparedness, and a business case for equity. Our lack of preparation for this pandemic will have cost our country tremendously. There’s going to be tremendous financial toll. So, there’s a business case to be made for preparedness.

      We learned that with the Flint water crisis. Not having the million-dollar investment in the water treatment system, not spending the 150 bucks a day on anticorrosives, those things will have cost us hundreds of millions of dollars to now replace and repair the whole water infrastructure system and pay settlements from the Flint water crisis.

      And then there’s also a business case for equity. Not doing a better job of equitably rolling out the vaccine early on caused a lot of people who were a “yes” to sort of say, “why bother?” And now many of them are a “no.” These are people who earlier on [were amenable], but then all these reports come out and get sensationalized by the media of side effects and blood clots and heart inflammation. And so a lot of people who were in line, trying to move through the line to get vaccinated are now an absolute “no.”

      That’s going to cost us as well, because we have fallen well short of that 70% goal. And new vaccinations are moving at a snail’s pace. So I think what we’ve learned—and we’ll really know, the impact of it in the next few years—is not being prepared and not practicing equity will have a tremendous financial toll on the country.

    • The case for a moratorium on booster shots

      The case for a moratorium on booster shots

      Chart from Nature revealing the unequal global distribution of COVID-19 vaccines.

      This week, the World Health Organization (WHO) called for wealthy nations to stop giving out booster shots in a push towards global vaccine equity. 

      These nations should stall any booster shots until at least September, said WHO Director-General Tedros Adhanom Ghebreyesus at a press conference on Wednesday. Instead, excess vaccines should be donated to COVAX, the international vaccine distributor that aims to mitigate COVID-19 in low-income countries. When 10% of the population in every country has been vaccinated, then wealthy countries could resume administering boosters, Tedros said.

      Here’s what he said at the conference (h/t Helen Branswell, STAT News):

      I understand the concern of all governments to protect their people from the Delta variant. But we cannot and we should not accept countries that have already used most of the global supply of vaccine using even more of it while the world’s most vulnerable people remain unprotected.

      It may seem counterintuitive for a country to not provide its citizens with extra protection when it has the means to do so. But the global numbers are staggering. About 50% of the U.S. population has now been fully vaccinated, and we have doses to spare (some of which are going to waste). Meanwhile, in most African countries, 1% or less of the population is vaccinated. This is even though vaccine demand is actually far higher in low-income nations than in the U.S.

      Nature’s Amy Maxmen has a great piece unpacking this inequity. She cites a rather damning WHO analysis:

      An internal analysis from the World Health Organization (WHO) estimates that if the 11 rich countries that are either rolling out boosters or considering it this year were to give the shots to everyone over 50 years old, they would use up roughly 440 million doses of the global supply. If all high-income and upper-middle-income nations were to do the same, the estimate doubles.

      About 3.5 billion people in low- and lower-middle-income countries have yet to be vaccinated, Maxmen estimates. Give one dose to 10% of that number, and you use 350 million doses—less than the 440 million that rich nations would use up with boosters.

      The longer that these low-income countries go without widespread vaccination, the more likely it is that new variants will emerge from their outbreaks. This is because, with every new COVID-19 case, the virus has a new opportunity to mutate. We’re already seeing Delta adapt to become even more transmissible and monitoring other potentially-concerning variants, like Lambda.

      It’s unclear how much power the WHO has to enforce a booster shot moratorium, especially now that some countries (like Israel) have already gotten started on administering these extra shots. And it’s also worth noting that public health officials in the U.S. are shifting away from using “booster” to describe third shots for immunocompromised people or second shots who for those who received the one-and-done Johnson & Johnson vaccine; they say that these shots rather bring patients up to the same immunity levels as those who received two mRNA doses.

      More vaccine reporting

      • Sources and updates, November 12
        Sources and updates for the week of November 12 include new vaccination data, a rapid test receiving FDA approval, treatment guidelines, and more.
      • How is the CDC tracking the latest round of COVID-19 vaccines?
        Following the end of the federal public health emergency in May, the CDC has lost its authority to collect vaccination data from all state and local health agencies that keep immunization records. As a result, the CDC is no longer providing comprehensive vaccination numbers on its COVID-19 dashboards. But we still have some information about this year’s vaccination campaign, thanks to continued CDC efforts as well as reporting by other health agencies and research organizations.
      • Sources and updates, October 8
        Sources and updates for the week of October 8 include new papers about booster shot uptake, at-home tests, and Long COVID symptoms.
      • COVID source shout-out: Novavax’s booster is now available
        This week, the FDA authorized Novavax’s updated COVID-19 vaccine. Here’s why some people are excited to get Novavax’s vaccine this fall, as opposed to Pfizer’s or Moderna’s.
      • COVID-19 vaccine issues: Stories from COVID-19 Data Dispatch readers across the U.S.
        Last week, I asked you, COVID-19 Data Dispatch readers, to send me your stories of challenges you experienced when trying to get this fall’s COVID-19 vaccines. I received 35 responses from readers across the country, demonstrating issues with insurance coverage, pharmacy logistics, and more.
    • The booster shot conversation: What you should know

      The booster shot conversation: What you should know

      Pfizer vaccine, in use at Walter Reed National Military Medical Center. DoD photo by Lisa Ferdinando.

