COVID-19 State Vaccine Programs: Medical Publications
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COVID-19 vaccination programs are seen as the only practical long-term solution to a pandemic that has now troubled the world for over one year. Vaccines have typically been the answer to disease outbreaks that threaten global populations. They work by bolstering the body’s natural defenses to recognize and fight bacteria and viruses. If the body is exposed to a disease-causing microbe after vaccination, it readily destroys it without further external help. By February 2021, at least seven different vaccination programs are being rolled out in various countries worldwide. The common denominator in all these programs is the targeting of vulnerable populations as the top priority.

COVID-19 Vaccination Programs in the U.S. — Overview

  • On December 14th, critical care nurse Sandra Lindsay officially kicked off a nationwide vaccination campaign by becoming the first person in the U.S., outside trials, to receive the Pfizer and BioNTech-developed COVID-19 vaccine.
  • Today, some 65 million Americans have received at least one dose, suggesting that 1.28 million doses are administered daily. At this rate, experts believe it will take slightly over 11 months to vaccinate 75% of the population with the Pfizer-BioNTech’s vaccine since it requires two doses for maximum efficacy.

1. Planning for a COVID-19 Vaccination Program — JAMA (https://jamanetwork.com/journals/jama/fullarticle/2766370)

  • Seventy-five percent is the magic number because of what medical experts refer to as ‘herd immunity.’ Depending on various environmental, socio-behavioral, and biological factors, the threshold for COVID-19 herd immunity is between 55% and 82% of the population.
  • These researchers believe that if 75% of the American population is vaccinated against COVID-19, there is a high chance the remaining individuals will develop natural immunity to the virus.
  • Certain people are ineligible for vaccinations due to age, pre-existing medical conditions, immunocompromise, etc. According to researchers, a vaccine refusal rate of 10% can impede the programs from attaining this goal.
  • Two recent surveys of 493 and 2200 respondents showed that 75% of the respondents would be vaccinated if a vaccine was available. Thirty percent of the respondents were willing to receive a vaccine as soon as it became available.

2. Countering Vaccine Hesitancy — Journal of the American Academy of Pediatrics (https://pediatrics.aappublications.org/content/138/3/e20162146)

  • In this article, researchers point out that vaccine confidence lies along a spectrum. Individuals who have had reservations about routine childhood vaccines are likely to have higher vaccine hesitancy.
  • In a report on vaccine hesitancy, two researchers identify three categories of individual concerns regarding childhood vaccines: vaccine safety, the necessity of the vaccine, and freedom of choice,
  • People who question the necessity of vaccines have underlying historical concerns on the principle of mass vaccination. The most common misconceptions are that vaccination benefits do not outweigh the risks and that immunity acquired from surviving a disease is stronger than vaccine-induced immunity.
  • The article traced the history of vaccine opposition to the 1800s when Jenner promoted smallpox vaccination using cowpox lesions. Such oppositions to universal vaccination initiatives are obstacles that vaccination programs must overcome if the goals are to be achieved.
  • Even though vaccine hesitancy is not a new concept, the article underlines its impact on public health. With the increasing ease of global travel, medical professionals contend that vaccine-preventable diseases spread much faster and appear in regions where care providers may not be conversant with their clinical presentations.

3. Should we Mandate a COVID-19 Vaccine for Children — JAMA Pediatrics (https://jamanetwork.com/journals/jamapediatrics/fullarticle/2770123)

  • While the speed of developing a coronavirus vaccine has been exceptional, this article examines the tricky topic of developing a vaccine for children.
  • Opinion is divided on whether the current U.S. approach about the influenza vaccine (that is, no influenza vaccination required for children attending school) should provide the roadmap for children vaccination.
  • The logic informing this line of thinking is that COVID-19 and influenza share epidemiological attributes that make them similar. For instance, both acute respiratory diseases are transmitted through human contact. Their common symptoms are fever and cough.
  • However, there are fundamental differences between COVID-19 and influenza that lead to different conclusions on whether children’s vaccination should be a requirement. For starters, children contribute to the spread of influenza, sometimes with devastating consequences for the elderly.
  • Children do not transmit SARS-CoV-2 as easily as influenza, even though not much is known about children’s role in spreading coronavirus. These researchers contend requiring COVID-19 vaccination for children would be superfluous given that the disease mostly appears in mild forms, and children are less likely to infect others.
  • However, the rate of spread of COVID-19 ([Ro] = 1) is much higher than influenza ([Ro] = 2 to 2.5). For this reason, the researchers contend it makes sense to mandate a vaccine for an agent with a higher Ro because it will need more individuals with immunity to curb the spread of the disease.
  • Using the 9-Standard criteria, the researchers develop a guide for determining whether mandating a COVID-19 for children is a good idea. They conclude that the dearth of knowledge on the epidemiology of SARS-CoV-2 in children and the effects of candidate COVID-19 vaccines on children makes it difficult to make a firm judgment on whether to mandate a COVID-19 vaccine for children.

4. Mandating COVID-19 Vaccines – JAMA Network (https://jamanetwork.com/journals/jama/fullarticle/2774712)

  • Given the information on vaccine hesitancy published in article 2 herein, this publication does well to provide medical insights on whether COVID-19 vaccination should be mandatory. These views have a bearing on the effectiveness of the vaccination programs.
  • Data obtained from the EUA database shows that vaccines are usually highly effective (95% efficacy). Still, such high efficacy rates will not prevent a virus from spreading if population coverage is low.
  • Recent data shows varying opinions regarding vaccine acceptancy. If a COVID-19 vaccine is developed and approved, 34% of respondents said they would receive it as soon as possible, 39% said they would wait, 9% would receive it only if it was required for work/school, and 15% said they would not take it at all.
  • The article traces the history of state mandates and quotes Jacobson v Massachusetts (1905), where the judiciary consistently ruled in favor of vaccination drives. All states in the country require children to be vaccinated before joining the school. Similarly, all states have medical exemptions, and at least 45 states grant religious exemptions.
  • However, vaccine exemptions correlate with higher risks of outbreaks, so enforcement of vaccine mandates is seen as key to improving vaccination rates. Nevertheless, adult vaccine mandates are rare, implying states are unlikely to implement mandatory COVID-19 vaccinations.
  • On the other hand, healthcare providers are an at-risk population and can contract infectious diseases and transmit them to vulnerable populations. Subsequently, healthcare institutions institute anti-infection protocols, including requiring care providers to be vaccinated.
  • In the corporate sector, most companies support COVID-19 vaccinations. The EEOC made a ruling that employers can compel employees to take SARS-CoV-2 tests and bar them from the workplace if they do not comply. The EEOC, however, implores employers to grant employees medical exemptions.
  • For schools and higher learning institutions, vaccinations are seen as critical to creating safe in-person learning environments
  • While legal mandates indicate policy support for measures to contain disease spread, if implemented incorrectly, they can cause backlash and undermine public support, ultimately reducing vaccine uptake. Mandates undermine individual autonomy, but with sufficient risk communication, the public can make more informed decisions.
GLENN TREVOR
Glenn is the Lead Operations Research Analyst at The Digital Momentum with experience in research, statistical data analysis and interview techniques. A holder of degree in Economics. A true specialist in quantitative and qualitative research.

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