Lambert here: Seems like expert opinion regards “immunity passports” as a demand booster (and a done deal).
By JoNel Aleccia, a Senior Correspondent focused on aging and end-of-life issues on the KHN enterprise team. Originally published at Kaiser Health News.
Americans have made no secret of their skepticism of COVID-19 vaccines this year, with fears of political interference and a “warp speed” timeline blunting confidence in the shots. As recently as September, nearly half of U.S. adults said they didn’t intend to be inoculated.
But with two promising vaccines primed for release, likely within weeks, experts in ethics and immunization behavior say they expect attitudes to shift quickly from widespread hesitancy to urgent, even heated demand.
“People talk about the anti-vaccine people being able to kind of squelch uptake. I don’t see that happening,” Dr. Paul Offit, a vaccinologist with Children’s Hospital of Philadelphia, told viewers of a recent JAMA Network webinar. “This, to me, is more like the Beanie Baby phenomenon. The attractiveness of a limited edition.”
Reports that vaccines produced by drugmakers Pfizer and BioNTech and Moderna appear to be safe and effective, along with the deliberate emphasis on science-based guidance from the incoming Biden administration, are likely to reverse uncertainty in a big way, said Arthur Caplan, director of the division of medical ethics at New York University School of Medicine.
“I think that’s going to flip the trust issue,” he said.
The shift is already apparent. A new poll by the Pew Research Center found that by the end of November 60% of Americans said they would get a vaccine for the coronavirus. This month, even as a federal advisory group met to hash out guidelines for vaccine distribution, a long list of advocacy groups — from those representing home-based health workers and community health centers to patients with kidney disease — were lobbying state and federal officials in hopes their constituents would be prioritized for the first scarce doses.
“As we get closer to the vaccine being a reality, there’s a lot of jockeying, to be sure,” said Katie Smith Sloan, chief executive of LeadingAge, a nonprofit organization pushing for staff and patients at long-term care centers to be included in the highest-priority category.
Certainly, some consumers remain wary, said Rupali Limaye, a social and behavioral health scientist at the Johns Hopkins Bloomberg School of Public Health. Fears that drugmakers and regulators might cut corners to speed a vaccine linger, even as details of the trials become public and the review process is made more transparent. Some health care workers, who are at the front of the line for the shots, are not eager to go first.
“There will be people who will say, ‘I will wait a little bit more for safety data,” Limaye said.
But those doubts likely will recede once the vaccines are approved for use and begin to circulate broadly, said Offit, who sits on the FDA advisory panel set to review the requests for emergency authorization Pfizer and Moderna have submitted.
He predicted demand for the COVID vaccines could rival the clamor that occurred in 2004, when production problems caused a severe shortage of flu shots just as influenza season began. That led to long lines, rationed doses and ethical debates over distribution.
“That was a highly desired vaccine,” Offit said. “I think in many ways that might happen here.”
Initially, vaccine supplies will be tight, with federal officials planning to ship 6.4 million doses within 24 hours of FDA authorization and up to 40 million doses by the end of the year. The CDC panel recommended that the first shots go to the 21 million health care workers in the U.S. and 3 million nursing home staff and residents, before being rolled out to other groups based on a hierarchy of risk factors.
Even before any vaccine is available, some people are trying to boost their chances of access, said Dr. Allison Kempe, a professor of pediatrics at the University of Colorado School of Medicine and expert in vaccine dissemination. “People have called me and said, ‘How can I get the vaccine?’” she said. “I think that not everyone will be happy to wait, that’s for sure. I don’t think there will be rioting in the streets, but there may be pressure brought to bear.”
That likely will include emotional debates over how, when and to whom next doses should be distributed, said Caplan. Under the CDC recommendations, vulnerable groups next in line include 87 million workers whose jobs are deemed “essential” — a broad and ill-defined category — as well as 53 million adults age 65 and older.
“We’re going to have some fights about high-risk groups,” said Caplan of NYU.
The conversations will be complicated. Should prisoners, who have little control over their COVID exposure, get vaccine priority? How about professional sports teams, whose performance could bolster society’s overall morale? And what about residents of facilities providing care for people with intellectual and developmental disabilities, who are three times more likely to die from COVID-19 than the general population?
Control over vaccination allocation rests with the states, so that’s where the biggest conflicts will occur, Caplan said. “It’s a short fight, I hope, in the sense in which it gets done in a few months, but I think it will be pretty vocal.”
