The transmission factor

In an ideal world, a coronavirus vaccine would be able to protect against not only symptomatic disease but also infection, effectively preventing vaccinated people from spreading the virus.

“That’s like the holy grail of vaccines,” Sarah Caddy, a clinical research fellow in viral immunology at Cambridge University, told DW News. “But that is really hard to achieve. To stop any virus particles getting in is virtually impossible.”

While more data is needed, many scientists are optimistic that the vaccines will reduce transmission, Dana Smith writes in Elemental. “I think that it’s very unlikely that vaccines this efficacious wouldn’t have some impact on transmission and would not be protective at all against infection,” Angela Rasmussen, a virologist affiliated with Georgetown University, told her.

Scientists seem less optimistic that the current vaccines will completely stop transmission, but many vaccines for other diseases don’t, and that level of immunity isn’t necessary to contain an epidemic. But until a larger share of the population is protected, experts say that vaccinated people should still take precautions in the presence of unvaccinated people.

“I think we message that these vaccines are extraordinary, but we don’t know yet what the limitations are, and we just need to wait a little bit longer,” Yvonne Maldonado, professor of pediatrics and infectious diseases at Stanford, told Smith. “I’m not saying we should shut down. I do think we should be opening up economies. I just think taking off the masks is not a good idea right now.”
The red tape

The intricate eligibility criteria that some states are using have slowed the pace of vaccination, sometimes in bewildering ways. In New York, for example, providers have had to throw out doses because they couldn’t find patients who matched the state’s strict guidelines. In Texas, a doctor who faced a similar situation but used the doses was fired and fined.

“While there is no one best way to roll out a vaccine in short supply, we’ve seen the wrong way,” Zeynep Tufekci writes in The Times. “Distributing it too slowly; setting up a complicated maze that needs to be navigated for access; and punitively micromanaging the process, which stalls it further.”

The goal of eligibility criteria was to ensure that the rollout is fair, but Tufekci argues that too much red tape can have the opposite effect. “Right now, too many states force people to create accounts online in multiple steps, get through to busy phone lines, upload documents and show up at exact appointments to get vaccinated,” she writes. “This all may appear to be a way to ensure fairness, but in reality we know from similar programs that those with more connections, free time and know-how will be better able to navigate this maze while the process slows it down for everyone else — especially those who need it.”

Stories abound about hospital administrators, college professors and even SoulCycle instructors nabbing vaccine appointments despite being very low risk. And officials in many cities say that their online booking systems are flooded by people from wealthier and whiter neighborhoods, even though Black people and Latinos are much more likely than whites to get infected.

In The Washington Post, Ruth Faden, Matthew Crane and Saad Omer propose a simple solution to make the rollout faster and fairer: Focus on individuals 65 and older nationwide, regardless of occupation.

“For many of the same structurally unjust reasons that people of color are dying of Covid-19 at higher rates than white people, they are also dying at earlier ages,” they write, noting that some states have set their cutoffs at 70 or 75 years old. “By simplifying vaccine prioritization to focus on people 65 and older across the nation, we can more effectively protect most Americans at the highest risk of dying in each ethnic and racial demographic in a way that focusing on essential workers would not.”
The skepticism

Public confidence has been slowly inching up since the summer, when only one in two Americans expressed willingness to get a vaccine. In recent weeks, that share has risen to two in three. Is that enough?

“No. No, no, no, no,” William Hanage, a Harvard expert on disease dynamics, told The Associated Press. “You’re going to need to get quite large proportions of the population vaccinated before you see a real effect.”

To increase the vaccination rate, government and health care workers should be studying how to “nudge” patients to get shots, Mitesh Patel argues in Nature. He notes that something as simple as prompting medical assistants to ask patients about whether they’d like to get vaccinated has been shown to increase flu vaccination rates by nearly 10 percentage points.

And it’s also possible that hesitancy will abate further on its own: A Gallup poll released on Wednesday found that 71 percent of Americans are now willing to get vaccinated, the highest share yet recorded.

“This makes sense,” John Brownstein, an epidemiologist at Boston Children’s Hospital, told ABC. “As these vaccines have more time on the market, you personally know people that have had it, and that social network will lend itself to creating a snowball effect of more people willing to get the vaccine.”
The New York Times