Contrary Paths to a Single Goal…
COVID-19 immunity across the US is rapidly evolving.
As the previous blog showed, US States have adopted quite different strategies. Some are keeping coronavirus controls tight while vaccinating the population as quickly as they can. Some are removing controls, judging that the social (or political) benefit of re-opening exceeds the damage of the resulting infections and deaths.
The goal is clear in both cases: to attain such widespread COVID-19 immunity, by infection recovery plus vaccination, that the virus will cease to be a serious threat. Today’s blog traces our path forward under the following headings:
A Plethora of Vaccines
How do I love thee (O vaccine)? Let me count the ways…
Pfizer-BioNTech, Moderna, Johnson & Johnson, AstraZenica-Oxford, Novavax, Sputnik V… And no doubt, more to follow.
We have a flood of vaccines, now and just days away. We will have SO MUCH vaccine!
For the moment, set aside the few folks who have been reading the wrong news, about whom see later. Vaccine is so plentiful that vaccine acceptors are saying, well, maybe I should choose WHICH vaccine is best for me.
– Comparing the Jabs
Are you a picker-and-chooser? (An example is my friend Joe, who has rational reasons for wanting a particular jab – see his comment on my blog.) If so, you will like the comparison assembled by WebMD.
However, you cannot believe everything you read, even from reliable sources like WebMD. It omits an important piece of information: how do the vaccines perform against the emerging COVID-19 variants?
In tests against these mutants, J&J vaccine is extremely effective at preventing hospitalization and deaths, gaining even more effectiveness over time. Here’s a relevant quote:
Dr. Paul Offit, a vaccine researcher at Children’s Hospital of Philadelphia, put it more bluntly: The Johnson & Johnson vaccine “will definitely keep you out of the hospital, keep you out of the ICU and will keep you out of the morgue.”
Data is accumulating that shows similar benefit from the Pfizer and Moderna vaccines.
– What About Sputnik V?
The references given above are silent on the subject of Russia’s vaccine, proudly named Sputnik V, and do not yet include info about Novavax.
An analysis of test results gives Sputnik V a good score for effectiveness. However, the data thus presented is sparse concerning vaccine recipients over age 60, and “full data” on adverse events is not yet available.
If you live in the US, you are not likely to be offered Sputnik V in the near future. By the time it gains US approval, if ever, the other five vaccines mentioned above will have satisfied most or all of the US demand. However, Sputnik does affect us in another way: see the discussion of Vaccine Hesitancy below.
– The Bottom Line About Vaccine Choice
Every vaccine manufacturer is continuing to intensively test its vaccines, and test amended vaccines targeted at coronavirus variants. The data will continue to evolve, both as tests are completed and as the virus continues to mutate.
Here is what we can say with high confidence at this time: every one of the currently approved vaccines does a great job of protecting you from infection, and also a great job of keeping you from dying in the hospital. If you are offered any of the vaccines, jump at the opportunity.
This fall or winter, when everyone feels relaxed, the drug makers will offer a booster shot for the vaccine that you took. And you should take the booster when it is available. If you follow that program you will be as highly protected as we can project at this time. Moreover, you will likely have enough protection to carry you through to that glorious future date when we can demote coronavirus to the category of “just one more virus, similar to influenza.”
Vaccine Hesitancy, Vaccine Denial
Just a few weeks ago, the problem in the US was a shortage of coronavirus vaccine, and healthcare systems poorly equipped to deliver the doses. But as vaccine plentitude looms, other problems dominate: hesitancy, and outright denial.
– I’m Not Sure I Want It
Hesitancy is a reluctance to take the vaccine. These are folks who are not intractably opposed to vaccination. Rather, they are people who are unsure, or who are taking a “wait and see” attitude. They may say:
- The government rushed this vaccine development, how do I know that it’s safe?
- The government has mistreated my (ethnic, religious, racial, …) group before. I don’t trust them to stick something into my arm.
- No one whom I trust has explained to me why I should take the vaccine.
- How can I get it? Where is it available? What do I have to do? Who will help me find it, make an appointment, get transportation?
Fortunately, hesitancy is dropping as people gain confidence in the vaccines, and as community groups reach out to their constituencies. Surveys indicate that 80% of the US population is persuadable to get the jab.
– Begone, Curst Demon!
However, we also have some fellow Americans who are total deniers. They do not want any vaccine, including COVID-19.
This situation is grievous but it doesn’t surprise me. Consider:
- The World Health Organization lists reluctance or refusal to be vaccinated as one of the top ten threats to global health.
- No medical treatment, including vaccination, is absolutely 100% effective. People who, for whatever reason, insist on certitude will never find the evidence in favor of vaccination to be convincing.
- Anti-vax views have gained credence through conspiracy theories. And conspiracy theories in general have been amplified by social media.
- Social media are supposed to provide a voice for every person, to be a great democratizer. Alas, social media posts are subject to the “loudest voice” effect, in which forceful repetition of a lie gradually leads to its acceptance as truth. This loudest voice is sometimes a persistent dedicated poster, but not always. Facebook estimates that 5% of its accounts are fake, created by robotic software to amplify a message. The motivation for boosting a message may be to make money, to advance a political agenda, or simply to “own” (that is, annoy or destroy) an opponent.
