Covid vaccine concerns are starting to spill over into routine immunizations

“Kids aren’t getting caught up on routine shots they missed during the pandemic, and many vaccination proponents are pointing to Covid-19 vaccine hesitancy as a big reason why.

Public health experts, pediatricians, school nurses, immunization advocates and state officials in 10 states told POLITICO they are worried that an increasing number of families are projecting their attitudes toward the Covid-19 vaccine onto shots for measles, chickenpox, meningitis and other diseases.”

Time for an Operation Warp Speed to Develop Pan-Coronavirus Vaccines

“Way back in May 2020, three researchers at National Institute of Allergy and Infectious Diseases (NIAID) published an op-ed in Nature arguing that with respect to developing universal coronavirus vaccines “the time to start is now.” As it turns out, the time to start for the NIAID was 15 months later when the agency got around to awarding three academic institutions a little over $36 million to research pan-coronavirus vaccines in September 2021.

The Trump administration’s Operation Warp Speed could serve as a much better model for incentivizing pharmaceutical companies to greatly speed up the development and deployment of the candidate pan-coronavirus vaccines on which some are currently working. In a recent op-ed in the Los Angeles Times, two immunologists point out that the global cost of the COVID-19 pandemic is an estimated $16 trillion, compared to the cost of developing a typical vaccine at $1 billion. They note that even a $10 billion vaccine is minuscule compared with the pandemic’s toll.

Among the promising pan-coronavirus candidate vaccines are the Walter Reed Army Institute of Research’s spike ferritin nanoparticle COVID-19 vaccine; Osivax’s nucleocapsid vaccine targeting a protein widely prevalent among coronaviruses that is unlikely to mutate; and Inovio’s DNA vaccine encoding variant sequences of the spike proteins the virus uses to invade cells.”

‘Recognition of failure’: A shift urged in global vaccination strategy

“47 countries still have inoculation rates below 20 percent.

Now, many health organizations involved in the global vaccination effort aim to immunize 90 percent of vulnerable populations in every country — a move that seems to undercut the WHO’s 70 percent target.”

“Prioritizing vulnerable populations — health care workers, elderly individuals and those with comorbidities — could undermine the global push to prevent variants if it reduces the total number of vaccinated people, some experts said. But facing the reality that the 70-percent-vaccination goal by mid-2022 is virtually doomed, some health groups working on the global vaccination effort are focusing on letting countries set targets according to their abilities and advising them to first target vulnerable populations.”

““Striving to vaccinate 70 percent of the population of every country remains essential for bringing the pandemic under control — with priority given to health workers, older people and other at-risk groups,” WHO Director-General Tedros Adhanom Ghebreyesus told reporters at a press conference Wednesday.”

What can actually convince vaccine skeptics to get their shots

“The researchers surveyed more than 6,000 people in the United States, United Kingdom, European Union, Australia, and New Zealand. They contacted them first in December 2020, to assess their intentions before the vaccines were widely available, and asked them to pick a number between 0 and 10 to represent their likelihood of getting vaccinated. Then they followed up in summer of 2021 to see how people actually behaved.

To me, their most interesting findings concerned the most ardent vaccine refusers. Six months later, one-third of the people who had rated themselves 0 in December had gotten vaccinated.

So what happened? What convinced them?

Some of it was circumstances. Among those who had put themselves between 0 and 3 on getting vaccinated, those who were older (and therefore at higher risk of serious illness) and concerned with their health risks were more likely to get vaccinated in spite of their skepticism. So did the people who anticipated indirect exposure to Covid-19 through their friends or relatives. People who consumed more traditional media and who had more trust in scientists were also more likely to come around.

Vaccine mandates were not in effect at the time of these surveys, but the study generally found a mixed response to compulsory vaccinations among the respondents.”

In the Case That Blocked OSHA’s Vaccine Mandate, the Justices Disagreed About When COVID-19 Counts As a Workplace Hazard

“Underlying that split is the question of whether and when COVID-19 counts as a workplace hazard, justifying regulation by the Occupational Safety and Health Administration (OSHA), as opposed to a general risk that Americans face throughout the day, which goes beyond that agency’s statutory mission. All of the justices agreed that OSHA does not have a general license to protect public health, and all of them agreed that the agency does have the power to address COVID-19 in the workplace. But while the dissenters were willing to let OSHA define that problem in general terms, justifying a broad solution covering 84 million employees, the majority thought the agency was obliged to be more specific and discriminating.”

