Grand Rounds’ Senior Medical Director Dr. Tista Ghosh with Venrock Partner Dr. Bob Kocher, who serves on the California COVID-19 Testing Task Force, joined forces to answer a medley of top questions in a recent webinar, “Navigating the Vaccine Release: Patchwork Distribution and How Employers Can Drive to Clarity.” The session covered topics ranging from factors affecting the COVID-19 vaccine rollout and the federal government’s organizing role in getting all Americans vaccinated to why herd immunity is a moving target and whether a return to business as usual is a realistic goal.
Read on to see several key Q&As from the webinar.
What are some of the headlines with respect to today’s current frame on COVID-19 vaccine distribution?
Dr. Ghosh: Overall, there are three factors that will come into play with getting the majority of the country vaccinated. The first factor is supply, which has been limited. But the J&J vaccine recently received emergency use authorization. And Merck has agreed to boost production, so hopefully vaccine supplies will pick up very soon. And a fourth vaccine, Novavax, will hopefully get authorization in May, so that’ll help even further.
That said, getting the coronavirus vaccine from manufacturers to the federal government is only the first step. From there, the federal government sends vaccines to states, which then, depending on their distribution plans, send it to local departments, hospitals, pharmacies, etc. So distribution is a second key factor that will influence our ability to get vaccinated.
The third factor that will play a role is vaccine hesitancy. At the end of January, the Kaiser Family Foundation did a survey of U.S. adults, and they found that only about half said they would get vaccinated, with disproportionate levels of uncertainty among the people of color. Meanwhile, myths about coronavirus vaccines causing infertility and other types of misinformation are definitely growing.
So, combating vaccine hesitancy is going to be extremely important, because fixing supply and distribution won’t be enough if people won’t take the COVID-19 vaccine.
Can you share some of the changes coming out in the Biden administration and what we might see over the next couple months in the handling of the COVID-19 vaccine rollout?
Dr. Kocher: The White House will coordinate the way the COVID-19 vaccines are both sourced for America and distributed. And … it will create more incentives to follow a uniform or national plan. It will be less about 50 states doing it 50 ways and much more coordination with the Biden team trying hard to have the federal government play that organizing role. President Biden has said every American should be able to at least have access to the supply of a vaccine by May; probably it will be sooner than that in many states. And so, then it will be a matter of how do you create enough locations to go get it? How do I make an appointment?
I’m worried that many states don’t have enough places to get the shot. We will only do well as a society when we have the vast majority of us vaccinated and protected against the coronavirus.
How does herd immunity translate into a percentage of the population that actually needs to be vaccinated against COVID-19? Does it need to be 100%? Is it 20%?
Dr. Ghosh: Herd immunity is the idea that such a high percentage of the population is immune to the virus that it really has little chance to spread. What we often miss in the general media version of herd immunity is that it’s actually a moving target. I’ve heard anything between 70% to 90% of the population would need to be immune to the COVID-19 virus in order to achieve herd immunity.
It depends on how fast we vaccinate people and how long their immunities with the vaccine lasts. But it also depends on how many people have natural infection and how long that immunity lasts. And then there are these new variants that are popping up that can intentionally escape immunity from vaccines or even natural infection. So there’s a lot of variables, and that’s why you see that moving target of a number.
How do employers need to consider things like network status when they’re communicating to their employees about when and where to get the COVID-19 vaccine?
Dr. Kocher: COVID-19 vaccinations is the one example where you can go anywhere in the country and it has to be treated as in-network and reimbursed by all health insurance. Because the federal government actually paid for all of the vaccines, they’re giving them away for free to all of the people. And that’s great because it means that people can go find the most convenient location for themselves, and it hopefully means that we get over some of the bottlenecks that will actually occur in some of the health systems that just don’t have the capacity.
I should add one more thing: There’s going to be a subset of people who don’t have insurance, and there’s funding to make sure that they also get vaccinated for free. No coronavirus vaccination sites are allowed to ask for money from any individual. And so, everyone can get vaccinated.
Will the current COVID-19 vaccines on the market or those coming up soon protect us against the variants?
Dr. Ghosh: Both the Pfizer and Moderna vaccines seem to be effective against the UK variant, but have been shown to be less effective against the South African variant. But the tests have only been in test tubes. Pfizer and Moderna haven’t tested their vaccine against the South African variant in humans, and that’s important because humans have other types of defenses besides antibodies like T cells, and those weren’t measured in the test tube study.
So it really is possible that both Pfizer and Moderna might be—though less effective against this variant—still within the acceptable range of preventing severe illness from COVID-19. Meanwhile, both companies are working on a booster that will be more effective against some of the new rising variants. Also, the J&J and Novavax vaccines have both been studied in South Africa, and both do seem to offer some protection against that particular variant.
Now, there’s going to be other coronavirus variants arising. We saw one in New York. This is something that we’re going to have to keep an eye on.
Should employers have a perspective on which COVID-19 vaccine their population receives?
Dr. Kocher: I would do the one-shot J&J vaccine, because you achieve the goal of protecting your community weeks faster. When you do the two-shot process, you get your first shot, wait three to four weeks, and then it takes two more weeks after that for the antibody response that provides the protection. So it’s just a lot slower. The theoretical benefits of a second shot are very small typically for employer populations, which are by definition going to be younger than the medical population.
I also would tell you: I think we’ll have booster shots maybe every year. And so, this is not the only vaccine people are ever going to get. They’re going to get boostered to help adapt to the variants. And so, again, even if something is modestly more effective for the next few months, because we’re going to have to give you another vaccine to protect you against the new variations of COVID-19, it makes no difference. And so, I would prefer one rather than two shots, but I would take whatever I can get.
How should employers be thinking about a return to business as usual with COVID-19 case numbers continuing to fall?
Dr. Kocher: I don’t think it’ll be business as usual. I think we’ll continue adapting business. The wise thing for employers to do is to encourage people to get vaccinated, and soon we’ll have enough supply of COVID-19 vaccines that employers will be able to do on-campus vaccinations in most of the country, and so they should consider that. They may also consider giving paid time off for people if they want to go get a vaccination during work hours.
Also, if you’re going to have people back in the office or together, more ventilation, physical distancing, masks, being able to keep things clean are also very smart things to do, and it shouldn’t be discontinued. While the coronavirus vaccines are super effective, we need to be patient enough to let people get them before we relax on the other things we’re doing.