Editor's Note: Below is a brief excerpt from a complimentary Health Policy Unplugged note written by our Health Policy analyst Emily Evans.
Politics. The pounding public health messaging has taken the last year is making Tyson-Spinks look like a fair fight. Things got a little worse this week when the Food and Drug Administration and the Center for Disease Control decided to “pause” administration of JNJ’s COVID vaccine.
The decision will have little impact on supply. There appears to be sufficient MRNA and PFE shots to keep vaccine administrators busy. The bigger issues are:
- Vaccine hesitancy ranges from 10-30% in US counties
- JNJ’s one shot vaccine is most needed for the vaccine shy
Consistent with immunizations generally, hesitancy to get the COVID-19 vaccine is more concentrated in rural areas and people living in poverty. Counties along the Washington-Boston corridor exhibit a high degree of vaccine acceptance while those in some the southeastern and mountain states are recording resistance as high as 30%
The correlation to rural classification and poverty status does not hold up uniformly, however, Texas appears to exhibit hesitancy levels in the mid-teens, even in remote counties of the Rio Grande Valley. Alabama and Mississippi, despite being neighbors seem to take different views of the COVID vaccine.
The value of the JNJ vaccine is that it only requires one dose. While there is probably nothing to be done about philosophical objections, JNJ’s simplicity means fewer logistical considerations in areas of the US with limited health service providers. It also cuts in half the opportunities for a mild reaction to take someone out of work for a day or two.
Under normal circumstances, the low incidence of adverse reactions would probably just have resulted in an advisory. In a tacit acknowledgement that there is a large chunk of the country that does not trust the public health apparatus, the CDC and the FDA chose a stronger message but one void of specifics and open to interpretation.
It may not matter. Vaccine hesitancy existed before the JNJ announcement. It just isn’t going to help.
A vaccination rate of 60-70% would be a stunning success. Near mandatory childhood programs have rates of ~70%. The annual flu vaccine garners ~50% compliance, albeit much higher among people over 65.
The political power of COVID-19, however, will drive mitigation and prevention efforts, regardless of the vaccination rate, for years to come. Exhibit A was the White House’s announcement last week of $1.7B in funding to identify COVID-19 variants. The appropriation had been included in the American Rescue Plan Act, but the White House provided some more specifics.
Funding will be used to expand the genomic sequencing infrastructure of the US through new “Centers of Excellence,” data and IT infrastructure that improves the sharing of critical mutations and presumably more ILMN boxes. Worth noting is that FLGT currently holds a contract with the CDC for sequencing work.
Another sign the Century of Biology is upon us.
One of the stranger episodes in the COVID drama has been the CDC’s treatment of cruise lines. Unlike most U.S. industries that can and have sought redress from mayors, governors and senators, the cruise industry is a little like a Man without a Country.
While the airline industry has kept planes in the air all year, cruise ships have been subject to a no sail order. The guidance the CDC has provided for restoring operations makes Governor Cuomo’s reopening plans look simple. CDC Director Rochelle Walensky indicated to Sen. Lisa Murkowski at a hearing that she did not know when service would be restored.
The most straightforward explanation for the CDC’s disparate treatment of two areas of the travel industry is because they can. The health agency maintains they have public health authority over international borders. The other explanation is that they want to avoid another Diamond Princess debacle, especially with varying public health approaches in cruise ships’ ports of call.
Florida, which handles about 60% of U.S. cruise traffic, made good on its promise to sue last week. The complaint claims Florida is irreparably harmed and seeks injunctive relief.