Coronavirus vaccine priority list – if I were elected the Emperor of Vaccines

coronavirus vaccine priority list

Despite the wild claims that a COVID-19 vaccine will be available real soon now, the initial limited supply would require a coronavirus vaccine priority list. Despite what Donald Trump says, and his veracity is limited, the supply of the vaccine will be limited for many months after approval, whether that approval is legitimate or not

The supply of a new COVID-19 vaccine is limited by many factors – regulatory review (yes, the FDA and other regulatory agencies must approve the manufacturing facilities for new drugs after the company receives approval to market their drugs), manufacturing bottlenecks, the number of doses required for “immunity,” and distributions problems, especially the need to store these vaccines at extremely low temperatures (no, your home refrigerator won’t get that cold).

In fact, that last point is something that everyone overlooks – your average physician does not have the ultra-low temperature freezers, usually only hospitals and major health departments. And they aren’t cheap. Furthermore, vaccines just don’t show up at a physician’s office or hospital directly from Big Pharma – they are delivered by a massive distributor network that may not have delivery vehicles that can properly store the vaccines as they drive their trucks across the deserts of Arizona in October.

This isn’t just an issue in the USA, it’s across the world. People magically believe that once a vaccine is approved it will suddenly be available to hundreds of millions of people. Nothing could be further from the truth.

Because the Big and Little Pharma companies are being much less transparent than they should, we have really no clue how many doses may be available soon after they get the go-ahead. 

Using the USA as an example, we’ll need around 750 million doses for every individual (assuming that two doses will be necessary and everyone gets the vaccine, which won’t happen). Overlooking the fact that the USA probably has a total vaccine manufacturing capacity of 200 doses at best (most of our current 300 million a year of vaccines are manufactured not only in the USA, but also in Canada, Belgium, Germany, France, and Japan), it’s highly improbable if not impossible to have 750 million doses on day 1. It may take years to manufacture that many.

If there are only 10-20 million doses available on day 1 (I’m highly skeptical of even that), you have to assume that there will be a coronavirus priority list. 

Now, there is a group that will be developing a coronavirus vaccine priority list (they’ll probably give it a better name) – the CDC’s Advisory Committee on Immunization Practices (ACIP). Dorit Rubinstein Reiss reported on a recent ACIP meeting which reviewed the ongoing efforts with the COVID-19 vaccine, but they did not make any recommendations on who should get the vaccine.

In light of that,  if I were elected Emperor of Vaccines, then I would have to create an official coronavirus vaccine priority list so that the right people get the vaccination. Spoiler alert – most of us aren’t on that list. Continue reading “Coronavirus vaccine priority list – if I were elected the Emperor of Vaccines”

June 2020 ACIP meeting – meningococcal, influenza, COVID-19 vaccines

June 2020 ACIP meeting

This article about the June 2020 ACIP meeting was written by Dorit Rubinstein Reiss, Professor of Law at the University of California Hastings College of the Law (San Francisco, CA), who is a frequent contributor to this and many other blogs, providing in-depth, and intellectually stimulating, articles about vaccines, medical issues, social policy, and the law.

Professor Reiss writes extensively in law journals about the social and legal policies of vaccination. Additionally, Reiss is also a member of the Parent Advisory Board of Voices for Vaccines, a parent-led organization that supports and advocates for on-time vaccination and the reduction of vaccine-preventable disease.

During June 2020, the Advisory Committee on Immunization Practices (ACIP) held its second annual meeting for the year. Because we are in the middle of the COVID-19 pandemic, and traveling is challenging for many – including, I suspect, for several of the Committee members, not all of which live near Georgia – the meeting, like most conferences this year (those which were not canceled) was held virtually. The CDC still provided an opportunity for oral comment, though there were some logistical challenges with their new system.

The June 2020 ACIP meeting discussed meningococcal vaccines, influenza vaccines, and then had the opportunity for public comment. The entire afternoon was devoted to COVID-19 and COVID-19 vaccines.

As with previous meetings, ACIP is a geek’s dream meeting and everyone else’s – except the experts, and I suspect – hope – most experts are geeks –  boredom feast. I learned a lot.

One of the most important lessons is that the committee takes vaccine safety very, very seriously. The other is that decisions on vaccines – like most policy decisions – are always made on incomplete knowledge. We never know everything. That is where expert judgment comes in. Incomplete knowledge does not mean there is not enough knowledge to assess benefits/risks, though any such assessment should be reassessed when new knowledge comes in.