Once vaccine supplies become more plentiful, perhaps by May or June, another consideration is sure to boost demand: requirements for proof of COVID vaccination for work and travel.
“It’s inevitable that you’re going to see immunity passports or that you’re required to show a certificate on the train, airplane, bus or subway,” Caplan predicted. “Probably also to enter certain hospitals, probably to enter certain restaurants and government facilities.”
But with a grueling winter surge ahead, and new predictions that COVID-19 will fell as many as 450,000 Americans by February, the tragic reality of the disease will no doubt fuel ample demand for vaccination.
“People now know someone who has gotten COVID, who has been hospitalized or has unfortunately died,” Limaye said.
“We’re all seeing this now,” said Kempe. “Even deniers are beginning to see what this illness can do.”
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“It’s inevitable…immunity passports…”
I’ll never miss a single one of them and happy to give up my spot to any of 7,500,000,000 more deserving people.
This is getting outright scary. People have been conditioned to accept anything, in order to get out of the current situation. Mandatory vaccination (explicit or implicit) coming in 2021. I’m very concerned about the safety of the vaccines, and I’ll gladly wait.
If they make it mandatory, I hope they at least wait until the late fall or early winter… I will be, at the minimum, very skeptical of it for the first few months.
Mandatory vaccination most likely will be implicit–it won’t be government saying you have to get the vaccine or go to jail but more along the lines of employers demanding it as a condition to get hired, airlines requiring it to travel, schools requiring it as a condition of enrollment, etc.
One thing to help with prediction is to look at who gets flu shots. It’s about half of the population in any given year, sometimes higher:
https://usafacts.org/articles/how-many-americans-get-flu-shots-vaccine-cdc/
Anecdote, but I was listening to two black entertainers recently, one was a DJ on a Philadelphia hip hop station, and another was a black comedian. Both said that they were skeptical of the vaccine. Black communities and other communities of color have a long history of being unethically targeted and used by scientists pushing certain drugs.
Will be interesting to see the groups opposed to vaccination in the future. Religious groups, for another, like the Amish that live near me. They don’t wear masks, no way in hell are they going to get a vaccine.
I notice with the flu vaccine, which I, as an older person, get in priority each year, that this year, so many people opted early to get it that NONE are now left, weeks later. Like the panic buying of toilet paper! All gone!
I wonder if the rumour that flu and covid-19 cannot coexist in a person at the same time is true? Flu has been very rare so far here (I am in France) and in Australia was almost absent throughout the winter this year.
I notice with the flu vaccine, which I, as an older person , get in priority each year. This year, so many people opted early to get it that NONE are now left, weeks later. Like the panic buying of toilet paper! All gone!
I wonder if the rumour that flu and covid-19 cannot coexist in a person at the same time is true? Flu has been very rare so far here (I am in France) and in Australia was almost absent throughout the winter this year;
To my understanding you can get flu and COVID at the same time and it is very dangerous, but anti COVID lock downs and masking also effect the normal flu, so that tends to imply a mild flu season. Well, mild except for the whole killer pandemic…
I find it incredible that anyone would be talking about immunity passports or mandatory anything as:
1. This will be (assuming it gets the FDA’s rubber stamp this week or next) an EMERGENCY authorization, not a general one.
2. None of the trials included pregnant women or children. Big carve-outs will need to be made for those groups. Not sure how workable that is. For bars maybe not unworkable; airlines are going to have a PR problem on their hands (why do I need to get vaccinated and that sniffling kid next to me doesn’t?)
3. No data on long term side effects, probably for years.
4. To much faith in technology. Easy to forge paper vaccine cards, and mandating everyone has a smart phone is likely not legal nor practical. Large black markets for fake immunity records.
2. is a big deal. I’m a little familiar with the FDA processes and Institutional Review Board processes and pregnant women and children both have a high level of compliance requirements involved in doing a study on them.
Have not honestly looked to see if Pfizer et al worked with pregnant women and children but I doubt it.
https://helix.northwestern.edu/article/thalidomide-tragedy-lessons-drug-safety-and-regulation
They are doing sort of long term studies for a couple years after people get the shots.
Until these pharmaceutical companies can show they can produce enough doses this year, any talk of an immunity passport is discrimination. I would love to see the litigation that arises from it.
