Thread by @DrTomFrieden

Covid Epi Weekly: An Epidemic of Vaccine Inequity

As predicted, a US 4th surge appears to be beginning, fueled by variants and reopening. Cases up 7%. Positivity inching up, to 4.7%. Because of vaccination, deaths won't increase substantially. We must solve vaccine inequity. 1/

Michigan hospitalizations are increasing rapidly esp. among 40-49 y.o. Middle and high school 30% increase in cases associated with outbreaks in tandem with increased community transmission. Fewer people staying home, similar to prepandemic levels. Harbinger of spring surges? 2/

Important new data on the mental health harms of the pandemic in the US. Large increases in depression and anxiety, especially among young people and those with less education. Treatment hasn’t kept up. At least 12 million more Americans are struggling.3/ bit.ly/3fflh7a

Vaccinations continuing at a high rate: 2-2.5 million/day. That’s ~1% of eligible Americans every day, and the challenge isn’t to increase much more but to keep up that pace to meet the new goal of 200M. Expanding eligibility helps. More J&J vaccine helps. Communication helps 4/

3 big gaps in US vaccine program. 1. Equity. Black and Latinx people still about twice as likely to be killed by Covid but half as likely to be vaccinated. We mocked up a data visualization [DATA NOT REAL]; every place should publish to track as they implement programs to fix.5/

2. Doctors. Covid vaccination should be available in just about every doctor’s office, in addition to pharmacies and community vaccination sites. Many people who are reluctant to get vaccinated elsewhere will get vaccinated by their doctor. All hands on deck. 6/

3. Convenience. Polls show that many people who want to be vaccinated haven’t been able to get vaccinated. Variability among states is big. Particularly as J&J becomes more available, 1-shot vaccination at malls and other sites will be important. Convenience trumps reluctance. 7/

Vaccines are saving lives already and will save even more in coming months. As estimated last wk, 40,000+ more people would have died since Jan 1 in US nursing homes & elsewhere without vax. Credit where due: the LTC vaccine program is a big success! bit.ly/3d8vwr7 8/

How long-lasting and strong is vaccine-induced immunity? Will variants evade vaccine protection? Time will tell. Reduce uncontrolled spread wherever it occurs for ethical and epidemiologic reasons; risk of dangerous variants is proportional to amount of uncontrolled spread. 9/

AZ and ?AE. People have adverse events after vaccination. 20 million doses of AZ vax, <30 blood clot cases reported. Link? Maybe, but even if so, not strong and benefits of vaccination outweigh risks. Resist drawing causal links where none may exist. bit.ly/3fhqtHD 10/

No vaccine is 100% effective or 100% safe. We’ll find out about vaccine failure when there are breakthrough cases, and about very rare adverse effects, if there are any, when many millions of people are vaccinated. So far, the vaccines are astonishingly safe and effective. 11/

Global vaccine inequity is horrific. There is simply no ethical justification for healthy young people in any country getting the vaccine before a senior or health worker in a place where virus is spreading does. Increase vaccine production fast. pandem-ic.com 12/

Vaccine nationalism is ethically inexcusable but politically inevitable. Must increase production. Tho vectored vaccines less expensive, easier to store& single-dose, mRNA technology has lower risk of missing production targets, more adaptable to variants and faster to scale. 13/

Inevitable unless, of course, you’re Norway. Again showing moral and financial global leadership. Norway played a critical role in development of many global health initiatives, and may well help create a better global system of solidarity and safety. bit.ly/3d7cbXy 14/

Cases are increasing again in many countries. Brazil, Kenya, Ethiopia, Poland, the Philippines just some of the countries struggling to control transmission and treat patients. We need control measures and vaccines quickly, for everyone. Until all are safe, none of us are. 15/

It's very unlikely SARS-CoV-2 was created in a lab. The genetic information strongly suggests that the virus evolved naturally. Is unintentional lab release a possibility? Yes, as the review commission has noted. In any case, we need better global lab safety and security. 16/

The last smallpox case in the world was from lab error in the UK. A flu strain accidentally released in the former Soviet Union in the 1970s may have spread around the world. Let's work together globally to make laboratories safer and reduce the risk of future health threats. 17/

Two great unknowns:
1/What will humans do–will we lose motivation as vaccines roll out and fail to maintain patience, discipline, and solidarity?
2/What will the virus do–will variants evade the vaccine?
The future isn’t certain, but it’s certain our actions can make it safer.18/

The Navajo Nation has crushed the curve with an impressive vaccination campaign: 57% received at least 1 dose (compared to 26% of the US population), maintained a mask mandate and continues to provide free masks and hand sanitizer and to discourage travel. Result: No cases. 19/

After 14 months writing weekly epi threads every Friday nite, I’m stopping. I may launch a weekly analysis of Covid & other public health issues. Remember, the right answer to epi questions is often: It depends. Life is complex, wonderful, and evolving. Thank you for reading! 20/

It’s been said the only thing certain in life is death and taxes. To that, we must add the threat of future pandemics. 21/

Covid is far from over, and the next pandemic could start any time. We must be better prepared, healthier, and more coordinated globally. Our public health and primary care systems need long-term investment.

Microbes outnumber us. If we work together, we can outsmart them. 22/

“Encountering apathy, ignorance, and avarice is the lot of all conscientious health officers. As preventive measures in the health area are more successful, the public is less inclined to support the programs which ensure this success.”

John Duffy
bit.ly/3rlaBq0
23/End