Thread by @DrTomFrieden

Covid Epi Weekly: The Centrality of Equity

Lots of good news on vaccines, but the virus and variants are gaining ground. Variants are spreading rapidly in the US, driving (along with premature opening) the fourth surge that’s now underway. 1/

I had planned to stop Friday night threads, but couldn’t help sharing thoughts on this week’s developments—there have been so many.

Fourth surge is building. Cases up 8%, test positivity up to 5.1%. Michigan situation worse, other states could follow. bit.ly/3duo8GL 2/

News on vaccines just keeps getting better. CDC study of mRNA vaccines found that Pfizer and Moderna vaccines blocked 90% of infections. Vaccinated people won’t spread much disease. HUGE implications for guidance for fully vaccinated people and the trajectory of the pandemic. 3/

Pfizer released new clinical trial data showing their vaccine protects for at least 6 months. Will likely be longer—only time will tell how long. Also found that vaccines work well against at least some variants. Highly effective against B.1.351, first identified in S. Africa. 4/

Now we have to get vaccine there and around the world. Transfer of mRNA technology is key, because it can be tweaked for variants and is less susceptible to production problems. A biological vaccine process made into a chemical, more predictable one. politi.co/3rN6a7F 5/

There’s no question the vaccines are working. Look at the striking impact protecting the elderly in Michigan. Vaccines rock...but, we’re failing to get them to where they are most needed. bit.ly/3miNZWm 6/

Israel is crushing the curve with vaccine. More places need the vaccine, especially Brazil and other places being hit hard. 7/

Despite glitches (see: J&J/Emergent’s 15 million botched doses), supply keeps increasing. US is vaccinating more than 2.5 million people a day now. BUT: quality, i.e. targeting of vaccines is important, probably more important than quantity. See below. 8/

Reluctance keeps decreasing. And more availability and more convenience will overcome much of the remaining reluctance. New survey from @KFF: bit.ly/3dw0lGA 9/

News on variants is mixed, but mostly bad. On a positive note, Israel’s success shows that these vaccines beat these variants. But variants are spreading rapidly in the US. 10/

Deaths aren’t falling nationally as rapidly as I had anticipated they would—likely because the variants are not only more transmissible but also more lethal. @EricTopol summarized the data on variant lethality well. 11/

https://twitter.com/EricTopol/status/1377358072314654720?s=20

Some think SARS-CoV-2 may be running out of genetic tricks, and I hope they’re right, but hope is not a plan. We have to anticipate the possibility of vaccine escape mutants and reduce uncontrolled spread wherever it occurs. 12/

Now the most important point of this non-thread thread, and the main reason I am writing it. Equity, equity, equity. This is not just about what’s right ethically, but what’s essential for pandemic control in both the near- and long-term. 13/

If we just chase the number vaccinated, we miss the point. We want maximum impact from vaccine—for fairness, to reduce deaths, to reduce cases, and to reduce risk of emergence of even more dangerous variants. 14/

100 million people in US have received 1 dose of vaccine. But about 50 million people over 50 (~37M age 50-64 and ~13M 60+) haven't been vaccinated. Vaccinating these folks, who are disproportionately Black & Latinx, will prevent many more deaths than vaccinating young folks. 15/

Think of it this way. Targeting vaccinations to people at highest medical risk—who are 10 to 100 times more likely to die if they get infected—is 10 to 100 times more likely to save a life. 16/

So we'd have to vaccinate 10 million people at low medical risk to save as many lives as vaccinating 100,000 to 1 million people at high medical risk. 17/

And targeting vaccinations to the communities at highest risk for spread is MUCH more likely to prevent cases than targeting vaccinations at low risk of spread. 18/

In some low-risk communities, for example, 0.6% of the population may be infected each month, while in high-risk communities, it may be 6%. With a vaccine that offers 90% protection, if we vaccinate 1M people in low-risk communities, 5,400 cases would be prevented. 19/

In contrast, If we vaccinate 1M in high-risk communities, this would prevent 54,000 cases—10 times as many. This difference will compound in future generations of spread, so the actual impact could be 40 times or 100 times larger. 20/

In other words, a single well-targeted vaccination could save 10x more lives and prevent 100x more cases than vaccinating a low-risk person in a low-risk community.

This is the essential fact we must act on. Equity isn’t only good ethics. It’s essential for epidemic control. 21/

“The availability of good medical care tends to vary inversely with the need for it in the population served.”

Julian Tudor Hart, The Lancet
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