“OSHA has previously issued regulations that addressed communicable diseases. In 1990, it issued a nonemergency standard dealing with bloodborne pathogens, and last June it published a COVID-19 ETS for the health care industry. But both of those rules aimed to protect employees who faced special hazards because of the nature of their work (handling blood samples and treating COVID-19 patients, respectively), and neither of them encouraged or required employers to make vaccination mandatory. That is something OSHA, which has existed for more than half a century, has never done before—a point that the justices emphasized during oral arguments last week and again in yesterday’s decision.
“OSHA has never before imposed such a mandate,” the Court notes. “Nor has Congress. Indeed, although Congress has enacted significant legislation addressing the COVID–19 pandemic, it has declined to enact any measure similar to what OSHA has promulgated here….The most noteworthy action concerning the vaccine mandate by either House of Congress has been a majority vote of the Senate disapproving the regulation on December 8, 2021.”

In a joint dissent, Justices Stephen Breyer, Sonia Sotomayor, and Elena Kagan argue that OSHA’s unprecedented rule is justified by the unprecedented threat that COVID-19 poses”

“Even as Breyer et al. emphasize the society-wide threat posed by COVID-19, they suggest the risk is especially acute in the workplace, where employees typically gather inside for eight hours a day. That basic fact, the dissenters argue, justifies OSHA’s broad approach, because the coronavirus “spreads mostly without regard to differences in occupation or industry.””

“More generally, the majority says, OSHA has failed to draw appropriate distinctions between different work situations that pose widely varying risks of virus transmission. “Although COVID-19 is a risk that occurs in many workplaces, it is not an occupational hazard in most,” the Court says. “COVID–19 can and does spread at home, in schools, during sporting events, and everywhere else that people gather. That kind of universal risk is no different from the day-to-day dangers that all face from crime, air pollution, or any number of communicable diseases. Permitting OSHA to regulate the hazards of daily life—simply because most Americans have jobs and face those same risks while on the clock—would significantly expand OSHA’s regulatory authority without clear congressional authorization.””

“The majority nevertheless concedes that OSHA has the authority to address COVID-19 in certain contexts:

“Where the virus poses a special danger because of the particular features of
an employee’s job or workplace, targeted regulations are plainly permissible. We do not doubt, for example, that OSHA could regulate researchers who work with the COVID–19 virus. So too could OSHA regulate risks associated with working in particularly crowded or cramped environments. But the danger present in such workplaces differs in both degree and kind from the everyday risk of contracting COVID–19 that all face. OSHA’s indiscriminate approach fails to account for this crucial distinction—between occupational risk and risk more generally—and accordingly the mandate takes on the character of a general public health measure, rather than an “occupational safety or health standard.”””

The Supreme Court can’t get its story straight on vaccines

“the Supreme Court handed down a pair of unsigned opinions that appear to be at war with each other.

The first, National Federation of Independent Business v. Department of Labor, blocks a Biden administration rule requiring most workers to either get vaccinated against Covid-19 or to routinely be tested for the disease. The second, Biden v. Missouri, backs a more modest policy requiring most health care workers to get the vaccine.

There are some things that differentiate the two cases. Beyond the fact that the first rule is broader than the second, the broader rule also relies on a rarely used provision of federal law that is restricted to emergencies, while the latter rule relies on a more general statute.

But the Court gives little attention to substantive differences between the laws authorizing both rules. Instead, it applies an entirely judicially created doctrine and other standards in inconsistent ways. The result is two opinions that are difficult to reconcile with each other.

The NFIB case relies heavily on something known as the “major questions doctrine,” a judicially invented doctrine which the Court says places strict limits on a federal agency’s power to “exercise powers of vast economic and political significance.” As the NFIB opinion notes, the vaccinate-or-test rule at issue in NFIB applies to “84 million Americans” — quite understandably a matter of vast economic significance.

But, if this manufactured doctrine is legitimate, then it’s not at all clear why it doesn’t apply with equal force in both cases. As Justice Clarence Thomas points out in a dissenting opinion in the Missouri case, the more modest health workers’ rule “has effectively mandated vaccination for 10 million healthcare workers.” That’s still an awful lot of Americans!

What if the Biden administration had pushed out a rule requiring 20 million people to get vaccinated? Or 50 million? The Court does not tell us just how many millions of Americans must be impacted by a rule for it to count as a matter of “vast economic and political significance.” And it’s hard to draw a legally principled distinction between 10 million workers and 84 million.