I think that these “experts” and their institutions are so vested in their self interest, they may not reflect public opinion or even represent a public constituency. The vaccines have been poorly communicated to the public and that is making as positive of a statement as possible. The way that vaccines are being promoted to the public is like asking someone for their signature while telling them not to read the document. The “experts” have conveniently forgotten that public trust is a big issue. There is so much that is unknown about the vaccines especially the mRNA ones. Nobody has a clear picture or explanation for what lies ahead. Nobody is actually addressing the public directly about vaccines. Without clarity, there is room for mistrust. I thought that the lone, dissenting voice on the CDC panel mentioned in the article had a valid and important opinion and observation. She is not opposed to the vaccines but said that the elderly/frail were not a good target group to start with. The elderly/frail do not have much lifetime left and if they die after being vaccinated, their death may become associated, correctly or not, with the vaccine. If it becomes known that grandma died because of the vaccine, who wants to get the vaccine! Right now where I live in a provincial jurisdiction of Canada, there is a public privacy issue about identifying who got Covid-19 or revealing any details that might allow someone to make an identification. “Immunity passports” are the flip side of this issue as it reveals who got vaccinated and who did not. There is anger in the populous and it is just below the surface. The “experts” better brace themselves for push-back.
Indeed. All this talk of overwhelming demand and shortages sounds like so much wishful thinking/agitprop to me, as has just about everything else surrounding this so-called “pandemic.”
Even if the polls are off by 10%, which is a huge margin, 50% of the public willing to take the vaccine (as opposed to 60% in the latest poll) is a lot. And that’s before Dr. Fauci and Biden and the three most recent presidents taking it in the upcoming PR push.
What is more likely to be an offset isn’t concerns about the rushed process and lack of data, which sadly will fade as Biden treats the vaccines as an initiative of his administration and the Trump taint wears off, but the fact that a lot of people have bad reactions to the mRNA vaccines (many patients feel terrible for a day, to the degree that they need to stay in bed) and you need to go back to get a second shot. Experts are already concerned that a lot of people won’t turn up for the second jab.
Do you honestly think Bill Clinton, Bush and Obama getting a vaccine is going to move the needle? No pun intended. I think all three of them have greatly diminished standings with the general public. I can see this going terrible own.
As PT Barnum said, “There’s a sucker born every minute.” And these former Presidents are rich and old-ish to old, and presumably their big ticket doctors would not let them risk their health. Why wouldn’t a lot of people would find this a meaningful proof of the vaccine safety?
Wouldn’t the ex-presidents get the most pristine possibly pre-tested samples available? Why would anyone believe they are just receiving random vaccines like the rest of us? If any president died the company responsible would be out of business or in bankruptcy in short order.
They probably are getting saline. Just like when Obama drank some tap water in Michigan or when they tell the public to isolate while they go on vacation.
It seems to me like they’re putting the “vaccine shortage” idea out there to trigger the herd to line up for their shot so they don’t miss out.
I second your idea.
But if even 50% of the public try to get shots I suspect the availability of the vaccine will make it appear as if there is a heated demand. A demand appears heated when demand exceeds or greatly exceeds the supply.
I am not going anywhere. I can and will wait and see before I run out an get this new vaccine. I already got my flu shots months ago, as I have every year since they first became available. [I will re-think getting flu-shots if Government and Cartels push this new technology to creating flu-shots also. Let them cure hoof and mouth disease first using this new shiny new toy.] I will keep wearing my mask and watching for better filtering materials.
There are other vaccines that are coming that are old school. Nullified point.
“The “experts” have conveniently forgotten that public trust is a big issue.”
and not just with vaccines…but generally. we’ve been in a metasticising legitimacy crisis for a long while, now…wherein just about every institution is suspect.(i was an early adopter of this stance…as were many, here, i’m sure)
from at least 9-11, distrust in everything from media to government to corporate has moved from the fringe into the mainstream…and that’s a terrible place to be going into a pandemic.
True, but the distrusted is as much social engineering as anything real.
There is a lot more known about mRNA theraputics and even vaccines than many people claim. I’m not saying there is no risk here but the ‘first mRNA vaccine’ status reflects more the current crisis and difficulty storing/transferring an mRNA vaccine and not status as a new approach. mRNA vaccines have been tested in humans before, for at least four infectious diseases: rabies, influenza, cytomegalovirus, and Zika.
mRNA theraputics have current widespread usage in cancer therapeutic targeting tumors.