      Recently, a lot of U.S. COVID-19 news has centered around booster shots—additional vaccine doses to boost patients’ immunity against the coronavirus. Questions abound: do we need these shots, when might we need them, how do they impact vaccination campaigns?

      In other countries, booster shots are being deployed as a measure of extra protection for people with weaker immune systems as Delta spreads. In France, extra vaccine doses are available for organ transplant recipients, those on dialysis, and others. Israel is similarly offering third Pfizer doses to Israelis with medical conditions that cause immunodeficiency. And in Thailand, healthcare workers are getting booster shots of the AstraZeneca vaccine after two doses of Sinovac, which has demonstrated lower efficacy than other vaccines.

      Even in the U.S., a small number of immunocompromised patients have received third doses—many of them in clinical trials analyzing how well boosters work. Medical experts tend not to question why boosters may be needed for immunocompromised patients, as their weakened immune systems also make the patients more vulnerable to severe cases of COVID-19.

      The real questions come when we start to consider booster shots for everyone. Pfizer, which has developed a third dose for the general population, recently announced that the company applied for Emergency Use Authorization from the FDA. The company says its currently approved two-shot regimen will cause patients to lose some protection six months after they’ve been vaccinated—and become more vulnerable to Delta—with continued lower immunity over time.

      Officials at the FDA and CDC, however, have said that boosters aren’t yet necessary. The agencies released a joint statement to that effect, and U.S. health officials say they want to see more data—especially from Israel, where Pfizer has been in heavy use. Pfizer’s data on waning efficacy aren’t yet public (released by press release, not scientific paper), which complicates the conversation. Still, some health officials say we will eventually need booster shots, just not right now, according to POLITICO.

      While U.S. public health experts seek more data, our booster shot conversation appears selfish in other parts of the world. While over 3.6 billion doses have been administered globally across 180 countries, high-income countries are getting vaccinated 30 times faster than lower-income countries, according to Bloomberg. More than half of Americans have received at least one shot, compared to under 1% in many African countries.

      Dr. Tedros Adhanom Ghebreyesus, Director-General of the WHO, slammed the U.S. and other wealthy nations at a press briefing last week for even considering booster shots. “The priority now must be to vaccinate those who have received no doses and protection,” he said. “Instead of Moderna and Pfizer prioritizing the supply of vaccines as boosters to countries whose populations have relatively high coverage, we need them to go all out to channel supply to COVAX, the Africa Vaccine Acquisition Task Team and low- and low-middle income countries, which have very low vaccine coverage.”

      For more details and expert takes on the situation, I recommend this article from several ace STAT News reporters.

      More vaccine reporting

      • Sources and updates, November 12
        Sources and updates for the week of November 12 include new vaccination data, a rapid test receiving FDA approval, treatment guidelines, and more.
      • How is the CDC tracking the latest round of COVID-19 vaccines?
        Following the end of the federal public health emergency in May, the CDC has lost its authority to collect vaccination data from all state and local health agencies that keep immunization records. As a result, the CDC is no longer providing comprehensive vaccination numbers on its COVID-19 dashboards. But we still have some information about this year’s vaccination campaign, thanks to continued CDC efforts as well as reporting by other health agencies and research organizations.
      • Sources and updates, October 8
        Sources and updates for the week of October 8 include new papers about booster shot uptake, at-home tests, and Long COVID symptoms.
      • COVID source shout-out: Novavax’s booster is now available
        This week, the FDA authorized Novavax’s updated COVID-19 vaccine. Here’s why some people are excited to get Novavax’s vaccine this fall, as opposed to Pfizer’s or Moderna’s.
      • COVID-19 vaccine issues: Stories from COVID-19 Data Dispatch readers across the U.S.
        Last week, I asked you, COVID-19 Data Dispatch readers, to send me your stories of challenges you experienced when trying to get this fall’s COVID-19 vaccines. I received 35 responses from readers across the country, demonstrating issues with insurance coverage, pharmacy logistics, and more.