Similarly, in NFIB, the Court notes that the agency which created the broad rule at issue in that case is the Occupational Safety and Health Administration (OSHA) which, as its name suggests, deals with health threats that arise in the workplace, and Covid-19 is not unique to the workplace. “COVID–19 can and does spread at home, in schools, during sporting events, and everywhere else that people gather,” the majority opinion notes.

But, as the three liberal justices point out in dissent, OSHA regulates threats that exist both inside and outside the workplace all the time, including “risks of fire, faulty electrical installations, and inadequate emergency exits.” It’s not at all clear why Covid-19 is any different. And the only explanation that the majority opinion gives — that a vaccination “cannot be undone at the end of the workday,” unlike the donning of fire-safety gear — applies with equal force to both the OSHA rule and the narrow health worker’s rule that the Court refused to block. Doctors’ vaccinations can’t be undone any more than an office worker’s can be.

The Court, in other words, appears unable to articulate a principled reason why some vaccination rules should stand and others should fall.”

“The opinions suggest that the Court will uphold rules that five of its members think are good ideas, and strike down rules that five of its members think are bad ideas.”

Omicron vs. the Unvaccinated and the Vaccinated

“The highly contagious omicron variant of the COVID-19 virus often does an end run around the immunological protections of vaccination or prior infection. But recent data from the U.K. and Canada indicate that these breakthrough omicron infections are much less dangerous than first-time infections in unvaccinated people.

Ontario public health authorities report that as of yesterday, 2,093 and 288 people are being treated for omicron variant infections in hospitals and intensive care units (ICUs), respectively. The hospitalization rate per million among unvaccinated people stands at 532.7; it’s 105.9 for folks vaccinated with at least two doses. This means that the reduction of hospitalization risk for those inoculated with at least two doses is 80.1 percent.

The ICU occupancy rate per million is 135.6 for unvaccinated people and just 9.2 for those who have gotten two doses of COVID-19 vaccines. So vaccination reduces the ICU risk by 93.2 percent.”

“These British and Canadian findings mirror those most recently reported by the New York State Health Department. It finds that the daily rate per 100,000 of COVID-19 hospitalizations stands at 4.56 for fully vaccinated people, compared to 58.27 for unvaccinated people. That means vaccinations are 92.3 percent effective at preventing hospitalization from COVID-19.”

Why Covid-19 is always one step ahead of the US response

“The Biden administration’s response to the omicron variant is belatedly kicking into gear. The White House announced Wednesday that it would soon ship 400 million N95 masks to US pharmacies and community health centers to be given away. Americans can submit their bills for at-home tests to their health insurer for reimbursement, and on Tuesday, a new federal website launched that lets people order a few free at-home coronavirus tests.

Free tests and free masks are finally here — after some public health experts have been calling for them since omicron was first detected around Thanksgiving or even earlier. But the tests and masks might not arrive in Americans’ hands until the end of the month.

“By the time the masks and tests get there, the surge will probably be over,” Monica Gandhi, an infectious diseases doctor at the University of California San Francisco, told me. It’s possible — but far from certain — that the omicron wave has already peaked. The average number of daily cases has dropped by 50,000 in the last week, a 6 percent decline.”

“Experts point to three main factors in the US government’s slow response to omicron: an over-reliance on vaccines, a failure to develop contingency plans, and the fracturing of the expert consensus on what the appropriate public health interventions would be.”

“There are limits on what the federal government can do under our federalist system of government. Mask mandates and social distancing restrictions are largely the purviews of state and local authorities. The Biden administration did attempt to take sweeping actions, such as a vaccine mandate for large employers, that got tied up in the courts.”

“Public health experts were never a monolith. But early in the pandemic, there was a fairly clear consensus about what to do about Covid-19: Close some businesses, ban most large gatherings, mandate masks, and develop a vaccine. A New York Times survey of hundreds of epidemiologists found in the summer of 2020 that more than half were in agreement about the timeline for resuming many activities that had been stopped because of Covid-19, such as vacationing within driving distance or eating out at a restaurant.

But as the pandemic has dragged on, expert opinions diverged. In spring 2021, the Times ran another survey of epidemiologists, asking them how long people would need to wear masks indoors, the answers varied wildly; 20 percent said half a year or less, while another 26 percent said people would wear masks indefinitely, at least in certain situations. As the Biden administration debated booster shots this summer and fall, some experts were full-throated supporters of giving everybody an additional dose, while other prominent experts argued boosters made sense only for certain people.”

