Why are so few people getting the latest Covid-19 vaccine?

“Experts say the public’s disinterest in the latest Covid shots is likely a combination of poor messaging from authorities, a diminishing fear about a virus that three years ago was wholly unknown, and the political polarization of the pandemic itself. But whatever the reasons, that vaccine ambivalence still poses a health threat.
Elderly people and very young infants continue to have a higher chance than the rest of the population that they will be hospitalized with Covid-19. Vaccination rates have fallen off for the former group, who are also most likely to die from an infection, and they were never strong to begin with for the latter”

“The known unknowns for the future, which could spur another round of investment and interest in updated Covid-19 vaccines, are biological. The virus has been evolving and will continue to evolve and could, in theory, reach a point where the current vaccines are ineffectual.

The other question mark is inside of us. The reason many people still enjoy protection from serious illness is because our body’s T-cells are familiar with the virus and can activate when they detect it. They may not be able to stop an infection entirely (that is the role of antibodies, which are quicker to fade) but they can stamp out the virus before a person becomes too sick.

What we don’t know today is how long our T cells’ memory will last, and how durable that immunity really is. The only way to find out is for more time to pass.”

https://www.vox.com/policy/2023/11/17/23964294/covid-19-vaccine-2023-us-vaccination-rates

The RSV shot shortage isn’t just a supply problem

“It’s more complicated to fix the fragmented US health care system that creates big barriers to Beyfortus access for some kids, O’Leary said. That system is structured such that many pediatricians have to take huge financial risks to keep Beyfortus in stock. For patients who get care at those practices, access will likely be a little touch-and-go until demand also stabilizes and pediatricians can better forecast how much to stock.
Why is it so risky for some pediatricians to stock certain immunization products?

It has to do with who’s paying for the products, and how much they cost. Pediatric vaccines are paid for and distributed in the US through two main mechanisms. About half of American kids get vaccines paid for by the federal government through a program called Vaccines for Children, or VFC. The program’s goal is to ensure cost isn’t a barrier to vaccinating kids, so eligibility is restricted to kids who are Medicaid-eligible, under- or uninsured, or American Indian or Alaska Native.

The other half of American kids get vaccines paid for by private insurance companies, but only after the pediatrician administers it. What insurance companies pay for each vaccine isn’t always enough to cover its full cost, and the pediatrician often doesn’t know how much an insurance company will pay them for a vaccine until after the fact.

This setup means ordering any vaccine is somewhat of a financial risk to pediatric practices. But because most vaccines are relatively cheap, and because their familiarity to most parents makes demand relatively predictable, the risk is relatively small.

The math is totally different for Beyfortus, though: One dose costs a doctor’s office nearly $500 — and as a totally novel immunization, its popularity was hard to forecast. “For a medium-sized practice, they might have to spend $250,000 to cover their patient population,” O’Leary said. “And that is not money they have lying around.””

“A universal vaccination program that made vaccines available across the lifespan, free of charge, would be wonderful, O’Leary said, and it’s what other industrialized countries like Canada and the United Kingdom do. “But that’s not where we are,” he said.”

https://www.vox.com/2023/10/25/23931321/rsv-beyfortus-nirsevimab-shortage-supply-vfc-vaccines-for-children-respiratory-syncytial-virus

‘I can’t believe we’re talking about polio in 2023’

“Former President Donald Trump’s administration marshaled unprecedented federal resources to develop and promote a Covid vaccine in record time. But within a few weeks of its arrival, lingering resentment over lockdowns and mistrust of government led to a widespread backlash, particularly among conservatives, that persists almost three years later. Nearly four in 10 Republicans say they will “definitely” or “probably” get the new vaccine, according to polling conducted by Morning Consult and POLITICO, while nearly eight in 10 Democrats expect to seek out the updated shot.
That skepticism is bleeding over into other vaccines, like those that prevent measles, mumps and rubella. Dr. Umair Shah, Washington state’s secretary of health, said it may even take the death of an influential figure to a vaccine-preventable disease to shock the public back to wider acceptance of immunizations.

“I’m really concerned, and a lot of people in public health and health care are very concerned, that this is the beginning of a really rough and tough time,” Shah said. “Unfortunately, people are going to get sick. We’re going to lose lives.”

For decades, being openly skeptical of vaccines made one a pariah in all but the smallest of political circles. Both parties generally accepted that modern science had made essential breakthroughs in health care. To cast doubt on them placed you on the fringe. But public health officials fear those days are increasingly numbered.

Robert F. Kennedy Jr., who notched 15 percent support in a Harvard-Harris poll of the Democratic presidential primary field earlier this month, is running on his anti-vaccine bona fides. Florida Gov. Ron DeSantis, a Republican, is campaigning on his work to promote “medical freedom” and has said he would put Kennedy on a task force to investigate government overreach in medicine if elected president. Vivek Ramaswamy, a biotech entrepreneur also running for the Republican nomination, has touted his plans to “expose and ultimately gut” the FDA and floated Kennedy as a running mate.

While these candidates are trailing in the polls, their followings are certain to outlast the campaign. Lingering resentment over pandemic restrictions is fueling further skepticism around public health, potentially leading to even lower vaccination rates, wider spread of disease and an inability to address future pandemics.

“Hundreds of thousands of Americans have died in this pandemic because of the bad information about vaccines and treatments,” said Dr. Ashish Jha, dean of the Brown School of Public Health and former White House Covid-19 response coordinator under the Biden administration. “I certainly am worried about what happens over the next three to five years.”

