Arnold Solof, MD  11/25/2020

Vaccine Readiness

It is estimated that at least 70% of the population needs to be immune in order to begin to see significant herd immunity.  Currently, only about 50% of Americans are willing to get vaccinated.  At this point in time, we have 2 vaccines completing phase 3 trials with emergency use authorization pending.  Pfizer’s mRNA vaccine on 12/10/2020 and Moderna’s mRNA vaccine on 12/17/2020.  Both these vaccines have demonstrated safety and about 95% efficacy in preventing symptomatic disease and about 99% efficacy in preventing severe disease.  We have been told that once given authorization, they can be immediately distributed and ready to be given with 2 days.  The details of the distribution plan are not yet available.  Other vaccines will become available soon afterward.

Initial Distribution

The initial supply of the vaccines will be severely limited and with 50% of Americans willing to receive them, the demand will far exceed the supply.  Therefore, those that refuse the vaccine will not slow the initial effort to protect the country.  The limited supplies will be prioritized to health care providers and other front line workers at high risk of exposure and the elderly and those with co-morbidities predisposing them to severe disease and death from Covid-19.

Hidden Problem

Most companies have not yet begun studying the vaccines in children.  Children make up 25% of the population in the USA.  Although children are at statistically lower risk than adults for severe disease, they also can become seriously ill and die from Covid-19.  In addition, although they are less likely to become seriously ill, they are just as likely to become infected and spread the infection.  Because they are more likely to be asymptomatic or mildly symptomatic, they are an unseen, concealed danger to everyone.  The American Academy of Pediatrics recommends children under 2 years of age not wear masks due to concerns about interfering with breathing.  Adults do not normally isolate themselves from infants and children.  During office visits, my greatest fear is not taking a nasal swab from a possibly Covid-19 positive patient, but instead, examining an unmasked, crying, struggling infant or toddler who is spraying his respiratory secretions throughout the room.  I wear an N95 mask and face shield for those exams.  Vaccinating children for Covid-19 is not the first priority and current vaccine supplies are very limited.  I expect that by the time the vaccine supplies increase substantially, the studies on children will have been completed.

Mid and End Distribution

After the first 100 million doses of vaccine are given an increasing majority of the remaining people will be unwilling to be vaccinated.  Assuming the safety and effectiveness of the vaccines hold up following the initial mass distribution, what strategies are likely to work to allow us to achieve herd immunity? 

• The safety and effectiveness data need to be clearly communicated to the public.
• Comparison data of infection rates in contained groupings like nursing homes, prisons, hospital employees, police force, etc. before and after vaccination.

Guaranteeing Herd Immunity

I never cease to be amazed by how many parents don’t have their children receive routine child vaccinations because they want to protect the health of their children, but rather do it because it is required for school or daycare attendance.  The same holds true for hospital employees, many of whom would refuse influenza vaccine if it were not required for their employment.  Given that is “standard behavior” for our population I propose the following as examples of entities that should require Covid-19 vaccination for their employees:

• Hospitals
• Medical Offices
• Nursing Homes (employees & residents)
• Federal, State, Local Government employees
• Police departments
• Fire departments
• Schools (employees & students)
  • College
  • High School
  • Middle School
  • Elementary School
  • Preschool/Daycare
• Prisons (employees & inmates)
• Public Transportation (Even better if you include passengers)
  • Airlines
  • Buses
  • Boats
  • Taxis, Uber, Lyft
• Delivery Services (UPS, FedEx, Amazon, etc.)
• Gyms
• Restaurants
• Bars
• Personal Services
  • Hair Salons
  • Nail Salons
  • Tattoo Parlors

 

Until Herd Immunity is Achieved

In the meantime, while we wait to achieve herd immunity, we must do our best to prevent infection spread (Don’t Share Air):

• Avoid contact with people whenever possible
• Social distancing (6+ feet apart)
• Wear a mask if around people
• Meet outdoors instead of indoors if possible
• Wash/sanitize your hands frequently

Conclusion

Many questions remain to be answered:

• How long will immunity last for each vaccine?
• How long will immunity last following a Covid-19 infection?
• Will there be rare serious vaccine side effects found after we have more experience with the vaccines?

Achieving herd immunity is readily achievable, but only if we “put our foot down” and insist it be done.  As of this writing, Worldometer shows 266,016 people have already died in the USA of Covid-19.  We now have the tools to stop it.  Let’s get it done.