The shape of the omicron wave is becoming clearer

“The omicron variant has helped drive the United States into uncharted territory for the pandemic. The country was reporting an average of more than 400,000 new Covid-19 cases every day as of January 3, easily eclipsing last winter’s record of 250,000. And infections are still spiking, with the number of newly reported cases quadrupling since the beginning of December.
There is still a lot of uncertainty with the omicron variant: We’re still learning exactly how transmissible it is, how likely it is to cause severe disease and for whom. But we know more now than we did when it first began spreading in the US.

All the early indications were that omicron was even more transmissible than its predecessors, at least in part because of its ability to partially evade preexisting immunity, and that has proven to be true. While earlier CDC estimates that the variant took over in the US in mid-December turned out to be overstated, omicron now appears to have surpassed the previously dominant delta variant in its share of new US cases.

With cases rising, so is the number of patients in the hospital with Covid-19. But, at least so far, hospitalizations are not rising as rapidly as infections, lending credence to the theory that omicron leads to less severe disease, particularly for vaccinated people. Deaths have barely budged over the last month, with about 1,250 new deaths being reported every day as of January 3, essentially unchanged from the 1,125 daily average on December 3. While there is always a time lag between new reported cases and the data showing more serious illness, the evidence, including biological research findings, that omicron poses less of a threat to each individual patient is only growing.”

Advance Market Commitments Worked for Vaccines. They Could Work for Carbon Removal, Too.

“we need a gigaton-scale portfolio of permanent carbon removal solutions, and those solutions don’t yet exist. The technology that exists is nascent at best. A growing number of innovative new carbon removal approaches are being tried — from using giant fans to pull CO2 out of the air, to growing kelp in the open ocean and then sinking it, to turning agricultural waste into bio-oil and putting it back underground. But it’s early days, and it’s not yet clear which approaches will be viable, let alone scale quickly.

A key reason permanent carbon removal is behind is that there has been legitimate uncertainty about whether anyone will pay for it. New technologies are typically expensive at first and get cheaper as they scale. Today, carbon removal solutions face a chicken-and-egg problem. As early technologies, they’re more expensive, so they don’t attract a critical mass of customers. But without wider adoption, they can’t scale production to become cheaper.

The uncertainty is particularly large for carbon removal because potential purchasers do not currently have a direct motivation to buy it. Governments and companies might consider carbon removal to fulfill their net-zero emissions pledges, but there are cheaper options that satisfy commitments as they are written today. So even though permanent carbon removal is critical to meeting climate goals, current guidelines do not explicitly reward it.

Carbon removal is thus in urgent need of a bold assist — and an “advance market commitment” could be the solution. This approach, in which money is provided to guarantee a market for a product, is modeled after a program successfully piloted a decade ago that incentivized the development of vaccines for poor countries at a time when pharmaceutical companies weren’t sure that countries could pay for a large volume of vaccines if they were developed.”

“Here’s how it could work. Companies and governments with net-zero pledges could fund the AMC by formalizing and pooling their financial commitments to buy carbon removal over a specified period of time — essentially turning ambiguous net-zero commitments into net-zero contracts to buy carbon removal. The AMC, run by technical experts acting on behalf of contributors, would buy carbon removal from high potential companies. When tons of CO2 get removed, the AMC would pay suppliers and issue credits back to buyers.

A large AMC for carbon removal would be transformative. Large contracts to purchase frontier carbon removal send a much stronger market signal to entrepreneurs and investors than fragmented companies making net-zero commitments, where innovators face substantial uncertainty about how the commitments will be met and whether the companies will choose to invest any resources in permanent carbon removal as opposed to other strategies.

An AMC has the further advantage that the demand signal can be sent now, without needing to pick a winning technology. A diverse set of technologies can be developed, while incentivizing inventors to meet rigorous standards that ensure they deliver real, permanent carbon removal.”

“Sustaining a market of this magnitude will undoubtedly require policy to regulate emissions. But policy takes time and tends to respond to emerging technologies rather than kickstart them. An AMC for carbon removal would help the field make progress while critical policy work happens in parallel. Furthermore, this early assist increases the likelihood that large amounts of permanent carbon removal will even be available at a reasonable price.”