Finally, it’s important to remember – and something the anti-vaccine observers of these meetings seem unaware of, but that doctors treating patients likely are not – that a decision not to use a vaccine is a decision with costs and risks – the costs and risks of the disease the vaccine prevents.

The choice is never between no risk and the vaccine because we don’t have vaccines unless a disease causes substantial mortality and morbidity. The choice is always whether, given the information, an informed decision can be made and which risks that information suggests are higher – those of the vaccine or those of not vaccinating.

Finally, my notes are over 14 pages of text for the June 2020 ACIP meeting, and that’s because my computer crashed at the end and I lost my last two pages of notes, which is really frustrating – and I have 153 screenshots of slides (yes, I am surprised too). I really want this post to be shorter. So I’m going to try and be very brief, and I’m happy to share my full notes, just email me at [email protected] Continue reading “June 2020 ACIP meeting – meningococcal, influenza, COVID-19 vaccines”

February 2020 ACIP Meeting review – Ebola, influenza, and coronavirus

february 2020 acip meeting

This article about the February 2020 ACIP meeting was written by Dorit Rubinstein Reiss, Professor of Law at the University of California Hastings College of the Law (San Francisco, CA), who is a frequent contributor to this and many other blogs, providing in-depth, and intellectually stimulating, articles about vaccines, medical issues, social policy, and the law.

Professor Reiss writes extensively in law journals about the social and legal policies of vaccination. Additionally, Reiss is also a member of the Parent Advisory Board of Voices for Vaccines, a parent-led organization that supports and advocates for on-time vaccination and the reduction of vaccine-preventable disease.

I attended a large part of the February 2020 ACIP meeting (Advisory Committee of Immunization Practices) in Atlanta, GA. I had planned to stay throughout, but my airline changed my return flight and I had to leave before the end on the second day. I did, however, watch the first day and the first two parts of the second.

The coronavirus crisis changed some things. For example, there were multiple international groups visiting the CDC (there was also at least one group that was there for other reasons and sat on part of the meeting). And we had a presentation on the topic from Dr. Nancy Messonnier.

I will describe the meeting in the order it happened, though this is the very abbreviated version. As I said before, an ACIP meeting is a geek’s dream – there’s a lot of data provided and in-depth discussions of details. The committee has a heavy and important responsibility, and since it was targeted by anti-vaccine activists is carrying it out under tricky circumstances. Continue reading “February 2020 ACIP Meeting review – Ebola, influenza, and coronavirus”

October 2019 ACIP public comments – anti-vaccine complaints, part 2

2019 ACIP public comments

This is part 2, the 2019 ACIP public comments, of Professor Dorit Rubinstein Reiss’ review of the recent Advisory Committee on Immunization Practices (ACIP) meeting. Part 1 can be found here.

There were 18 people slotted for the October 2019 ACIP public comments. Because more people signed up for comments than could fit in the hour allotted for it, they used a lottery to determine who will comment (note that in addition, the committee offered unlimited opportunity to comment in writing).

However, six of these people did not attend the meeting, so there were 12 commenters in all. Three of them were pro-vaccine, two members of the Immunization Action Coalition – LJ Tan and Julie Murphy – and one, a pediatrician from Oklahoma, Dr. Eve Switzer.

Nine of the 2019 ACIP public comments were from anti-vaccine individuals. Continue reading “October 2019 ACIP public comments – anti-vaccine complaints, part 2”

October 2019 ACIP meeting review – vaccine discussions, part 1

2019 ACIP meeting review

This article is my October 2019 ACIP meeting review. On October 23, 2019, I attended one out of two days of the meeting of the Advisory Committee on Immunization Practices (ACIP). 

Unfortunately, I could not stay both days, because I had to get back to teach on Thursday. But that one day was instructive. Like last time, this meeting was data-heavy and intensive, and the process was thorough.

While a number of anti-vaccine activists attended, there was no real indication that they followed the committee’s deliberations, tried to understand what was discussed, or learned from the information presented.

Their comments during and after the meeting did not contribute substantively to the discussion or offered anything that could lead to meaningful policy changes.

Because of the length of this review, it will be divided into two parts:

  • Part I describes the content of the meeting.
  • Part II addresses the public comments.

