Those rates, presented in a new report from the Commonwealth Fund, a nonprofit foundation supporting research on health care issues, are well below the 60 percent to 70 percent threshold needed for “herd immunity” — the point at which enough of the population is immune from a virus to stop it from spreading widely.
Experts say achieving herd immunity with the coronavirus is crucial for life in the United States to return to normal next year.
States will face big hurdles to vaccinating large swaths of residents against the coronavirus, if history is any guide.
“Our vaccination systems don’t function at a high reliability level or even a moderate reliability level under normal circumstances, and it’s a lot to expect of them in the midst of a pandemic,” said Eric Schneider, senior vice president for policy and research at Commonwealth.
This is particularly true among southern states, which have larger uninsured populations. People are most likely to receive a vaccine while visiting a medical provider; about one-quarter of vaccines are distributed by pharmacies, while the rest are typically given out at doctors’ offices.
If people lack health insurance, they’re less likely to see a medical provider and therefore have fewer opportunities to get vaccinated. The coronavirus pandemic has further reduced in-person medical visits, as providers have moved to telehealth and, at times, asked patients to forgo elective procedures and visits.
In the 2009 H1N1 outbreak, states in the Northeast and the Midwest had the highest vaccination rates.
Texas, Florida and the states in between them had the lowest vaccination rates. Thirteen states vaccinated less than 20.5 percent of their populations.
Some of the low rates were due to early supply shortages. Yet the same states also struggled to distribute last year’s influenza vaccine, suggesting long-standing challenges with their distribution strategies that could hinder the impending immunization effort.
“Mounting a successful COVID-19 vaccination program in the United States will be especially challenging,” the Commonwealth study says. “States have substantial autonomy to chart their own course on public health, and historically they are responsible for organizing public health interventions in response to disease outbreaks.”
Americans may have more interest in a coronavirus vaccine — but it’s unclear.
Schneider said he was initially optimistic that there will be less resistance to the coronavirus vaccine compared with past outbreaks.
At surface, this makes sense. At least 272,000 people have died of covid-19 and it has massively disrupted daily life. By comparison, the seasonal flu killed about 22,000 people last year and the swine flu outbreak killed about 12,000.
But his optimism faded as he viewed surveys suggesting many Americans don’t trust the coronavirus vaccines. Vaccine hesitancy is strongest among minority communities; in a recent survey, 14 percent of Black Americans and 34 percent of Latino Americans said they believe a vaccine will be safe.
The Commonwealth authors found that in 19 U.S. states and jurisdictions, there is a vaccination gap of at least 10 percentage points between Black people and White people.
But there’s some bright news, too.
Older Americans — a top priority for the coronavirus vaccines — are more willing than younger ones to get vaccinated.
People age 65 and older were the only age group with flu vaccination rates higher than 60 percent last year. That’s especially good news when it comes to this year’s coronavirus pandemic, which has killed the elderly at hugely disproportionate rates.
Nearly 40 percent of all covid-19 deaths have been among residents and staff members of nursing homes and long-term care facilities. They — along with front-line medical workers — will be prioritized in getting the first coronavirus vaccine shots, according to recommendations issued on Tuesday by an advisory panel to the Food and Drug Administration.
“A union representing 1.3 million food and retail workers — the United Food and Commercial Workers International Union — urged the CDC on Tuesday evening to prioritize workers in grocery, meatpacking and food processing for the next round, citing the thousands who have already died,” they wrote. “An ongoing debate about the ranking of priority groups will probably intensify as the Food and Drug Administration gets closer to clearing a vaccine later this month.”
States are getting ready to start distributing Pfizer’s vaccine as soon as the FDA approves it.
Operation Warp Speed, the Trump administration’s vaccine and therapeutics initiative, plans to send 6.4 million doses of the vaccine within 24 hours of FDA clearance.
New York Gov. Andrew Cuomo (D) announced yesterday that the state’s first vaccine delivery will be large enough to immunize 170,000 residents. He expects New York to receive the shipment by Dec. 15, provided all safety and efficacy approvals are granted.
But there are already hurdles. While the federal government is paying for the vaccine doses, Cuomo asked for more money to pay for outreach and distribution.
“We need the federal funding. We need a real aggressive outreach effort,” Cuomo said in a news conference. “We need social acceptance and confidence to take the vaccine.”
And Virginia expects to get 70,000 doses by the end of this month, which Gov. Ralph Northam (D) said will fall short of what is needed for the highest-priority recipients, Rebecca Tan, Erin Cox, Laura Vozzella and Michael Brice-Saddler report. Maryland’s first shipment will contain 150,000 doses, which Gov. Larry Hogan (R) said will cover about half the state’s health-care workers. D.C. Health Director LaQuandra Nesbitt said the city will receive an estimated 6,800 doses of the vaccine in its first shipment, which our colleagues report is “less than a 10th of what is needed to vaccinate 85,000 health-care workers in the city. Nesbitt said city officials are petitioning the federal government not to tie D.C.’s share of vaccines to its population because many health-care workers live outside the city and commute in for work.”