See https://www.nature.com/articles/nrd.2017.243 or more accessible https://www.medpagetoday.com/infectiousdisease/covid19/89998 (which cites less sources but seems to be based primarily on the other nature study linked)
if they are smart they will artificially limit supplies so as to create the beanie baby phenomenon.
I don’t think you need to worry if half the population is refusing to get the vaccine, then that would leave many shots available to those that want them.
I work at a few hospitals on the CV units from the start, we were all scared at first and didn’t want to even go in the rooms. We are still short of PPE, but I can say I am nervous caring for TB patients, CV not so much. We have many patients from long term care that are not even sick, they just tested positive. we need two negatives tests at one chain and 10 days at the other for discharge back to the LTC.
That is where I am here in the states, cannot speak for other areas.
if only we had a way to ensure that public safety and not profit was the first order of the day.
if only…
this evening, long article at the Hill…
Race heats up for workers getting early access to COVID-19 vaccine – Business groups from various industries are ramping up efforts to get their workers near the front of the line for the COVID-19 vaccine now that distribution plans are taking shape.
I distrust anything and everything said by the government and the pharm companies about these vaccines. They are greatly misleading everyone in the statistics they cite, because the vaccines are nowhere near as effective as the numbers that are being distributed publicly. For instance while Pfizer says that their vaccine is “95%” effective what does that mean in immunology parlance? According to their numbers that means that the vaccine “reduced the infection rate from .75% to 0.04%”. That is where the 95% number comes from. But in reality, their vaccine is only reducing the chance overall that you will get the virus by 1%! Yes, 1% (actually I rounded up because the actual number is 0.71%). The numbers are basically the same for the Moderna vaccine. These vaccines are not the cure all, end all, that the government and pharmas are touting them to be. Also, always keep in mind the money the pharm companies stand to make over the next couple of years, selling a product for huge profits that they did not even have to pay to develop. It is their best interest to gin up the effectiveness, lack of side effects, and necessity that everyone get the vaccine.
Dude, these vaccines are easy to understand and you must weigh benefit vs cost. They are rushed for a reason.
They say there is going to be an agency to put pro-vaccine comments on social media, not sure if that is true.
Not sure what you are saying, “benefit vs. cost”. That is the point I was trying to make. There is very little benefit and a whole lot of hype. Another example. Pfizer vaccine requires 256 people to be vaccinated to prevent one person from getting infected. This is from their own data. Its just buried and hardly anyone is bothering to explain how little these vaccines are going to accomplish. I mainly pointed this out, because what happens after we spend tons of money to vaccinate everyone and Covid doesn’t go away and people still get sick?
So if a magic vaccine existed where recipients could never get COVID once they received one dose, it should be reported as 1% effective, and we should do away with how reporting on vaccine effectiveness has always been reported?
The way the results are stated (i.e. 95% effectiveness) is not misleading. The 0.75% infection rate of control largely reflects the exposure profile of the control group. For example, if you live in Antarctica by yourself a vaccine will not reduce your chance of getting COVID because it was already at 0%. But it will significantly reduce the chance of someone who lives in an area with widespread outbreak. This just happens to average out to 0.75%. Whether the vaccine is truly as effective as advertised in practice can be questioned, especially given the logistical challenges. I understand your distrust but this is not a valid concern (though there may be other concerns that are valid).
you are mistaken. in fact, it is well known that clinical trials should describe both relative risk reduction (95%) and absolute risk reduction (.7%). They both play a role as you indicate. But FAR TOO OFTEN relative risk reduction is used to fool people.
I have not heard if Pfizer or Moderna have released all the data regarding their trials nor if it has been “peer reviewed.”
As to the roll out, I wouldn’t be surprised if there is indeed a rush on the vaccine nor would I be surprised to learn it had at least in part been created artificially. We are after all, living in a time of corruption and ever more visible collapse; so much so that what is really surprising may well be that considerable effort has gone into making these vaccines as safe as possible given the stunning time frame in which they have been developed.
We have at least one comforting fact. As with the great problem of train wrecks; that those poor first class passengers might get hurt, our
aristocracymeritocracy will -I suspect- be taking the same vaccines as the rest of us mopes, and they might not appreciate even a single pea underneath 20 mattresses, never mind if they start dropping off like flies.