Continue reading “October 2019 ACIP meeting review – vaccine discussions, part 1”

California SB276 – legislation to limit vaccine medical exemptions – UPDATED

sb276

On 20 June 2019, after a long day of testimony on California SB276 from both sides of the mandatory vaccine issue, the assembly health committee voted 9 in favor, 2 against, and 2 abstaining to move forward with the bill which can prevent fake medical exemptions.

This post will describe the amended bill and then shortly address today’s events. Continue reading “California SB276 – legislation to limit vaccine medical exemptions – UPDATED”

ACIP vaccine recommendations – updates for HPV, HepA, MenB, flu

vaccine recommendations

On 26-27 June 2019, the CDC’s Advisory Committee for Immunization Practices (ACIP) updated vaccine recommendations for several vaccines including the human papillomavirus (HPV), hepatitis A (HepA), and serogroup B meningococcal disease (MenB). These vaccine recommendations do not become official until they are published in the CDC’s peer-reviewed journal, Morbidity and Mortality Weekly Report (MMWR)

This article will review the ACIP process and new recommendations. Continue reading “ACIP vaccine recommendations – updates for HPV, HepA, MenB, flu”

HPV prevalence drops by 86% since introduction of vaccine

hpv prevalence

Ten years after the introduction of the human papillomavirus (HPV) vaccine in the USA in 2006, HPV prevalence has dropped significantly in a new study from the Centers for Disease Control and Prevention (CDC). This is very encouraging research that further strengthens the evidence behind the effectiveness of the HPV vaccine.

One of the tropes pushed by the anti-vaccine religion is that we don’t know if the vaccine actually will prevent an HPV infection after 10 years. Well, now we know. 

Let’s take a look at the study on HPV prevalence in the USA. Continue reading “HPV prevalence drops by 86% since introduction of vaccine”

February 2019 ACIP Meeting – the process for vaccine recommendations

In February 2019, I attended a meeting of the Advisory Committee for Immunization Practices (ACIP) for the first time. This post describes my observations from the two-day ACIP meeting process.

Generally, the meeting taught me that the process the committee goes through is highly deliberative, data-intensive, and the committee pays close attention to safety and maximizing benefits. Though no process is perfect, the meeting increased my confidence in the decision-making process behind the vaccines recommendations that apply to my children.

Numerous anti-vaccine group attended added some excitement and some stress, but was, from a standpoint of vaccine policy-making, largely irrelevant. 

I am initially, a public administration scholar – I wrote my dissertation on agency accountability, taught the Federal Advisory Committee Act multiple times, and teach almost annually about agency decision making. This made me very interested in the committee’s process. I also knew in advance that there will be – as there has been in several previous meeting – numerous anti-vaccine activists, and was curious to see their interaction with the meeting in reality.

Initially, I thought I would describe in detail what was addressed in the meeting, but I think that would make this post too long. For those who are interested, here is the agenda for the February 2019 ACIP meeting (pdf).

Instead, I will offer my observations about the process. I will mention that the only things voted on in this meeting were related to Japanese encephalitis vaccine and anthrax vaccine. The committee voted to make some changes to the language of the recommendation of the Japanese encephalitis vaccine for travelers to clarify it, but not changes to the actual recommendation, changes to the timeline for adult priming series (the initial vaccine series) from a 28-day interval to an interval that can span 7-28 days, and expanding the age for recommending a booster for children and putting that recommendation on equal footing to the recommendation for an adult booster.

With respect to anthrax vaccines, the committee recommended giving a booster dose to high-risk people (like first responders) who are not currently exposed but may be at risk of exposure, if they want it.

Everything else discussed was informational – some of it as part of the process of preparing for future votes (Like whether to extend the recommendation for HPV vaccines to include those 26-45), some of it as part of ongoing monitoring (like the examination of flu vaccines’ data). Continue reading “February 2019 ACIP Meeting – the process for vaccine recommendations”

Meningococcal vaccine to prevent meningitis approved for 1-9 year olds

meningococcal vaccine

Well, this isn’t going to be popular with the anti-vaccine religion, since they go all in with the old “too many, too soon” trope which says that our children get way too many vaccines when they’re too young. Ignoring that thoroughly debunked myth, the powerful meningococcal vaccine that trains the immune system to attack the bacteria that can lead to deadly meningitis has now been approved by the FDA for 1-9-year-old children.

Let’s take a look at this vaccine and the disease it prevents, just so parents know that they can protect their children. Continue reading “Meningococcal vaccine to prevent meningitis approved for 1-9 year olds”