Ahh, oof and ouch
AHH: British drug regulators smashed previous speed records with their approval of the Pfizer vaccine yesterday.
The United Kingdom became the first Western nation to approve a vaccine for widespread use.
“Drug regulators in Britain have a global reputation for being tough but fast, employing a system of continuous ‘rolling review’ of incoming data from drug companies,” William Booth, Karla Adam, Laurie McGinley and Jose A. Del Real write. “But to see a potentially lifesaving shot invented, tested and approved in less than a year smashes all speed records.”
Some countries that have taken a slower approach to the approval were not thrilled to see Britain approve the inoculation first.
“I consider this decision to be problematic and recommend that EU Member States do not repeat the process in the same way,” Peter Liese, health spokesman for the center-right parties in the European Parliament, said in a statement.
President Trump has also signaled displeasure that Britain cleared regulatory hurdles before the United States could.
The head of the U.S. Food and Drug Administration “said Tuesday that it would take the time needed to ‘get this right,’ despite increasing pressure from President Donald Trump to speed up the process,” the Associated Press reported.
OOF: Jeff Zients and Vivek Murthy are being considered for Biden’s coronavirus czar.
“One contender for Biden’s coronavirus coordinator, envisioned as a powerful role in setting the agenda and orchestrating the work of federal agencies, is Jeff Zients, a co-chairman of the Biden transition team who led the Obama administration’s National Economic Council. Another is Vivek H. Murthy, a co-chair of the transition’s covid-19 advisory board and a former U.S. surgeon general,” Amy Goldstein and Toluse Olorunnipa report.
Zients has no background in medicine or public health, but the Biden team is said to admire him for his management skills, first as a business executive and later as the acting director of the Office of Management and Budget under the Obama administration. Zients is credited with stepping in to help repair the Affordable Care Act’s insurance enrollment website after a messy rollout left HealthCare.gov unusable for some consumers.
Murthy has less experience managing large organizations but is a trained physician and early supporter of Biden who has played a crucial role in shaping the president-elect’s health care stances. Murthy is also considered a leading contender to lead the sprawling Department of Health and Human Services. New Mexico Gov. Michelle Lujan Grisham (D), who had been considered a leading candidate and who had the support of many Latino organizations, has said she is out of the running.
While individuals close to the transition process say that Biden wants to move at a deliberate pace in assembling the team that will confront the defining issue at the beginning of his presidency, pressure is mounting for him to name his health-care leadership team, with some insiders saying that a decision could come as early as next week.
OUCH: Top health officials are calling for increasingly stringent public health measures.
Although the reports are not made available to the public, the task force included recommendations that individuals over 65 should not enter any indoor public spaces with unmasked people and that people under 40 who gathered with people outside of their immediate household for Thanksgiving should assume they became infected and isolate immediately.
The U.S. Centers for Disease Control and Prevention also ramped up its warnings on Wednesday, with Director Robert Redfield warning that the next three months may be “the most difficult time in the public health history” of the nation. Speaking at a U.S. Chamber of Commerce event, Redfield warned that the United States could see another 200,000 coronavirus deaths over the winter.
The CDC urged people once again to stay home for the holidays. For those who travel anyway, agency officials recommend getting coronavirus tests one to three days before the trip and then again three or five days afterward. In an effort to improve compliance and better reflect new research, the CDC finalized new guidelines that shorten the recommended length of quarantine to 10 days without symptoms or seven days with no symptoms and a negative coronavirus test.
More in coronavirus
Elsewhere in healthcare
The Trump administration is locking in a permanent expansion of Medicare telehealth services.
Sweeping new payment rules from the Centers for Medicare and Medicaid Services on Tuesday codify Medicare reimbursement for some telehealth services even after the coronavirus emergency ends. During the public health emergency, more than a third of fee-for-service Medicare recipients used telehealth services.
“However, the new additions only apply to patients in rural areas in a medical facility, such as a nursing home or hospital. Medicare doesn’t have the statutory authority to reimburse for telehealth permanently for beneficiaries outside of rural areas, or generally let patients receive telehealth in the home, due to geographic and originating site restrictions legislated in the Social Security Act,” Health Care Dive’s Rebecca Pifer reports.
It’s unclear if Congress will act to change those restrictions.
The new rules also increase reimbursement for primary care providers and other physicians who spend more time with patients suffering from chronic diseases. But because Medicare is expected to be budget neutral, the payment schedule is expected to slash reimbursements to some surgical groups, eliciting an outcry from the Surgical Care Coalition, an advocacy group representing surgeons.