The data show the vast majority of Americans still trust science, listen to doctors and vaccinate their children. But the growing number of those who don’t threatens to undo generations of work combatting deadly and debilitating diseases that haven’t widely circulated for decades.”

https://www.politico.com/news/2023/09/21/covid-vaccines-science-2024-election-00116520

New Covid vaccines are coming out. The CDC wants you to get one.

“Updated Covid-19 boosters are needed for two fundamental reasons: first, that the virus is continually evolving, and second, that our immunity wanes over time.”

https://www.vox.com/coronavirus-covid19/2023/9/9/23854114/covid-vaccines-boosters-flu-shots-eris-fornax-pirola-cdc-guidelines

Here’s what you need to know about new Covid shots

“The updated Covid-19 shots are formulated to prevent severe disease and hospitalization by the XBB1.5 strain, as well as other XBB subvariants, which make up more than 90 percent of the subvariants circulating as of Sept. 2, according to the CDC. This includes EG.5 and FL.1.5.1, which make up more than 30 percent of current cases.
CDC officials said in today’s meeting that lab data also suggest that the updated vaccine will generate neutralizing antibodies against BA.2.86, which has garnered attention due to its high number of mutations. It has only been found in 10 countries worldwide, and seven states within the U.S, but it is not clear that it will gain additional traction.”

https://www.politico.com/news/2023/09/12/covid-flu-rsv-shots-00115388

The Steep Cost of Ron DeSantis’ Vaccine Turnabout

“on the single factor that those experts say mattered most in fighting COVID — widespread vaccinations — DeSantis’ approach proved deeply flawed. While the governor personally crusaded for Floridians 65 and older to get shots, he laid off once younger age groups became eligible.
Tapping into suspicion of public health authorities, which the Republican right was fanning, he effectively stopped preaching the virtues of COVID vaccines. Instead, he emphasized his opposition to requiring anyone to get shots, from hospital workers to cruise ship guests.

While Florida was an early leader in the share of residents older than 65 who were vaccinated, it had fallen to the middle of the pack by the end of July 2021. When it came to younger residents, Florida lagged behind the national average in every age group.

That left the state particularly vulnerable when the delta variant hit that month. Floridians died at a higher rate, adjusted for age, than residents of almost any other state during the delta wave, according to the Times analysis. With less than 7% of the nation’s population, Florida accounted for 14% of deaths between the start of July and the end of October.

Of the 23,000 Floridians who died, 9,000 were younger than 65. Despite the governor’s insistence at the time that “our entire vulnerable population has basically been vaccinated,” a vast majority of the 23,000 were either unvaccinated or had not yet completed the two-dose regimen.

A high vaccination rate was especially important in Florida, which trails only Maine in the share of residents age 65 and older. By the end of July, Florida had vaccinated about 60% of adults, just shy of the national average. Had it reached a vaccination rate of 74% — the average for five New England states at the time — it could have prevented more than 16,000 deaths and more than 61,000 hospitalizations that summer, according to a study published in the medical journal The Lancet.

Florida’s spike in deaths subsided that autumn, as it did elsewhere. Overall, the state’s death rate during the pandemic, adjusted for age, ended up better than the national average. Some public health experts credit the state’s robust health system and strong performance in the pandemic’s first year or so.

But in Florida, unlike the nation as a whole — and states like New York and California that DeSantis likes to single out — most people who died from COVID died after vaccines became available to all adults, not before. As the governor’s political positions began to shift, so did his state’s death rate, for the worse.

DeSantis and his aides have said that his opposition was to mandates, not to the vaccinations themselves. They say the governor only questioned the efficacy of the shots once it became evident that they did not necessarily prevent infection — which prompted him to criticize experts and the federal government.”

“for some with a close-up view of COVID in Florida, the delta wave’s toll was evidence of the insular leadership style that DeSantis has also displayed in his struggling presidential campaign. He boasted of standing up to health experts but carefully tended to his base of political supporters. Tapping into the Republican revolt against scientific authority made him a political star. But that revolt came with costs.

“These were preventable deaths,” Rivkees, who resigned as Florida’s surgeon general in September 2021, said in a recent interview. “It breaks my heart thinking that things could have turned out differently if people embraced vaccines instead of this anti-vax stuff.””

“As of this summer, more than 345,000 Americans younger than 70 have died of the virus, and more than 3.5 million have been hospitalized with COVID. The disease has killed nearly 2,300 children and adolescents, and nearly 200,000 have been hospitalized.”

“DeSantis accused the media in early August of “lying” about COVID patients flooding hospitals. Two weeks later, Mary Mayhew, head of the Florida Hospital Association, said, “There can be no question that many Florida hospitals are stretched to their absolute limits.”

Mickey Smith was then the CEO of Oak Hill, the biggest hospital in Hernando County. As the delta variant raged through the county that month, he documented the impact on the 346-bed hospital in almost daily staff memos.

The morgue was filled to capacity. Oxygen was in such demand that the supplier would only partly fill Oak Hill’s tank. Ambulances were lined up outside to unload new patients, some of whom had to be shunted to a hastily erected outdoor tent.

“Our patients are younger and sicker,” Smith wrote. Of 17 patients on ventilators in intensive care Aug. 13, 2021, more than half were younger than 55. Only one was vaccinated.

“People say that the decision about vaccination is a personal one and it doesn’t affect anyone else,” Smith wrote. “Tell that to the kids who lost their mom.””