- The Wall Street Journal reports that both Russia and China are purposely spreading disinformation to discredit competing vaccines, in order to sell more of their own products. Nation-states have a powerful capability to spread false info to support their goals.
The Elusive Herd (Red Fish, Blue Fish)
How high a percentage do we need? No one knows for sure. The example of Brazil implies that 76% is likely not enough. Dr Anthony Fauci has estimated numbers from 70% to 90%. He has most recently said that as much as 85% may be needed.
– The Path to 85% COVID-19 Immunity
How will we get there? The path forward depends on which state you live in. Why? Because the search for COVID-19 immunity has turned into a partisan affair, at least in the US:
- Social Distancing: Counties that voted for Trump in 2016 followed 14% less physical distancing in Spring 2020 than those who voted for Clinton. Less distancing encourages more virus spread.
- Anti-Vax: Only 33% of Republicans plan to get vaccinated, compared with 70% of Democrats and 47% of Independents.
- More Anti-Vax: Republicans are more likely to follow anti-vax Twitter accounts than pro-vax accounts (32.2% versus 9.41%).
I conclude that “red” (Republican-leaning) counties and states are more likely to let the virus spread, and less likely to accept vaccines, than “blue” (Democrat-leaning) ones.
– Blue State Herd Immunity
Polling shows that for the US as a whole, about 80% of people are willing to take the coronavirus vaccine, either now or soon. This poll mentioned was not reported by political party but based on the data above, let me guess that the 80% rises to 90% in blue states and falls to 70% in red states.
At present, experts estimate that 10% of the US population has contracted, then recovered, from coronavirus. In a blue state we should be able to vaccinate 90% of the remaining 90% of the people. That would give a total of 91% who are immune from recovery or immune from the vaccine or both. That exceeds the highest number speculated for herd immunity.
– Red State Herd Immunity
What about in a red state? Let’s start with 10% of the population as recovered from the virus. Then provide vaccine to 70% of the remaining 90%, which would give 63% more. The total COVID-19 immunity level would be 73%. Based on Brazil, that doesn’t seem to be enough to stop the virus. If 80% or 85% is necessary, these states need 7% to 12% more of their population to catch, and hopefully recover from, coronavirus.
However, as noted above, red states practice less social distancing. And in the previous blog we discussed 5 states removing their mask mandates, all of which voted red in the last two presidential elections. Therefore, if these states need to attain 80% or 85% COVID-19 immunity to stop the virus, they will rely on both vaccination and the intentional spread of infection via re-opening.
– Let’s Applaud Progress of Both Kinds
We have previously discussed – some would say celebrated – the polar-opposite approaches to COVID-19 being taken by various US States. And the discussion above, taken in its simplest terms, suggests the following:
- In the blue states we should look at the percentage of population vaccinated as a measure of success along their chosen pathway.
- In the red states the vaccination rate is important, but so is the coronavirus infection rate. So if they report booming infections (hopefully without a boom in deaths) we should consider that successful progress toward their goal.
In both cases, the total fraction of immune population is the critical quantity. And to be consistent and fair, we shouldn’t judge every state by a single standard. We should assess them in the context of the strategy they have selected. We can applaud progress toward total COVID-19 immunity in a state, even if we don’t agree with the path that state has elected.
What May Accelerate COVID-19 Immunity
There are some unknowns that could speed our path to nationwide immunity, by accelerating infections and vaccinations:
- The lower health restrictions in red states will not only encourage the spread of coronavirus, they may also increase the number of mild infections. Weak infections may grant many people immunity without causing death or serious side effects.
- We may expect red state teens and young adults to enthusiastically embrace socialization, which may increase infection in this population. However, people in this age group are extremely unlikely to die if they catch coronavirus, and they benefit from their innate “youth immunity.” These folks bring society the benefit of higher population immunity without the burden of more deaths.
- Businesses see benefit in having more of their employees vaccinated. They are already beginning to incentivize workers to get vaccinated and receiving government encouragement in this direction. Some companies may even require vax as a condition of employment.
- Some anti-vaxxers may be willing to accept the vaccine when they find themselves excluded from desirable activities. Businesses are free to require vaccinations to receive their services. Possible vax-only venues are international travel, domestic air travel, attending a concert or sporting event and entering a shopping mall. Ticketmaster and passenger airlines are preparing to enforce such rules.
- Eventually there may also be coronavirus vaccines that don’t require injection. As of 3/12/2021 the WHO tracker page lists 3 oral candidates under development. However, they are in the earliest stage of trials, involving only a few dozen people, with first results expected between October 2021 and April 2022. Vaccines administered by a nasal spray or skin patch are also in the works. When these are finally available, they may be acceptable to people for whom an injection is unwanted or impractical.
– Herd Immunity for the Nation
The path forward varies by US State, and may be accelerated by events such as those above. Overall, many experts believe that all the US states can reach a very high level, probably a “herd” level, of immunity, by this fall.