Pulse on Public Health

To Read Part I, Click Here.

It seems that the key question is not whether we can or cannot mandate; rather, it is whether we should. It seems peculiar that many prominent people who are vaccinated or who understand the importance of the vaccine are choosing to either stay silent about it or actively oppose it. After attending a meeting at my local medical society, however, I understand that the issue is not black or white for many administrators. Governor DeSantis and many healthcare leaders have noted that while vaccination rates may be high among their employed physicians, the rates are lower when looking at other healthcare providers such as nurses. Some healthcare workers have stated that they are hesitant because the vaccine is not fully FDA-approved. Many of these workers get their flu shots on a yearly basis and have no hesitancy with other required vaccines. Moreover, administrators at long-term care facilities are afraid to lose their staff over mandates and would rather continue implementing masks, social distancing, and regular testing. Some hospitals have seen improvements in vaccination rates after devising education campaigns around the safety and efficacy of the COVID-19 vaccines. While a small number of vaccinated individuals are still testing positive for covid, their chances of hospitalization and mortality are far lower than those who are unvaccinated. Nevertheless, people hear that covid outbreaks are still occurring among the vaccinated populations, their skepticism re-ignites (1).

Unfortunately, this virus and the vaccine have become heavily politicized. The fight against covid has been more of a moral argument since the respect for science and the authority of officials in the National Institutes of Health (NIH) and Centers for Disease Control and Prevention (CDC) is no longer phasing a large percentage of our population. And yet, the moral argument to go beyond our own needs in order to protect our neighbor is somehow not good enough.  Perhaps this tune will change once the vaccine has been fully approved. Both Pfizer and Moderna have filed for a fast-track approval and rolling review (sending in portions of the application, including data, as they become available). According to a report from the company, Pfizer expects this decision to arrive around January 2022 (2). With the fast track, the FDA can take up to 6 months to review the entire application to make a decision. The review process includes inspection of the manufacturing facilities. Some experts believe that the FDA is working rigorously to build back public confidence in their approval process after taking hits from some prominent political figures in 2020 (3).

Meanwhile, another concern looms large in the minds of those who are vaccinated as well as those who are not: booster shots. Pfizer recently announced that booster shots are on the horizon and that they would file for an emergency use authorization for those as well. Once it receives its approval, it will be up to the NIH and CDC to determine whether to recommend the booster shot and who should be recommended to receive them (4). Dr. Fauci has reported that the federal government is working to get the booster shots authorized for immunocompromised patients such as organ transplant recipients, cancer patients, and HIV patients. There are roughly 7 million patients who represent such a need (5). Israel, France, and Germany are beginning to offer booster shots for populations in need. The World Health Organization (WHO), however, has called on developed nations to hold off on additional vaccine shots until September so that developing nations can receive the vaccines they need to get to a 10 percent vaccination rate worldwide (6). Dr. William Schaffner, a member of the CDC panel, has stated that rather than using the word “booster” to describe the shots, we should think of it as a 3-dose regimen for immunocompromised people as they may not have achieved an appropriate immune response to the 2-doses. 

While developed nations are rushing to get a majority of the population vaccinated, developing nations are struggling. WHO officials remain concerned that this inequity will result in numerous mutations that could set the world back despite high vaccination rates in some nations. Thus, while some are refusing to get the vaccine, others are anxiously awaiting theirs. This pandemic is a true test of our humanity. It is perhaps the most difficult test. And currently, many have already failed.